title: Evaluation of hospital and patient factors that influence the effective administration of surgical antimicrobial prophylaxis.
abstract: OBJECTIVE
  To analyze and model the patient and healthcare system factors that may interfere with the appropriate administration of surgical antimicrobial prophylaxis.
  
  
  METHODS
  Between 1994 and 1998, surgical-site surveillance data were collected prospectively for a cohort of eligible surgical patients. For all cases, and each individual procedure (cardiothoracic, colonic, gynecologic, orthopedic, or vascular), forward stepwise multiple logistic regression was applied to relate key hospital and patient factors to an effective first prophylactic dose (ie, appropriate administration time, dose, route, and drug).
  
  
  METHODS
  A 450-bed, tertiary-care teaching hospital in Canada.
  
  
  METHODS
  A total of 4,835 patients admitted for surgical procedures who required antimicrobial prophylaxis.
  
  
  RESULTS
  Factors positive for an effective first prophylactic dose for all cases were when an order was written (OR, 19.7; CI95, 9.1-42.7; P < .001) and given in the operating room (OR, 13.9; CI95, 7.5-25.6; P < .001). Factors negative for an effective first prophylactic dose were beta-lactam allergy (OR, 0.49; CI95, 0.4-0.61; P < .001) and same-day surgery (OR, 0.57; CI95, 0.4-0.82; P < .001).
  
  
  CONCLUSIONS
  With few exceptions, the four factors included in the procedure models showed that when a preoperative order was written or the antibiotic was given in the operating room, a patient was more likely to receive an effective first prophylactic dose. Conversely, when a patient had a beta-lactam allergy or the surgery was performed on the day the patient was admitted, the administration of an effective first prophylactic dose was less likely.
authors.affiliation: Department of Community Health & Epidemiology, Queen's University, Kingston, Ontario, Canada. bruce.turnbull@i3magnifi.com
authors.forename: Bruce R R
authors.initials: BR
authors.lastname: Turnbull
authors.forename: Dick E
authors.initials: DE
authors.lastname: Zoutman
authors.forename: Mui
authors.initials: M
authors.lastname: Lam
mesh_terms: D000368:Aged; D019072:Antibiotic Prophylaxis / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010361:Patients; D013530:Surgical Wound Infection / Q000517:prevention & control*