Optimising antimicrobial drug use in surgery: an intervention study in a Dutch university hospital.

Following a one-month prospective study of antimicrobial drug use in surgical departments, new guidelines were implemented. The review was repeated after two years. In both study periods, one third of patients were prescribed antimicrobial drugs. Prophylactic antibiotic consumption decreased from 0.75 to 0.53 defined daily doses/operation. Compliance with guidelines improved from 32% to 79%. Duration of prophylaxis > 24 h decreased from 21% to 8%. Single dose prophylaxis increased from 34% to 80%. Quality of the prophylactic courses improved, as evaluated by experts using established criteria. For prophylaxis, cost savings amounted to 57%. Better quality of therapeutic courses was associated with a cost increase of 15%. Indicators of satisfactory outcome with the new policy were a stable median length of stay (5.5 days in the first review and 5.0 days after intervention) and a reduction in the number of nosocomial infections treated with antimicrobial drugs/100 bed days (1.0 before intervention vs 0.77 after intervention).

Optimizing the timing of antimicrobial prophylaxis in surgery: an intervention study.

The timing of surgical antimicrobial prophylaxis was determined before and after an intervention programme of education of surgeons, anaesthetists and nurses on the subject of antimicrobial drug prophylaxis, and the subsequent implementation of new protocols of single dose prophylaxis administered within one hour before incision. This prospective study was performed in three surgical departments of a university hospital. For comparison, the timing of prophylaxis was also determined in an operating department of a community hospital. The timing improved considerably in the departments of the university hospital where the intervention was carried out: administration of the first dose within one hour before incision increased from 39% to 69% in department A and from 64% to 80% in department B. Before the intervention, seven out of 16 prophylactic doses were given after inflation of the tourniquet. After the intervention all doses of prophylactic antibiotics were administered before inflation of the tourniquet. Initially, the intervals of multidose prophylaxis varied widely. In the second review, single-dose prophylaxis increased from 21% to 78% in department A and from 31% to 85% in department B. We conclude that the intervention succeeded in improving the quality of surgical prophylaxis.