Need of Improvement in Timing of Prophylactic Antibiotic in Elective Surgery

Abstract

INTRODUCTION:
 
 Infections in surgery are major concern of morbidity, mortality, and costs. Timely antibiotic prophylaxis before incision ensures optimum concentration of AP in blood and tissues to prevent surgical site infections . However, proper timing of AP remains problematic as reported by various studies, though none so far from Nepal. Aim of this prospective observational study was to assess and address the issues for improvements in timing of AP.
 METHODS:
 The pattern of antibiotic prophylaxis were prospectively collected in respect to time of induction, and incision time were recorded on predesigned 'AP form'. The study included all the elective major cases who received AP of intravenous Cefazoline 1 g as per our existing protocol. The emergency surgeries and obstetric cases were excluded from the study.
 RESULTS:
 There were 125 cases of which 89% received AP before incision (63% within 5 minutes before incision), while 11% had AP after the incision and 1% within the recommended time period of 2 hour to 30 minutes before incision.
 CONCLUSIONS:
 Current practice of antibiotic prophylaxis (AP) needs improvement as per standard guidelines of AP within 2 hour to 30 before incision.
 Keywords: antibiotic, infection, prophylaxis, surgery.

Surgical Antimicrobial Prophylaxis and Incidence of Surgical Site Infections at Ethiopian Tertiary-Care Teaching Hospital

“…14,15 Hence, antimicrobial prophylaxis should be started prior to contamination, which is considered essential to control bacterial growth and significantly lower the incidence of SSIs. 10,16,17 It is estimated that 60% of SSIs are preventable, mostly related to the use of recommended evidence-based practices such as the timing, selection, and duration of preoperative prophylactic antibiotics. 18,19…”

Intervention to Improve Timing of Preoperative Antibiotic Prophylaxis in Major Elective Surgery

“…Studies have shown that two thirds of SSIs can be prevented [25][26][27] by timely and appropriate administration of AP. 25,[28][29][30] However, compliance with the established guidelines is often far from optimal as found in our earlier study 17 and reported literatures. 14,[18][19][20][21] Awareness, lack of co-ordination and resistance to accept changes are some of the barriers to successful implementation of evidencebased practice of AP.…”

“…In initiation of surgeons, the anesthetist took charge of timing of AP administration with the help of OR nurses. This resulted in 99% (119/120) of AP before incision (from earlier 81% 17 ). Also, the number of patients increased to 48% (from earlier 1% 17 ) who got AP within optimum time of 60 to 30 minutes before incision.…”