[Evaluation of surgical antibiotic prophylaxis in a Tunisian University Hospital] (original) (raw)
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Appropriate use of antimicrobial prophylaxis: an observational study in 21 surgical wards
BMC surgery, 2015
Surveillance of Surgical Site Infections (SSI) in 2010 found 39 % compliance with hospital guidelines in Piedmont (Italy). The aim of the study was to estimate the appropriate use of antimicrobial prophylaxis and compliance with hospitals guidelines in surgical wards. This survey study took place in 21 surgery wards of 4 public hospitals. Forms were completed by public health resident doctors together with a medical ward referent and infection control nurses. 15 consecutive surgical procedures were randomly chosen from each ward. A total of 320 cases were analyzed. The study period was from July 2012 to January 2013. Data were collected using a survey form. A final score variable from 0 to 4 was given to each case. The results were compared with hospital and international guidelines. Data were analyzed using Epi-Info software. Of the 320 cases collected, 63 were excluded; of the remaining 257 cases, 56.4 % of the procedures were appropriate (score 4), 15.2 % were acceptable and 28.4...
Adherence to guidelines for antibiotic prophylaxis in general surgery: a critical appraisal
Journal of Antimicrobial Chemotherapy, 2007
Methods: Eight hundred and ninety-eight patients were enrolled and operated on electively. Questionnaires concerning demographic data, health status, type of surgery (clean and cleancontaminated) and parameters of antibiotic prophylaxis (antibiotic choice, route, dose, timing of first dose, timing of operative redosing and duration of prophylaxis) were completed. Results: Of the patients, 44.8% underwent a clean surgical operation and 55.2% underwent a cleancontaminated surgical operation. Inguinal hernia repair and laparoscopic cholecystectomy were the commonest operations in each category. Second-generation cephalosporins were the most frequently prescribed antibiotics, in 67%. Although, only 78.5% of procedures required prophylaxis, it was administered in 97.5%, so it was not justified and inappropriately administered in 19%. It was revealed that 100% of patients received antibiotic prophylaxis on time. The choice of antimicrobial agent was appropriate in 70% and the duration of prophylaxis was optimal in 36.3%. The overall compliance rate of surgeons with guidelines for antibiotic prophylaxis was 36.3%. Conclusions: Adherence to separate aspects of guidelines for surgical prophylaxis has to be improved. The duration of antibiotic prophylaxis was the main parameter of interest. Interventions have to be made about the development, distribution and adoption of adequate guidelines in collaboration with surgeons.
Objective: Surgical site infections are the second most common type of adverse events occurring in hospitalized patients, whereas an estimated 40-60% of these infections are thought to be preventable. Choice of regimen, administration timing or duration of antibiotic prophylaxis is reported to be inappropriate in approximately 25-50% of cases. We tried to evaluate an antibiotic administration pattern for surgical antibiotic prophylaxis in a teaching hospital. Methods: This study was conducted at the general surgery and orthopedic wards of a teaching hospital affiliated with Mazandaran University of Medical Sciences. The medical records of admitted patients who underwent different surgical procedures were reviewed. Compliance was assessed with the recommendations of the American Society of Health-System Pharmacists' guidelines for every aspect of antibiotic prophylaxis. All data were coded and analyzed by SPSS16 software using Student's t-test and Chi-square test. Findings: During 1 year, 759 patients who underwent different surgeries were included in the study. Mean age of patients was 32.02 ± 18.79 years. Hand and foot fractures repair were the most frequent surgery types. About 56.4% of administered prophylactic antibiotics were in accordance with the American Society of Health System Pharmacists (ASHP) guidelines regarding prophylaxis indication. The most commonly antibiotic used was cefazolin and antibiotic choices were appropriate in 104 of 168 surgical procedures (62%). Gentamicin, metronidazole and ceftriaxone were the most frequently antibiotics that used inappropriately. Only in 100 of 168 procedures, duration was concordant with the ASHP guideline, whereas in 68 procedures, duration was longer than recommended time. In 98 procedures, the dose was lower and in one procedure, it was higher than recommended doses. Conclusion: Although such guidelines have been in place for many years, studies showed that much inappropriate antibiotic use as prophylaxis and poor adherence to guidelines are still major issues. It is essential for surgeons to be aware to consider the best antibiotic choices, dose and duration based on reliable guidelines for antibiotic prophylaxis.
Assessment of Prophylactic Antibiotic Use in Patients with Surgical Site Infections
Hospital Pharmacy, 2013
Background: Surgical site infections (SSIs) are the leading cause of hospital-acquired infections and are associated with substantial health care costs, with increased morbidity and death. The Surgical Care Improvement Project (SCIP) contains standards that are nationally reported with the aim of improving patient outcomes after surgery. Our institution's standards for antimicrobial prophylaxis in the perioperative period are more stringent than these measures and may be considered ''beyond SCIP.'' The 4 elements of appropriate antimicrobial prophylaxis are timing, antibiotic selection, dosing, and intraoperative redosing. Objective: To quantify antimicrobial SSI prophylaxis compliance in accordance with institutional standards and to identify potential opportunities for improvement. Methods: Patients aged 18 years or older were included if they had an SSI between January 1, 2009, and June 30, 2010, according to the database maintained prospectively by the Infection Prevention and Control Unit. Adherence to our institution's practice standards was assessed through analysis of antibiotics administered-timing in relation to the incision, closure, and tourniquet inflation times for the procedure and antibiotic selection, dose, and redosing. Results: Overall noncompliance with all 4 elements of antimicrobial prophylaxis was 75.4% among the 760 cases. Repeat dosing had the greatest noncompliance (45.1%); antibiotic selection had the lowest incidence of noncompliance (10.8%). Conclusions: Noncompliance existed in each element of antimicrobial SSI prophylaxis, with antibiotic redosing leading in noncompliance. With the implementation of tools to assist the surgical team in following institutional standards, noncompliance will likely decline and additional research opportunities will exist.
An audit of prophylactic surgical antibiotic use in a Sudanese Teaching Hospital
International Journal of Clinical Pharmacy, 2012
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Effect of Optimized Antibiotic Prophylaxis on the Incidence of Surgical Site Infection •
Infection Control and Hospital Epidemiology, 2006
Objective. To compare the rate of surgical site infection (SSI) before and after an intervention period in which an optimized policy for antibiotic prophylaxis was implemented. To demonstrate that a more prudent, restrictive policy would not have a detrimental effect on patient outcomes. Design. Before-after trial with prospective SSI surveillance in the Dutch nosocomial surveillance network (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]), using the criteria of the Centers for Disease Control, including postdischarge surveillance for up to 1 year. Methods. During a preintervention period and a postintervention period (both 6-13 months), 12 Dutch hospitals collected data on antimicrobial prophylaxis and SSI rates. The study was limited to commonly performed surgical procedures in 4 specialties: vascular, intestinal, gynecological and orthopedic surgery. Selected risk factors for analysis were sex, age, American Society of Anesthesiologists classification, wound contaminat...
The Journal of Infection in Developing Countries, 2012
Introduction: The use of antimicrobial prophylaxis for surgical procedures is one of the measures employed to prevent the development of surgical site infections (SSI). The appropriate choice of antimicrobial agents, dosage regimen, timing, duration and use of intravenous route must be evidence based. This study aimed to assess the practice of surgical antibiotic prophylaxis and adherence of practitioners to the American Society of Health-System Pharmacists (ASHP) guidelines for antimicrobial prophylaxis in surgery and to explore reasons for non-compliance. Methodology: A cross-sectional study was conducted in 20 Jordanian hospitals from October 2006 to June 2007. A questionnaire was designed to collect information from physicians regarding the practice of surgical antibiotic prophylaxis (SAP), references used for guiding SAP practice, prevalence of surgical site infection (SSI), and causative microorganisms. Results: SAP was employed in almost all surgical departments of hospitals. The improper timing of antimicrobial administration for SAP was attributed to lack of knowledge of the guidelines (46.1%), while the improper antimicrobial choice was ascribed to drug unavailability (61.8%). Conclusion: This study shows that physicians are aware of the importance of antimicrobial prophylaxis before surgical procedures. However, further efforts are needed to ensure the implementation of the standard SAP guidelines in Jordanian hospitals.
Protocol for Antibiotic Prophylaxis in General Surgery: Influence on Prescribing Patterns
Objective: The main aim of this prospective study was to identify the influence of introduction of a new protocol for antibiotic prophylaxis in general surgery on prescribing patterns. in the General Surgery Department of Khartoum Teaching Hospital, Sudan. All patients, ages >18 years, admitted for elective surgery were recruited consecutively. Pre-intervention prescriptions were assessed against a set of predetermined international criteria and against a locally developed protocol post-intervention. Results: A total of 681 and 384 patients were recruited in pre-and post-intervention phases respectively. Administration of antibiotics in the operating rooms to patients for whom prophylaxis was recommended declined from 99.3% in the pre-intervention period to 95.3% in the postintervention one, (P=0.014). The percentage of patients for whom prophylaxis was not recommended and given preoperative antibiotic doses decreased from 95.3% to 31.1%, (P=0.000) before and after the intervention respectively. Significant improvements in adequacy of antibiotic choice, dose accuracy, and percentage of patients who were given prophylaxis as single dose were documented after introduction of the new protocol compared to baseline results; {74.2% to 92.6% ; P=0.000), (68.5% to 91.7% (P=0.000), and (13.3 % to 31.4% ; P= 0.000) respectively}. No significant change was found in the percentage of patients who were given the first preoperative doses in the proper time window in the postintervention phase 3.3%; compared to 1.9% in the pre-intervention period; (P=0.716). Overall adherence to all aspects of the new protocol was 46.6%, significantly higher than adherence to the predetermined criteria during the pre-intervention phases ;( P<0.001). Conclusion: Significant improvement in several performance measures related to the use of antibiotic prophylaxis was observed following introduction of clinical guidelines in a tertiary care teaching hospital.
International Journal of Clinical Pharmacy, 2014
Background There is a lack of evidence to support standard of care and concordance with surgical antimicrobial prophylaxis (SAP) guidelines in our setting. There is an opportunity for clinical pharmacists to facilitate this process across all surgical disciplines. Objective To assess adherence of surgeons to SAP guidelines. Method This was a retrospective study of 250 patients who underwent surgery during 2012 in Mafraq Hospital, Abu Dhabi. We evaluated prescribing of SAP, antimicrobial selection, first-dose timing, dose interval, treatment duration and adherence of surgeons to local hospital guidelines. Results We reviewed 250 patients (193 were male and 57 were female, mean age 36 ± 1.2 years); 54 % had elective operations and 46 % underwent emergency surgery. Adherence to hospital guidelines was 32.1 %. Antimicrobial selection, timing of the first dose, dosage interval and treatment duration were concordant with the hospital guidelines in 26, 31 and 40.3 % of cases, respectively. Main barriers to adherence to hospital guidelines were lack of awareness and education. Conclusions The present study indicated poor adherence to the SAP guidelines. The timing of administration of SAP was not appropriate in two-thirds of the patients and more than half received more than three doses of SAP inappropriately. Continuing medical education should target antimicrobial prophylaxis (selection, timing and duration), clinical pharmacy antibiotic services and cyclic auditing.
Background: Surgical site infections (SSIs) are a major cause of morbidity, associated with extended hospital stays, increasing costs and even death. Perioperative antibiotic prophylaxis has been proven to prevent SSIs. Guidelines have been published to promote best practice but studies continue to highlight poor compliance. Objective: This study aimed to assess adherence to antibiotic prophylaxis guidelines in common surgical operations in the teaching hospital of the national university in the Philippines. Methods: This was a medical records-based, cross-sectional study. Common surgical procedures included were breast surgery, enterostomy closure, open and laparoscopic colectomy, and open and laparoscopic cholecystectomy performed from December 2013 to March 2014. Data were extracted relating to patients' demographic characteristics, types of surgery, prophylactic antibiotic choice, route, dose, timing, redosing and duration of prophylaxis. Observed antibiotic prophylaxis was compared with guidelines. Results: Of the 244 cases that warranted prophylaxis, 93% were given antibiotics. Of these, 44% conformed with the guideline for type of antibiotic, 39% for dose, 100% for route, 45% for timing, 93% for redosing, and 67% for duration. Only 13% conformed to guidelines for all parameters of prophylaxis. Most cholecystectomies received Cefuroxime, no longer recommended by latest international guidelines. Of the laparoscopic surgeries, 38% received antibiotics earlier than the 1 hour before surgery recommended in latest guidelines. Conclusions: Ensuring surgeons fully follow guidelines on antibiotic prophylaxis remains a challenge, as highlighted by this study and others conducted around the world. Awareness-raising initiatives might be beneficial at institutional level to improve compliance with best practice guidelines.