Implementation of a Hang Time Project in a private hospital in the Eastern Cape

Abstract

Background: Surgical site infections (SSIs) are the second most common cause of hospital acquired infection (HAI) and defined as infections that occur within 30 days of surgery or within 1 year of surgery if an implantable device is used. SSIs result in increased morbidity and mortality and result in increased length of hospital stay (LOS) and health care and reputational costs. Selection and dosage of antibiotics; the timing prior to incision (0-60min) and the duration of surgical prophylaxis after surgery (< 24hours post surgery except cardiac surgery <48hours) are of particular importance in surgical antibiotic prophylaxis. The aim of this study is to ensure and monitor that all patients receive the correct antibiotic at the correct dose, at the correct time before incision and for the correct duration of surgery. Methods & Materials: 375 peri-operative cases were audited over a 32-week period in the main theatre complex. The following parameters were monitored: (1)appropriate use and dosage of antibiotics according to theNetcare Ltd. Surgical antibiotic prophylaxis guidelines (2) time of administration of antibiotic prior to the incision and (3) duration of therapy after surgery. Improvement methodology was used therefore six data points above the median suggests a significant improvement. Results: It was found that over the 32week period the % of cases with a surgery-choice of antibiotic match has shown no improvement, although the median were 96%. There has been a significant improvement in the cases with the correct prophylactic dose given and with the amount of cases with the correct time of antibiotic dose given prior to incision. No improvements have been made with regards to the duration of prophylactic antibiotic treatment after surgery. Furthermore no improvements could be shown with the overall compliance to the surgical prophylactic protocol. Conclusion: Themajority of surgical cases at Netcare Christiaan BarnardMemorial Hospital (CBMH) are compliantwith theNetcare Ltd surgical antibiotic prophylactic guidelines. Although improvements could not be shown in all the aspects of surgical prophylaxis, the journey will continue until the destination is reached: “Perfect Prophylaxis”.