Preoperative antibiotic prophylaxis practice and guideline adherence in Jordan: a multi-centre study in Jordanian hospitals

Abstract

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 HealthSystem 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.

A Study on the Usage Pattern of Antimicrobial Agents for the Prevention of Surgical Site Infections (SSIs) in a Tertiary Care Teaching Hospital

“…All the above findings suggested that the antimicrobial prophylaxis was clearly overused in our study, which was similar to the findings of several earlier studies which had reported an overuse and/or misuse of the preoperative antimicrobials in different countries [12]. Various measures like the development of local hospital guidelines, surveillance on SSIs, educational interventions, hospital antibiotic policy, promoting good surgical techniques and strict asepsis in the operating theatre, are suggested to prevent the emergence of multiresistant organisms [14].…”

“…Very similar to most of the previous studies, the main parameter of concern which was noted in our study was the prolonged duration of the antibiotic prophylaxis [7,9,12,22]. Overall, only 10 (3.9%) patients in our study received the antimicrobials for less than 36 hours, inspite of the published guidelines which had recommended discontinuation of the prophylaxis within 24-48 hours [17].…”

“…As for the choice of the antimicrobial agent, the third generation cephalosporins were commonly used in our hospital, as noted in earlier studies which were done in India and elsewhere in Asia [9,12,[14][15][16][17][18]. The use of antimicrobials in most of these cases seemed to be empirical, based on operating surgeon's clinical experience.…”

“…All the cases in our study received prophylactic antimicrobials prior to the surgery, even though prophylactic systemic antimicrobials are not typically indicated for the patients who undergo clean surgical procedures [11,12].…”

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

“…6 However, despite the presence of evidence-based guidelines, poor adherence to guidelines has been reported internationally. [7][8][9][10][11][12][13] The King Hussein Cancer Centre (KHCC) in Amman, Jordan, is a 170-bed comprehensive teaching cancer centre with a surgical service consisting of nine teams with various specialties. Among these teams, an average of 25 patients are seen and five major elective surgeries are performed per day.…”