Pre-operative abx

[Neogenesis]

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Having a discussion with some colleagues. Does SCIP INF-1 require COMPLETION of the preoperative antibiotic or INITIATION of it within the 1 hr prior to incision?

 

[deleted171991]

Having a discussion with some colleagues. Does SCIP INF-1 require COMPLETION of the preoperative antibiotic or INITIATION of it within the 1 hr prior to incision?

The way I understand it, COMPLETION (see the part about vanco).

Performance Measure Name: Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision.*

Description: Surgical patients who received prophylactic antibiotics within one hour prior to surgical incision. *Patients who received vancomycin or a fluoroquinolone for prophylactic antibiotics should have the antibiotics administered within two hours prior to surgical incision. Due to the longer infusion time required for vancomycin or a fluoroquinolone, it is acceptable to start these antibiotics within two hours prior to incision time.

Rationale: A goal of prophylaxis with antibiotics is to establish bactericidal tissue and serum levels at the time of skin incision.

http://web.doh.state.nj.us/apps2/Hpr/docs/2008/2zf_SCIP-Inf-1,3.pdf

 

[Neogenesis]

Doing some digging, this is from the most updated statement from The Joint Commission website

Reading that, I would say the SCIP measure looks at initiation, no?

 

[deleted171991]

If they cared only about INITIATION, they wouldn't give vanco and fq an extra hour preop just because they take longer to infuse. 😉

 

[pgg]

Doing some digging, this is from the most updated statement from The Joint Commission website View attachment 193273View attachment 193274

Reading that, I would say the SCIP measure looks at initiation, no?

Disagree -

Rationale: A goal of prophylaxis with antibiotics is to establish bacteriocidal tissue and serum levels at the time of skin incision.

If it's not completed before incision then tissue and serum levels won't be bacteriocidal at the time of incision.

Also -

If they cared only about INITIATION, they wouldn't give vanco and fq an extra hour preop because they take longer to infuse. 😉

+1

You can always bolus the vanc. And then chase it with phenylephrine and a squirt of epi for the benefit of those angry mast cells. 🙂

 

[Neogenesis]

Don't disagree on the rationale of completing prior to incision. But why then is there a change in the language. It appears that we are looking at the same document FFP, with yours being from 2008 and mine the current one. So do you guys document the completion of you abx? And for the longer running ones, do you delay surgery/incision if not completely infused?

 

[deleted171991]

Don't disagree on the rationale of completing prior to incision. But why then is there a change in the language. It appears that we are looking at the same document FFP, with yours being from 2008 and mine the current one. So do you guys document the completion of you abx? And for the longer running ones, do you delay surgery/incision if not completely infused?

I am sorry. YOU WIN. I did not notice the change in language. It clearly speaks about INITIATION in 2015.

Anyway, it's more of a technicality. The quality measure was more about the bactericidal activity dropping significantly after one hour. So if one gives it too early (like they probably used to), it's useless.

Suppose I give vanco slowly, and I don't have bactericidal activity at incision, but I have it 5-15-30 minutes later. Those bacteria are already so numerous and well hidden that it won't kill them? I doubt it. 🙂

 

[periopdoc]

The SCIP measure has always been initiation, I worked with one of the guys that worked on development of SCIP and he admitted as much.

Doesn't really matter as it is being removed from the quality measures since everyone was >99% compliant.

 

[BuzzPhreed]

SCIP is complete bullsh*t anyway.