The Timing of Surgical Antimicrobial Prophylaxis

Weber, Walter; Marti, Walter R.; Zwahlen, Marcel; Misteli, Heidi; Rosenthal, Rachel; Reck, Stefan; Fueglistaler, Philipp; Bolli, Martin; Trampuž, Andrej; Oertli, Daniel; Widmer, Andreas F.

doi:10.1097/sla.0b013e31816c3fec

Cited by 235 publications

(152 citation statements)

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“…19 20 Furthermore, it has been suggested that the administration of prophylaxis at 30 to 59 minutes pre-incision is more effective than antibiotics administered within 30 minutes of incision. 21 Although it is well established that the timely and appropriate administration of prophylactic antibiotics reduces SSI rates, ensuring proper administration of antibiotics before surgery continues to be a difficult challenge. Our findings are consistent with what has been previously reported, i.e.…”

Section: Discussionmentioning

confidence: 99%

Preventing infection in general surgery: improvements through education of surgeons by surgeons

McHugh

Corrigan

Dimitrov

et al. 2011

Journal of Hospital Infection

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Section: Discussionmentioning

confidence: 99%

Preventing infection in general surgery: improvements through education of surgeons by surgeons

McHugh

Corrigan

Dimitrov

et al. 2011

Journal of Hospital Infection

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“…10 The comparison of SSI was performed (a) for all cholecystectomies/colon resections with the exception of class IV wounds and (b) for class I and II wounds only, since antibiotic prophylaxis for class III wounds may be regarded as preemptive therapy.…”

Section: Definitionsmentioning

confidence: 99%

“…For time period A, baseline data were retrieved from the prospective observational study. 10 The interval between administration of RAP and incision was compared between cohort A and cohort B. There was no change in practice of RAP over the investigated time periods.…”

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confidence: 99%

“…9 In a prospective cohort study of 6,540 interventions, administration of RAP 30-74 minutes before skin incision achieved the lowest SSI risk. 10 ceral, vascular, and trauma divisions at Basel University Hospital were prospectively recorded. Operations involving no incision (closed reductions of joint dislocations), hospital stay of less than 24 hours, and procedures classified as dirtyinfected were excluded.…”

mentioning

confidence: 99%

“…10 As an observational study within the quality improvement project, it was exempted from the written informed consent requirement. The 3 Interventions 1.…”

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confidence: 99%

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Successful Implementation of a Window for Routine Antimicrobial Prophylaxis Shorter than That of the World Health Organization Standard

Misteli

Widmer

Weber

et al. 2012

Infect. Control Hosp. Epidemiol.

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OBJECTIVE. To evaluate the feasibility of implementation of the refined window for routine antimicrobial prophylaxis (RAP) of 30-74 minutes before skin incision compared to the World Health Organization (WHO) standard of 0-60 minutes.DESIGN. Prospective study on timing of routine antimicrobial prophylaxis in 2 different time periods.SETTING. Tertiary referral university hospital with 30,000 surgical procedures per year.METHODS. In all consecutive vascular, visceral, and trauma procedures, the timing was prospectively recorded during a first time period of 2 years (A; baseline) and a second period of 1 year (B; after intervention). An intensive intervention program was initiated after baseline. The primary outcome parameter was timing; the secondary outcome parameter was surgical site infection (SSI) rate in the subgroup of patients undergoing cholecystectomy/colon resection.RESULTS. During baseline time period A (3,836 procedures), RAP was administered 30-74 minutes before skin incision in 1,750 (41.0%) procedures; during time period B (1,537 procedures), it was administered in 914 (56.0%; P<.001). The subgroup analysis did not reveal a significant difference in SSI rate.CONCLUSIONS. This bundle of interventions resulted in a statistically significant improvement of timing of RAP even at a shortened window compared to the WHO standard. Infect Control Hosp Epidemiol 2012;33(9):912-916Surgical site infections (SSIs) significantly impact morbidity and mortality and represent a leading cause of healthcareattained infection. 1 " 3 Appropriate perioperative antimicrobial prophylaxis can reduce the incidence of SSI. 4 " 6 Today, singleshot administration of a first-or second-generation cephalosporin is the state-of-the-art procedure in routine antimicrobial prophylaxis (RAP), 7 supplemented with metronidazole in colorectal surgery for anaerobic coverage. In addition to the type of antibiotic, the timing of RAP in relation to skin incision is crucial. Based on the findings of the landmark publication in 1992 by Classen et al, 8 guidelines recommend the administration of RAP within 2 hours before skin incision, whereas the 2008 World Health Organization (WHO) guidelines for safe surgery support administration within 1 hour before skin incision. 9 In a prospective cohort study of 6,540 interventions, administration of RAP 30-74 minutes before skin incision achieved the lowest SSI risk. 10

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Surgical Site Infection in Elective Operations for Colorectal Cancer After the Application of Preventive Measures

Serra‐Aracil

García-Domingo²,

Parés³

et al. 2011

Arch Surg

114

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The Timing of Surgical Antimicrobial Prophylaxis

Abstract: When cefuroxime is used as a prophylactic antibiotic, administration 59 to 30 minutes before incision is more effective than administration during the last half hour.

Cited by 235 publications

References 20 publications

Preventing infection in general surgery: improvements through education of surgeons by surgeons

Preventing infection in general surgery: improvements through education of surgeons by surgeons

Successful Implementation of a Window for Routine Antimicrobial Prophylaxis Shorter than That of the World Health Organization Standard

Surgical Site Infection in Elective Operations for Colorectal Cancer After the Application of Preventive Measures

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