Outpatient Preoperative Prophylactic Antimicrobial Use and Surgical Site Infection Rates

Date
2019-07
Authors
Zima, Ashlie
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Abstract
In the United States, most postoperative orthopedic surgical site infections (SSIs) and prophylactic antimicrobial use research are hospital-based. However, 50% of the orthopedic procedures occur outpatient and postoperative SSI research is lacking (Berríos-Torres et al., 2017). Hospital-based preoperative prophylactic intravenous antibiotics administration supports decreased SSI rates (Al-Mulhim, Baragbah, Sadat-Ali, Alomran, & Azam, 2014). The research question posed was: For the adult patient undergoing an orthopedic surgical procedure at an outpatient facility, what is the effect of preoperative prophylactic antimicrobials on postoperative surgical site infection rates within the first 30-days? This descriptive study examined a convenience sample of adults, following an orthopedic procedure, administered a preoperative prophylactic intravenous antimicrobial for a postoperative SSI at an outpatient surgical facility. Guiding the research was Meleis’ transitions theory which examines the transitional experience throughout the surgical encounter to reduce associated risks (Omar, 2017). Of the 149 orthopedic cases reviewed between January 1, 2019-April 30, 2019, N = 103 patients met the inclusion criteria. The various intravenous antimicrobials and the doses administered were Cefazolin 1 gram, Cefazolin 2 grams, Clindamycin 600mg, Clindamycin 900mg, Vancomycin 1 gram, and Rocephin 1 gram. The study found 1 (0.01%) SSI documented for a patient administered Rocephin; significantly, 99.9% administered a preoperative prophylactic antimicrobial experienced no SSI within 30-days postoperatively. Future research recommendations include investigating the type, dose, and time of preoperative antibiotic administrations, and all surgical procedures performed at an outpatient surgical facility.
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Keywords
preoperative prophylactic antimicrobials, surgical site orthopedic infections
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