Peri-operative antibiotic prophylaxis: adherence to guidelines and effects of educational intervention.
BACKGROUND
This study was aimed to determine the propriety of perioperative antimicrobial prophylaxis, to evaluate the effects of a training intervention on correction.


METHODS
This prospective educational intervention study was performed on clean, clean-contaminated, and contaminated wounds in elective procedures. The accuracy of the antimicrobial prophylaxis was analyzed according to international guidelines. The outcome measures were appropriateness of prophylactic antibiotic indication, choice, dose and duration; and cost of inappropriate administration.


RESULTS
Before the intervention, 312 procedures were recorded compared with 322 after the intervention. Total compliance rate decreased from 34.3% to 28.5% after the intervention, though insignificantly (p=0.59). Educational training intervention did not change the rate of inappropriate antibiotic choice statistically, and prolonged antibiotic use was significantly higher after the intervention (p=0.01). The positive impact of the intervention was observed in decreased "not indicated but administered" rate (p=0.009) and absence of procedures with "indicated but not administered" and "inappropriate antibiotic dose" which also decreased significantly (both p<0.001). The total cost of irrational antibiotic use was US$26,230.20.


CONCLUSIONS
Although this educational intervention study achieved improvements in indications, choice, and dosing of surgical antimicrobial prophylaxis, it failed to improve prolonged use and total compliance rate, and to lower the costs sufficiently. It will probably provide better results by means of compulsory measures for surgeons to comply with available protocols and guidelines, as well as education programs, in order to change the antibiotic utility habits on surgical prophylaxis and to achieve accurate prophylactic administrations.
Ozgun
Hedef
H
Department of General Surgery, Adnan Menderes University, 09100 Aydin, Turkey. hedefozgun@yahoo.com
Ertugrul
Bulent M
BM
Soyder
Aykut
A
Ozturk
Barcin
B
Aydemir
Mujgan
M
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000592:standards* / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D004305:Dose-Response Relationship, Drug; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D019990:Perioperative Care / Q000592:standards; D011182:Postoperative Care / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011300:Preoperative Care / Q000592:standards; D011336:Probability; D011446:Prospective Studies; D013503:Surgery Department, Hospital; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000592:standards; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000517:prevention & control*; D017749:Total Quality Management; D014421:Turkey
D000890:Anti-Infective Agents