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Adherence to general surgery prophylaxis guidelines at Alder Hey Children's Hospital
  1. C Todd,
  2. D Sharpe
  1. Alder Hey Children's Hospital NHS Foundation Trust

Abstract

Objective The aim of surgical prophylaxis is to reduce the risk of developing surgical site infections. SIGN guidelines1 suggest that in most cases a single dose of antibiotic with a long enough half-life to achieve activity throughout the procedure prevents surgical site infections, and that antibiotics selected for prophylaxis must cover the expected pathogens and should take into account local resistance patterns. Local guidelines for surgical prophylaxis are essential to ensure that the risks of surgical site infection and the development of antibiotic resistance are minimised. The objective of this audit is to determine adherence with the recently introduced Trust guidelines for prophylaxis in general surgery procedures.2

Method A prospective study of general surgery procedures was undertaken over an 8-week period. Patient's case notes, operative sheets and drug charts were reviewed and data collected on whether antibiotics were prescribed, choice of antibiotic, dose, duration, and switch to oral therapy. Data was analysed and tabulated in Microsoft Excel.

Results 59 patients were included in the audit. In 24 cases, the patient did not receive prophylaxis. 11 of these cases (46%) should have received prophylaxis according to the Trust's guideline.

Fourty-two (49%) of the prescribed doses of antibiotics were not in accordance with doses recommended in the BNFc or the Trust care pathways, and the majority of these doses were lower doses than recommended.

For those patients prescribed antibiotics, duration was documented in 13(62%) case notes and on 5(24%) drug charts. In 8(38%) cases the prescribed duration was in accordance with the Trust's guideline.

None of the 10 cases that lasted >3 h received a second dose of antibiotic during surgery.

There was one case with a documented meticillin-resistant staphylococcus aureus (MRSA) positive status that did not have cefuroxime changed to teicoplanin and gentamicin as per the Trust guideline.

Overall adherence with all parts of the Trust guideline was 31%.

Conclusions This audit showed that overall adherence with the Trust guideline was low. Problems highlighted were:

  • Prophylaxis was indicated but not prescribed in a number of cases.

  • Duration of antibiotics was often longer than recommended.

  • Antibiotic doses selected were frequently lower than that required.

  • Patients were not re-dosed with antibiotics during prolonged procedures.

  • MRSA positive patient did not receive appropriate prophylactic antibiotics.

  • These problems could increase the risk of surgical site infections and encourage the development of antibiotic-resistant organisms.

  • This audit shows that there is a lack of awareness of the guidelines amongst staff, in particular the General Surgeons and Ward Pharmacists. The findings of this audit will be presented to the General Surgeons to publicise the local guidelines, and to Ward pharmacists to encourage them to be more proactive in ensuring adherence to guidelines.

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