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Surveillance of Antimicrobial Prophylaxis for Surgical Procedures

Published online by Cambridge University Press:  02 January 2015

Victor Vaisbrud ,
David Raveh ,
Yechiel Schlesinger  and
Amos M. Yinnon
Victor Vaisbrud
Affiliation:
Department of Orthopedics, Shaare Zedek Medical Center and Hadassah-Hebrew University, Jerusalem, Israel
David Raveh
Affiliation:
Infectious Diseases Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University, Jerusalem, Israel
Yechiel Schlesinger
Affiliation:
Infectious Diseases Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University, Jerusalem, Israel
Amos M. Yinnon*
Affiliation:
Infectious Diseases Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University, Jerusalem, Israel
*
Infectious Diseases Unit, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel
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Abstract

Objective:

To assess the practice of antimicrobial prophylaxis for surgical procedures in eight surgical departments in a 550-bed teaching hospital.

Methods:

A list of all major procedures performed in our hospital, with recommendations for prophylaxis based upon the literature, has been distributed since 1993 and is updated periodically. The practice of surgical prophylaxis between January 1 and March 31,1996, was examined by assessing four variables: (1) Did the particular procedure justify prophylaxis, and was it provided? (2) Was timing optimal, ie, within 1 hour prior to surgery? (3) Was the appropriate antimicrobial selected? (4) Was duration optimal, ie, ≤24 hours?

Results:

During the study period, 2,117 operations were performed, of which 1,631 (77%) were reviewed. Sixty-six percent were clean surgery, 28% clean-contaminated, and 6% contaminated; 72% of procedures were elective, 28% emergencies. Of 1,631 operations requiring prophylaxis, 1,142 (70%) received it, 489 (30%) did not. Of 1,631 patients, 1,392 (85%) received appropriate care: 929 (67%) appropriately received prophylaxis, and 463 (33%) appropriately did not receive prophylaxis. Of 955 patients who received prophylaxis, 26 (3%) did so inappropriately. Of 1,142 patients who should have received prophylaxis, 213 (19%) did not receive it. Female gender, clean surgery, elective operations, and infrequently performed procedures were all significant indicators of inappropriately withheld prophylaxis (P<.001). In addition, the rate of appropriately provided prophylaxis varied between departments from 71% to 97% (P<.001). Assessment of the 929 procedures for which prophylaxis was justified and given revealed that 100% of patients received it on time, the choice of antimicrobial was appropriate in 95% of cases, and duration was ≤24 hours in 91%.

Conclusions:

Audits of surgical prophylaxis are expected to detect different errors in different institutions. Conducting audits of surgical prophylaxis probably should be part of the routine activity of infection control teams. Feeding the information back to surgeons could improve adherence to recommended guidelines and might contribute to reduced wound infection rates.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 9 , September 1999 , pp. 610 - 613
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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