Surgical Antibiotic Prophylaxis Administration Improved after introducing Dedicated Guidelines: A Before-and-After Study from Dhulikhel Hospital in Nepal (2019–2023)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Setting
2.3. Study Site
2.4. Dissemination Activities, Recommendations and Actions Taken
2.5. Development of Dedicated Guidelines for SAP
2.6. Study Population and Periods
2.7. Data Collection and Validation
2.8. Sample Size Calculation
2.9. Data Analysis and Statistics
3. Results
3.1. Demographic and Clinical Characteristics of Surgical Patients
3.2. Overall Proportion of Patients Who Received SAP in Compliance with the Guidelines
3.3. The Proportion of Eligible and Non-Eligible Patients Who Received Initial and Redosing of SAP
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Recommendations | Action Status | Details of Action (When and What) |
---|---|---|
Establishment of a hospital committee for rational antibiotic use Establishment of an antibiotic stewardship program | Implemented Ongoing | July 2022 Hospital committee established. Lead persons assigned from internal medicine and pharmacology. One doctor is being trained in infection, prevention and control |
Develop a dedicated SAP guideline | Implemented | May 2022 Seek funding for guidelines development and training. A proposal was accepted by the WHO country office in Nepal. 1500 US$ funding was provided by TDR. |
December 2022 SAP guidelines developed and endorsed | ||
Training of surgeons, anesthetists and nurses | Implemented | December 2022 Training done in batches and continued. |
Wound Class | Definition | Indication for SAP | Timing for Initial Dose of SAP | Indication for Redosing |
---|---|---|---|---|
Clean | Primarily closed, elective procedures involving no inflammation, no break in technique, and no entry into the gastrointestinal, oropharyngeal, biliary, genitourinary tracts or tracheobronchial tracts (e.g., herniorrhaphy) | Not recommended Recommended when: (1) risk factors are present, for example patients with immunosuppressive states, diabetes mellitus, malignancies or (2) patient has prosthesis in-situ | IV bolus: should be administered no more than 60 min prior to skin incision. | A single pre-operative dose is enough for most of the procedures, however, redosing is recommended when: (1) there is prolonged surgery, more than four hours from the time of the initial dose or (2) if major blood loss occurs (1500 mL) |
Clean-contaminated | Surgery during which colonized viscus (e.g., gastrointestinal, tracheobronchial or genitourinary tract) is entered; minor breaches in technique; procedures following blunt trauma; cholecystectomy; prostate surgery; upper and/or lower urinary tract surgery; or uncomplicated appendectomy | Recommended | ||
Contaminated | Surgery in the presence of non-purulent inflammation or major spillage from a colonized viscus, major breach in aseptic technique, or traumatic wounds less than 4 h old | Recommended | ||
Dirty | Surgery in the presence of established infection (e.g., perforated viscous, devitalized tissue) and traumatic wounds more than 4 h old | NA * |
Characteristics | Baseline Study (July–December 2019) | Follow-Up Study (January–April 2023) | |||
---|---|---|---|---|---|
n | (%) | n | (%) | p Value | |
Total | 874 | 751 | |||
Sex | |||||
Male | 497 | (57) | 428 | (57) | 0.959 |
Female | 377 | (43) | 323 | (43) | |
Age (years) | |||||
Median [IQR] | 40 (26–53) | 43 (30–57) | 0.432 | ||
Type of surgery | |||||
Elective | 661 | (76) | 638 | (85) | <0.001 |
Emergency | 213 | (24) | 113 | (15) | |
Anatomical site of surgery | |||||
Gastrointestinal | 476 | (54) | 339 | (45) | <0.001 |
Inguinal Hernia | 128 | (15) | 68 | (9) | |
Upper Urinary | 101 | (12) | 100 | (13) | |
Lower Urinary | 54 | (6) | 48 | (7) | |
Thoracic | 8 | (1) | 8 | (1) | |
Vascular | 42 | (5) | 88 | (12) | |
Others | 65 | (7) | 100 | (13) | |
Surgical wound class | |||||
Clean | 202 | (23) | 216 | (29) | 0.001 |
Clean-contaminated | 587 | (67) | 434 | (58) | |
Contaminated | 57 | (7) | 70 | (9) | |
Dirty | 28 | (3) | 31 | (4) | |
Comorbidity * | |||||
None | 817 | (94) | 692 | (92) | 0.002 |
Cancer | 16 | (2) | 5 | (0.7) | |
HIV/AIDS | 0 | (0) | 1 | (0.1) | |
TB | 8 | (1) | 2 | (0.3) | |
Diabetes mellitus | 31 | (3) | 51 | (6.7) | |
Presence/insertion of prosthesis | |||||
No | 758 | (87) | 694 | (92) | <0.001 |
Yes | 116 | (13) | 57 | (8) |
Characteristics | Baseline Study (July–December 2019) | Follow-Up Study (January–April 2023) | p Value * |
---|---|---|---|
n (%) | n (%) | ||
Total patients | 846 | 720 | |
Eligible for SAP | 717 | 569 | |
Received initial dose | 708 (99) | 541 (95) | <0.001 |
Not eligible for SAP (a) | 129 | 151 | |
Received initial dose (b) | 65 (50) | 57 (38) | 0.045 |
Eligible for redosing (c) | 164 | 27 | |
Received redosing (d) | 23 (14) | 6 (22) | 0.272 |
Not eligible for redosing (e) | 544 | 514 | |
Received redosing (f) | 0 | 2 (0.4) | 0.145 |
Overall SAP compliance * | 632 (75) | 612 (85) | <0.001 |
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Shrestha, I.; Shrestha, S.; Vijayageetha, M.; Koju, P.; Shrestha, S.; Zachariah, R.; Khogali, M.A. Surgical Antibiotic Prophylaxis Administration Improved after introducing Dedicated Guidelines: A Before-and-After Study from Dhulikhel Hospital in Nepal (2019–2023). Trop. Med. Infect. Dis. 2023, 8, 420. https://doi.org/10.3390/tropicalmed8080420
Shrestha I, Shrestha S, Vijayageetha M, Koju P, Shrestha S, Zachariah R, Khogali MA. Surgical Antibiotic Prophylaxis Administration Improved after introducing Dedicated Guidelines: A Before-and-After Study from Dhulikhel Hospital in Nepal (2019–2023). Tropical Medicine and Infectious Disease. 2023; 8(8):420. https://doi.org/10.3390/tropicalmed8080420
Chicago/Turabian StyleShrestha, Indira, Sulekha Shrestha, Mathavaswami Vijayageetha, Pramesh Koju, Saugat Shrestha, Rony Zachariah, and Mohammed Ahmed Khogali. 2023. "Surgical Antibiotic Prophylaxis Administration Improved after introducing Dedicated Guidelines: A Before-and-After Study from Dhulikhel Hospital in Nepal (2019–2023)" Tropical Medicine and Infectious Disease 8, no. 8: 420. https://doi.org/10.3390/tropicalmed8080420