gms | German Medical Science

Objective: Perioperative preventative antibiotics (PPA) are an important factor for the reduction of postoperative infections. The time of administration is however critical and the correct substances have to be selected. In this intervention-study we targeted the PPA therapy in order to optimize the administration and thus reduce the rate of postoperative infection.

Method: In a first step we evaluated the PPA administration in our department. Parameters were time of administration, consideration of risk factors, such as allergies and of microbiological factors, such as MRSA colonization/infections. The administration process was analysed for potential weaknesses and solutions were developed by an interdisciplinary task force of neurosurgeons, anaesthesiologists and pharmacists. Following this PPA administration was re-evaluated.

Results: 147 consecutive patients were evaluated. 131 patients received PPAs, while 2 received antibiotic therapy and did not require an additional PPA. In 18.3% PPA was administered as prescribed by the neurosurgeon. An allergy was respected in 77.8%. In two cases PPA was not adapted to an already diagnosed MRSA-colonization. 27.4% of the 131 patients who received PPAs did get it within the critical time frame of 30-60min prior to skin incision. In 9.9% PPAs were administered earlier, while it was given to late in 62.6%. Process analysis revealed that anaesthesiologists often lacked crucial information. Except for some cases, the responsible neurosurgeon was unsure of the correct PPA. The interdisciplinary task force defined standard operating procedures (SOPs) including PPAs. The required PPA can now be prescribed via a drop-down menu, which provides specific rows for colonization, infections, allergies, etc. Besides the prescription can be reviewed via the hospital information system, so that the information is available at all times. The first re-evaluation included 35 patients, of which 32 received PPAs, while the other 3 were under ongoing antimicrobial therapy. PPAs were administered as prescribed by the neurosurgeon in 82.9%. Of the 32 PPAs administered 50% were in the time-frame of 30-60min prior to skin incision. 12.5% of PPAs were given to early, 37.5% too late.

Conclusions: PPA administration was found to be suboptimal. Reasons were missing knowledge and restricted visibility of clinical information. Definition of SOPs, providing guidelines for PPA administration and electronic prescription in the hospital information system did improve the process greatly.