Current challenges in adherence to clinical guidelines for antibiotic prophylaxis in surgery

S.A. Khan, G. Rodrigues, P. Kumar, P.G.M. Rao

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

To study the impact of guidelines on surgical antibiotic prophylaxis in clinical practice, barriers involved in adherence to guidelines and how to overcome the same. Methods: Literature pertaining to prophylactic antibiotic usage was searched. Medscape, Medline, Cochrane, Surgical Infection Prevention (SIP) project databases were reviewed. Recent articles from relevant journals, texts, and standard guidelines were also studied. Results: Local guidelines seem more likely to be accepted and followed than those developed nationally. Major barriers involved in adherence to guidelines include lack of awareness about the guidelines, general perception of guideline as a bureaucratic rather than educational tool. Some practitioners perceive guidelines as "cookbook medicine" that does not permit them to make their own medical decisions. Other barriers are complex, multi-step systems that create confusion, decrease accountability. Methods for guideline adherence include surveillance and data analysis, new systems to facilitate documentation and improving workflow, education regarding current evidence-based guidelines and promoting the development of local guidelines or protocol, development and implementation of reminders to facilitate adherence to the local guidelines. Conclusion: A multidisciplinary steering team of surgeons, infectious disease specialists, pharmacists, anesthesiologists, microbiologists and nurses should develop local guidelines suitable to their institution and methods for adherence to prevent the surgical site infections. The gap between evidence-based guidelines and practice must be addressed in order to achieve optimal practice in this domain.
Original languageEnglish
Pages (from-to)435-437
Number of pages3
JournalJournal of the College of Physicians and Surgeons--Pakistan : JCPSP
Volume16
Issue number6
Publication statusPublished - 2006

Fingerprint

Antibiotic Prophylaxis
Guidelines
Guideline Adherence
Surgical Wound Infection
Confusion
Workflow
Evidence-Based Practice
Social Responsibility
Pharmacists
Documentation
Communicable Diseases
Nurses
Medicine
Databases
Anti-Bacterial Agents
Education

Cite this

@article{9cb7dd0d02c14bea94ef69594e4fd065,
title = "Current challenges in adherence to clinical guidelines for antibiotic prophylaxis in surgery",
abstract = "To study the impact of guidelines on surgical antibiotic prophylaxis in clinical practice, barriers involved in adherence to guidelines and how to overcome the same. Methods: Literature pertaining to prophylactic antibiotic usage was searched. Medscape, Medline, Cochrane, Surgical Infection Prevention (SIP) project databases were reviewed. Recent articles from relevant journals, texts, and standard guidelines were also studied. Results: Local guidelines seem more likely to be accepted and followed than those developed nationally. Major barriers involved in adherence to guidelines include lack of awareness about the guidelines, general perception of guideline as a bureaucratic rather than educational tool. Some practitioners perceive guidelines as {"}cookbook medicine{"} that does not permit them to make their own medical decisions. Other barriers are complex, multi-step systems that create confusion, decrease accountability. Methods for guideline adherence include surveillance and data analysis, new systems to facilitate documentation and improving workflow, education regarding current evidence-based guidelines and promoting the development of local guidelines or protocol, development and implementation of reminders to facilitate adherence to the local guidelines. Conclusion: A multidisciplinary steering team of surgeons, infectious disease specialists, pharmacists, anesthesiologists, microbiologists and nurses should develop local guidelines suitable to their institution and methods for adherence to prevent the surgical site infections. The gap between evidence-based guidelines and practice must be addressed in order to achieve optimal practice in this domain.",
author = "S.A. Khan and G. Rodrigues and P. Kumar and P.G.M. Rao",
note = "Cited By :5 Export Date: 10 November 2017 CODEN: JSPJE Correspondence Address: Khan, S.A.; Department of Pharmacy Practice, SS Cancer Hospital and Research Centre, Manipal- 576 104 Karnataka, India; email: sohailkhan1981@gmail.com References: Graham, J.C., Pedler, S.J., Surgical antibiotic prophylaxis (2003) Clinical Pharmacy and Therapeutics, pp. 569-581. , In: Walker R, Edwards C, (edi). 3rd ed. London: Churchill Livingstone; Bratzler, D.W., Houk, P.M., Richards, C., Steele, L., Dellinger, E.P., Fry, D.E., Use of antimicrobial prophylaxis for major surgery: Baseline results from the National Surgical Infection Prevention Project (2005) Arch Surg, 140, pp. 174-182; Kirkland, K.B., Briggs, J.P., Sexton, D.J., Trivette, S.L., Wilkinson, W.E., The impact of surgical site infections in the 1990s: Attributable mortality, excess length of hospitalization and extra costs (1999) Infect Control Hosp Epidemiol, 20, pp. 725-730; Mangram, A.J., Horan, T.C., Pearson, M.I., Silver, L.C., Jarvis, W.R., Guideline for prevention of surgical site infection (1999) Infect Control Hosp Epidemiol, 20, pp. 250-278. , The hospital Infection Control Practices Advisory Committee; Gaynes, H., Richards, C., Edwards, J., Emori, T.G., Horan, T., Alonso, A.E., Feeding back surveillance data to prevent hospital-acquired infections (2001) Emerg Infect Dis, 7, pp. 295-298; Roy, M.C., Perl, T.M., Basics of surgical site infection surveillance (1997) Infect Control Hosp Epidemiol, 18, pp. 659-668; Mckonkey, S.J., L'Ecuyer, P.B., Murphy, D.M., Leet, T.L., Sundt, T.M., Fraser, V.J., Results of a comprehensive infection control program for reducing surgical-site infections in coronary artery bypass surgery (1999) Infect Control Hosp Epidemiol, 20, pp. 791-792; Gyssens, E.C., Preventing postoperative infections: Current treatment recommendations (1999) Drugs, 57, pp. 175-185; Sackett, D.L., Rosenberg, W.M., Gray, J.A., Haynes, R.B., Richardson, W.S., Evidence-based. medicine: What it is and what it isn't (1996) BMJ, 312, pp. 71-72; Narrative project document, project # QI4201: Improving postoperative infection rates with prophylactic antibiotics (1996), Northeast Health Care Quality Foundation; Dellinger, E.P., Gross, P.A., Barrett, T.L., Krause, P.J., Martone, W.F., McGowan, F.E., Quality standard for antimicrobial prophylaxis in surgical procedures (1994) Clin Infect Dis, 18, pp. 422-427; Girotti, M.J., Fodoruk, S., Irvine Meek, J., Rotstein, O.D., Antibiotic handbook and pre-printed perioperative order forms for surgical antibiotic prophylaxis: Do they work? (1990) Can J Surg, 33, pp. 385-388; Matuschka, P.R., Cheadle, W.G., Burke, J.D., Garrison, R.N., A new standard of care: Administration of pre-operative antibiotics in the operating room (1997) Am Surg, 63, pp. 500-503; Delvin, J.W., Kanji, S., Tanning, S.W., Surgery (2002) Antimicrobial Prophylaxis in Surgery. Pharmacotherapy: A Pathophysiologic Approach, pp. 2111-2122. , In: Dipiro JT, Labert RL, Yee GC, (edit). 5th ed. New York: McGraw Hill; Yousuf, M., Hussain, M., Need and duration of antibiotic therapy in clean and clean contaminated operations (2002) J Pak Med Assoc, 52, pp. 284-286; Smith, J.M.B., Payne, J.E., Berne, T.V., (2000) Antibacterial Prophylaxis in Surgery: The Surgeons Guide to Antimicrobial Chemotherapy, pp. 114-120. , London: Arnold Publications",
year = "2006",
language = "English",
volume = "16",
pages = "435--437",
journal = "Journal of the College of Physicians and Surgeons--Pakistan : JCPSP",
issn = "1022-386X",
publisher = "College of Physicians and Surgeons Pakistan",
number = "6",

}

Current challenges in adherence to clinical guidelines for antibiotic prophylaxis in surgery. / Khan, S.A.; Rodrigues, G.; Kumar, P.; Rao, P.G.M.

In: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, Vol. 16, No. 6, 2006, p. 435-437.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Current challenges in adherence to clinical guidelines for antibiotic prophylaxis in surgery

AU - Khan, S.A.

AU - Rodrigues, G.

AU - Kumar, P.

AU - Rao, P.G.M.

N1 - Cited By :5 Export Date: 10 November 2017 CODEN: JSPJE Correspondence Address: Khan, S.A.; Department of Pharmacy Practice, SS Cancer Hospital and Research Centre, Manipal- 576 104 Karnataka, India; email: sohailkhan1981@gmail.com References: Graham, J.C., Pedler, S.J., Surgical antibiotic prophylaxis (2003) Clinical Pharmacy and Therapeutics, pp. 569-581. , In: Walker R, Edwards C, (edi). 3rd ed. London: Churchill Livingstone; Bratzler, D.W., Houk, P.M., Richards, C., Steele, L., Dellinger, E.P., Fry, D.E., Use of antimicrobial prophylaxis for major surgery: Baseline results from the National Surgical Infection Prevention Project (2005) Arch Surg, 140, pp. 174-182; Kirkland, K.B., Briggs, J.P., Sexton, D.J., Trivette, S.L., Wilkinson, W.E., The impact of surgical site infections in the 1990s: Attributable mortality, excess length of hospitalization and extra costs (1999) Infect Control Hosp Epidemiol, 20, pp. 725-730; Mangram, A.J., Horan, T.C., Pearson, M.I., Silver, L.C., Jarvis, W.R., Guideline for prevention of surgical site infection (1999) Infect Control Hosp Epidemiol, 20, pp. 250-278. , The hospital Infection Control Practices Advisory Committee; Gaynes, H., Richards, C., Edwards, J., Emori, T.G., Horan, T., Alonso, A.E., Feeding back surveillance data to prevent hospital-acquired infections (2001) Emerg Infect Dis, 7, pp. 295-298; Roy, M.C., Perl, T.M., Basics of surgical site infection surveillance (1997) Infect Control Hosp Epidemiol, 18, pp. 659-668; Mckonkey, S.J., L'Ecuyer, P.B., Murphy, D.M., Leet, T.L., Sundt, T.M., Fraser, V.J., Results of a comprehensive infection control program for reducing surgical-site infections in coronary artery bypass surgery (1999) Infect Control Hosp Epidemiol, 20, pp. 791-792; Gyssens, E.C., Preventing postoperative infections: Current treatment recommendations (1999) Drugs, 57, pp. 175-185; Sackett, D.L., Rosenberg, W.M., Gray, J.A., Haynes, R.B., Richardson, W.S., Evidence-based. medicine: What it is and what it isn't (1996) BMJ, 312, pp. 71-72; Narrative project document, project # QI4201: Improving postoperative infection rates with prophylactic antibiotics (1996), Northeast Health Care Quality Foundation; Dellinger, E.P., Gross, P.A., Barrett, T.L., Krause, P.J., Martone, W.F., McGowan, F.E., Quality standard for antimicrobial prophylaxis in surgical procedures (1994) Clin Infect Dis, 18, pp. 422-427; Girotti, M.J., Fodoruk, S., Irvine Meek, J., Rotstein, O.D., Antibiotic handbook and pre-printed perioperative order forms for surgical antibiotic prophylaxis: Do they work? (1990) Can J Surg, 33, pp. 385-388; Matuschka, P.R., Cheadle, W.G., Burke, J.D., Garrison, R.N., A new standard of care: Administration of pre-operative antibiotics in the operating room (1997) Am Surg, 63, pp. 500-503; Delvin, J.W., Kanji, S., Tanning, S.W., Surgery (2002) Antimicrobial Prophylaxis in Surgery. Pharmacotherapy: A Pathophysiologic Approach, pp. 2111-2122. , In: Dipiro JT, Labert RL, Yee GC, (edit). 5th ed. New York: McGraw Hill; Yousuf, M., Hussain, M., Need and duration of antibiotic therapy in clean and clean contaminated operations (2002) J Pak Med Assoc, 52, pp. 284-286; Smith, J.M.B., Payne, J.E., Berne, T.V., (2000) Antibacterial Prophylaxis in Surgery: The Surgeons Guide to Antimicrobial Chemotherapy, pp. 114-120. , London: Arnold Publications

PY - 2006

Y1 - 2006

N2 - To study the impact of guidelines on surgical antibiotic prophylaxis in clinical practice, barriers involved in adherence to guidelines and how to overcome the same. Methods: Literature pertaining to prophylactic antibiotic usage was searched. Medscape, Medline, Cochrane, Surgical Infection Prevention (SIP) project databases were reviewed. Recent articles from relevant journals, texts, and standard guidelines were also studied. Results: Local guidelines seem more likely to be accepted and followed than those developed nationally. Major barriers involved in adherence to guidelines include lack of awareness about the guidelines, general perception of guideline as a bureaucratic rather than educational tool. Some practitioners perceive guidelines as "cookbook medicine" that does not permit them to make their own medical decisions. Other barriers are complex, multi-step systems that create confusion, decrease accountability. Methods for guideline adherence include surveillance and data analysis, new systems to facilitate documentation and improving workflow, education regarding current evidence-based guidelines and promoting the development of local guidelines or protocol, development and implementation of reminders to facilitate adherence to the local guidelines. Conclusion: A multidisciplinary steering team of surgeons, infectious disease specialists, pharmacists, anesthesiologists, microbiologists and nurses should develop local guidelines suitable to their institution and methods for adherence to prevent the surgical site infections. The gap between evidence-based guidelines and practice must be addressed in order to achieve optimal practice in this domain.

AB - To study the impact of guidelines on surgical antibiotic prophylaxis in clinical practice, barriers involved in adherence to guidelines and how to overcome the same. Methods: Literature pertaining to prophylactic antibiotic usage was searched. Medscape, Medline, Cochrane, Surgical Infection Prevention (SIP) project databases were reviewed. Recent articles from relevant journals, texts, and standard guidelines were also studied. Results: Local guidelines seem more likely to be accepted and followed than those developed nationally. Major barriers involved in adherence to guidelines include lack of awareness about the guidelines, general perception of guideline as a bureaucratic rather than educational tool. Some practitioners perceive guidelines as "cookbook medicine" that does not permit them to make their own medical decisions. Other barriers are complex, multi-step systems that create confusion, decrease accountability. Methods for guideline adherence include surveillance and data analysis, new systems to facilitate documentation and improving workflow, education regarding current evidence-based guidelines and promoting the development of local guidelines or protocol, development and implementation of reminders to facilitate adherence to the local guidelines. Conclusion: A multidisciplinary steering team of surgeons, infectious disease specialists, pharmacists, anesthesiologists, microbiologists and nurses should develop local guidelines suitable to their institution and methods for adherence to prevent the surgical site infections. The gap between evidence-based guidelines and practice must be addressed in order to achieve optimal practice in this domain.

M3 - Article

VL - 16

SP - 435

EP - 437

JO - Journal of the College of Physicians and Surgeons--Pakistan : JCPSP

JF - Journal of the College of Physicians and Surgeons--Pakistan : JCPSP

SN - 1022-386X

IS - 6

ER -