Timing of Prophylactic Antibiotic Administration in Elective Surgical Patients at Jimma University Teaching Hospital: South West Ethiopia

Abstract

Study objective: To evaluate the timing of prophylactic antibiotic administration in elective surgical patients, and anesthetists' opinion regarding this issue.Design: Prospective, facility based cross-sectional study was employed. Setting: Jimma university teaching hospital (JUTH)Patient: Elective surgical patients and anesthesia professional of the hospital.Measurement: Data were collected prospectively from all elective surgical patients (except emergency, obstetric cases) and interred in predesigned forms as per existing protocol in JUTH from February 01 to March 30, 2014. The time of antibiotic prophylactic administration in respect to incision time was analyzed and descriptive result was presented as percentages of total responses.Main results: Prophylactic antibiotics was given before skin incision for 107 (79.9%) patients and 27 (20.1%) after skin incision. However; only 75 (56%) patients were get administered within proper time (60minutes) and the mean time of preoperative administration was 66+24 minutes. Prophylactic antibiotic medication was continued for >24 hours in 95% cases and re-dosing were not given for six surgical procedures which lasted >3 hours.Out of 26, only 71% anesthetists could mention the recommended time of antibiotic prophylaxis administration. About 21(80.8%) of anesthetists agreed that its surgeon's responsibility for preoperative antibiotic selection and shared with nurses for preoperative administration. Anesthetists assume that they are responsible for confirmation of pre-incision administration and repeat administration during prolonged surgery. They indicated training was inadequate and deemed necessary in 77% of participants. Conclusion:The timing of prophylactic antibiotic administration was below the standard of practice. Hospital administration and infection control officer should work to improve compliance in accordance with published evidence-based guidelines.

Antibiotic usage in surgical prophylaxis: A prospective observational study in the surgical ward of Nekemte referral hospital

“…This research finding indicated that surgical antibiotics commonly practiced in NRH were neither part of the STG of the country nor the primary choice of the international guidelines. Analogous reports were noted in similar studies conducted in different areas of the country [ 7 , 10 ]. Therefore, what one should be skeptical to our country context is that some common custom on broad-spectrum antibiotic use has been held and communicated across (probably) all hospitals of the country that should be further investigated and intervened as soon as possible.…”

“…Although the guidelines promote to end prophylactic administration within 24 hours [ 4 , 5 ], 44.4% of the administrations continued for up to five days. Comparable results were reported from a study in Iran (46%) [ 13 ], and in southwestern Ethiopia (50.7%) [ 10 ]. To be specific, in this study only less than a quarter (20.9%) of the patients’ discontinued surgical antibiotics within a day.…”

“…Data abstraction format was prepared based on previously published studies [ 7 , 9 , 10 ]. It was pretested on 15 patients, modified accordingly and used for data collection.…”

“…Including our country, findings from different countries had reported that guideline compliance was poor and thus SAP was used inappropriately [ 7 – 10 ]. Thus, inappropriate use of surgical antibiotics has to be well-thought-out in order to achieve an overall reduction in morbidity, mortality and healthcare cost.…”

“…Thus, inappropriate use of surgical antibiotics has to be well-thought-out in order to achieve an overall reduction in morbidity, mortality and healthcare cost. One study done at Jimma University teaching hospital (southwestern Ethiopia) tried to assess the likely factors for poor preoperative timing and duration [ 10 ]. Another study in Ayder referral hospital (northern Ethiopia) investigated the guideline compliance regardless of assessing the contributing factors.…”