Implementation of an antibiotic prophylaxis protocol in an intensive care unit.
BACKGROUND
When properly employed, the prophylactic use of antimicrobials is associated with a reduction in surgical site infections (SSIs). We found that the appropriate use of antimicrobial prophylaxis was only 50.5% (53/105) among patients undergoing surgery in the adult intensive care unit of our hospital. In 2001, a protocol was designed to improve compliance with recommended practice.


METHODS
We used a prospective interventional study and a case control study carried out between 2001 and 2007, including follow-up and daily intervention to improve compliance with antimicrobial prophylaxis guidelines and to monitor antimicrobial consumption and SSI rates. Cases of noncompliance to the prophylaxis protocol (group I) were matched to controls (group II) with appropriate prophylaxis and compared with regards to type of surgery, operative duration, intraoperative antimicrobial use, type of antimicrobial used, length of hospital stay, severity of illness, comorbidities, invasive devices, possible adverse reactions, and death.


RESULTS
Compliance with antimicrobial prophylaxis metrics reached 85%; however, we were unable to detect a change in SSI rate or consumption and cost of antimicrobials. Inappropriate use was not associated with higher likelihood of death. There were no other significant differences between the 2 groups.


CONCLUSIONS
Our intervention increased compliance with appropriate antimicrobial surgical prophylaxis with no negative impact on patient safety.
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. silvanama@einstein.br
Silvana Maria
SM
de Almeida
Alexandre R
AR
Marra
Sergio B
SB
Wey
Elivane da Silva
Eda S
Victor
Oscar Fernando Pavão
OF
Dos Santos
Michael B
MB
Edmond
D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000592:standards*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D013503:Surgery Department, Hospital; D013530:Surgical Wound Infection / Q000517:prevention & control*
D000890:Anti-Infective Agents