Nonconcordance with Surgical Site Infection Prevention Guidelines and Rates of Surgical Site Infections for General Surgical, Neurological, and Orthopedic Procedures

Abstract

Surgical site infection (SSI) is a common and preventable complication of surgery, but the relative importance of individual measures recommended by guidelines has not been determined. Elective general surgical, neurological, and orthopedic procedures requiring antibiotic prophylaxis from a 3-month period were retrospectively studied to determine concordance with SSI prevention guidelines and to identify factors which predicted the development of SSIs. A total of 216 surgeries were reviewed, with 18 SSIs (8.3%). A mean of 1.4 antibiotic prophylaxis errors per surgery were identified, with correct antibiotic type identified for 64%, antibiotic timing for 83%, supplemental antibiotic dosing for 34%, and antibiotic duration of less than 24 h for 44%. Normothermia was present in 79% of surgeries, and normoglycemia was present in 17%. Univariate analysis of the SSI rate identified four significant factors. National and international surveillance programs (9, 33) and numerous guidelines (1-3, 11, 19, 24, 26) have been developed to prevent surgical site infection (SSI), the most common nosocomial infection in postsurgery patients. These guidelines emphasize the role of appropriate evidence-based antibiotic prophylaxis, hair removal by clipping as needed (31), avoidance of hypothermia (except in cardiac surgery) (16), and normoglycemia for diabetic patients (17) to reduce SSI rates.A recent pilot project at our institution prior to the current study demonstrated that implementation of such guidelines can be successful locally, but compliance elsewhere has been shown to be poor (4, 18). Furthermore, there is a high prevalence of multidrug-resistant bacteria in Singapore hospitals, and inappropriate antibiotic use, including for SSI prophylaxis, can aggravate the selective pressure for antimicrobial resistance (15).We evaluated SSI prevention practiced in our hospital to assess concordance with published international evidencebased SSI prevention guidelines and the effects of failure to comply with subsequent SSI rates.

Antibiotics in surgical wards: use or misuse? A newly industrialized country’s perspective

“…The SSI rate per patient observed in our study was similar to a previous local study [27]; but higher than the overall SSI rate reported by others (1.2%-8.3%) [19,25,28,29] except for India (20.1%) [30]. The reason for this is uncertain but the impact of a high prevalence of inappropriate antibiotic use for prophylaxis, current infection control policies or a combination of these factors requires further consideration.…”

“…Contrary to this, many developed countries prefer the use of first generation cephalosporins or a combination of penicillin and betalactamase-inhibitors [18,20,23,24,25]. Studies, however, have shown no difference between the use of broad spectrum and narrow spectrum prophylactic antibiotics in terms of lowering rate of SSI [12].…”

Impact of a New Practice Guideline on Antibiotic Use With Pediatric Tonsillectomy

“…12 In January 2011, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 13(p517) published a treatment guideline for pediatric tonsillectomy that included a recommendation that "clinicians should not routinely administer or prescribe perioperative antibiotics to children undergoing tonsillectomy." Because adherence to national prescribing guidelines has been shown to vary 14,15 we examined the effect of this guideline on antibiotic use with tonsillectomy and measures of postoperative morbidity across a large, pediatric health care network.…”

Hygienemanagement im OP und in der Endoskopie

“…Die Umsetzung dieser Maßnahmen hat einen signifikanten Einfluss auf die Rate nosokomialer Infektionen [3,21,22]. …”