Antimicrobial prophylaxis in surgical procedures: assessment of the guidelines application, and the use of an antibioti c kit.

Infections related to surgical procedures (1/4 of nosocomial infections)are a major cause of morbidity and increase post-surgicalmortality rates. Antibiotic prophylaxis, in conjunction with elementaryhygiene and good surgical practice, is one of the essential toolsfor reducing infection risk. Moreover, surgical antibiotic prophylaxisrepresents approximately one third of antibiotic prescriptionsin the hospital setting. Its modalities (choice of compound, mode ofadministration…) are specified in validated recommendations, butimplementation remains unsatisfactory (Recommendations for AntibioticProphylaxis in Surgery 1999).Materials and method: Study N° 1: evaluation (practice audit) ofsurgical antibiotic prophylaxis and impact of recommendations: 3audits were conducted at 4-year intervals (1994, 1998 et 2002) toassess trends in implementation of recommendations and indirectlythe impact of guidelines.Study N°2: evaluation of antibiotic prophylaxis kits via a prospective,comparative, single-centre study between 2 groups: exposedversus non-exposed patients. The kits were nominative and containedthe recommended antibiotics at the recommended dose accompaniedby « instructions for use » for each type of surgical procedure.Results: Study N°1: our work showed a significant increase in thenumber of antibiotic prophylaxis prescriptions between 1994 and2002 (23 %). After a transient increase form 1994 to 1998, conformitywith recommendations for the indication of antibiotic prophylaxisprescription decreased by 7 % between 1998 and 2002. Howeveran overall improvement in implementation of recommendationswas observed. Persisting weak points in 2002 include choiceof compound (25% error), duration of prescription (19 % abnormallyextended prescriptions) and timing of administration (31%error).Study N° 2: antibiotic prophylaxis kits resulted in improved conformityof practice with recommendations. Implementation of antibioticprophylaxis was found to be completely in line with the guidelinesfor 82% of exposed versus 41% of non-exposed patients.Choice of compound, timing of administration and duration of prescriptionwere particularly well corrected by this technique.Conclusion: In our study, dissemination of guidelines proved essentialbut insufficient to improve prescription. Daily nominative deliveryof surgical antibiotic prophylaxis in the form of antibiotic prophylaxis kits led to optimization of compliance with recommendationsby largely correcting the persistent shortcomings revealed byour audit. Since limiting antibiotic prescription is a primary objectiveboth in terms of individual patient and public health for thecommunity, such a change in the habits of hospital teams is in linewith a prescription improvement policies (improved effectivenessat less cost).