Surveillance of antimicrobial prophylaxis for surgical procedures

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 rec ommendations for prophylaxis based upon the literature, has been distribute d since 1993 and is updated periodically. The practice of surgical prophyla xis between January 1 and March 31, 1996, was examined by assessing four va riables: (1) Did the particular procedure justify prophylaxis, and was it p rovided? (2) Was timing optimal, ie, within 1 hour prior to surgery? (3) Wa s the appropriate antimicrobial selected? (4) Was duration optimal, ie, les s than or equal to 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% em ergencies. 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%) appropria tely 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 el ective operations, and infrequently performed procedures were all significa nt 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 proph ylaxis was justified and given revealed that 100% of patients received it o n time, the choice of antimicrobial was appropriate in 95% of cases, and du ration was less than or equal to 24 hours in 91%. CONCLUSIONS: Audits of surgical prophylaxis are expected to detect differen t: errors in different institutions. Conducting audits of surgical prophyla xis probably should be part of the routine activity of infection control te ams. Feeding the information back to surgeons could improve adherence to re commended guidelines and might contribute to reduced wound infection rates Infect Control Hosp Epidemiol 1999;20:610-613).