TIMELINESS AND USE OF ANTIBIOTIC-PROPHYLAXIS IN SELECTED INPATIENT SURGICAL-PROCEDURES

BACKGROUND: Twenty-five percent of all nosocomial infections are wound infections. Professional guidelines support the timely use of preoper ative prophylaxis for prevention of postoperative wound infections. Ba rriers exist in implementing this practice, IPRO, the New York State p eer review organization, as part of the Health Care Financing Administ ration's Health Care Quality Improvement Program, sought to determine the proportion of patients receiving timely antibiotic prophylaxis for aortic grafts, hip replacements and colon resections in 44 hospitals in New York State. METHODS: IPRO conducted a retrospective medical rec ord review of 44 hospitals through out New York State stratified for t eaching, nonteaching status. A sample was drawn of 2651 patients, 2256 from Medicare and 395 from Medicaid, undergoing either abdominal aort ic aneurysm repair, partial or total hip replacement or large bowel re section. The study determined the proportion of patients who had docum entation of receiving antibiotics and those who received antibiotics t imely, that is less than or equal to 2 hours preoperatively. RESULTS: Eighty-six percent of patients had documentation of receiving an antib iotic. Forty-six percent of aneurysm repairs and 60% of hip replacemen ts had evidence of receiving timely antibiotic prophylaxis, that is wi thin 2 hours prior to surgery. For colon resections, 73% of cases had either oral prophylaxis or timely parenteral therapy. An increased pro portion of patients had received parenteral antibiotics prematurely as the surgical start time occurred later in the day. A total of 44 diff erent antibiotics were recorded for prophylaxis, CONCLUSIONS: Antibiot ic prophylaxis was performed in 81% to 94% of cases, however, anywhere from 27% to 54% of all cases did not receive antibiotics in a timely fashion, By delegating implementation of ordered antibiotic prophylaxi s to the anesthesia team, timing may be improved and the incidence of postoperative wound infections may decrease.