title: Ensuring appropriate timing of antimicrobial prophylaxis.
abstract: BACKGROUND
  Delivery of intravenous antibiotic prophylaxis within one hour prior to surgical incision is considered important in helping to decrease the incidence of surgical site infections, but methods to ensure compliance have not been established.
  
  
  METHODS
  All patients at our institution are subjected to a surgical "time-out" protocol to prevent wrong-site surgery. During a seven-week period, all patients undergoing spine surgery, total hip arthroplasty, or total knee arthroplasty had another safety initiative, that of ensuring that prophylactic intravenous antibiotics were administered at least one hour prior to incision, "piggybacked" onto our existing time-out verification checklist. In addition, we compared compliance during the study period with compliance during a three-month period prior to institution of this protocol and compliance for eighteen months after institution of this protocol.
  
  
  RESULTS
  The average time (and standard deviation) between the antibiotic administration and the incision was 26 +/- 12 minutes for all patients. The protocol was effective in ensuring antibiotic administration at the optimal time to 316 (99.1%) of the 319 patients. Analysis of a group of forty patients who had undergone total hip or knee replacement during the three months prior to the beginning of the study demonstrated a compliance rate of 65%. The difference between this baseline compliance rate and the rate during the study period was significant (p < 0.0001). The compliance rate was 97% for 160 patients who underwent similar procedures during the eighteen months after completion of the study. Independent audits demonstrated continuation of the significantly better compliance with timing of antibiotic prophylaxis for patients undergoing total hip and knee arthroplasty since the implementation of the protocol in our institution.
  
  
  CONCLUSIONS
  Piggybacking of verification of prophylactic antibiotic administration onto the wrong-site-surgery time-out protocol is an effective, cost-free, and easy-to-adopt method to ensure compliance with appropriate timing of prophylactic antibiotics.
authors.affiliation: NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA. Andrew.Rosenberg@med.nyu.edu
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Rosenberg
authors.forename: Daniel
authors.initials: D
authors.lastname: Wambold
authors.forename: Linede
authors.initials: L
authors.lastname: Kraemer
authors.forename: Maureen
authors.initials: M
authors.lastname: Begley-Keyes
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.forename: Neeraj
authors.initials: N
authors.lastname: Singh
authors.forename: Max M
authors.initials: MM
authors.lastname: Cohen
authors.forename: Michele V
authors.initials: MV
authors.lastname: Bennett
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D019983:Guideline Adherence; D006801:Humans; D019637:Orthopedic Procedures / Q000592:standards*; D011300:Preoperative Care; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents