Prophylactic antibiotic administration prior to hysterectomy: a quality improvement initiative.
OBJECTIVE
To determine whether institution of a preoperative antibiotic policy could increase the use of prophylactic antibiotics prior to hysterectomy.


METHODS
A retrospective cohort study of 400 women who underwent abdominal, vaginal or laparoscopic hysterectomy for benign indications at Women and Infants Hospital was performed. Rates and timing of prophylactic preoperative antibiotic administration were determined, as were the rates of postoperative febrile morbidity. These data were compared to data collected in a medical record review of 686 hysterectomies performed prior to institution of the antibiotic policy.


RESULTS
Prior to the institution of the antibiotic policy, 50% of patients (342/686, 95% CI 46.0, 53.7) received prophylactic preoperative antibiotics. After introduction of the antibiotic policy, 91.2% (95% CI 88.0, 93.8) of patients received prophylactic preoperative antibiotics. Approximately 66% of the antibiotics were administered within the 60 minutes preceding the surgical incision. Postoperative febrile morbidity was noted in 14% of patients prior to the antibiotic policy as compared to 11% of patients after the policy was instituted. Abdominal surgical approach was found to be a clinically and statistically significant risk factor for febrile morbidity (OR = 7.0; 95% CI 2.3, 20.9).


CONCLUSIONS
Rates of prophylactic preoperative antibiotic administration significantly increased after institution of a hospital policy advocating routine antibiotic prophylaxis prior to hysterectomy. Additional steps must be taken to ensure more routine and appropriately timed administration of antibiotics prior to hysterectomy and to continuously monitor the use of prophylactic antibiotics.
DiLuigi
Andrea J
AJ
Division of Research in Women's Health, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island 02905, USA.
Peipert
Jeffrey F
JF
Weitzen
Sherry
S
Jamshidi
Roxanne M
RM
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents