Preventing of surgical site infection: An analysis of compliance with antibiotic prophylaxis standards

Abstract

Background. Surgical site infections increase patient morbidity and mortality as well as increase the consumption of resources, both human and durable. An effective strategy for prevention of surgical site infection is appropriate surgical antibiotic prophylaxis.

Methods. Data from an existing hospital performance improvement data set were analyzed for relationships between the outcome variables of antibiotic choice, administration within 60 minutes prior to incision, discontinuation in 24 hours and total compliance with all three outcomes and characteristics of cases such as location of antibiotic administration, length of procedure, and who administered antibiotic. These data were reported from August 8, 2005–August 31, 2006. The total number of cases included in this study was 1,355.

Results. Compliance with antibiotic choice was 94.8%, administration within 60 minutes prior to incision was 91.3%, discontinuation within 24 hours (or 48 hours for Cardiac surgery) was 87.7% and total antibiotic compliance was 79.5%. Outcome Choice compliance was significantly related to procedure category (p < .001) with Cardiac surgery most compliant at 99.7% and Abdominal - General with only 55% compliant with choice. Outcome Administration within 60 minutes prior to incision was significantly related to location of administration with administration in the OR 95.8% compliant (p < .001) and administration in CV Holding compliant at 41.7% (p < .001). Administration by anesthesia was also significantly related to compliance with compliance of 100% (p < .001). Outcome Discontinuation within 24 hours (or 48 hours for Cardiac surgery) was significantly related to procedure category (p < .001) with Cardiac surgery 97.7%, Abdominal - General 53.5% and Joint at 73.6% compliant. Total antibiotic compliance was significantly related to procedure category (p < .001) with Cardiac surgery 95.5%, Abdominal - General 36.7% and Joint 58.2% compliant. Administration in the OR 85.0% vs. 66.6% (p < .001) compliance and administration by anesthesia 87.1% vs. 0% (p < .001) compliance were both significantly related to total antibiotic compliance.

Conclusions. Hospitals and healthcare providers striving to improve compliance with antibiotic choice, administration and discontinuation should focus interventions on who is administering the antibiotic and where it is being administered. Anesthesia should be administering the antibiotic in the OR for optimal compliance with the outcomes of choice and administration timing. Additional interventions based on procedure category should focus educational strategies for these surgical services staff to promote compliance with the outcomes of choice and discontinuation.