Surgical Antibiotic Prophylaxis in Smaller Hospitals, Victoria, Australia

ISSUE: In 2004, a ‘novel’ nosocomial infection surveillance program was implemented in 85 smaller (≤100 public acute care beds) predominately rural hospitals in Victoria. This program included an optional process indicator surveillance module monitoring surgical antibiotic prophylaxis (SAP). It was based on the ‘National Surgical Infection Prevention Medicare Quality Improvement Project’ that was developed by The Centers for Medicare and Medicaid Services and The Centers for Disease Control and Prevention. PROJECT: Surgical procedures assessed included appendicectomy, cholecystectomy, colon surgery, caesarean section, gastric surgery, hernia repair, hip replacement, abdominal hysterectomy, knee replacement, transrectal prostatic biopsy, prostatectomy and vaginal hysterectomy. For at least 50 consecutive procedures, hospitals were requested to report on three measurements in regard to SAP: 1. Antibiotic choice, 2. Timing and 3. Duration. Concordance was assessed according to Australian national guidelines.1 Timing of administration was deemed ‘concordant’ if all prophylactic antibiotics (except vancomycin) were given within 120 minutes before incision. Duration was deemed concordant if all prophylactic antibiotics were discontinued within 24 hours. RESULTS: Fifty smaller hospitals performed surgery. Twenty-four of these hospitals contributed data to the SAP module between 1/5/04 and 30/9/05. Most commonly assessed procedures were hernia repair (413), cholecystectomy (295) and caesarean section (289). Eight hospitals were unable to submit data on at least 50 procedures. Aggregate data is presented in Table 1. No hospitals were 100% concordant for choice of antibiotics. Three hospitals were 100% concordant for duration of administration. Table 1 n/a Not applicable. LESSONS LEARNED: This baseline data highlighted, in Victorian smaller hospitals, recommendations from the Australian national guidelines were not routinely incorporated into practice. In particular the choice and timing of prophylactic surgical antibiotics needed to be improved. 1. Therapeutic Guidelines: antibiotic Version 12, 2003.