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INFECTION PREVENTION
Kevin Driscoll, CRNA
How We Slashed Our Colorectal SSIs
Johns Hopkins reduced its infection rate using these 4 steps.
C
olorectal surgery is notorious for its disproportionately higher
SSI rates than general surgery. A couple years ago here at Johns
Hopkins Hospital, our colorectal SSI rate was alarmingly high
(27.3%). By working from the ground up with our frontline clinicians,
we've drastically cut colorectal SSIs by targeting these 4 areas.
1
Prophylactic antibiotic treatment for penicillin-allergic patients. The
protocol for administration of gentamicin — used for penicillin-
allergic patients — is 5mg/kg. But our team wanted to know, is that
based on ideal or actual body weight? (Because we see many heavy
patients.) There was also confusion about re-dosing of gentamicin and
clindamycin.
To clear that up: Gentamicin should be dosed based on ideal body
weight. To fix the issue of anesthesia having to do the math every time,
we put a calculator in the EMR — the dose is automatically computed
once you enter the numbers.
Gentamicin is not re-dosed, but clindamycin is. That's because gentamicin is based on tissue concentration and, even if the patient loses
a lot of blood, that level won't change. Clindamycin, on the other
hand, is based on plasma concentration, so patients need to be redosed post-op.
Dosing is performed in the OR, and there's now a full stop in the
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | D E C E M B E R 2012