Abstract
ObjectiveIrrational use of antimicrobial agents for preventing postoperative SSIs is a common phenomenon in China, which results in more bacterial resistance, higher hospital infection rates, extra costs of antimicrobial agents. The aim of the study is to evaluate the effect of Drug Rational Usage Guidelines System (DRUGS) on the surgeon's prescription behavior of antimicrobial agents.Methods10 common surgical operations which included 1543 cases (where 778 cases using paper-based guidelines and 765 cases using DRUGS) were selected and their demographic and clinical data were collected. The selected operations include thyroid resection, breast mass resection, myomectomy, etc. The evaluation criteria were antibiotic administrative categories, the time of initial dose, duration of administration, length of stay, the costs of antibiotics, SSIs and drug adverse reactions(ADR).ResultsThe antimicrobial agents were mostly administrated within 0.5 h to 2 h before incision, 656 patients (85.75%) were intervened with DRUGS and 256 (32.90%) with paper-based guidelines according to the protocol. For the clean wounds incision, 547 patients (91.62%) were within 24 h of withdrawal antibiotics with using paper-based guidelines versus 91 (14.79%) with using DRUGS. A total of 19 kinds of antibiotics were used in the 1543 cases. The leading three on the list of frequency were piperacillin and sulbactam sodium, cefathiamidine and cefoperazone. While after the intervention, the list of frequency changed to cefazolin, cefathiamidine, cefoperazone. The average hospital stay was (7.00±4.31)d with paper-based guidelines and (2.54±1.57)d with DRUGS, respectively. The average cost of antibiotics was ¥(3481.36±2584.46) with paper-based guidelines and ¥(1693.39±1478.27) with DRUGS, respectively. However, there were no significant differences in the incidence of SSIs and ADR between two groups.ConclusionIn this study, the increased availability of antibiotic guidelines at the time of drug ordering, combined with DRUGS, was associated with an enhanced surgeon adherence to guidelines.
Highlights
Surgical site infections (SSIs) account for approximately 15% of nosocomial infections and are associated with prolonged hospital stays and increased cost [1]
According to the evidence-based guidelines for the prevention of SSIs published by the Centers for Disease Control (CDC), strategies for the prevention of SSIs are based both on reducing the risk of bacterial contamination and improving the patient’s defense against infection
Surgical antibiotic prophylaxis (SAP) is designed for achieving effective antibiotic concentration at the time of initial surgical incision, and maintained throughout the vulnerable period of the procedure, which is between skin incision and skin closure [2]
Summary
Surgical site infections (SSIs) account for approximately 15% of nosocomial infections and are associated with prolonged hospital stays and increased cost [1]. One of the most important interventions in preventing surgical site infections is the optimization of antimicrobial prophylaxis. In many countries the use of SAP adhering to the guidelines is not always optimal [7,8,9]. Less than 40% of patients in the public sector and 30% in the private sector are treated following clinical guidelines [10]. The key point to prevent SSIs is to improve the dependence on the guidelines for the prevention of SSIs. In addition, some studies have reported that making guidelines or decision supports can supply therapeutic information to prescribers ‘just-in-time’ to influence the decision at the time of clinical decision, so that surgeon is likely to apply it [13,14,15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
