Noncompliance with surgical antimicrobial prophylaxis guidelines: A Jordanian experience in cesarean deliveries

• Published in: American journal of infection control 2018-01, Vol.46 (1), p.14-19
• Main Authors: Abdel Jalil, Mariam Hantash, Abu Hammour, Khawla, Alsous, Mervat, Hadadden, Rand, Awad, Wedad, Bakri, Faris, Fram, Kamil
• Format: Article
• Language: English
• Subjects: Adherence; Anti-Infective Agents - administration & dosage; Anti-Infective Agents - pharmacology; Antibiotic Prophylaxis - methods; Antibiotics; Antimicrobial Stewardship; ASHP; C-section; Cesarean Section; Female; Guideline Adherence - standards; Humans; Jordan; Pregnancy; Retrospective Studies; Surgery; Surgical Wound Infection - prevention & control
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2017.06.033

•Compliance with antibiotic prophylaxis guidelines prior cesareans was evaluated.•Overall compliance and compliance with the duration of prophylaxis were poor.•Compliance with indication and choice of antibiotic was high.•Emergent cesareans reduced noncompliance risk with dose/time of administration.•Emergent operations increased the risk of prolonging prophylaxis following surgery. Surgical site infections are common, especially in developing countries. Nevertheless, up to 60% of surgical site infections can be prevented with appropriate perioperative care, which includes among other measures using suitable surgical antimicrobial prophylaxis (SAP). After a short interview with patients and retrospective review of medical charts, compliance with 6 SAP parameters was assessed for appropriateness; those parameters are indication, choice, dose, time of administration, intraoperative redosing interval, and duration of prophylaxis in 1,173 operations. Overall compliance was poor; nevertheless, certain components showed high compliance rates, such as indication and choice of antibiotics. The most frequent error noted was extended administration of prophylactic antibiotics, which was observed in 88.2% of the study population. Emergency operations were associated with a lower risk of noncompliance in administering the correct dose at the correct time (odds ratio, 0.63; 95% confidence interval, 0.47-0.83 and odds ratio, 0.21; 95% confidence interval, 0.14-0.3, respectively). On the other hand, women who underwent an emergency operation were associated with a 6-fold higher risk of receiving prophylactic therapy following surgery. The present study demonstrated the existence of a surprisingly low level of overall compliance with the hospital-adapted SAP guidelines. Factors implicated in noncompliance were investigated, and the present results create a starting point to improve the current practice.