Surgical Antibiotic Prophylaxis in a Private Hospital Compliance with Guidelines

Abstract

Objective: To prospectively evaluate the appropriateness of prophylactic surgical antibiotic use and the cost of inappropriate surgical antibiotic prophylaxis in a 115‐bed private hospital.Method: Details of prophylactic antibiotic administration were recorded by operating theatre nursing staff and the clinical pharmacists assessed the appropriateness of the indication, antibiotic choice and dose. Surgical antibiotic prophylaxis was considered appropriate if it met either the in‐house Surgical Antimicrobial Protocol or the Antibiotic Guidelines 96/97 9th edition. We assessed the timing of administration and analysed the cost of inappropriate drug use and laboratory monitoring.Results: Surgical antibiotic prophylaxis was indicated in 92% of procedures (230/251) and used, or not used, appropriately in 86% of procedures (215/251). In the 197 cases in which antibiotics were indicated and used: only 62% of doses (122/197) were administered at or less than two hours before induction; and the correct antibiotic was chosen in 90% of cases (178/197). Dosage was correct in 77% of cases overall (192/251), but in 98% of cases when the appropriate antibiotic was chosen (174/178). Single doses were employed in only 68% of procedures (133/197). There was compliance with all five criteria in only 35% of cases. The annual cost to this hospital of inappropriate antibiotic prophylaxis was estimated at over $40 000.Conclusion: This study demonstrated modest compliance with current recommendations for surgical antimicrobial prophylaxis. As a result, the in‐house protocol is being revised to include ENT procedures and a new anaesthetic record form is being developed. Further education is being targeted to anaesthetists, urologists, orthopaedic, colorectal and ENT surgeons.