title: Appropriate use of antimicrobial prophylaxis: an observational study in 21 surgical wards.
abstract: BACKGROUND
  Surveillance of Surgical Site Infections (SSI) in 2010 found 39 % compliance with hospital guidelines in Piedmont (Italy). The aim of the study was to estimate the appropriate use of antimicrobial prophylaxis and compliance with hospitals guidelines in surgical wards.
  
  
  METHODS
  This survey study took place in 21 surgery wards of 4 public hospitals. Forms were completed by public health resident doctors together with a medical ward referent and infection control nurses. 15 consecutive surgical procedures were randomly chosen from each ward. A total of 320 cases were analyzed. The study period was from July 2012 to January 2013. Data were collected using a survey form. A final score variable from 0 to 4 was given to each case. The results were compared with hospital and international guidelines. Data were analyzed using Epi-Info software.
  
  
  RESULTS
  Of the 320 cases collected, 63 were excluded; of the remaining 257 cases, 56.4 % of the procedures were appropriate (score 4), 15.2 % were acceptable and 28.4 % were not acceptable. The study found an unjustified continuation of antimicrobial prophylaxis in 17.1 % of the 257 cases, an unjustified re-start of antimicrobial therapy in 9.7 % and a re-dosing omission in 7.8 %.
  
  
  CONCLUSIONS
  The study demonstrated critical problems in antimicrobial prophylaxis management in surgical wards due to a lack of compliance between hospitals and national guidelines, a shortage of specific and updated recommendations for some surgical interventions and incorrect local specific procedures. Coordination between local and national recommendations, strengthening of evidence based decisions and continuous sharing of policy updates are needed.
authors.affiliation: School of specialization in Hygiene and Preventive Medicine, Turin, Italy. m.testa@unito.it.|Department of Public Health and Pediatrics, University of Turin, Turin, Italy. m.testa@unito.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Testa
authors.affiliation: School of specialization in Hygiene and Preventive Medicine, Turin, Italy.|Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Stillo
authors.affiliation: School of specialization in Hygiene and Preventive Medicine, Turin, Italy.|Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Giacomelli
authors.affiliation: School of specialization in Hygiene and Preventive Medicine, Turin, Italy.|Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Scoffone
authors.affiliation: Infection Control Unit, Rivoli and Pinerolo Hospital, Turin, Italy.
authors.forename: Pier Angelo
authors.initials: PA
authors.lastname: Argentero
authors.affiliation: Department of General Surgery, City of Science and Health, Turin, Italy.
authors.forename: Enzo Carlo
authors.initials: EC
authors.lastname: Farina
authors.affiliation: Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
authors.forename: Carla Maria
authors.initials: CM
authors.lastname: Zotti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D002648:Child; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents