The Journal of Bone & Joint Surgery

The Journal of Bone & Joint Surgery, Volume 90, Issue 2

Scientific Articles | February 01, 2008

Ensuring Appropriate Timing of Antimicrobial Prophylaxis

Andrew D. Rosenberg, MD¹; Daniel Wambold, MD¹; Linede Kraemer, RN, MA, CNOR¹; Maureen Begley-Keyes, BS, RN, CPHRM, CPHQ¹; Scott L. Zuckerman¹; Neeraj Singh, BA¹; Max M. Cohen, MD²; Michele V. Bennett, RN, MA, ONC¹

¹ Department of Anesthesiology (D.W., S.L.Z., and N.S.), NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail address for A.D. Rosenberg: Andrew.Rosenberg@med.nyu.edu
² NYU Hospital Center, 550 First Avenue, New York, NY 10016

View Disclosures and Other Information

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site () and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Investigation performed at the NYU Hospital for Joint Diseases, New York, NY

The Journal of Bone and Joint Surgery, Inc.

J Bone Joint Surg Am, 2008 Feb 01;90(2):226-232. doi: 10.2106/JBJS.G.00297

5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Article

Comments (1)

text A A A

Abstract

Background: Delivery of intravenous antibiotic prophylaxis within one hour prior to surgical incision is considered important in helping to decrease the incidence of surgical site infections, but methods to ensure compliance have not been established.

Methods: All patients at our institution are subjected to a surgical "time-out" protocol to prevent wrong-site surgery. During a seven-week period, all patients undergoing spine surgery, total hip arthroplasty, or total knee arthroplasty had another safety initiative, that of ensuring that prophylactic intravenous antibiotics were administered at least one hour prior to incision, "piggybacked" onto our existing time-out verification checklist. In addition, we compared compliance during the study period with compliance during a three-month period prior to institution of this protocol and compliance for eighteen months after institution of this protocol.

Results: The average time (and standard deviation) between the antibiotic administration and the incision was 26 ± 12 minutes for all patients. The protocol was effective in ensuring antibiotic administration at the optimal time to 316 (99.1%) of the 319 patients. Analysis of a group of forty patients who had undergone total hip or knee replacement during the three months prior to the beginning of the study demonstrated a compliance rate of 65%. The difference between this baseline compliance rate and the rate during the study period was significant (p < 0.0001). The compliance rate was 97% for 160 patients who underwent similar procedures during the eighteen months after completion of the study. Independent audits demonstrated continuation of the significantly better compliance with timing of antibiotic prophylaxis for patients undergoing total hip and knee arthroplasty since the implementation of the protocol in our institution.

Conclusions: Piggybacking of verification of prophylactic antibiotic administration onto the wrong-site-surgery time-out protocol is an effective, cost-free, and easy-to-adopt method to ensure compliance with appropriate timing of prophylactic antibiotics.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

Figures in this Article

Introduction

Introduction | Materials and Methods | Results | Discussion | References

Surgical site infections result in increased morbidity, mortality, and cost of patient care^1-12. With hospitalization costs ranging from $3000 to more than $30,000 per infection, these infections cost an estimated 1.5 billion health-care dollars per year^6-8,13-17. Recently, those involved in monitoring the quality of patient care as well as those paying for care have launched a major patient safety campaign to decrease the incidence of surgical site infection. Organizations such as the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Agency for Healthcare Research and Quality (AHRQ), and medical subspecialty societies are collaborating in an attempt to decrease its incidence^5,6,18-22. The Surgical Infection Prevention Project and its Surgical Infection Prevention Guideline Writers Workgroup are promoting three major interventions to prevent surgical site infections: proper timing of prophylactic antibiotics so that administration occurs within one hour prior to surgical incision, correct selection of antibiotics, and correct duration of postoperative antibiotic administration⁷.

Although data demonstrating the efficacy of appropriate timing of prophylactic antibiotic administration prior to incision have existed for many years^6,23-28, compliance is remarkably lacking^6,29,30. One frequently quoted study demonstrated that only 61% of patients received prophylactic antibiotics in a timely fashion²⁹. In a recently published study of 34,133 Medicare surgical inpatients, Bratzler et al. found that only 55.7% of eligible patients had received antibiotics within one hour prior to incision⁶. Another recent report discussing the potential linking of pay for performance with a measure such as timely administration of prophylactic antibiotics revealed that 13% of patients did not receive antibiotics at the optimal time³¹.

With increasing frequency, patients are admitted to the hospital on the day of the surgery and present to the operating room just prior to their operation. It is essential therefore to ensure that safeguards regarding the correct surgical site and the administration of prophylactic antibiotics within one hour prior to the surgery are implemented as part of an institutional process. We hypothesized that compliance could be improved by "piggybacking" the proper timing of intravenous antibiotic delivery onto an already existing safety measure: the "time-out" used to ensure that wrong-site surgery does not occur.

Materials and Methods

Introduction | Materials and Methods | Results | Discussion | References

After obtaining approval from the NYU School of Medicine institutional review board, we conducted a prospective evaluation of the efficacy of the piggybacking of patient safety initiatives in a group of 319 consecutive patients undergoing spine surgery or primary total knee or hip joint arthroplasty at the NYU Hospital for Joint Diseases over a seven-week period, including nights and weekends, from March 28, 2005, to May 13, 2005.

At our institution, anesthesiologists routinely administer antibiotics to the patient just prior to or shortly after induction of anesthesia. The time interval between administration of antibiotics and performance of the incision results from positioning, preparing, and draping of the patient, with the longest average time occurring in total hip arthroplasty procedures. Immediately prior to the incision, an official "time-out" is called by the circulating nurse in the operating room, during which the anesthesiologist, the circulating nurse, and the attending surgeon communicate and verify that the correct patient and the correct surgical site have been chosen³². Identifiers used for verification of the correct patient and the correct surgical site or side included the patient's name, the patient's date of birth, a signed operative consent form, the surgeon's initials in the operative field, and the appropriate imaging studies with the patient's name printed on them, oriented correctly and with the operative site flagged. This verification process, which is both state and nationally mandated³², is documented in the hospital record on a Time Out Preoperative Verification Checklist (Fig. 1).

View Large | Download Slide(.ppt)
Add to My JBJS

Fig. 1: Time Out Preoperative Verification Checklist.

For this study, as part of the process of filling out the Time Out Preoperative Verification Checklist, the circulating nurse also queried the anesthesiologist about the specific antibiotic medication administered, the dose administered, and the time of administration. This information was recorded on the checklist along with the time of incision. All patients received 1 g of cefazolin unless there was a history of penicillin or cephalosporin allergy, in which case the patient received 600 mg of clindamycin.

The type of surgery, time of preoperative antibiotic administration, specific antibiotic, and time of incision were obtained for each patient from the time-out verification sheets and patient charts, and then this information was deidentified. The time from antibiotic administration until surgical incision was calculated for each patient; for the major groupings of total hip, total knee, and spine procedures; and for the group as a whole.

Statistical Analysis

Chi-square analysis was used to compare compliance with the appropriate timing of antibiotic prophylaxis for patients undergoing total hip or knee arthroplasty at our institution among three time-periods: during the three months prior to implementation of the time-out protocol, during the study period, and during the one and one-half years after it. Chi-square analysis was also performed to compare the results obtained with use of our compliance checklist with the compliance reported in a recent large survey⁶. Finally, chi-square analysis was performed to compare our results in the subgroups of patients undergoing total hip and knee arthroplasty with those of Bratzler et al.⁶. Significance was considered at the p < 0.05 level.

Results

Introduction | Materials and Methods | Results | Discussion | References

The protocol was effective in ensuring that antibiotics were administered within one hour prior to surgical incision in 316 (99.1%) of 319 patients. The average time (and standard deviation) from administration of the antimicrobial prophylaxis to the surgical incision for all patients who received antibiotics at or prior to the incision was 26 ± 12 minutes. The average time was 24 ± 9 minutes for the patients undergoing total knee arthroplasty, 26 ± 12 minutes for the patients undergoing spine surgery, and 30 ± 12 minutes for those undergoing total hip arthroplasty. The distribution of the times of antibiotic administration prior to incision, by fifteen-minute pre-incision groupings, is demonstrated for the series as a whole in Figure 2.

View Large | Download Slide(.ppt)
Add to My JBJS

Fig. 2: Distribution of timing of antibiotic administration in the pre-incision period by fifteen-minute groupings.

One patient, undergoing total hip replacement, was given antibiotics earlier than the optimal time, at one hour and eighteen minutes prior to incision; the incision was delayed because of a difficult intubation. Another patient was given antibiotics at the time of incision for reasons that we could not determine. While the anesthesiologist of record did not recall the details about this particular case, he did state that there were other times when the time-out protocol reminded him to administer antibiotics. There was no official time-out recorded in the chart of a third patient and no record of antibiotics being administered to that patient in the operating room. We therefore assumed that no antibiotics were administered until the patient received the first postoperative dose.

We found that, in the three months prior to the study period, only twenty-six (65%) of forty patients undergoing total hip or total knee arthroplasty had received prophylactic antibiotics within one hour before incision. In contrast, during the study period and for eighteen months after it, during which time the study protocol was used, 180 (96.8%) of 186 patients undergoing total hip or total knee arthroplasty received antibiotics within one hour before incision. The difference in compliance between the three months preceding the study and the study period was significant (p < 0.0001), as was the difference in compliance between the three months preceding the study and the eighteen months following it (p < 0.0001) (Fig. 3). A comparison of compliance during the study period with that for the eighteen months following the study period, when the compliance rate was 97% (155 of 160 patients), demonstrated no significant change, indicating that compliance remained high. A comparison between our study and the survey reported by Bratzler et al.⁶ demonstrated that our methodology was associated with significantly better timing of antibiotic prophylaxis within the optimal one-hour pre-incision time-frame for all patients evaluated (p < 0.0001) as well as for the subgroup of patients treated with total knee or hip arthroplasty (p < 0.0001).

View Large | Download Slide(.ppt)
Add to My JBJS

Fig. 3: Comparison of compliance before and after implementation of the time-out protocol, demonstrating significantly improved compliance for the total hip arthroplasty group, the total knee arthroplasty group, and both patient groups (p < 0.0001). Q = quarter.

Discussion

Introduction | Materials and Methods | Results | Discussion | References

To our knowledge, a reliable method to ensure compliance with the appropriate timing of prophylactic antibiotics did not exist prior to our study. While use of computer monitoring appears to be helpful in increasing compliance with the recommended duration of administration of antibiotics postoperatively³³, hospital information systems cannot ensure that intravenous antibiotics will be administered within one hour before incision; they can merely alert practitioners about the need for medication administration and monitor compliance^33,34. Additionally, computerized hospital information systems are costly and require substantial training and practice modification for optimal implementation.

Performing the "time-out" to verify antibiotic administration prior to incision and documenting it on the "time-out sheet" not only serve to remind the operating room staff to ensure that antibiotics are administered in a timely manner, but also document that the patient received the appropriate medication at the appropriate time should that verification become necessary as a pay-for-performance measure.

We believe that adding verification of antibiotic administration to the existing time-out process markedly reduces the chance of omission or delay. Our Time Out Preoperative Verification Checklist (Fig. 1) contains a checkpoint for such verification.

Prior to the onset of our study, we believed that we had a very high rate of compliance with proper timing of antibiotic prophylaxis for total joint arthroplasty and spine procedures. Physician and nursing leadership had worked to educate operating room staff about the need for compliance, and all operating room personnel, including the surgeons, anesthesiologists, and nursing staff, were committed to the concept that patients should receive antibiotics in a timely manner. We thus assumed that, in a hospital such as ours that specializes in orthopaedic surgery, the baseline rate of compliance with antibiotic administration would be very high. Yet, when we audited a sample of forty patients operated on during the three months prior to the start of the study, we found the compliance rate to be only 65%. Institution of the protocol resulted in not only a higher rate of compliance but also documentation of the administration and timing of the antibiotic delivery.

Our hospital participates in the collection of core measure data, a project promoted by JCAHO and CMS for examining specific patient information in an effort to improve patient care. The core measures are used to evaluate patients with heart failure, acute myocardial infarction, pneumonia, and pregnancy and patients who fit the criteria of the Surgical Care Improvement Project (SCIP) to determine if they received appropriate care. One of the factors evaluated under SCIP is timing of antibiotic prophylaxis. Patient charts are independently reviewed for core measures. While the core measures are determined in random samples of the total number of cases performed, they are considered indicative of general practice patterns. When assessing core measures, evaluators look for appropriate documentation in the chart and use only such documentation as verification of compliance.

The one patient in our series who had no record of antibiotic administration in the operating room did not have a time-out sheet in the chart and was assumed to have not received the first dose of antibiotics until the postoperative period. This is the only patient in our series who did not receive antibiotics in the operating room, and this event actually reinforces the concept that, had the appropriate protocol been followed, the patient would likely have received antibiotics in a timely manner.

In a recent survey of anesthesiologists at our hospital, a majority of them stated that verification of antibiotic administration during the surgical time-out protocol had at times reminded them that they had not yet administered antibiotics and provided the opportunity for them to do so prior to incision. Thus, physicians who are responsible for administration of antibiotics on a daily basis indicate that they believe that the protocol is an effective tool that has helped them to provide appropriate patient care.

A concern when evaluating the effectiveness of this type of initiative is the so-called Hawthorne effect: i.e., that behavior changes when people know that they are being observed and the change may be only temporary³⁵. However, we confirmed that compliance remains high even after the study period.

Since the time-out protocol for wrong-site surgery is already in place nationwide, simply adding verification of antibiotic administration to this protocol can ensure that antibiotics are administered at the appropriate time prior to incision. The addition of verification of antibiotic administration to the time-out sheet has not met any resistance by those performing the time-out in the operating room. In contrast, those understanding its purpose have been enthusiastic about incorporating it into the protocol. With the cost of surgical site infections estimated to be $1.5 billion per year, methods need to be adopted to help decrease their occurrence^5,6,8. We propose that institutions utilize our protocol, which is cost-free, easy to use, and easy to adopt. Image Not Available

References

Introduction | Materials and Methods | Results | Discussion | References

Astagneau P, Rioux C, Golliot F, Brücker G; INCISO Network Study Group. Morbidity and mortality associated with surgical site infections: results from the 1997-1999 INCISO surveillance. J Hosp Infect.2001;48:267-74.48267 2001 [PubMed][CrossRef]

Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol.2002;23:183-9.23183 2002 [CrossRef]

Fry DE. The economic costs of surgical site infection. Surg Infect (Larchmt).2002;3 Suppl 1:S37-43.3S37 2002 [CrossRef]

Burke JP. Infection control—a problem for patient safety. N Engl J Med.2003;348:651-6.348651 2003 [CrossRef]

MedQIC Surgical Care Improvement Project (SCIP) . Accessed 2007 Nov 22. 2007
http://www.medqic.org/scip/

Bratzler DW, Houck PM, Richards C, Steele L, Dellinger EP, Fry DE, Wright C, Ma A, Carr K, Red L. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg.2005;140:174-82.140174 2005 [CrossRef]

Bratzler DW, Houck PM; Surgical Infection Prevention Guidelines Writers Workgroup; American Academy of Orthopaedic Surgeons; American Association of Critical Care Nurses; American Association of Nurse Anesthetists; American College of Surgeons; American College of Osteopathic Surgeons; American Geriatrics Society; American Society of Anesthesiologists; American Society of Colon and Rectal Surgeons; American Society of Health-System Pharmacists; American Society of PeriAnesthesia Nurses; Ascension Health; Association of periOperative Registered Nurses; Association for Professionals in Infection Control and Epidemiology; Infectious Diseases Society of America; Medical Letter; Premier; Society for Healthcare Epidemiology of America; Society of Thoracic Surgeons; Surgical Infection Society. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis.2004;38:1706-15.381706 2004 [CrossRef]

Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol.1999;20:725-30.20725 1990 [CrossRef]

Martone WJ, Jarvis WR, Culver DH, Haley RW. Incidence and nature of endemic and epidemic nosocomial infections. In: Bennett JV, Brachman PS, editors. Hospital infections. 3rd ed. Boston: Little, Brown; 1992. p 577-96. 1992

Hollenbeak CS, Murphy D, Dunagan WC, Fraser VJ. Nonrandom selection and the attributable cost of surgical-site infections. Infect Control Hosp Epidemol.2002;23:177-82.23177 2002 [CrossRef]

Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH. Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg.1993;128:79-88. Erratum in: Arch Surg. 1993;128:410.12879 1993

Auerbach AD. Prevention of surgical site infections. In: Shojania KG, Duncan BW, McDonald KM, Wachter RM, editors. Making health care safer: a critical analysis of patient safety practices. Rockville, MD: Agency for Healthcare Research and Quality, US Department of Health and Human Services; 2001. p 221-44. 2001

National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1996, issued May 1996. A report from the National Nosocomial Infections Surveillance (NNIS) System. Am J Infect Control.1996;24:380-8.24380 1996 [CrossRef]

National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 to June 2002, issued August 2002. Am J Infect Control.2002;30:458-75.30458 1992 [CrossRef]

Calderone RR, Garland DE, Capen DA, Oster H. Cost of medical care for postoperative spinal infections. Orthop Clin North Am.1996;27:171-82.27171 1996

Sculco TP. The economic impact of infected joint arthroplasty. Orthopedics.1995;18:871-3.18871 1995

O'Donoghue MA, Allen KD. Costs of an outbreak of wound infections in an orthopaedic ward. J Hosp Infect.1992;22:73-9.2273 1992 [CrossRef]

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol.1999;20:250-80.20250 1999 [CrossRef]

Joint Commission on Accreditation of Healthcare Organizations. Performance Measurement Initiatives. SCIP core measure set. 2006 Nov 28. . Accessed 2005 Dec 18. 2005
http://www.jointcommission.org/PerformanceMeasurement/SCIP+Core+Measure+Set.htm

American Hospital Association. National project launched to reduce surgical complications by 25%. 2005 Jul 28. . Accessed 2007 Nov 22. 2007
http://www.aha.org/aha/press-release/2005/050728-pr-scip.html

Berwick DM. Disseminating innovations in health care. JAMA.2003;289:1969-75.2891969 2003 [CrossRef]

Institute of Medicine. Committee on Identifying Priority Areas for Quality Improvement. Priority areas for national action: transforming health care quality. Adams K, Corrigan JM, editors. Washington, DC: National Academies Press; 2003. 2003

Abramowicz M. Antimicrobial prophylaxis for surgery. Treat Guidel Med Lett.2004;2:27-32.227 2004

Polk HC Jr, Trachtenberg L, Finn MP. Antibiotic activity in surgical incisions. The basis of prophylaxis in selected operations. JAMA.1980;244:1353-4.2441353 1980 [CrossRef]

ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery. American Society of Health-System Pharmacists. Am J Health Syst Pharm.1999;56:1839-88.561839 1999

Oishi CS, Carrion WV, Hoaglund FT. Use of parenteral prophylactic antibiotics in clean orthopedic surgery. A review of the literature. Clin Orthop Relat Res.1993;296:249-55.296249 1993

Antimicrobial prophylaxis in surgery. Med Lett Drugs Ther.2001;43:92-7. Erratum in: Med Lett Drugs Ther. 2001;43:108.4392 2001

Hanssen AD, Osmon DR. The use of prophylactic antimicrobial agents during and after hip arthroplasty. Clin Orthop Relat Res.1999;369:124-38.369124 1999 [CrossRef]

Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med.1992;326:281-6.326281 1992 [CrossRef]

Silver A, Eichorn A, Kral J, Pickett G, Barie P, Pryor V, Dearie MB. Timeliness and use of antibiotic prophylaxis in selected inpatient surgical procedures. The Antibiotic Prophylaxis Study Group. Am J Surg.1996;171:548-52.171548 1996 [CrossRef]

Bhattacharyya T, Hooper DC. Antibiotic dosing before primary hip and knee replacement as a pay-for-performance measure. J Bone Joint Surg Am.2007;89:287-91.89287 2007 [CrossRef]

Joint Commission on Accreditation of Healthcare Organizations. Universal protocol for preventing wrong site, wrong procedure, wrong person surgery. . Accessed 2007 Nov 22. 2007
http://www.jointcommission.org/PatientSafety/UniversalProtocol/

Larsen RA, Evans RS, Burke JP, Pestotnik SL, Gardner RM, Classen DC. Improved perioperative antibiotic use and reduced surgical wound infections through use of computer decision analysis. Infect Control Hosp Epidemiol.1989;10:316-20.10316 1989 [CrossRef]

Burke JP. Maximizing appropriate antibiotic prophylaxis for surgical patients: an update from LDS Hospital, Salt Lake City. Clin Infect Dis.2001;33 Suppl 2:S78-83.33 Suppl 2S78 2001

Jones SRG. Was there a Hawthorne effect? Am J Sociol.1992;98:451-68.98451 1992 [CrossRef]

Topics

antibiotics ; antibiotic prophylaxis ; hip replacement arthroplasty ; time out

Username

Password

Access for Patients

Forgot Password?

Have a subscription to the print edition?

Not a Subscriber?

Buy this Article

Get online access for 30 days for $35

New to JBJS?

Subscribe to the online edition for 30 days for $75

Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.

Have a subscription to the print edition?

Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.

Activate your online account now

Forgot your password?

Enter your username and email address. We'll send you a reminder to the email address on record.

Username:*

Email Address:*

Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
by your institution, please contact you librarian or administrator for username and password information. Institutional
administrators, to reset your institution's master username or password, please contact subs@jbjs.org

References

Accreditation Statement

These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.

CME Activities Associated with This Article

Submit a Comment

Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

* = Required Field

Comment Author(s) * (if multiple authors, separate names by comma)

Example: John Doe

Affiliation & Institution*

Disclosure

Comment Title*

Comment*

Cancel

Devdatta S Neogi

Posted on February 04, 2008

Ensuring Appropriate Timing of Antimicrobial Prophylaxis

All India Institute of Medical Sciences, New Delhi, India

To The Editor:

We read with interest the article â€œEnsuring Appropriate Timing of Antimicrobial Prophylaxisâ€(1). Despite promulgation of appropriate guidelines, proper antibiotic timing is still thwarted by substantial obstacles that include individual values, professional conflicts, and organizational conflicts. These factors must be addressed in order to achieve optimal practice in this domain(2).

Intensive educational effort using group interviews and resource crew management principles have been shown to improve communication among surgeons, anesthetists, and operating room personnel(2,3). Interventions for improvement included reinforcement of use of preoperative antibiotic order forms, eliminating administration of antibiotics in the preoperative admission area, and sending appropriate antibiotics and IV tubing with the patient to the operating room(4). Completion of the pre-operative checklist and surgical timeout protocol by the OR nurse is an innovative approach to ensure compliance in antibiotic prophylaxis timing by non physician personnel.

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

References:

1. Rosenberg AD, Wambold D, Kraemer L, Begley-Keyes M, Zuckerman SL, Singh N, Cohen MM, Bennett MV. Ensuring appropriate timing of a ntimicrobial prophylaxis. J Bone Joint Surg Am. 2008;90:226-232.

2. Tan JA, Naik VN, Lingard L. Exploring obstacles to proper timing of prophylactic antibiotics for surgical site infections Quality and Safety in Health Care 2006;15:32-38.

3. Awad SS, Fagan SP, Bellows C, et al. Bridging the communication gap in the operating room with medical team training. Am J Surg 2005;190:770â€“4.

4. Parker BM, Henderson MJ, Vitagliano S et al. Six sigma methodology can be used to improve adherence for antibiotic prophylaxis in patients undergoing noncardiac surgery. Anesth Analg 2007;104:140-146

Print
PDF
Email

Recipient(s) will receive an email with a link (good for 5 days) to 'Ensuring Appropriate Timing of Antimicrobial Prophylaxis'.
Your Name:*
Example: John Doe

Email Address:* CC Me:
Enter your valid email address. Example: jdoe@example.com

Recipient's Email Address:*

Separate multiple email address with semi-colons (up to 5).

Subject:* 's The Journal of Bone & Joint Surgery: 'Ensuring Appropriate Timing of Antimicrobial Prophylaxis'
Subject for your email.

Message:

(Optional, message will truncate at 1000 characters)

Processing your request... Please Wait...

Copyright © in the material you requested is held by The Journal of Bone & Joint Surgery, Inc. (unless otherwise noted). This email ability is provided as a courtesy, and by using it you agree that that you are requesting the material solely for personal, non-commercial use, and that it is subject to Journal of Bone & Joint Surgery, Inc.'s Terms of Use. The information provided in order to email this topic will not be used to send unsolicited email, nor will it be furnished to third parties. Please refer to The Journal of Bone & Joint Surgery Inc.'s Privacy Policy for further information.

Copyright © The Journal of Bone & Joint Surgery Inc. All rights reserved.
Share
Get Citation

Andrew D. Rosenberg, Daniel Wambold, Linede Kraemer, Maureen Begley-Keyes, Scott L. Zuckerman, Neeraj Singh, Max M. Cohen, Michele V. Bennett; Ensuring Appropriate Timing of Antimicrobial Prophylaxis. The Journal of Bone & Joint Surgery. 2008 Feb;90(2):226-232.

Download citation file:

RIS (Zotero)

EndNote

BibTex

Medlars

ProCite

RefWorks

Reference Manager

Copyright © The Journal of Bone and Joint Surgery, Inc.
Rights & Permissions
Article Alerts

Processing your request... Please Wait.
Submit a Comment
Supplemental Content