Hostname: page-component-745bb68f8f-5r2nc Total loading time: 0 Render date: 2025-01-18T10:14:20.606Z Has data issue: false hasContentIssue false
  • English
  • Français

Reduction in Surgical Antibiotic Prophylaxis Expenditure and the Rate of Surgical Site Infection by Means of a Protocol That Controls the Use of Prophylaxis

Published online by Cambridge University Press:  21 June 2016

Marisa I. Gómez ,
Silvia I. Acosta-Gnass ,
Luisa Mosqueda-Barboza  and
Juan A Basualdo
Marisa I. Gómez
Affiliation:
Sanatorio Adventista del Plata, Facultad de Ciencias de la Salud de la Universidad Adventista del Plata, Libertador San Martín, Entre Ríos, Argentina Secretaría de Investigatión, Facultad de Ciencias de la Salud de la Universidad Adventista del Plata, Libertador San Martín, Entre Ríos, Argentina
Silvia I. Acosta-Gnass*
Affiliation:
Sanatorio Adventista del Plata, Facultad de Ciencias de la Salud de la Universidad Adventista del Plata, Libertador San Martín, Entre Ríos, Argentina Secretaría de Investigatión, Facultad de Ciencias de la Salud de la Universidad Adventista del Plata, Libertador San Martín, Entre Ríos, Argentina
Luisa Mosqueda-Barboza
Affiliation:
Sanatorio Adventista del Plata, Facultad de Ciencias de la Salud de la Universidad Adventista del Plata, Libertador San Martín, Entre Ríos, Argentina
Juan A Basualdo
Affiliation:
Secretaría de Investigatión, Facultad de Ciencias de la Salud de la Universidad Adventista del Plata, Libertador San Martín, Entre Ríos, Argentina
*
25 de Mayo 255, 3103 Libertador San Martin, Entre Ríos, Argentina ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate the effectiveness of an intervention based on training and the use of a protocol with an automatic stop of antimicrobial prophylaxis to improve hospital compliance with surgical antibiotic prophylaxis guidelines.

Design.

An interventional study with a before-after trial was conducted in 3 stages: a 3-year initial stage (January 1999 to December 2001), during which a descriptive-prospective survey was performed to evaluate surgical antimicrobial prophylaxis and surgical site infections; a 6-month second stage (January to June 2002), during which an educational intervention was performed regarding the routine use of a surgical antimicrobial prophylaxis request form that included an automatic stop of prophylaxis (the “automatic-stop prophylaxis form”); and a 3-year final stage (July 2002 to June 2005), during which a descriptive-prospective survey of surgical antimicrobial prophylaxis and surgical site infections was again performed.

Setting.

An 88-bed teaching hospital in Entre Ríos, Argentina.

Patients.

A total of 3,496 patients who underwent surgery were included in the first stage of the study and 3,982 were included in the final stage.

Results.

Comparison of the first stage of the study with the final stage revealed that antimicrobial prophylaxis was given at the appropriate time to 55% and 88% of patients, respectively (relative risk [RR], 0.27 [95% confidence interval {CI}, 0.25-0.30]; P < .01); the antimicrobial regimen was adequate in 74% and 87% of patients, respectively (RR, 0.50 [95% CI, 0.45-0.55]; P < .01); duration of the prophylaxis was adequate in 44% and 55% of patients, respectively (RR, 0.80 [95% CI, 0.77-0.84]; P < .01); and the surgical site infection rates were 3.2% and 1.9%, respectively (RR, 0.59 [95% CI, 0.44-0.79]; P < .01). Antimicrobial expenditure was US$10,678.66 per 1,000 patient-days during the first stage and US$7,686.05 per 1,000 patient-days during the final stage (RR, 0.87 [95% CI, 0.86-0.89]; P<.01).

Conclusion.

The intervention based on training and application of a protocol with an automatic stop of prophylaxis favored compliance with the hospital's current surgical antibiotic prophylaxis guidelines before the intervention, achieving significant reductions of surgical site infection rates and substantial savings for the healthcare system.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 12 , December 2006 , pp. 1358 - 1365
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Hollenbeak, C, Alfrey, E, Sheridan, K, Burger, T, Dillon, P. Surgical site infections following pediatric liver transplantation: risks and costs. Transpl Infect Dis 2003; 5:72–78.Google Scholar
2. Ríos, J, Murillo, C, Carrasco, G, Humet, C. Increment of costs relative to surgical site infections in appendectomies and colectomies. Gac Sanit 2003; 17:218–225.Google Scholar
3. Perencevich, E, Sands, K, Cosgrove, S, Guadagnoli, E, Meara, E, Piatt, R. Health and economic impact of surgical site infections diagnosed after hospital discharged. Emerg Infect Dis 2003; 9:196–203.Google Scholar
4. Jenney, A, Harrington, G, Russo, P, Spelman, D. Cost of surgical site infections following coronary artery bypass surgery. ANZ J Surg 2001; 71:662–664.Google Scholar
5. Kirkland, K, Briggs, J, Trivette, S, Wilkinson, W, Sexton, D. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999; 20:725–730.CrossRefGoogle ScholarPubMed
6. Nichols, RL. Preventing surgical site infections: a surgeon's perspective. Emerg Infect Dis 2001; 7:220–224.CrossRefGoogle ScholarPubMed
7. Zelenitsky, S, Ariano, R, Harding, G, Silverman, R. Antibiotic pharmacodynamics in surgical prophylaxis: an association between intraoperative antibiotic concentrations and efficacy. Antimicrob Agents Chemother 2002; 46:3026–3030.Google Scholar
8. Vaisbrud, V, Raveh, D, Schlesinger, Y, Yinnon, AM. Surveillance of antimicrobial prophylaxis for surgical procedures. Infect Control Hosp Epidemiol 1999; 20:610–613.Google Scholar
9. Zoutman, D, Chau, L, Watterson, J, Mackenzie, T, Djurfeldt, M. A Canadian survey of prophylactic antibiotic use among hip-fracture patients. Infect Control Hosp Epidemiol 1999; 20:752–755.Google Scholar
10. Kernodle, DS, Kaiser, AB. Postoperative infections and antimicrobial prophylaxis. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone; 1995:2742–2756.Google Scholar
11. Polk, HC Jr, Wilson, MA. Systemic antimicrobial prophylaxis in surgery. In: Fry, DE, ed. Surgical Infections. Boston, MA: Little Brown; 1995:127–133.Google Scholar
12. Gorecki, P, Schein, M, Rucinski, JC, Wise, L. Antibiotic administration in patients undergoing common surgical procedures in a community teaching hospital: the chaos continues. World J Surg 1999; 23:429–433.Google Scholar
13. Gyssens, IC. Preventing postoperative infections: current treatment recommendations. Drugs 1999; 57:175–185.Google Scholar
14. Sohn, A, Parvez, F, Vu, T, et al. Prevalence of surgical-site infections and patterns of antimicrobial use in a large tertiary-care hospital in Ho Chi Minh city, Vietnam. Infect Control Hosp Epidemiol 2002; 23:382–387.Google Scholar
15. US Unit of Public Health and Human Services. National Nosocomial Infections Surveillance System Manual. Atlanta, GA: Centers for Disease Control and Prevention; 1994.Google Scholar
16. Pan American Health Organization. Surgical Antimicrobial Prophylaxis: Guideline for the Treatment of Infectious Disease. Washington, DC: Pan American Health Organization; 2004:79–85.Google Scholar
17. Classen, DC, Evans, RS, Pestotnik, SL, Horn, SD, Menlove, RL, Burke, JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992; 326:281–286.Google Scholar
18. Wong, ES. Surgical site infection. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore, MD: Williams & Wilkins; 1996:170–171.Google Scholar
19. Mensa, J, Gatell, JM, Jiménez de Anta, MT, Prats, G. Antimicrobial Therapeutic Guidelines. 11th ed. Barcelona, Spain: Masson; 2001.Google Scholar
20. Argentinean Society of Infectology and Argentinean Society of Clinical Bacteriology. Pre-surgical antimicrobial prophylaxis guidelines. Infect Microbiol Clin 1997; 9(Suppl 1):27–44.Google Scholar
21. The Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection. Infect Control Hosp Epidemiol 1999; 20:250–278.Google Scholar
22. Antimicrobial prophylaxis in surgery. Med Lett Drugs Ther 1999; 41:75–80.Google Scholar
23. Raveh, D, Levy, Y, Schlesinger, Y, Greenberg, A, Rudensky, B, Yinnon, AM. Longitudinal surveillance of antibiotic use in the hospital. QJM 2001; 94:141–152.Google Scholar
24. Martin, C, Pourriat, JL. Quality of postoperative antibiotic administration by French anaesthetists. J Hosp Infect 1998; 40:47–53.Google Scholar
25. Pestotnik, S, Classen, D, Evans, S, Burke, J. Implementing antibiotic practice guidelines trough computer assisted decision support: clinical and financial outcomes. Ann Intern Med 1996; 124:884–890.Google Scholar
26. Coignard, B, Siegel, J, Weinstein, R, Sohn, A, Sinkowitz-Cochran, R, Jarvis, W. Reality check: ho6w should we control antimicrobial use? current practices and controversies. Infect Control Hosp Epidemiol 2000; 21:792–795.Google Scholar
27. Prado, MA, Patelli, M, Da Rocha, I, Bergsten, G. The implementation of a surgical antibiotic prophylaxis program: the pivotal contribution of the hospital pharmacy. Am J Infect Control 2002; 30:49–56.Google Scholar
28. Fukatsu, K, Saito, H, Matsuda, T, Ikeda, S, Furukawa, S, Muto, T. Influences of type and duration of antimicrobial prophylaxis on an outbreak of methicillin resistant Staphylococcus aureus and on the incidence of wound infection. Arch Surg 1997; 132:1320–1325.Google Scholar
29. McGuckin, M, Shea, J, Sanford, J. Infection and antimicrobial use in laparoscopic cholecystectomy. Infect Control Hosp Epidemiol 1999; 20:624–626.Google Scholar
30. Shapiro, M. Perioperative prophylactic use of antibiotics in surgery: principles and practices. Infect Control 1982; 3:38–40.Google Scholar