Peri-operative antibiotic prophylaxis: Adherence to guidelines and effects of educational intervention

Özgün, Hedef; Ertuğrul, Mustafa Bülent; Soyder, Aykut; Öztürk, Barçın; Aydemir, Mujgan

doi:10.1016/j.ijsu.2009.12.005

Cited by 72 publications

(74 citation statements)

References 25 publications

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“…Similar finding was observed in cesarean section [12]. Similar finding to ours had been reported in different settings and countries [13][14][15][16]. In our setting, one of the most important challenges was to overcome the previous experience of the staff and provide the best evidence regarding the proper use of antibiotics and to demonstrate the benefits of following it in terms of patient safety and more efficient use of the resources.…”

Section: Discussionsupporting

confidence: 89%

Quality of Perioperative Antibiotic Prophylaxis in a Community Hospital in Western Qatar

Guanche¹,

Villanueva²,

Nonato³

2017

J Infect Dis Epidemiol

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Objective: Describe the compliance with Antibiotic Prophylaxis (AP) in selected surgical procedures in a community hospital during a 3.5 year period. Methods:Descriptive study was carried out in a 75-bed public hospital in Western Qatar. The study included the patients underwent selected procedures who required antibiotic prophylaxis from Jan-2013 to June 2016. Data was collected by the infection control practitioner, from patient files to assess the compliance with timing, selection and dose and discontinuation of the antibiotic prophylactic as per policy, with a 100% compliance set as a program goal. The local infection control program mandates the monitoring of AP, feedback and staff education.Results: Data on 2386 procedures was collected. The 46.5% of the procedures were performed by general surgery, with lower frequency for trauma (24.4%), Gyn-Obst (17.8%) and plastic surgeries (11.3%). The compliance with timing and selection and dose was 61.1% and 94.4% during the first quarter, after which was observed figures over 98%. The discontinuation had the lowest figures during the quarter 2 to 4, with increased compliance over 99% after the quarter seven. Conclusion:Even when the compliance with antibiotic prophylaxis did not achieve the goals, especially for the timely administration, an increased adherence with guidelines was observed during the study period as a result of the strategy implemented by the infection control program. KeywordsAntibiotic prophylaxis, Surgical procedures, Compliance, Qatar is related with prolonged hospital stay, increased cost and other adverse outcomes [1,2]. The preventable outcomes of inappropriate antimicrobial use include infectious morbidity, sepsis-related mortality, and the incidence of Clostridium difficile infections and the emergence of antimicrobial resistant organisms [3].The guidelines emphasize on three key issues: The timely administration before surgical procedures, the selection of the antibiotics according to the expected microbial flora in the surgical site, the re-dosing schedule in specific conditions and the duration of the prophylaxis [2]. Published reports describe a variable compliance with guidelines and the effectiveness of an intervention for its improvement [4][5][6][7][8][9].In public health hospitals in Qatar, the antibiotic prophylaxis is guided by a corporate policy and the compliance is monitored by the infection control department. The aim of this study was to describe the compliance with antibiotic prophylaxis in selected surgical procedures in a community hospital during a 3.5 year period.

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Section: Discussionsupporting

confidence: 89%

Quality of Perioperative Antibiotic Prophylaxis in a Community Hospital in Western Qatar

Guanche¹,

Villanueva²,

Nonato³

2017

J Infect Dis Epidemiol

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“…The researchers suggested that educational interventions should be augmented with protocols and guidelines in order to improve overall adherence. 15 In the current study, the authors believe that the presence of a clinical pharmacist on the surgery floor was essential in encouraging adherence to the revised antimicrobial prophylaxis guidelines. This clinical pharmacist helped with specific recommendations related to prescribed antibiotics and offered oneto-one and group educational sessions for surgical residents.…”

Section: Discussionmentioning

confidence: 78%

“…As with any programme, education is essential to promote evidence-based practice. However, educational intervention alone is not sufficient to change practice, as demonstrated by Ozgun et al 15 In their study, the educational intervention resulted in improvements in indications, choice and dosage of surgical antimicrobial prophylaxis but did not result in improved prophylaxis use or total compliance rate. The researchers suggested that educational interventions should be augmented with protocols and guidelines in order to improve overall adherence.…”

Section: Discussionmentioning

confidence: 87%

Improvement in Adherence to Surgical Antimicrobial Prophylaxis Guidelines after Implementation of a Multidisciplinary Quality Improvement Project

Telfah¹,

Nazer²,

Dirani³

et al. 2015

SQUMJ

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abstract:Objectives: This study aimed to show the impact of a multidisciplinary quality improvement project on adherence to antimicrobial prophylaxis guidelines in oncological surgery. Methods: This pre-and post-intervention prospective observational study was carried out at the King Hussein Cancer Centre (KHCC) in Amman, Jordan, between August 2009 and February 2012. The quality improvement project consisted of revising the institutional guidelines for surgical antimicrobial prophylaxis, assigning a clinical pharmacist to the surgical department, establishing an operating room satellite pharmacy and providing education regarding the appropriate utilisation of antibiotics. The medical records of adult cancer patients who underwent surgery were evaluated one month before and one month after the project was implemented to assess adherence to the guidelines with regards to antibiotics prescribed, drug doses and timing and treatment duration. Results: A total of 70 patients were evaluated before and 97 patients were evaluated after the intervention, of which 57 (81.4%) and 95 (97.9%) patients received antibiotics, respectively. In comparing the pre-and post-intervention groups, an improvement was observed in the proportion of patients who received antibiotics at the appropriate time (n = 12 versus n = 79; 21.1% versus 83.2%; P <0.01), for the appropriate duration of time (n = 22 versus n = 94; 38.6% versus 99.0%; P <0.01) and in the appropriate dose (n = 9 versus n = 87; 56.3% versus 98.9%; P <0.01). Conclusion: Adherence to the antimicrobial prophylaxis guidelines at KHCC improved significantly after the implementation of a quality improvement project.

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“…Inappropriate antibiotic use in SP can lead to various adverse outcomes, such as selection of resistant micro-organisms and increased costs [8,15,20]. Prevention of inappropriate use must represent a priority in Turkey, as in other countries.…”

Section: Selection Of Antibiotic Inappropriatementioning

confidence: 99%

“…In particular, it must be remembered at antibiotics are not the only option in protection from SSI. A significant improvement can be achieved in prophylaxis with close observation, educational activities, and increasing compliance with guidelines [4,20]. Improvements from 35% to 100%% in terms of dose and duration have been reported with the development and application of common SP protocols in collaboration with the surgical team [4,5].…”

Section: Selection Of Antibiotic Inappropriatementioning

confidence: 99%

An Evaluation of Surgical Prophylaxis Procedures in Turkey: A Multi-Center Point Prevalence Study

Kaya¹,

Aktas²,

Şenbayrak³

et al. 2016

Eurasian J Med

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Objective: The purpose of this study was to evaluate compliance with guidelines in surgical prophylaxis (SP) procedures in Turkey. Materials and Methods:A point prevalence study involving 4 university, 5 education and research and 7 public hospitals was performed assessing compliance with guidelines for antibiotic use in SP. Compliance was based on the "Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013" guideline.Results: Sixteen centers were included in the study, with 166 operations performed at these being evaluated. Parenteral antibiotic for SP was applied in 161 (96.9%) of these. Type of antibiotic was inappropriate in 66 (40.9%) cases and duration of use in 47 (29.1%). The main antibiotics used inappropriately in SP were ceftriaxone, glycopeptides and aminoglycosides. No significant difference was observed between secondary and tertiary hospitals in terms of inappropriate selection. Duration of prophylaxis was also incompatible with guideline recommendations in approximately half of surgical procedures performed in both secondary and tertiary hospitals, however statistical significance was observed between institutions in favor of tertiary hospitals. ÖzAmaç: Bu çalışmanın amacı, ülkemizdeki cerrahi proflaksi uygulamalarının rehberlere uygunluğunun değerlendirilmesidir. Gereç ve Yöntem:Bu amaçla, 4 üniversite, 5 eğitim-araştırma ve 7 devlet hastanesini içine alan bir nokta prevalans çalışması yapılmıştır. Cerrahi proflaksideki uygunluğunun değerlendiril-mesinde "Clinical Practice Guidelines for Antimicrobial Surgery (CPGAS) 2013" rehberi baz alınmıştır. Bulgular:Toplam 16 merkez çalışmaya katılmış olup, bu merkezlerdeki 166 operasyon değerlendirilmiştir. Bunların 161'inde (%96,9) cerrahi proflaksi amacıyla parenteral antibiyotik uygulanmıştır. Olguların 66'sında (%40,9) kullanılan antibiyotiğin türü, 47'sinde (%29,1) ise süresi uygunsuz bulunmuştur. Cerrahi proflakside uygunsuz kullanılan antibiyotikler olarak en çok; seftriakson, glikopeptidler ve aminoglikozitler dikkati çekmektedir. İkinci ve 3.basamak sağlık kuruluşları arasında antibiyotik seçimindeki uygunsuzluk açısından anlamlı bir fark görülmemiştir. Cerrahi uygulamaların yaklaşık yarısında proflaktik antibiyotiklerin süresi rehber önerileriyle uyumlu bulunmamış olmakla birlikte; istatistiksel olarak 3.basamak hastanelerinin lehine bir durum olduğu görülmüştür.

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Peri-operative antibiotic prophylaxis: Adherence to guidelines and effects of educational intervention

Cited by 72 publications

References 25 publications

Quality of Perioperative Antibiotic Prophylaxis in a Community Hospital in Western Qatar

Quality of Perioperative Antibiotic Prophylaxis in a Community Hospital in Western Qatar

Improvement in Adherence to Surgical Antimicrobial Prophylaxis Guidelines after Implementation of a Multidisciplinary Quality Improvement Project

An Evaluation of Surgical Prophylaxis Procedures in Turkey: A Multi-Center Point Prevalence Study

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