Clinical Practice Audit of Perioperative Antimicrobial Prophylaxis in a Tertiary Care Hospital: Do Routine Academic Activities Improve Adherence to Practice Guidelines?

Background: Antimicrobial prophylaxis should be used in circumstances where efficacy has been demonstrated and benefits outweigh the risk. Each hospital must have an antibiotic policy that is implementable and fully adhered to. Methods: A prospective observational study was conducted in 209 patients, admitted to wards of various surgical departments including surgery, obstetrics & gynaecology (O), otorhinolaryngology (ENT) and orthopaedics. Relevant antimicrobial use data of each patient was collected in a customized Case Record Form (CRF) from day one until patient was discharged. Results: Majority of the patients were young adults between 19-39 years of age. Preoperative antibiotics were given in 151 and postoperative antibiotics were prescribed in all. Third generation cephalosporins was the most frequently prescribed group. The selection of antibiotics by different departments varied greatly and many prescribed (n=85) two antibiotics for preoperative prophylaxis. Average duration of surgical prophylaxis was 6.25 days. In 90 patients, preoperative antibiotic was administered before 3 hours. Conclusion: Despite routine interactive academic activities, pattern of antibiotic used was not as per guidelines suggested by competent authorities. Interventions are warranted to promote the development, dissemination and adoption of evidence based antibiotic policy. The policy should be simple, clear, noncontroversial, clinically relevant and implementable. The constant monitoring with periodic audit to ensure adherence is warranted.