Outpatient Surgery Magazine

The Great Prepping Debate - December 2012 - Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 45 of 159

OSE_1212_part1_Layout 1 12/5/12 10:20 AM Page 46 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 4 6 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

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