JAC Advance Access originally published online on May 13, 2003
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Journal of Antimicrobial Chemotherapy (2003) 51, 1389-1396
© 2003 The British Society for Antimicrobial Chemotherapy
Adherence to local hospital guidelines for surgical antimicrobial prophylaxis: a multicentre audit in Dutch hospitals
1 Department of Internal Medicine 541, University Medical Centre Nijmegen, and Nijmegen University Centre for Infectious Diseases, P.O. Box 9101, 6500 HB Nijmegen; 2 National Institute for Public Health and the Environment, RIVM, Bilthoven; 3 Dutch Institute for Healthcare Improvement, CBO Utrecht; 4 Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
Received 14 November 2002; returned 1 January 2003; revised 25 March 2003; accepted 25 March 2003
Objective: To study the adherence to local hospital guidelines for antimicrobial prophylaxis in surgery, and explore reasons for non-adherence.
Methods: A prospective, multicentre audit of elective procedures, without prior suspicion of infection, was carried out in 13 Dutch hospitals. By reviewing medical, anaesthetic and nursing records, and medication charts, the prescription of antibiotics was compared with the local hospital guideline on antibiotic choice, duration of prophylaxis, dose, dosing interval and timing of the first dose.
Results: Between January 2000 and January 2001, 1763 procedures were studied. Antibiotic choice, duration, dose, dosing interval and timing of the first dose were concordant with the hospital guideline in 92%, 82%, 89%, 43% and 50%, respectively. Overall adherence to all aspects of the guideline, however, was achieved in only 28%. The most important barriers to local guideline adherence were lack of awareness due to ineffective distribution of the most recent version of the guidelines, lack of agreement by surgeons with the local hospital guidelines, and environmental factors, such as organizational constraints in the surgical suite and in the ward.
Conclusion: This study shows that, although adherence to separate aspects of local hospital guidelines for surgical prophylaxis in the Netherlands is favourable, overall adherence to all parameters is hard to achieve. Adherence to guidelines on dosing interval and timing needs improvement, in particular. To increase the quality of antimicrobial prophylaxis in surgery, effort should be put into developing guidelines acceptable to surgeons, in adequately distributing the guidelines and to facilitating logistics. Audits of surgical prophylaxis may help hospitals identify barriers to guideline adherence.
Keywords: antibiotic policy, adherence
* Corresponding author. Tel: +31–24–3616499; Fax: +31–24–3541734; E-mail: M.vanKasteren{at}aig.umcn.nl
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