Variation in Use of Prophylactic Antibiotics in Gynecologic Procedures Before and After an Educational Intervention.

OBJECTIVES: Guidelines for use of prophylactic antibiotics in gynecologic procedures are outlined by the American Congress of Obstetricians and Gynecologists. There remains, however, a high rate of unindicated administration of antibiotics for surgeries. A retrospective study performed at our institution in 2012-2013 demonstrated that unindicated prophylactic antibiotics were administered over half the time. This study aimed to examine variations in the use of prophylactic antibiotics in patients undergoing gynecologic surgery at Scott and White Memorial Hospital and determine whether an educational intervention to gynecology physicians was associated with a significant decrease in unindicated prophylactic antibiotics. METHODS: A retrospective chart review was performed for all women undergoing gynecologic surgery at Scott and White Memorial Hospital in Temple, Texas for 1 year. An educational intervention regarding prophylactic antibiotic usage was held for obstetricians and gynecologists in the middle of that year. Subjects were included if they had procedures with a Current Procedural Terminology code corresponding to a procedure that does not require prophylactic antibiotics. Subjects were excluded if they had concurrent procedures for which antibiotics are recommended. RESULTS: A total of 500 subjects met inclusion and exclusion criteria, with 243 before the educational intervention and 257 after the intervention. In our study, a significant decrease (P < 0.0001) in unindicated prophylactic antibiotic use was demonstrated: from 45.7% (111/243) preintervention to 24.9% (64/257) postintervention. Before the educational intervention, both the gynecology oncology and reproductive endocrinology and infertility divisions had the highest rates of unindicated antibiotic use-91.7% (44/48) and 91.7% (33/36), respectively. The generalist and urogynecology divisions had the lowest rates for specialists before the intervention: 20.6% (30/146) and 30.8% (4/13), respectively. After the intervention, all of the divisions demonstrated an improvement in their rates of unindicated prophylactic antibiotic use. The urogynecology division demonstrated an improvement that can be considered clinically significant while not meeting statistical significance. The adverse event rates were not different between subjects who received preoperative prophylactic antibiotics (2.9%) and subjects who did not (2.8%). CONCLUSIONS: A simple educational intervention was associated with a significant decrease in unindicated prophylactic antibiotics in gynecologic procedures.

Inappropriate use of antibiotics in patients undergoing gynecologic surgery.

We retrospectively examined prophylactic antibiotic use and documentation of wound classification in patients having gynecologic surgery at a tertiary hospital. Of the 326 cases reviewed, 175 (54%) received prophylactic antibiotics when not indicated according to guidelines of the American College of Obstetricians and Gynecologists. Antibiotic administration varied significantly (P < 0.02) among the different types of surgery, being given in 82% of laparoscopic cases, 35% of nonobstetrical dilation and curettage and operative hysteroscopy procedures, and 51% of open abdominal procedures. There were no recorded episodes of anaphylaxis or pseudomembranous colitis. In conclusion, antibiotic use is high among gynecologic surgeons at a tertiary hospital, but this use was unnecessary.

Improving compliance with cervical cancer screening guidelines.

Current cervical cancer screening guidelines for the care of healthy women include HPV cotesting with all Papanicolaou (Pap) smears after the age of 30. To improve compliance with current guidelines, we instituted two processes: first, simplifying the ordering process to a single order for Pap smear plus HPV cotesting using an electronic medical record system (EMR); and second, providing education for clinic staff. Baseline and postintervention data were collected by retrospective chart review. Patients were selected during three intervals: prior to the transition to Epic EMR, after the transition to Epic, and after an educational intervention. Compliance with standard guidelines was evaluated in relation to the trial intervals, type of provider, patient age, and duration from the previous Pap smear. Provider type was analyzed by considering gynecologists versus nongynecologist providers, and physicians versus mid-level providers. Overall, the percentage of compliance with HPV test ordering did not differ (P = 0.21) between intervals. Univariate analyses performed to identify factors likely to be associated with the practice of ordering HPV cotesting only involved the type of provider. In conclusion, transition to Epic and a training session had minimal impact on compliance with ordering HPV cotesting at the time of a Pap smear except among family practice physicians, who did significantly improve their compliance rate. Gynecologists and mid-level providers were more compliant with ordering HPV cotesting throughout, but did not significantly improve after the interventions.