The Impact of Timing, Selection, and Dosage of Preoperative Prophylactic Antibiotics on Preventable Surgical Site Infections
Surgical site infections (SSIs) are a subset of a larger group of infections that are known as hospital acquired infections (HAis). SSIs are a huge financial burden, costing billions of dollars in excess hospital charges every year. There is a considerable amount of evidence-based practice recommendations that can help reduce the incidence of SSIs. Research has supported the efficacy of preoperative antibiotic prophylaxis when appropriately selected and timed according to published guidelines. In addition to these measures, re-dosing of antibiotics must occur for those procedures that last more than four hours in order to continue to maintain tissue perfusion throughout the surgical procedure. The purpose of this study was to evaluate the timely administration, appropriate selection, and dosage of preoperative prophylactic antibiotics in surgical patients in one community hospital. A retrospective research design was used to obtain information on 100 randomly selected colon, hysterectomy, total hip and knee arthroplasty cases. Data were collected on those surgical procedures that occurred between October 1, 2010 and March 31 , 2011. During this time period, there were eight documented SSIs, three involving an organ space, and five that were superficial. In more than half of the colon and hysterectomy cases, the prophylactic antibiotic was administered less than 30 minutes before surgical incision, and in more than half of the total hip and total knee arthroplasty cases, antibiotic administration was between 30-60 minutes. All the procedures met the SCIP recommendations for timing and selection of prophylactic antibiotic. This study suggests that to ensure adequate tissue perfusion prior to surgical incision, the antibiotic should be administered in the preoperative holding unit, immediately prior to transfer to the operating room. This would assure that the antibiotic is given 30-60 minute timeframe, thus reducing the potential for the development of a SSI. Recommendations for further research and advanced nursing practice are discussed.