Survey and evaluation of antibiotic prophylaxis usage in surgery wards of tertiary level institution before and after the implementation of clinical guidelines

Background: Wound infections are the commonest hospital-acquired infections in surgical patients. Approximately 30-50% of antibiotic use in hospitals, is now for surgical prophylaxis. However, between 30-90% of this prophylaxis is inappropriate, that increases the selective pressure favoring the emergence of antimicrobial resistance. Judicious use of antibiotics in the hospital through effective antibiotic policy and guideline development is thus essential. Aims: To prepare a guideline for surgical antibiotic prophylaxis and to evaluate the impact of it in clinical practice. Settings and Design: A retrospective and prospective study was carried out over a nine month period, in a surgical unit of a tertiary care institution. Materials and Methods: An antibiogram was prepared to evaluate the sensitivity pattern retrospectively. A prospective study was done to evaluate the prescription pattern of antibiotic prophylaxis and incidence of surgical site infection. A draft guideline was prepared with expertise by the surgeon. Standardized recommendations in the guideline were done by the nominal group technique. Post-recommendation evaluation was done to observe the impact of the guideline in clinical practice. Results and Conclusions: 222 cases were evaluated during the pre-recommendation period, of which 21 were infected with surgical site infections that were rated as 9.45%. Use of prophylactic antibiotics was widespread and inconsistent with published guidelines. 56 cases were evaluated during the post-recommendation period. None of the cases were infected. Prophylactic antibiotic use was consistent with respect to choice and duration. The study showed the importance of a multidisciplinary approach in implementing local guidelines in healthcare institutions, as per their hospital antimicrobial sensitivity pattern and expert′s opinions.