Surgical Antibiotic Prophylaxis in a Private Hospital Compliance with Guidelines

Abstract

C o m p lia n ce w ith G u id elin esK e rri A M cConachy, Sylvia C uell, P asch al J K ent, M alcolm I M cD onald ABSTRACT Objective: To prospectively evaluate the appropriate ness of prophylactic surgical antibiotic use and the cost of inappropriate surgical antibiotic prophylaxis in a 115bed private hospital. Method: Details of prophylactic antibiotic administra tion were recorded by operating theatre nursing staff and the clinical pharmacists assessed the appropriate ness of the indication, antibiotic choice and dose. Surgi cal antibiotic prophylaxis was considered appropriate if it met either the in-house Surgical Antimicrobial Pro tocol or the Antibiotic Guidelines 96197 9th edition. We assessed the timing of administration and analysed the cost of inappropriate drug use and laboratory monitor ing. Results: Surgical antibiotic prophylaxis was indicated in 92% of procedures (230/251) and used, or not used, appropriately in 86% of procedures (215/251). In the 197 cases in which antibiotics were indicated and used: only 62% of doses (122/197) were administered at or less than two hours before induction; and the correct antibiotic was chosen in 90% of cases (178/197). Dos age was correct in 77% of cases overall (192/251), but in 98% of cases when the appropriate antibiotic was chosen (174/178). Single doses were employed in only 68% of procedures (133/197). There was compliance with all five criteria in only 35% of cases. T he annual cost to this hospital of inappropriate antibiotic prophy laxis was estimated at over $40 000. Conclusion: This study demonstrated modest compli ance with current recommendations for surgical anti microbial prophylaxis. As a result, the in-house proto col is being revised to include E N T procedures and a new anaesthetic record form is being developed. Fur ther education is being targeted to anaesthetists, urolo gists, orthopaedic, colorectal and E N T surgeons. A ust J H osp Pharm 1999; 29: 5-9.

Post‐discharge surgical wound infection surveillance in a provincial hospital: Follow‐up rates, validity of data and review of the literature

“…The anaesthetic/ theatre nurse documented the ASA score, skin cut time and finish time; wound classification was decided in consultation with the surgeon and anaesthetist. The use and timing of prophylactic antibiotics were also recorded and the data used for a separate study 23 . The form was then transferred with the patient from recovery room to the nursing unit.…”

“…The use and timing of prophylactic antibiotics were also recorded and the data used for a separate study. 23 The form was then transferred with the patient from recovery room to the nursing unit. Nursing staff documented the state of the surgical site on a daily basis until discharge; direct observation of the wound was done only after dressings were removed.…”