JAC Advance Access published online on May 13, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg264
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Internal
Medicine 541, University Medical Centre Nijmegen, and Nijmegen University
Centre for Infectious Diseases, P.O. Box 9101, 6500 HB Nijmegen
* Corresponding author. E-mail: M.vanKasteren{at}aig.umcn.nl.
Received 14 November 2002
; revised 1 January 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
Adherence to local hospital guidelines for surgical
antimicrobial prophylaxis: a multicentre audit in Dutch hospitals
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
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