Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-28T15:20:08.838Z Has data issue: false hasContentIssue false
  • English
  • Français

A Canadian Survey of Prophylactic Antibiotic Use Among Hip-Fracture Patients

Published online by Cambridge University Press:  02 January 2015

Dick Zoutman ,
Laurence Chau ,
James Watterson ,
Thomas Mackenzie  and
Marina Djurfeldt
Dick Zoutman*
Affiliation:
Department of Pathology, Queen's University, Kingston, Ontario, Canada Department of Medicine, Queen's University, Kingston, Ontario, Canada
Laurence Chau
Affiliation:
Department of Medicine, Queen's University, Kingston, Ontario, Canada
James Watterson
Affiliation:
Department of Pathology, Queen's University, Kingston, Ontario, Canada
Thomas Mackenzie
Affiliation:
Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
Marina Djurfeldt
Affiliation:
Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
*
Infection Control Service, Kingston General Hospital, 76 Stuart St, Kingston, Ontario K7L 2V7, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To study how surgical prophylactic antibiotics (SPAs) were utilized in the perioperative management of surgery for hip fractures.

Design:

Retrospective chart review of randomly selected medical records.

Setting:

Twenty-two hospitals (teaching, nonteaching, community, and large urban referral centers) from across Canada.

Patients:

Patients admitted in 1990 with a diagnosis of hip fracture.

Methods:

Complete medical records of 438 patients were examined; 352 cases who underwent surgical repair of a fractured hip with insertion of prosthetic material were included in analysis. Perioperative SPA use was assessed by abstracting the agent(s) chosen, dosages, time given with respect to the incision, and duration of postoperative use. Fourteen patient and process-of-care variables related to SPA were examined.

Results:

247 (70%) of 352 cases did not receive a dose of SPA 2 hours preoperatively. Ten percent of preoperative SPA was administered either too early or during the procedure. In 91 (39%) of 231 cases receiving SPA the first dose was not administered until the end of the procedure. Preoperative SPA consisted of a parenteral first-generation cephalosporin for 94% of cases. SPAs were continued more than 24 hours postoperatively in 78% of cases.

Lack of a written order for SPA, being a nonteaching hospital, and shorter duration of surgical procedure were predictive of failure to receive SPA in an effective manner.

Conclusions:

Most hip-fracture-surgery patients did not receive effective antibiotic prophylaxis as required to prevent serious wound infections. This important variable can be included for surveillance, so that corrective measures can be taken to assure effective prophylactic antibiotic administration.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 11 , November 1999 , pp. 752 - 755
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

†

Deceased

References

1. Zuckerman, JD. Hip fracture. N Engl J Med 1996;334:1519–1525.Google Scholar
2. Papadimitropoulos, EA, Coyte, PC, Josse, RG, Greenwood, CE. Current and projected rates of hip fracture in Canada. Can Med Assoc J 1997;157:1357–1363.Google Scholar
3. Leape, LL, Brennan, TA, Laird, N, Lawthers, AG, Localio, AR, Barnes, B. et al. The nature of adverse events in hospitalized patients: results of the Harvard Medical Practice Study II. N Engl J Med 1991;324:377–384.Google Scholar
4. Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG, Munn, VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in U. hospitals. Am J Epidemiol 1985;121:182–205.Google Scholar
5. Haley, RW. Managing Hospital Infection Control for Cost Effectiveness: A Strategy for Reducing Infectious Complications. Chicago, IL: American Hospital Publishing, Inc; 1986.Google Scholar
6. Haley, RW. Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. Am J Med 1991;91:32S–38S.Google Scholar
7. Haley, RW, Schaberg, DR, Crossley, KB, Von Allmen, SD, McGowan, J Jr. Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med 1981;70:51–58.Google Scholar
8. Haley, RW, Schaberg, DR, Von Allmen, SD, McGowan, J Jr. Estimating the extra charges and prolongation of hospitalization due to nosocomial infections: a comparison of methods. J Infect Dis 1980;141:248–257.CrossRefGoogle ScholarPubMed
9. Miller, PJ, Farr, BM, Gwaltney, J Jr. Economic benefits of an effective infection control program: case study and proposal. Rev Infect Dis 1989;11:284–288.Google Scholar
10. Green, JW, Wenzel, RP. Postoperative wound infection: a controlled study of the increased duration of hospital stay and direct cost of hospitalization. Ann Surg 1977;185:264–268.Google Scholar
11. Kaiser, AB, Clayson, KR, Mulherin, J Jr. Antibiotic prophylaxis in vascular surgery. Ann Surg 1978;188:283–289.Google Scholar
12. Cuhna, B. Gossling, HR, Pasternack, HS, Nightingale, CH, Quintiliani, R. Penetration of cephalosporins into bone. Infection 1984;12:80–84.Google Scholar
13. Patzakis, MJ, Harvey, P Jr, Ivler, D. The role of antibiotics in the management of open fractures. J Bone Joint Surg Am 1974;56-A532–541.Google Scholar
14. Classen, DC, Evans, R, Pestotnik, SL, Horn, SD, Menlove, RL, Burke, J. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992;326:281–286.Google Scholar
15. Leape, LL, Lawthers, AG, Brennan, TA, Johnson, WG. Preventing medical injury. Qual Rev Bull 1993;19:144–149.Google Scholar
16. Rubin, HR, Rogers, WH, Kahn, KL, Rubenstein, LV, Brook, RH. Watching the doctor-watchers. How well do peer review organization methods detect hospital care quality problems? JAMA 1992;267:2349–2354.Google Scholar
17. Rubenstein, LV, Kahn, KL, Reinisch, EJ, Sherwood, MJ, Rogers, WH, Kamberg, C, et al. Changes in quality of care for five diseases measured by implicit review, 1981-1986. JAMA 1990;264:1974–1979.CrossRefGoogle Scholar
18. Boyd, RJ, Burke, JF, Colton, T. A double-blind clinical trial of prophylactic antibiotics in hip fractures. J Bone Joint Surg Am 1973;55-A1251–1258.Google Scholar
19. Hill, C, Flamant, R, Mazas, F, Evrard, J. Prophylactic cefazolin versus placebo in total hip replacement. Report of a multicentre double-blind randomised trial. Lancet 1981;1:795–797.Google Scholar
20. Dellinger, EP, Gross, P. Barrett, TL, Krause, PJ, Martone, WJ, McGowan, J. Jr, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Infect Control Hosp Epidemiol 1994;15:182–188.Google Scholar
21. Nelson, CL, Green, TG, Porter, R. One day versus seven days of preventive antibiotic therapy in orthopedic surgery. Clin Orthop 1983;176:258–263.Google Scholar
22. Shapiro, M, Townsend, TR, Rosner, B, Kass, EH. Use of antimicrobial drugs in general hospitals: patterns of prophylaxis. N Engl J Med 1979;301:351–355.Google Scholar
23. Ehrenkranz, NJ, Meakins, JL. Surgical infections. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. Boston, MA: Little, Brown & Company; 1992:685–710.Google Scholar
24. DiPiro, JT, Cheung, RPF, Bowden, T Jr, Mansberger, J. Single dose systemic antibiotic prophylaxis of surgical wound infections. Am J Surg 1986;152:552–559.Google Scholar
25. Pestotnik, SL, Classen, DC, Evans, RS, Burke, JP. Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med 1996;124:884–890.Google Scholar
26. Mugford, M, Banfield, P, O'Hanlon, M. Effects of feedback of information on clinical practice: a review. BMJ 1991;303:398–402.Google Scholar
27. Davis, D. Thomson, M. Oxman, AD, Haynes, RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA 1995;274:700–705.Google Scholar