Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-21T13:21:46.806Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2015

Heidi Misteli ,
Andreas F. Widmer ,
Walter P. Weber ,
Evelyne Bucher ,
Marc Dangel ,
Stefan Reck ,
Daniel Oertli ,
Walter R. Marti  and
Rachel Rosenthal
Heidi Misteli*
Affiliation:
Division of General Surgery, University Hospital of Basel, Basel, Switzerland
Andreas F. Widmer
Affiliation:
Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
Walter P. Weber
Affiliation:
Division of General Surgery, University Hospital of Basel, Basel, Switzerland
Evelyne Bucher
Affiliation:
Division of Anesthesiology, University Hospital of Basel, Basel, Switzerland
Marc Dangel
Affiliation:
Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland
Stefan Reck
Affiliation:
Division of General Surgery, University Hospital of Basel, Basel, Switzerland
Daniel Oertli
Affiliation:
Division of General Surgery, University Hospital of Basel, Basel, Switzerland
Walter R. Marti
Affiliation:
Division of General Surgery, Kantonsspital Aarau, Aarau, Switzerland
Rachel Rosenthal
Affiliation:
Division of General Surgery, University Hospital of Basel, Basel, Switzerland
*
Department of General Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland (mistelih@uhbs.ch)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

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.

Design.

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

Setting.

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

Methods.

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.

Results.

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.

Conclusions.

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

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 9 , September 2012 , pp. 912 - 916
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Burke, JP. Infection control: a problem for patient safely. N Engl J Med 2003;348:651–656.10.1056/NEJMhpr020557Google Scholar
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;20:725–730.10.1086/501572Google Scholar
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):S69–S77.10.1086/321860Google Scholar
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;15:182–188.10.2307/30145558Google Scholar
5. Kaiser, AB. Antimicrobial prophylaxis in surgery. N Engl J Med 1986;315:1129–1138.Google Scholar
6. Page, CP, Bohnen, JM, Fletcher, JR, et al. Antimicrobial prophylaxis for surgical wounds: guidelines for clinical care. Arch Surg 1993;128:79–88.10.1001/archsurg.1993.01420130087014Google Scholar
7. Bratzier, DW, Houck, PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004;38:1706–1715.Google Scholar
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;326:281–286.Google Scholar
9. World Health Organization (WHO). WHO Guidelines for Safe Surgery, 2008. http://www.gawande.com/documents/WHOGuidelinesforSafeSurgery.pdf. Accessed May 23, 2011.Google Scholar
10. Weber, WP, Marti, WR, Zwahlen, M, et al. The timing of surgical antimicrobial prophylaxis. Ann Surg 2008;247:918–926.10.1097/SLA.0b013e31816c3fecGoogle Scholar
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;27:97–132.10.1016/S0196-6553(99)70088-XGoogle Scholar
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;355:2725–2732.10.1056/NEJMoa061115Google Scholar
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:c309.10.1136/bmj.c309Google Scholar
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; 64:1307–1315.10.1093/jac/dkp367Google Scholar
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;250:10–16.10.1097/SLA.0b013e3181ad5fcaGoogle Scholar
16. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
17. Smith, RL, Bohl, JK, McElearney, ST, et al. Wound infection after elective colorectal resection. Ann Surg 2004;239:599–605.10.1097/01.sla.0000124292.21605.99Google Scholar
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;206:814–819.10.1016/j.jamcollsurg.2007.12.013Google Scholar
19. Bode, LG, Kluytmans, JA, Wertheim, HF, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus . N Engl J Med 2010;362:9–17.10.1056/NEJMoa0808939Google Scholar
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;363:1928–1937.10.1056/NEJMsa0911535Google Scholar
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;4:6.10.1186/1754-9493-4-6Google Scholar