Infection Control & Hospital Epidemiology

Original Article

Successful Implementation of a Window for Routine Antimicrobial Prophylaxis Shorter than That of the World Health Organization Standard

Heidi Mistelia1 c1, Andreas F. Widmera2, Walter P. Webera1, Evelyne Buchera3, Marc Dangela2, Stefan Recka1, Daniel Oertlia1, Walter R. Martia4 and Rachel Rosenthala1

a1 Division of General Surgery, University Hospital of Basel, Basel, Switzerland

a2 Division of Infectious Disease and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland

a3 Division of Anesthesiology, University Hospital of Basel, Basel, Switzerland

a4 Division of General Surgery, Kantonsspital Aarau, Aarau, Switzerland

Abstract

Objective. To evaluate the feasibility of implementation of the refined window for routine antimicrobial prophylaxis (RAP) of 30-74 minutes before skin incision compared to the World Health Organization (WHO) standard of 0-60 minutes.

Design. Prospective study on timing of routine antimicrobial prophylaxis in 2 different time periods.

Setting. Tertiary referral university hospital with 30,000 surgical procedures per year.

Methods. In all consecutive vascular, visceral, and trauma procedures, the timing was prospectively recorded during a first time period of 2 years (A; baseline) and a second period of 1 year (B; after intervention). An intensive intervention program was initiated after baseline. The primary outcome parameter was timing; the secondary outcome parameter was surgical site infection (SSI) rate in the subgroup of patients undergoing cholecystectomy/colon resection.

Results. During baseline time period A (3,836 procedures), RAP was administered 30–74 minutes before skin incision in 1,750 (41.0%) procedures; during time period B (1,537 procedures), it was administered in 914 (56.0%; P < .001). The subgroup analysis did not reveal a significant difference in SSI rate.

Conclusions. This bundle of interventions resulted in a statistically significant improvement of timing of RAP even at a shortened window compared to the WHO standard.

(Received January 17 2012)

(Accepted April 05 2012)

Correspondence

c1 Department of General Surgery, University Hospital of Basel, Spitalstrasse 21, CH-4031 Basel, Switzerland (mistelih@uhbs.ch)