Intraoperative Antibiotic Redosing in High Blood Loss Cases for Adults Hue Huynh BSN, SRNA, Jacob Rowley BSN, SRNA, Raneen George BSN, SRNA Introduction Methodology Intraoperative blood loss ≥ 1,500mL? • Surgical site infection (SSI) is the most expensive type of hospital- • Initial in-person educational session was made in May with acquired infection resulting in approximately $3.5 to $8 billion in algorithmic diagram handouts made available to the anesthesia annual cost and carries a 3% mortality rate. 1 providers. • It is estimated that 60% of SSI’s are preventable.1 • Those who were not present during the in-person session • The Surgical Care Improvement Project (SCIP) was created in received an email regarding the protocol with contact 2002 to prevent costly complications associated with SSI and Yes No information. improve quality of care. • Collaborated with information technologist (IT) to develop an • SCIP measures were retired in 2015 but helped create subsequent EMR trigger when blood loss >1,500 mL. practice guidelines. • Approval from Michigan State University Institutional Review • Large surgical blood loss (>1,500 mL) decreases antibiotic serum Hemostasis and Continue to monitor. Board and facility. Project deemed as non-research. and tissue concentrations.2 hemodynamic Re-dose antibiotic • Data analysis using descriptive statistics. stability achieved? according to half-life Purpose Results • The purpose of this quality improvement initiative is to improve • Project implemented May 1, 2022. antibiotic re-administration during high blood loss events in • Root-cause analysis was conducted by the QI team to determine trauma, neurosurgical, and cesarean section at a level one trauma Yes No cause of low compliance rate in June and July 2022. center located in mid-Michigan. • Primary cause identified as delays in blood loss documentation • Clinical question: Will the implementation of a new antibiotic by obstetric nurses. redosing protocol and electronic medical record (EMR) triggers • While the overall percentage of pre-implementation and intra- increase antibiotic redosing compliance rate in high blood loss Call for help. Obtain implementation compliance rates did not significantly change cases by 50% before August 31, 2022? Re-dose preoperative hemostasis and during the project implementation phase, there was less antibiotic initiate volume resuscitation variability suggesting improvement in compliance. Literature Summary • Plans to implement a best-practice that would trigger a pop-up • The minimum inhibitory concentration (MIC) can be defined as the window within the EMR was unsuccessful due to the lack of lowest antibiotic concentration it takes to inhibit bacterial growth.3 time and resources. • Cefazolin concentration reduction in the blood and tissue becomes significant when blood loss is >1,500 mL, allowing opportunistic Conclusion bacteria to translocate into the surgical site and bloodstream.3 • High blood loss leads to decreased blood and tissue antibiotic • To maintain a therapeutic MIC in the plasma and tissue, antibiotic concentration. redosing is recommended when >1,500 mL of blood loss has • Competing surgical specialty protocols influenced EMR trigger occurred or the duration of the procedure exceeds the 2nd half-life implementation. of the antibiotic agent.2 • Multiple quality improvement cycles will be needed. References 1. Centers for Disease Control and Prevention. (2020, January 17). 9 Surgical Site Infection (SSI) Event. U.S. Department of Health and Human Services. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf Acknowledgments 2. Swoboda, S. M., Merz, C., Kostuik, J., Trentler, B., & Lipsett, P. A. (1996). Does Intraoperative Blood We would like to thank the following individuals for their guidance Loss Affect Antibiotic Serum and Tissue Concentrations? Archives of Surgery, 131(11), 1165. https://doi.org/10.1001/archsurg.1996.01430230047009 and support throughout the project: 3. Bratzler, D. W., Dellinger, E. P., Olsen, K. M., Perl, T. M., Auwaerter, P. G., Bolon, M. K., Fish, D. N., Napolitano, L. M., Sawyer, R. G., Slain, D., Steinberg, J. P., Weinstein, R. A., American Society of Health- • Gayle Lourens, DNP, MS, CRNA System Pharmacists, Infectious Disease Society of America, Surgical Infection Society, & Society for • Tina Reamer, MS, CRNA Healthcare Epidemiology of America. (2013). Clinical practice guidelines for antimicrobial prophylaxis in surgery. American Journal of Health-System Pharmacy:AJHP:Official Journal of the American Society of • Bethany Lipka, MS, CRNA Health-System Pharmacists, 70(3), 195–283. https://doi.org/10.2146/ajhp120568