A NEW STANDARD OF CARE - ADMINISTRATION OF PREOPERATIVE ANTIBIOTICS IN THE OPERATING-ROOM

Surgical site infections increase total hospital expenses and extend t he length of hospital stay. Properly administered antibiotics are succ essful in minimizing postoperative subcutaneous wound infection second ary to perioperative bacterial contamination at the surgical site and are effective in most clean-contaminated surgical procedures, It is im perative that therapeutic levels of antibiotics be present during the time when the wound is open to maximize their effect to prevent the de velopment of surgical wound infections. Only 32 per cent of 97 patient s sampled from 1992 to 1994 at the Louisville Veterans Affairs Medical Center were administered preoperative antibiotics within 1 hour prior to surgical incision. Changing the responsibility for preoperative an tibiotic administration from ward or holding room nurses to the anesth esiologist in the operating room rendered such antibiotics delivered c loser to the induction of anesthesia and subsequent incision. Eighty-e ight per cent of 220 patients sampled in 1995 had antibiotics administ ered within 1 hour of incision. This change in institutional policy of antibiotic administration maximizes the likelihood of appropriate ant ibiotic tissue levels and thereby their potential efficacy. Routine pr ophylaxis should be administered as close to the time of induction of anesthesia as possible to provide the best chance for appropriate tiss ue levels above the minimum inhibitory concentration for potential bac terial contamination.