抗生素(英文精品) Best Practice in General Surgery总结概括.pptVIP

Antimicrobial Recommended Dosing Interval Cefazolin q4h Gentamicin dosed at 2mg/kg Gentamicin dosed at 5mg/kg q6h none required Metronidazole q8h Vancomycin q12h Clindamycin q8h *Assumes normal renal function Intraoperative Re-dosing Recommendations Preoperative Hair Removal For the purpose of SSI prevention, hair removal should not be performed. If hair removal is required, clipping should be done rather than shaving Best Practice in General SurgeryA University of Toronto, Division of General Surgery Initiative to Improve Patient Care Aim: To promote standardized evidence based practices in the adult teaching hospitals at the univeristy of toronto within general surgery. Rationale improve patient care improve resident education capitalize on expertise within our division possibly be “ahead of the game” if LHINs exert more influence foster collaboration in clinical research Steering Committee SSI prevention Standard Resident Handbook Guidelines Implementation TE prophylaxis Standardized OR Reports Wound closure Lap appendectomy Inguinal hernia Breast Lap chole Bowel preps An example of an initiative designed to improve practice by engaging physicians. BPIGS Mission Survey of general surgeons SSI Prevention-first initiative Antibiotic Prophylaxis Hair Removal Temperature Control (Normothermia) Supplemental Oxygen Beliefs and practices:- Survey distributed to all general surgeons and residents- Heads of divisions interviewed in person, quality managers interviewed by telephone- Documents at the individual hospitals assessed Survey: antimicrobial prophylaxis Do you use antibiotic prophylaxis for SSI prevention? 97.4% yes (similar for staff and resident surgeons) Where is antibiotic prophylaxis delivered? 11.8% ward, 23.7% preop holding, 60.5% OR In what way is antibiotic prophylaxis delivered? 82.9% IV, 11.8% oral, 6.6% combo Survey: antimicrobial prophylaxis In what % of cases is it initiated within 1hr of incision? no responses Who is resp