title: Assessment of prophylactic antibiotic use in patients with surgical site infections.
abstract: BACKGROUND
  Surgical site infections (SSIs) are the leading cause of hospital-acquired infections and are associated with substantial health care costs, with increased morbidity and death. The Surgical Care Improvement Project (SCIP) contains standards that are nationally reported with the aim of improving patient outcomes after surgery. Our institution's standards for antimicrobial prophylaxis in the perioperative period are more stringent than these measures and may be considered "beyond SCIP." The 4 elements of appropriate antimicrobial prophylaxis are timing, antibiotic selection, dosing, and intraoperative redosing.
  
  
  OBJECTIVE
  To quantify antimicrobial SSI prophylaxis compliance in accordance with institutional standards and to identify potential opportunities for improvement.
  
  
  METHODS
  Patients aged 18 years or older were included if they had an SSI between January 1, 2009, and June 30, 2010, according to the database maintained prospectively by the Infection Prevention and Control Unit. Adherence to our institution's practice standards was assessed through analysis of antibiotics administered-timing in relation to the incision, closure, and tourniquet inflation times for the procedure and antibiotic selection, dose, and redosing.
  
  
  RESULTS
  Overall noncompliance with all 4 elements of antimicrobial prophylaxis was 75.4% among the 760 cases. Repeat dosing had the greatest noncompliance (45.1%); antibiotic selection had the lowest incidence of noncompliance (10.8%).
  
  
  CONCLUSIONS
  Noncompliance existed in each element of antimicrobial SSI prophylaxis, with antibiotic redosing leading in noncompliance. With the implementation of tools to assist the surgical team in following institutional standards, noncompliance will likely decline and additional research opportunities will exist.
authors.affiliation: Pharmacy Services.
authors.forename: Whitney J
authors.initials: WJ
authors.lastname: Goede
authors.affiliation: Pharmacy Services.
authors.forename: Jenna K
authors.initials: JK
authors.lastname: Lovely
authors.affiliation: Division of Infectious Diseases.
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Thompson
authors.affiliation: Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota. Corresponding author: Jenna K. Lovely, PharmD, Pharmacy Services, Mayo Clinic, 200 First Street SW, Rochester MN 55905; e-mail: lovely.jenna@mayo.edu .
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
keywords: antibiotic prophylaxis; perioperative care; surgical wound infection