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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Surgery 1/2015

Appropriate use of antimicrobial prophylaxis: an observational study in 21 surgical wards

Zeitschrift:
BMC Surgery > Ausgabe 1/2015
Autoren:
Marco Testa, Michela Stillo, Sebastian Giacomelli, Silvia Scoffone, Pier Angelo Argentero, Enzo Carlo Farina, Carla Maria Zotti
Wichtige Hinweise

Competing interests

No competing financial interests exist. All authors report no conflicts of interest relevant to this article. Manuscript preparation: America Journal Experts provided assistance in translating and editing the manuscript (Am J Exp 9CAR0103045519).

Authors’ contributions

MT, MS, SG, SS and PA participated in the collection of data and creation of the database. MT, MS and SG carried out the statistical analysis and the preparation of tables. ECF was responsible for the creation of the flow chart and the discussion of the results. CMZ carried out the design of the study and provided the overall supervision of the study. All authors read and approved the final manuscript.

Authors’ informations

MT: Medical Doctor. Presently attending the specialization training in hygiene and preventive medicine at Department of public health and pediatrics of the University of Turin. Currently working the surveillance of health care associated infection control and vaccination policy.
MS: Medical Doctor. Presently attending the specialization training in hygiene and preventive medicine at Department of public health and pediatrics of the University of Turin.
SG: Medical Doctor, working at the Department of public health and pediatrics of the University of Turin.
SS: Medical Doctor. Currently attending the third year of specialization training in Hygiene and Preventive Medicine at Department of Public Health and Pediatrics of the University of Turin.
PAA: Chief Infection Control Unit Rivoli and Pinerolo Hospital (Turin) Italy..
Member of Regional Healthcare Associated Infection Committee Piemonte- Italy
ECF: Member of Infection Control Committee - City of Science and Health, Turin, Italy .
Member of Regional Healthcare Associated Infection Committee Piemonte-Italy.
Member of Scientific Committee of SIMPIOS (Italian Multidisciplinary Society for the Prevention of Infection in Health Care Organizations).
Member of Scientific and Editorial Committee of GIMPIOS, Official journal of SIMPIOS
CMZ: Associate Professor of Hygiene and Preventive medicine in Medicine Faculty - University of Turin-Italy
Member of Regional Healthcare Associated Infection Committee Piemonte-Italy
Member of Regional Technical Group on Vaccination Piemonte - Italy

Abstract

Background

Surveillance of Surgical Site Infections (SSI) in 2010 found 39 % compliance with hospital guidelines in Piedmont (Italy). The aim of the study was to estimate the appropriate use of antimicrobial prophylaxis and compliance with hospitals guidelines in surgical wards.

Methods

This survey study took place in 21 surgery wards of 4 public hospitals. Forms were completed by public health resident doctors together with a medical ward referent and infection control nurses. 15 consecutive surgical procedures were randomly chosen from each ward. A total of 320 cases were analyzed. The study period was from July 2012 to January 2013. Data were collected using a survey form. A final score variable from 0 to 4 was given to each case. The results were compared with hospital and international guidelines. Data were analyzed using Epi-Info software.

Results

Of the 320 cases collected, 63 were excluded; of the remaining 257 cases, 56.4 % of the procedures were appropriate (score 4), 15.2 % were acceptable and 28.4 % were not acceptable. The study found an unjustified continuation of antimicrobial prophylaxis in 17.1 % of the 257 cases, an unjustified re-start of antimicrobial therapy in 9.7 % and a re-dosing omission in 7.8 %.

Conclusions

The study demonstrated critical problems in antimicrobial prophylaxis management in surgical wards due to a lack of compliance between hospitals and national guidelines, a shortage of specific and updated recommendations for some surgical interventions and incorrect local specific procedures. Coordination between local and national recommendations, strengthening of evidence based decisions and continuous sharing of policy updates are needed.
Literatur
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