Skip to main content Accessibility help

Successful Implementation of a Window for Routine Antimicrobial Prophylaxis Shorter than That of the World Health Organization Standard

  • Heidi Misteli (a1), Andreas F. Widmer (a2), Walter P. Weber (a1), Evelyne Bucher (a3), Marc Dangel (a2), Stefan Reck (a1), Daniel Oertli (a1), Walter R. Marti (a4) and Rachel Rosenthal (a1)...



To evaluate the feasibility of implementation of the refined window for routine antimicrobial prophylaxis (RAP) of 30-74 minutes before skin incision compared to the World Health Organization (WHO) standard of 0-60 minutes.


Prospective study on timing of routine antimicrobial prophylaxis in 2 different time periods.


Tertiary referral university hospital with 30,000 surgical procedures per year.


In all consecutive vascular, visceral, and trauma procedures, the timing was prospectively recorded during a first time period of 2 years (A; baseline) and a second period of 1 year (B; after intervention). An intensive intervention program was initiated after baseline. The primary outcome parameter was timing; the secondary outcome parameter was surgical site infection (SSI) rate in the subgroup of patients undergoing cholecystectomy/colon resection.


During baseline time period A (3,836 procedures), RAP was administered 30–74 minutes before skin incision in 1,750 (41.0%) procedures; during time period B (1,537 procedures), it was administered in 914 (56.0%; P < .001). The subgroup analysis did not reveal a significant difference in SSI rate.


This bundle of interventions resulted in a statistically significant improvement of timing of RAP even at a shortened window compared to the WHO standard.


Corresponding author

Department of General Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland (


Hide All
1. Burke, JP. Infection control: a problem for patient safely. N Engl J Med 2003;348:651656.
2. Kirkland, KB, Briggs, JP, Trivette, SL, et al. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999;20:725730.
3. Gaynes, RP, Culver, DH, Horan, TC, et al. Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis 2001;33(suppl 2):S69S77.
4. Dellinger, EP, Gross, PA, Barrett, TL, et al. Quality standard for antimicrobial prophylaxis in surgical procedures—the Infectious Diseases Society of America. Infect Control Hosp Epidemiol 1994;15:182188.
5. Kaiser, AB. Antimicrobial prophylaxis in surgery. N Engl J Med 1986;315:11291138.
6. Page, CP, Bohnen, JM, Fletcher, JR, et al. Antimicrobial prophylaxis for surgical wounds: guidelines for clinical care. Arch Surg 1993;128:7988.
7. Bratzier, DW, Houck, PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004;38:17061715.
8. Classen, DC, Evans, RS, Pestotnik, SL, et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281286.
9. World Health Organization (WHO). WHO Guidelines for Safe Surgery, 2008. Accessed May 23, 2011.
10. Weber, WP, Marti, WR, Zwahlen, M, et al. The timing of surgical antimicrobial prophylaxis. Ann Surg 2008;247:918926.
11. Mangram, AJ, Horan, TC, Pearson, ML, et al. Guideline for prevention of surgical site infection, 1999—Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97132.
12. Pronovost, P, Needham, D, Berenholtz, S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:27252732.
13. Pronovost, PJ, Goeschel, CA, Colantuoni, E, et al. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ 2010;340:c309.
14. Miliani, K, L'heriteau, F, Astagneau, P. Non-compliance with recommendations for the practice of antibiotic prophylaxis and risk of surgical site infection: results of a multilevel analysis from the INCISO Surveillance Network. J Antimicrob Chemother 2009; 64:13071315.
15. Steinberg, JP, Braun, BI, Hellinger, WC, et al. Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the trial to reduce antimicrobial prophylaxis errors. Ann Surg 2009;250:1016.
16. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470485.
17. Smith, RL, Bohl, JK, McElearney, ST, et al. Wound infection after elective colorectal resection. Ann Surg 2004;239:599605.
18. Hawn, MT, Itani, KM, Gray, SH, et al. Association of timely administration of prophylactic antibiotics for major surgical procedures and surgical site infection. J Am Coll Surg 2008;206:814819.
19. Bode, LG, Kluytmans, JA, Wertheim, HF, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus . N Engl J Med 2010;362:917.
20. de Vries, EN, Prins, HA, Crolla, RM, et al. Effect of a comprehensive surgical safety system on patient outcomes. N Engl J Med 2010;363:19281937.
21. de Vries, EN, Dijkstra, L, Smorenburg, SM, et al. The Surgical Patient Safety System (SURPASS) checklist optimizes timing of antibiotic prophylaxis. Patient Saf Surg 2010;4:6.

Related content

Powered by UNSILO

Successful Implementation of a Window for Routine Antimicrobial Prophylaxis Shorter than That of the World Health Organization Standard

  • Heidi Misteli (a1), Andreas F. Widmer (a2), Walter P. Weber (a1), Evelyne Bucher (a3), Marc Dangel (a2), Stefan Reck (a1), Daniel Oertli (a1), Walter R. Marti (a4) and Rachel Rosenthal (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.