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Evaluation of Hospital and Patient Factors that Influence the effective Administration of Surgical Antimicrobial Prophylaxis

Published online by Cambridge University Press:  21 June 2016

Bruce R. R. Turnbull ,
Dick E. Zoutman  and
Mui Lam
Bruce R. R. Turnbull*
Affiliation:
Department of Community Health & Epidemiology, Queen's University, Kingston, Ontario, Canada
Dick E. Zoutman
Affiliation:
Department of Community Health & Epidemiology, Queen's University, Kingston, Ontario, Canada Department of Pathology & Molecular Medicine, Queen's University, School of Medicine, Kingston, Ontario, Canada Department of Medical Microbiology, Infection Control Service, Kingston General Hospital, Kingston, Ontario, Canada
Mui Lam
Affiliation:
Department of Community Health & Epidemiology, Queen's University, Kingston, Ontario, Canada
*
Riverside Center 3-120, 275 Grove Street, Auburndale, MA 02466. [email protected]
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Abstract

Objective:

To analyze and model the patient and healthcare system factors that may interfere with the appropriate administration of surgical antimicrobial prophylaxis.

Design:

Between 1994 and 1998, surgical-site surveillance data were collected prospectively for a cohort of eligible surgical patients. For all cases, and each individual procedure (cardiothoracic, colonic, gynecologic, orthopedic, or vascular), forward stepwise multiple logistic regression was applied to relate key hospital and patient factors to an effective first prophylactic dose (ie, appropriate administration time, dose, route, and drug).

Setting:

A 450-bed, tertiary-care teaching hospital in Canada.

Patients:

A total of 4,835 patients admitted for surgical procedures who required antimicrobial prophylaxis.

Results:

Factors positive for an effective first prophylactic dose for all cases were when an order was written (OR, 19.7; CI95, 9.1–42.7; P < .001) and given in the operating room (OR, 13.9; Cl95, 7.5–25.6; P < .001). Factors negative for an effective first prophylactic dose were beta-lactam allergy (OR, 0.49; CI95, 0.4–0.61; P < .001) and same-day surgery (OR, 0.57; CI95, 0.4–0.82; P < .001).

Conclusions:

With few exceptions, the four factors included in the procedure models showed that when a preoperative order was written or the antibiotic was given in the operating room, a patient was more likely to receive an effective first prophylactic dose. Conversely, when a patient had a beta-lactam allergy or the surgery was performed on the day the patient was admitted, the administration of an effective first prophylactic dose was less likely.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 5 , May 2005 , pp. 478 - 485
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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