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Frontiers in veterinary science2021; 8; 630111; doi: 10.3389/fvets.2021.630111

Use of Clinical Audits to Evaluate Timing of Preoperative Antimicrobials in Equine Surgery at a Veterinary Teaching Hospital.

Abstract: Based on human surgical guidelines, intravenous antimicrobials are recommended to be administered within 60 min of surgical incision. Achieving this target in horses is reportedly challenging and influenced by hospital policies. The objectives of this study were to evaluate and improve: (1) the timing of antimicrobial administration to surgical incision (tAB-INC), (2) contributions of anesthesia pre-induction (tPRI) and surgical preparation (tPREP) periods to tAB-INC, and the (3) completeness of antimicrobial recording. Two clinical audits were conducted before and after the policy changes (patient preparation and anesthesia record keeping). tPRI, tPREP, and tAB-INC were calculated and compared for elective arthroscopies and emergency laparotomies within and between the audits. The percentage of procedures with a tAB-INC <60 min was calculated. Antimicrobial recording was classified as complete or incomplete. A median tAB-INC <60 min was achieved in laparotomies (audit 1; 45 min, audit 2; 53 min) with a shorter tPREP than arthroscopies ( < 0.0001, both audits). The percentage of procedures with tAB-INC <60 min, tAB-INC, tPRI, and tPREP durations did not improve between the audits. There was a positive correlation between the number of operated joints and tPREP (audit 1, <0.001, = 0.77; audit 2, < 0.001, = 0.59). Between audits, antimicrobial recording significantly improved for elective arthroscopies (82-97%, = 0.008) but not emergency laparotomies (76-88%, = 0.2). Clinical audits successfully quantified the impact of introduced changes and their adherence to antimicrobial prophylaxis guidelines. Antimicrobial recording was improved but further policy changes are required to achieve a tAB-INC <60 min for arthroscopies.
Copyright © 2021 Ceriotti, Westerfeld, Bonilla and Pang.
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Publication Date: 2021-03-26 PubMed ID: 33842572PubMed Central: PMC8032889DOI: 10.3389/fvets.2021.630111Google Scholar: Lookup
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  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research evaluates and aims to improve the timing and recording of preoperative antimicrobial administration in equine surgery, employing clinical audits at a veterinary teaching hospital for the purpose. The audits succeeded in quantifying the effects of policy changes and adherence to guidelines, though it revealed more policy adjustments are necessary, especially for arthroscopies.

Objectives of Research

  • The research aimed to evaluate and improve the timing of antimicrobial administration prior to equine surgical incision, and how this is influenced by different stages of the surgical process and hospital policies.
  • The study also sought to evaluate the completeness of antimicrobial recording.
  • The administration of antimicrobials within 60 minutes of surgical incision is considered the ideal practice as per human surgical guidelines. This time threshold was used as the target in this veterinary context.

Methodology

  • The study involved two clinical audits, one before and one after changes in policy related to patient preparation and anesthesia record-keeping.
  • Three time variables – anesthesia pre-induction (tPRI), surgical preparation (tPREP), and time from antimicrobial administration to surgical incision (tAB-INC) were calculated and compared.
  • The research considered both elective arthroscopies and emergency laparotomies.
  • The audits also checked for completeness of the antimicrobial recording practice.

Findings

  • The study achieved the targeted median tAB-INC of less than 60 minutes in laparotomies. This achievement was consistent across both audits.
  • The study found a positive relationship between the number of operated joints and tPREP, indicating that surgeries involving more joints required longer preparation.
  • The percentage of procedures that met the tAB-INC target did not improve between the audits.
  • However, the recording of antimicrobial administration improved markedly for elective arthroscopies, and slightly for emergency laparotomies.

Conclusion

  • The clinical audits successfully quantified the impact of changes made to hospital policies and adherence to antimicrobial prophylaxis guidelines.
  • Despite improvements in record-keeping, further policy changes were found to be necessary to hit the target of tAB-INC being less than 60 minutes for arthroscopy procedures.

Cite This Article

APA
Ceriotti S, Westerfeld R, Bonilla AG, Pang DSJ. (2021). Use of Clinical Audits to Evaluate Timing of Preoperative Antimicrobials in Equine Surgery at a Veterinary Teaching Hospital. Front Vet Sci, 8, 630111. https://doi.org/10.3389/fvets.2021.630111

Publication

Frontiers in veterinary science
ISSN: 2297-1769
NlmUniqueID: 101666658
Country: Switzerland
Language: English
Volume: 8
Pages: 630111
PII: 630111

Researcher Affiliations

Ceriotti, Serena
  • Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada.
Westerfeld, Roxane
  • Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada.
Bonilla, Alvaro G
  • Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada.
Pang, Daniel S J
  • Department of Clinical Sciences, University of Montreal, Saint-Hyacinthe, QC, Canada.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Citations

This article has been cited 2 times.
  1. Rockow M, Griffenhagen G, Landolt G, Hendrickson D, Pezzanite L. Current Antimicrobial Use in Horses Undergoing Exploratory Celiotomy: A Survey of Board-Certified Equine Specialists. Animals (Basel) 2023 Apr 22;13(9).
    doi: 10.3390/ani13091433pubmed: 37174470google scholar: lookup
  2. Kauter A, Brombach J, Lübke-Becker A, Kannapin D, Bang C, Franzenburg S, Stoeckle SD, Mellmann A, Scherff N, Köck R, Guenther S, Wieler LH, Gehlen H, Semmler T, Wolf SA, Walther B. Antibiotic prophylaxis and hospitalization of horses subjected to median laparotomy: gut microbiota trajectories and abundance increase of Escherichia. Front Microbiol 2023;14:1228845.
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