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Compliance With Guidelines on Antibiotic Prophylaxis in Total Hip Replacement Surgery: Results of a Retrospective Study of 416 Patients in a Teaching Hospital

Published online by Cambridge University Press:  02 January 2015

Pierrick Bedouch ,
José Labarère ,
Emmanuel Chirpaz ,
Benoit Allenet ,
Alain Lepape ,
Magali Fourny ,
Patricia Pavese ,
Pierre Girardet ,
Philippe Merloz  and
Dominique Saragaglia
...Show all authors
Pierrick Bedouch
Affiliation:
Unité devaluation Médicale, DMAS
José Labarère*
Affiliation:
Unité devaluation Médicale, DMAS
Emmanuel Chirpaz
Affiliation:
Unité devaluation Médicale, DMAS
Benoit Allenet
Affiliation:
Département de Pharmacie, DMAS
Alain Lepape
Affiliation:
Service d'Anesthésie-Réanimation, Centre Hospitalier Universitaire, Lyon, France
Magali Fourny
Affiliation:
Unité devaluation Médicale, DMAS
Patricia Pavese
Affiliation:
Service de Médecine Interne et Maladies Infectieuses, DMAS
Pierre Girardet
Affiliation:
Département d'Anesthésie-Réanimation, Centre Hospitaller Universitaire de Grenoble, France
Philippe Merloz
Affiliation:
Service de Chirurgie Orthopédique Nord, Centre Hospitaller Universitaire de Grenoble, France
Dominique Saragaglia
Affiliation:
Service de Chirurgie Orthopédique Sud, Centre Hospitaller Universitaire de Grenoble, France
Jean Calop
Affiliation:
Département de Pharmacie, DMAS
Patrice Francois
Affiliation:
Unité devaluation Médicale, DMAS
*
Unite d'Evaluation Medicate, Pavilion D, CHU-BP 217, 38 043 Grenoble cedex 9, France
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Abstract

Objective:

To assess compliance of anesthesiologist practices in antibiotic prophylaxis during total hip replacement (THR) surgery with the French Society of Anesthesiology and Intensive Care consensus-based guidelines.

Design:

Retrospective review of medical records. Compliance of anesthesiologist practices with the guidelines was assessed according to antibiotic prophylaxis use, antimicrobial agent, dosage of first injection, time from first dose to incision, and total duration of antibiotic prophylaxis.

Setting:

Orthopedic surgery wards in a 2,200-bed French teaching hospital.

Patients:

A random sample of 416 patients undergoing THR from January 1999 to December 2000.

Results:

Three hundred eighty-six (93%) of the sampled medical records were usable. Antibiotic prophylaxis was used for 366 (95%) of the patients. Total duration of prophylaxis did not exceed 48 hours in 98% (359 of 366) of the patients. Drug selection complied with national guidelines in 259 (71%) of the patients. Dosage and timing of the first injection were appropriate in 98% (290 of 296) and 80% (236 of 296) of the patients, respectively, who received one of the recommended antibiotics. Overall, 53% (203 of 386) of the patients met all five criteria. In multivariate analysis, there was a significant anesthesiologist effect on overall compliance with the guidelines (likelihood ratio chi-square with 9 degrees of freedom, 25.7; P < .01). Undergoing surgery during 2000 was the only patient characteristic associated with an increased rate of appropriate practices (adjusted OR, 1.56; CI95,1.02-2.38).

Conclusion:

The overall compliance rate should be improved by disseminating the guidelines and the results of this study following audit and feedback.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 4 , April 2004 , pp. 302 - 307
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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