Document Detail


Surveillance of antimicrobial prophylaxis for surgical procedures.
MedLine Citation:
PMID:  10501259     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the practice of antimicrobial prophylaxis for surgical procedures in eight surgical departments in a 550-bed teaching hospital. METHODS: A list of all major procedures performed in our hospital, with recommendations for prophylaxis based upon the literature, has been distributed since 1993 and is updated periodically. The practice of surgical prophylaxis between January 1 and March 31, 1996, was examined by assessing four variables: (1) Did the particular procedure justify prophylaxis, and was it provided? (2) Was timing optimal, ie, within 1 hour prior to surgery? (3) Was the appropriate antimicrobial selected? (4) Was duration optimal, ie, < or =24 hours? RESULTS: During the study period, 2,117 operations were performed, of which 1,631 (77%) were reviewed. Sixty-six percent were clean surgery, 28% clean-contaminated, and 6% contaminated; 72% of procedures were elective, 28% emergencies. Of 1,631 operations requiring prophylaxis, 1,142 (70%) received it, 489 (30%) did not. Of 1,631 patients, 1,392 (85%) received appropriate care: 929 (67%) appropriately received prophylaxis, and 463 (33%) appropriately did not receive prophylaxis. Of 955 patients who received prophylaxis, 26 (3%) did so inappropriately. Of 1,142 patients who should have received prophylaxis, 213 (19%) did not receive it. Female gender, clean surgery, elective operations, and infrequently performed procedures were all significant indicators of inappropriately withheld prophylaxis (P<.001). In addition, the rate of appropriately provided prophylaxis varied between departments from 71% to 97% (P<.001). Assessment of the 929 procedures for which prophylaxis was justified and given revealed that 100% of patients received it on time, the choice of antimicrobial was appropriate in 95% of cases, and duration was < or =24 hours in 91%. CONCLUSIONS: Audits of surgical prophylaxis are expected to detect different errors in different institutions. Conducting audits of surgical prophylaxis probably should be part of the routine activity of infection control teams. Feeding the information back to surgeons could improve adherence to recommended guidelines and might contribute to reduced wound infection rates.
Authors:
V Vaisbrud; D Raveh; Y Schlesinger; A M Yinnon
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America     Volume:  20     ISSN:  0899-823X     ISO Abbreviation:  Infect Control Hosp Epidemiol     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-10-28     Completed Date:  1999-10-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8804099     Medline TA:  Infect Control Hosp Epidemiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  610-3     Citation Subset:  IM; N    
Affiliation:
Department of Orthopedics, Shaare Zedek Medical Center and Hadassah-Hebrew University, Jerusalem, Israel.
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MeSH Terms
Descriptor/Qualifier:
Adult
Antibiotic Prophylaxis / statistics & numerical data*
Female
Hospitals, Teaching
Humans
Infection Control / statistics & numerical data*
Israel
Male
Middle Aged
Prospective Studies
Surgery Department, Hospital / statistics & numerical data*
Surgical Procedures, Operative / classification*,  statistics & numerical data*
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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