Appropriateness of Surgical Antibiotic Prophylaxis in a Tertiary Hospital

Young Nam Eun; Bin Kim Hong; Bae Hyunok; Moon Soyoung; Hee Na Sun; Yong Kim Se; Yoon Doran; Youn Lee Ha; Kim Joohae; Kim Chung-Jong; Song Kyoung-Ho; Suk Kim Eu; Joong Kim Nam

doi:10.14192/kjnic.2014.19.2.64

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Eun, Hong, Hyunok, Soyoung, Sun, Se, Doran, Ha, Joohae, Chung-Jong, Kyoung-Ho, Eu, and Nam: Appropriateness of Surgical Antibiotic Prophylaxis in a Tertiary Hospital

Original Article

J Nosocomial Infect Control 2013;19(2):64-70.

Published online: 3 May 2013

DOI: https://doi.org/10.14192/kjnic.2014.19.2.64

Appropriateness of Surgical Antibiotic Prophylaxis in a Tertiary Hospital

Young Nam Eun, Bin Kim Hong, Bae Hyunok, Moon Soyoung, Hee Na Sun, Yong Kim Se, Yoon Doran, Youn Lee Ha, Kim Joohae, Kim Chung-Jong, Song Kyoung-Ho, Suk Kim Eu, Joong Kim Nam

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Korea

Center of Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Korea

Department of Management Innovation, Seoul National University Bundang Hospital, Seongnam, Korea

Address reprint requests to Hong Bin Kim, Infection Control Office, Seoul National University Bundang Hospital, 82, 173 beon-gil, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea Tel: 031-787-7021, Fax: 031-787-4052 E-mail: hbkimmd@)snu.ac.kr

Received 10 July 2014 Accepted 21 October 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

This study aimed to evaluate the quality of surgical antibiotic prophylaxis (SAP) in a tertiary hospital.

Methods

Medical, anesthetic, and nursing records from the 27,320 procedures conducted in a tertiary hospital during 2012 were retrospectively reviewed. Three clinical performance indicators of SAP (selection of antibiotic, timing of the first administration, duration of prophylaxis) were included as part of the National Hospital Evaluation Program (NHEP) of the Health Insurance Review and Assessment Service. In addition, 2 other parameters were assessed according to recent guidelines (weight-based initial dosing for obesity, intraoperative re-dosing for excessive blood loss, and prolonged duration of procedures).

Results

Prophylactic antibiotics were administered in 19,637 (71.8%) of 27,320 total procedures. Quality of the 3 performance indicators was higher in the types of operations included in NHEP than in other procedures. However, additional doses were administered in 15 (1.2%) of 1,299 surgical procedures that lasted more than twice the half-life of the antibiotic used, and in 9 (3.3%) of 273 procedures with excessive blood loss greater than 1,500 mL. NHEP and non-NHEP results did not differ significantly.

Conclusion

Three SAP quality indicators showed more improvement in NHEP surgical procedures than in non-NHEP, but the other parameters did not perform well regardless of NHEP assessment. Therefore, more measures to improve the appropriateness of SAP should be developed.

Keywords: Clinical performance indicator, Quality, Surgical antibiotic prophylaxis

References

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Table 1.

Appropriateness of surgical antibiotic prophylaxis (SAP) according to surgical procedures by National Hospital Evaluation Program (NHEP)

Parameter	The 1^st quarter of 2007		2012		P-value for 2007 vs. 2012
Parameter	Total SAP (n=4,349)	NHEP surgery (n=1,169)	Non-NHEP surgery (n=3,180)	P-value	P-value for 2007 vs. 2012	Total SAP (n=19,637)	NHEP surgery (n=4,177)	Non-NHEP surgery (n=15,460)	P-value
Preoperative-dose timing
Within 60 min before surgical incision	3,144	768	2,376	ä0.001*	18,419	4,160	14,259	ä0.001*	ä0.001*
	(72.3%)	(65.7%)	(74.7%)		(93.8%)	(99.6%)	(92.2%)
Selection of antibiotics other than 1^st generation cephalosporins
Aminoglycoside	533	185	348	ä0.001*	648	0	648	ä0.001*	ä0.001*
	(12.3%)	(15.9%)	(10.9%)		(3.3%)	(0.0%)	(4.2%)
Third-generation cephalosporins	2,208	529	1,679	ä0.001*	2,133	34	2,099	ä0.001*	ä0.001*
	(50.8%)	(45.2%)	(52.8%)		(10.9%)	(0.8%)	(13.6%)
Antibiotic combination	3,269	650	2,619	ä0.001*	473	7	466	ä0.001*	ä0.001*
	(75.2%)	(55.6%)	(82.4%)		(2.4%)	(0.2%)	(3.0%)
Duration of prophylaxis
Antibiotic prescriptions at discharge	2,759	457	2,302	ä0.001*	7,167	58	7,109	ä0.001*	ä0.001*
	(63.4%)	(39.1%)	(72.4%)	ä0.001^†	(36.5%)	(1.4%)	(46%)	ä0.001^†	ä0.001^†
Days of prophylactic antibiotic use	4	1.2	4	ä0.001^†		3.9	1.0	ä0.001^†	ä0.001^†	4.0
	(0-7.0)	(0.3-4.0)	(0.6-8.3)		(0.5-10.0)	(0.3-3.6)	(0.8-10.0)
Weight-based initial dosing
BMIâ25 kg/m²	NA	NA	NA		705/5,316(13.2%)	88/1,210(7.3%)	531/3,363(15.8%)	ä0.001*	NA
BMIâ30 kg/m²	NA	NA	NA		86/743 (11.6%)	10/198 (5.1%)	76/545 (13.9%)	0.001*	NA
Intraoperative redosing
Excessive blood loss â1,500 mL	NA	NA	NA		9/273 (3.3%)	3/125 (2.4%)	6/248 (2.4%)	0.991*	NA
Duration of surgery â2 half-lives of antibiotic	NA	NA	NA		13/1,299(1.0%)	4/396(1.0%)	9/903(1.0%)	0.982*	NA

*The datas were anlyzed by chi-square, Fisher’s exact. ^†The median days (Interquartile test) and P-value by Mann whitney test. Abbreviation: NA, not applicable.

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