Prophylactic antimicrobial practice in the Orthopaedic wards of RIPAS Hospital

Lah Kheng CHUA

Department of Pharmacy, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam

Introduction: Surgical site infections (SSI) are common healthcare associated infections (HAI) that is associated with increased morbidity and cost. Antimicrobial prophylaxis is effective when used appropriately. This study assesses the prophylactic antimicrobial prescribing and practice in the orthopaedic wards based on the Scottish Intercollegiate Guidelines Network (SIGN) guideline on antibiotic prophylaxis in surgery. Materials and Methods: Patients admitted to the Orthopaedics wards over a four-week period were studied (n = 68). Criterions 1 to 4; appropriateness, choice of antimicrobial and route of administration (1- given when indicated, 2- not given when not indicated, 3- appropriate choice and 4- given intravenously), criterions 5 to 7; allergy status and documentation (5: documentation, 6- details and 7- definite or possible history reaction immediately after penicillin therapy should not receive prophylaxis with a beta-lactam antimicrobial), criterions 8 to 10; documentation of antimicrobial given (8- name, dose and route of administration, 9- documentation in the appropriate ‘one-off’ section of the drug chart and 10- documentation of time of administration and surgical incision) and criterion 11 to 14; time and doses required (11- prophylaxis should be given 30 minutes before surgery, 12- additional intra-operative dose not required, 13- post-operative doses of prophylaxis not given and 14- a 24 hours regimen of prophylactic antimicrobial is given for primary arthroplasty procedures). A simple scoring system was used to allocate level of appropriateness. The rate was considered ‘very good’ for above 85%, ‘good’ for 70%-85%, ‘moderate’ for 50%-69%, ‘poor’ for 30%-49% and ‘very poor’ for below 30%. Results: The overall conformation to criteria and standards was 66.4% (95% CI 61.7-70.7). The rates were rated as ‘very good’ for criterion 1, 3, 4, 5b, 6, 8 and 9, ‘good’ for criterion 5a and ‘poor’ for criterions 2 and 5c. The adherence rates were ‘very poor’ to criterion 10a, 10b, 13 and 14. Intravenous cefuroxime was used as the first choice for antimicrobial prophylaxis. Conclusions: The overall practice was moderate and the choice of drug was considered appropriate. However, certain areas such as documentation need improvement. A local guideline may be useful.

Keywords: Antimicrobial prescribing, antimicrobial prophylaxis, orthopaedic, surgical site infection

Correspondence author: Lah Kheng CHUA, Department of Pharmacy, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam

E mail: clk88@hotmail.com

Brunei Int Med J. 2012; 8 (2): 78-85