The successful use of antibiotic prophylaxis in selected high-risk surgical patients under non-trial, everyday conditions

Abstract

The use of prophylactic antibiotic protocols in the control of wound infection in high-risk surgical patients under everyday ward conditions was evaluated over a period of between one and three years. Patients undergoing hip or large bowel surgery, caesarian section or hysterectomy, had the highest wound infection rates and were chosen as the target groups for intervention. The overall reduction in wound infection rates in all the groups after intervention was from 12·7 to 7·4 per cent. Reduction in wound infection rates varied in each group: in hip surgery from 25·7 to 1·2 per cent, in caesarian section from 10·5 to 5·1 per cent and in abdominal hysterectomy from 9·0 to 3·2 per cent. Not all patients within each group were similarly affected. When subdivided into different risk groups, patients in the highest risk group generally showed little, if any, reduction in wound infection rate. The length of postoperative stay was shortened considerably after the introduction of the protocol for hip surgery and abdominal hysterectomy. Although the proportion of patients who received prophylactic antibiotics increased after the introduction of the protocols there was a concomitant decrease in the total amount of antibiotics used.