Implementing 1-dose antibiotic prophylaxis for prevention of surgical site infection.
OBJECTIVE
Replacing a 24-hour regimen with a 1-dose antibiotic prophylaxis for elective surgery would not increase rates of surgical site infection and would decrease costs.


METHODS
Before-after trial in a tertiary, private general hospital in Ribeirão Preto, São Paulo, Brazil.


METHODS
Surgery was performed on 6140 consecutive patients from February 2002 through October 2002 (period 1) and 6159 consecutive patients from December 2002 through August 2003 (period 2). Studied surgeries included orthopedic, gastrointestinal, urology, vascular, lung, head and neck, heart, gynecologic, oncology, colon, neurologic, and pediatric surgeries. The study excluded patients with infection at the time of surgery.


METHODS
Decreasing the 24-hour prophylactic antibiotic regimen to 1-dose antibiotic prophylaxis.


METHODS
Surgical site infections in both periods measured by in-hospital surveillance and postdischarge surveillance; compliance with 1-dose prophylaxis; and costs with cephazolin.


RESULTS
We followed up 12,299 patients during their hospital stay; postdischarge surveillance increased significantly from 2717 patients (44%) to 3066 patients (50%, P<.001). One-dose prophylaxis was correctly followed in 6123 patients (99% compliance). The rate of surgical site infection did not change in either period (2% and 2.1% respectively, P = .67). The number of cephazolin vials purchased monthly decreased from 1259 to 467 with a corresponding monthly savings of $1980.


CONCLUSIONS
One-dose antibiotic prophylaxis did not lead to an increase in rates of surgical site infection and brought a monthly savings of $1980 considering cephazolin alone. High compliance to 1-dose prophylaxis was achieved through an educational intervention encouraged by the hospital director and administrative measures that reduced access to extra doses.
Fonseca
Silvia Nunes Szente
SN
Infection Control Department, Hospital São Francisco, Ribeirão Preto, São Paulo, Brazil. silvia-fonseca@saofrancisco.com.br
Kunzle
Sônia Regina Melon
SR
Junqueira
Maria José
MJ
Nascimento
Renata Teodoro
RT
de Andrade
José Ivan
JI
Levin
Anna S
AS
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002437:Cefazolin / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002437:Cefazolin