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Harbi H, Merzougui L, Barhoumi MH, Rebai H, Abdelkefi S, El Kamel R, Barhoumi T. [Evaluation of surgical antibiotic prophylaxis in a Tunisian University Hospital]. Pan Afr Med J 2018; 30:191. [PMID: 30455820 PMCID: PMC6235464 DOI: 10.11604/pamj.2018.30.191.14861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/24/2018] [Indexed: 11/27/2022] Open
Abstract
Antibiotic prophylaxis (ATBP) is one of the specific measures for the prevention of surgical site infections, whose impact has been quantified in clean or clean-contaminated surgery. Our study aims to evaluate the conformity of ATBP practices and the adherence to the prescribing protocols adopted in our Hospital. We conducted a clinical audit retrospective observational study, evaluating antibiotic prophylaxis practices in our Hospital in the month of March 2015. The primary study endpoint was the overall compliance of the observed practices with the 5 major criteria defined by the French National Authority for Health (FNAH). We followed the guidelines of the French Society of Anesthesia and Intensive Care published in 2010. The study included 150 patients who had undergone surgery in the Department of General Surgery, Orthopaedics and Urology. The overall compliance rate was 33.3%. The compliance with each of the 5 major criteria defined by the FNAH was 74% for the indication; 84% for the time between injection and incision; 60% for the choice of ATB; 89.3% for the dose of the first injection and 72% for the duration of ATBP. The compliance was variable depending on the Department; better compliance was reported in the Department of Urology, in scheduled surgery and when the prescriber was an anesthetist-resuscitator. A global strategy including organization, education and restriction, could lead to a real improvement in the rate of compliance with ATBP practices. Successive audits should be carried out regularly in order to evaluate the impact of the undertaken actions.
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Affiliation(s)
- Hayett Harbi
- Direction Régionale de la Santé, Kairouan, Tunisie
| | - Latifa Merzougui
- Service d'Hygiène Hospitalière CHU Ibn El Jazzar, Kairouan, Tunisie
| | | | - Hedi Rebai
- Service d'Orthopédie CHU Ibn El Jazzar, Kairouan, Tunisie
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Muller A, Leroy J, Hénon T, Patry I, Samain E, Chirouze C, Bertrand X. Surgical antibiotic prophylaxis compliance in a university hospital. Anaesth Crit Care Pain Med 2015; 34:289-94. [PMID: 26384755 DOI: 10.1016/j.accpm.2015.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 04/01/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess surgical antibiotic prophylaxis (SAP) practices in a university hospital in order to identify risk factors associated with non-compliance. STUDY DESIGN Retrospective monocentric study conducted over a 4-month period. PATIENTS AND METHODS Data were collected from the software used in the operating theatre. Practice non-compliance was evaluated in comparison with the 2010 version of the French national recommendations. We only took in account the interventions identified as priority surveillance interventions according to the surgical site infections national surveillance. The risk factors associated with SAP non-compliance were identified with a multivariate statistical analysis. RESULTS We evaluated 1312 SAPs. Among the 1298 indicated SAPs, 44.4% were not compliant. The most frequent inappropriate criterion was the timing of injection (34.8% non-compliance), which was, in the majority of cases, too close to the time of incision. Other inappropriate criteria were identified: antibiotic choice for patients allergic to β-lactams (inappropriate among 45% of allergic patients), and antibiotic dosing for obese patients (96% of non-compliance). Obesity (OR=84.32), allergy to β-lactams (OR=17.11) and certain types of surgery (digestive, OR=4.56; gynaecological and obstetrical, OR=7.10; urological, OR=3.95) were independently associated with the non-compliance of SAP practices. CONCLUSION Improvement measures that target the timing of injection, obese or allergic patients are necessary.
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Affiliation(s)
- Allison Muller
- UMR 6249 chrono-environnement, service d'hygiène hospitalière, centre hospitalier régional universitaire, 3, boulevard Fleming, 25000 Besançon, France.
| | - Joel Leroy
- UMR 6249 chrono-environnement, service des maladies infectieuses, centre hospitalier régional universitaire, 3, boulevard Fleming, 25000 Besançon, France
| | - Thierry Hénon
- Pharmacie centrale, centre hospitalier régional universitaire, 3, boulevard Fleming, 25000 Besançon, France
| | - Isabelle Patry
- Service de bactériologie, centre hospitalier régional universitaire, 3, boulevard Fleming, 25000 Besançon, France
| | - Emmanuel Samain
- Pôle d'anesthésie-réanimation chirurgicale, centre hospitalier régional universitaire, 3, boulevard Fleming, 25000 Besançon, France
| | - Catherine Chirouze
- UMR 6249 chrono-environnement, service des maladies infectieuses, centre hospitalier régional universitaire, 3, boulevard Fleming, 25000 Besançon, France
| | - Xavier Bertrand
- UMR 6249 chrono-environnement, service d'hygiène hospitalière, centre hospitalier régional universitaire, 3, boulevard Fleming, 25000 Besançon, France
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Parulekar L, Soman R, Singhal T, Rodrigues C, Dastur FD, Mehta A. How good is compliance with surgical antibiotic prophylaxis guidelines in a tertiary care private hospital in India? A prospective study. Indian J Surg 2009; 71:15-8. [PMID: 23133102 DOI: 10.1007/s12262-009-0004-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 10/18/2008] [Indexed: 10/21/2022] Open
Abstract
PURPOSE There is a need to study compliance with surgical antibiotic prophylaxis guidelines in India. METHODS In this prospective study, 100 consecutive surgical procedures performed at a tertiary care private hospital in Mumbai, India were observed. The choice of antibiotic, timing and duration of administration were recorded and compared to the hospital guidelines. RESULTS Appropriateness of choice of antibiotic was seen in 68%, timing in 89%, dose in 75% and duration in 63% of cases. Hundred percent compliance to all criteria was observed in 52% of cases. The SSI rate was 3.3%. CONCLUSIONS These compliance rates though suboptimal are similar to those reported in world literature. There is an urgent need to improve compliance with optimal surgical antibiotic prophylaxis guidelines so as to reduce risk of SSI and to prevent resistance and costs potentially associated with antibiotic misuse.
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Pessaux P, Lermite E, Blezel E, Msika S, Hay JM, Flamant Y, Deepak V, Arnaud JP. Predictive risk score for infection after inguinal hernia repair. Am J Surg 2006; 192:165-71. [PMID: 16860624 DOI: 10.1016/j.amjsurg.2006.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Revised: 11/24/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Identification of subgroups of patients at high and low risk for global infectious complications (GIC) after inguinal hernia repair without mesh. METHODS A database of 1254 patients who underwent inguinal hernia repair without mesh, issued from 3 prospective multicenter randomized trials, has been established (group A). After multivariate analysis, a score for GIC was calculated and tested using data from a similar prospective randomized multicenter study (group B). RESULTS A risk score for GIC was constructed: -4.7 + (0.95 x age > or =75 years) + (1.1 obesity) + (2.1 x urinary catheter). In case of score less than -4.2 (low-risk group), the GIC rate was 2.7%; therefore, in case of score more than -4.2 (high-risk score), the GIC rate was 14.3% (P < .001). In the low-risk group, the administration of antibiotic prophylaxis did not reduce the infectious complication rate, while in high-risk group the administration of antibiotic prophylaxis significantly reduced the rates of surgical site infection, GIC, and urinary infection by 72%, 67%, and 76.8%, respectively. CONCLUSIONS This study demonstrates the efficacy of antibiotic prophylaxis in inguinal hernia surgery in the subgroup of high-risk patients.
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Affiliation(s)
- Patrick Pessaux
- Service de Chirurgie Digestive, Centre Hospitalier et Universitaire Angers, France.
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Chadli M, Rtabi N, Alkandry S, Koek JL, Achour A, Buisson Y, Baaj A. Incidence des infections du site opératoire étude prospective à l'hôpital militaire d'instruction Mohamed-V de Rabat, Maroc. Med Mal Infect 2005; 35:218-22. [PMID: 15914291 DOI: 10.1016/j.medmal.2005.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2004] [Accepted: 03/17/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The authors had for aim to determine prospectively the incidence of surgical site infections (SSI) in a visceral surgery department, in the Mohamed V military hospital (Rabat), and to identify risk factors. PATIENTS AND METHODS All patients who had undergone surgery between April 1 and September 30, 2002 and were then admitted in the visceral surgery unit were included in this study. Patients were assessed within the following month. For each patient, data including perioperative factors, type of procedure, and SSI occurrence were collected on a standardized form. RESULTS During the study, 310 patients were operated. The number of surgical wound infections was 16 (5.2%). This analysis pointed out: 11 superficial wounds, 5 deep wounds, and 1 organ/site wound. Emergency, age, ASA score, Altemeier classification, and procedure duration were found to be risk factors for SSI in visceral surgery. According to the NNIS index, SSI rates increase from 2.7% for patients with a risk index of 0 to 10.2% for patients with a risk index of 3. CONCLUSION The high incidence of SSI emphasizes the importance of implementing SSI surveillance in surgery to obtain standardized incidence ratios necessary for adapted control measures.
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Affiliation(s)
- M Chadli
- Département de biologie clinique, hôpital militaire d'instruction Mohamed-V, Rabat, Maroc.
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D'Escrivan T, Lemaire JS, Ivanov E, Boulo M, Soubrier S, Mille FX, Alfandari S, Guery B. [Surgical antimicrobial prophylaxis: compliance to guidelines and impact of targeted information program]. ACTA ACUST UNITED AC 2005; 24:19-23. [PMID: 15661460 DOI: 10.1016/j.annfar.2004.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Accepted: 10/25/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Surgical antimicrobial prophylaxis is used to decrease postoperative wound infection. We assessed the compliance to surgical antimicrobial prophylaxis guidelines in our hospital and the impact of an information program. PATIENTS AND METHODS Observational study of clean or clean contamined surgery, during two 3-week periods, separated by a targeted information period. The following data were collected prospectively: prophylaxis indication, antimicrobial agent, timing, dose, route and duration of prophylaxis. Chi square test was used for analysis or Fischer test when available. RESULTS Four hundred seventy-seven patients were enrolled - 270 and 207 for each period respectively. For both periods only 49% of prophylaxis was appropriated. When prophylaxis should be administered - 15 and 13% of patients for each period - it was antibioprophylaxy was strictly adequate with recommandations. The most common error was administration timing. Only the choice of antimicrobial agent was optimized after information period. DISCUSSION These results are consistent with previous studies. Information program alone have no effect on the good use of antimicrobial for surgical prophylaxis. Only a policy associating organization, restriction and education could improve practices.
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Affiliation(s)
- T D'Escrivan
- Service de réanimation et maladies infectieuses, centre hospitalier de Tourcoing, 135, rue du Président-Coty, 59208 Tourcoing, France.
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Lallemand De Conto S, Bretl E, Huc B, Picard A, Tuefferd N, Talon D. [Long-term usefulness of an information programme on practices in surgical antimicrobial prophylaxis]. ANNALES DE CHIRURGIE 2003; 128:438-46. [PMID: 14559192 DOI: 10.1016/s0003-3944(03)00185-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
INTRODUCTION In France, numerous concordant studies show that there are some discrepancies between guidelines on surgical antibiotic prophylaxis and the current practice. In a previous study, conducted in April-June 2001, we found that the rate of appropriateness of surgical antimicrobial prophylaxis was approximately 40%. An information programme was implemented and the purpose of this paper was to present the short- and long-term usefulness of this campaign. METHODS A total of 13 pairs of surgeons/anaesthetists participated in data collection during the three periods of the study. Prescriptions were observed in order to answer to five questions. Five variables describing practices concerning antibiotic prophylaxis in surgery were compared to national recommendations (updated in 1999): did the surgical procedure require antibiotic prophylaxis and was this carried out? Was the antibiotic used appropriate? Was the timing of the first injection optimal? Was the total duration of the treatment correct? Was the dose correct? RESULTS The overall compliance with recommendations was significantly improved during the third period (P = 0.0002). This improvement was particularly marked for antimicrobial prophylaxis duration. CONCLUSION It seems that sequential surveillance of antimicrobial prophylaxis, including numerous surgical teams, could considerably improve the practices, if it was associated to informations that allowed physicians to appropriate the procedures.
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Affiliation(s)
- S Lallemand De Conto
- Réseau Franc-Comtois de lutte contre les infections nosocomiales (RFCLIN), CHU Jean-Minjoz, 25030 Besançon, France
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Gupta N, Kaul-Gupta R, Carstens MM, Franga D, Martindale RG. Analyzing Prophylactic Antibiotic Administration in Procedures Lasting More than Pour Hours: Are Published Guidelines Being Followed? Am Surg 2003. [DOI: 10.1177/000313480306900807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Published guidelines for surgical antibiotic prophylaxis recommend that an appropriately selected and administered antibiotic should be repeated in a timely manner in lengthy procedures. To assess concordance with published guidelines we reviewed the prophylactic antibiotic usage in procedures lasting more than 4 hours at a 500-bed university hospital. The records of 300 procedures longer than 4 hours in duration from the gastrointestinal, neurosurgery, and vascular surgery services were retrospectively reviewed. Analysis was confined to the usage of antibiotics in a prophylactic setting. Using a liberal interpretation of the American College of Surgeons, Centers for Disease Control and Prevention, Surgical Infection Society, and Medical Letter Guidelines each case was evaluated for the appropriateness of the antibiotic selection, the interval between the first dose and the skin incision, and the timeliness of repeat dosing. Twenty-five patients (8.3%) did not receive any antibiotic coverage at all. One hundred ninety cases (63.3%) received the correct antibiotic, but only 96 (32%) received it in a timely manner before surgery. Nine patients (3%) in 300 cases received repeat doses at the correct time for the entire duration of the surgery in complete compliance with the published guidelines. We conclude that antibiotic prophylaxis of lengthy procedures is rarely in accordance with published guidelines.
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Affiliation(s)
- Naren Gupta
- From the Department of Surgery, Medical College of Georgia, Augusta, Georgia
| | - Rina Kaul-Gupta
- From the Department of Surgery, Medical College of Georgia, Augusta, Georgia
| | - Miki M. Carstens
- From the Department of Surgery, Medical College of Georgia, Augusta, Georgia
| | - Dion Franga
- From the Department of Surgery, Medical College of Georgia, Augusta, Georgia
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Perniceni T, Vons C. [Interest of a programme of monitoring of infections' incidence of the operative site in digestive surgery]. ANNALES DE CHIRURGIE 2002; 127:786-90. [PMID: 12538102 DOI: 10.1016/s0003-3944(02)00918-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- T Perniceni
- Département médicochirurgical de pathologie digestive, Institut mutualiste Montsouris, Paris, France.
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Thouverez M, Lallemand S, Bailly P, Bertrand X, Talon D. [Determination of indicators for non-compliance with guidelines for surgical antimicrobial prophylaxis]. PATHOLOGIE-BIOLOGIE 2002; 50:547-51. [PMID: 12490418 DOI: 10.1016/s0369-8114(02)00352-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We conducted a prospective study to identify predictors of inappropriateness of surgical prophylaxis. A total of 72 surgeon-anaesthesist pairs participated in data collection. We assessed practices by addressing 5 questions: did the surgical procedure justify the use of antimicrobial prophylaxis, and was it provided? Was the correct agent used? Was the timing of prophylaxis optimal? Was the duration of prophylaxis correct? Was the dose correct? We reviewed 687 procedures, 513 (74.7%) of which were included in the analysis. The proportion of these procedures with totally compliant prescriptions was 41.7%. Of the 156 patients who received an inappropriate drug, 133 (85.3%) received a drug with a broader spectrum than that recommended. Prophylaxis lasted too long in 81 (89.0%) of the 91 patients who received prophylaxis of incorrect duration. Multivariate analysis revealed a clear association between non-compliant prophylaxis and two operation-specific factors: prosthesis implantation (with a relative risk of 2.52) and clean-contaminated operations (with a relative risk of 4.19). More than 50% of patients received inappropriate surgical prophylaxis. Non-observance of guidelines was related to factors that did not influence the infectious potential of the flora.
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Affiliation(s)
- M Thouverez
- Réseau Franc-Comtois de lutte contre les infections nosocomiales, service d'hygiène hospitalière CHU Jean-Minjoz, 25030, Besançon, France
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Lallemand S, Albin C, Huc B, Picard A, Roux C, Tuefferd N, Talon D. [Evaluation of practices in surgical antimicrobial prophylaxis in the Franche-Comté before and after implementation of an information program]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2002; 21:634-42. [PMID: 12471784 DOI: 10.1016/s0750-7658(02)00706-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To assess the practices of surgical antimicrobial prophylaxis in the Franche-Comté region of France before and after the implementation of information program. STUDY DESIGN Prospective multicenter transversal study type before/after. The information program included a feedback on the observed results during the period before and a meeting with opinion leaders. PATIENTS AND METHODS Data were collected by 28 pairs of surgeons/anaesthetists. Prescriptions were analysed to answer five questions about antibiotic prophylaxis practices in surgery: did the surgical procedure require antibiotic prophylaxis and was this carried out? Was the appropriate antibiotic used? Was the timing of the first injection optimal? Was the total duration of the treatment correct? Was the dose correct? Our data were compared to national recommendations (updated in 1999). RESULTS The overall frequency of conformity was about 40% both before and after the implementation of an information/awareness campaign. Only the conformity of the total duration of the prophylaxis was significantly higher after the action, but only for interventions that lasted less than two hours. [RR = 2.09 (1.32-3.31), p = 0.001]. This improvement in the total duration of regulation seemed to be related to the more frequent use of written protocols in the surgical units. CONCLUSION Our study confirms that information campaign have little effect within the framework of the good use of antibiotics. We agree with the experts who claim that only an overall strategy including organization, education and restriction will really improve the frequency of conformity of the practices of surgical prophylaxis.
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Affiliation(s)
- S Lallemand
- Réseau franc-comtois de lutte contre les infections nosocomiales, CHU Jean Minjoz, 25030 Besançon, France
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