4CPS-075 Compliance of a perioperative antibiotic prophylaxis protocol in cardiac surgery

Background An interdisciplinary working group developed a standardised perioperative antibiotic prophylaxis (AP) protocol. In 2014, in the first post-intervention evaluation, we observed that 26.8% of the surgeries’ non-compliance with the protocol (43.75% of these were cardiac surgeries). Purpose To evaluate compliance with selected process measures for perioperative AP in patients undergoing cardiac surgery. Material and methods The prospective study included all cardiac procedures performed on adult patients during a 2 week period (6 to 17 February 2017). Compliance with process measures were: correct antibiotic selection (appropriate drug, dosage regimen), dose timing (30 min before surgical incision), parenteral AP dose recorded in clinical history (CH), intraoperative AP dose recorded in more than 3 hours of prolonged surgeries and discontinuation of perioperative AP. Results Thirty-five cardiac procedures required AP. Appropriate drug and dosage regimen were used in 20 surgeries (57.1%). It was not correct in the remaining 15 surgeries: Appropriate dose was not used in one patient (2.9%). Appropriate dosage regimen was not used in 12 patients (34.3%). Appropriate drug was not used in two patients (5.7%). Antibiotic dose administration was registered in electronic CH in 34 cases (97.1%), however one case was not registered on the surgical sheet. Antibiotic dose timing was registered in CH in 32 cases (91.4%), but it was not registered on the surgical sheet in all the cases. It was observed that dose timing was incorrect in 10 patients (28.6%) (AP was administered less than 30 min before the beginning of the surgical procedure in nine cases and it was administered later in one case). The surgery lasted more than 3 hours in 18 cases. A second intraoperative antibiotic dose was used and registered in all cases. All patients discontinued AP within 48 hours after the end of the surgery. Conclusion A high compliance with the process measures was observed in the dosage registration and discontinuation of perioperative AP. Meanwhile, a poor compliance in the correct selection of AP (dosage regimen) and dose timing were noticed. It is necessary for an intervention to improve non-compliance rates. Some corrective measures are proposed such as stressing the importance of administering the first dose of antibiotic 30 min before surgical incision, using the dosage regimen according to the surgical procedure and registering AP on the surgical sheet. No conflict of interest