Appropriate Timing of Prophylactic Antibiotics at Cesarean Delivery [23D

Abstract

INTRODUCTION: Cesarean section has one of the highest infection rates among surgical procedures. In an effort to reduce this rate, American Congress of Obstetricians and Gynecologists (ACOG) established guidelines for administration of prophylactic antibiotics. At our institution, these antibiotics were previously administered by the nursing. We sought to determine if changing the responsible party to the anesthesiology team en route to the operating room would improve compliance with these recommendations. METHODS: This was retrospective review of non-emergent cesarean sections performed at our institution over 2 different periods, before and after our institution modified the administration provider. A random sample of 1,433 charts was generated: 733 charts from November 2010 to October 2011 and 700 charts from March 2014 and December 2014. RESULTS: Only 60% of cesarean sections received antibiotic prophylaxis in the recommended ACOG time frame prior to our intervention. After the staff responsible for administering the antibiotics was changed to anesthesia, 99% of subjects received antibiotics with 60 minutes of incision time (P<.001). Further analysis revealed significantly better antibiotic timing with anesthesia staff administration compared to nursing staff administration (P<.001), with only 83% of cesarean sections receiving appropriate timing of antibiotics by the nursing staff. CONCLUSION: When prophylactic antibiotics were administered by anesthesia, rates of accurate administration significantly improved. Given cesarean sections carry a significantly higher rate of postoperative wound infection compared with other surgeries, such change should be considered for other hospitals providing obstetrics care.