Infection control measures for adult cardiac surgery in the UK--a survey of current practice.
The aim of the study was to define current UK practice for antimicrobial prophylaxis and preoperative screening for bloodborne viruses and methicillin-resistant Staphylococcus aureus (MRSA) before routine cardiac surgery. An e-mail survey was sent to the Association of Cardiothoracic Anaesthetists (ACTA) Linkmen in all 36 UK adult cardiac surgical units, during May 2001. Questions were asked regarding MRSA, hepatitis B, C and human immunodeficiency virus (HIV) screening. Regarding antimicrobial prophylaxis questions were asked regarding agent(s), dose, frequency and duration of use for coronary artery and value surgery. Responses were received from 29 units (response rate 81%). There was a wide variety of practices for all units surveyed. For MRSA screening, 19 units (65%) screened all patients before surgery, but two (7%) screened none, with the remaining eight units (28%) screening selected high-risk groups. Regarding screening for bloodborne viruses: eight units (28%) tested all patients routinely for hepatitis B, 11 units (39%) selectively tested only high-risk patients and transplant recipients. No units tested for hepatitis C and HIV infection routinely. All units used prophylactic antibiotics routinely, but the type and number of agents, along with dose and duration of therapy all varied widely. For coronary artery bypass graft (CABG) surgery, a single agent was used by 16 units (55%), two agents by 12 units (41%) and three agents by one unit (4%). There is a wide variation in infection control practice in adult cardiac units throughout the UK. Rationalization of preoperative screening and use of prophylactic antibiotics, by adopting nationally agreed practice guidelines, could significantly reduce costs and potentially reduce the incidence of resistant organisms.
Kendall
J B
JB
Department of Anaesthesia, The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK. jbkendall@doctors.org.uk
Hart
C A
CA
Pennefather
S H
SH
Russell
G N
GN
D000328:Adult; D006348:Cardiac Surgical Procedures; D018890:Chemoprevention / Q000379:methods*; D015658:HIV Infections / Q000517:prevention & control; D019538:Health Care Surveys; D006509:Hepatitis B / Q000517:prevention & control; D006526:Hepatitis C / Q000517:prevention & control; D006801:Humans; D017053:Infection Control / Q000379:methods*; D016106:Methicillin Resistance; D011300:Preoperative Care / Q000379:methods*; D013203:Staphylococcal Infections / Q000517:prevention & control; D006113:United Kingdom