Evaluation of surgical prophylaxis practices

Health Care-Associated Infections (HAI) cause an increase in patient morbidity/mortality, prolongation of hospital stay, loss of workforce and productivity, cost increases, and an increase in antibiotics used and resistant microorganisms. Surgical site infections (SSI) are among the most common infections among HAIs and cause additional costs in healthcare facilities. Strategies, including surgical prophylaxis (SP), are available to prevent SSI. In this study, 1913 operations in General Surgery, Neurosurgery, Orthopedics and Traumatology Clinics between 11.08.2020-28.02.2021 were included and SP applications were evaluated and analyzed with SPSS statistical program. Significance was accepted as p<0.05 for all statistics. While the appropriateness of SP was determined on the basis of national and international guidelines, the antibiotic used specifically for the surgery, the administration of the antibiotic at the appropriate dose and at the appropriate time, and the continuation of the appropriate duration were considered as SP incompatibility, while all other cases were considered SP non-compliance. The mean age of the patients in the operations was 47.4±19.6 years and 50.2% of them were male. The inappropriate SP rate was determined as 73.9%, and the most common reason for non-compliance among 500 unsuitable operations was the continuation of postoperative prophylaxis, followed by prophylaxis given without an indication for prophylaxis, continuing the prophylaxis started with an appropriate antibiotic at the beginning with a different antibiotic postoperatively, Although there was an indication for inappropriate antibiotic use and prophylaxis at the beginning, the reasons for non-compliance were followed. A significant difference was found between the clinics in the Orthopedics and Traumatology Clinic, where the duration of SP was evaluated (p<0.001). Surgical prophylaxis applications lasting longer than 24 hours were not found to be significant in terms of SSI development (p=0.23). Inappropriate SP is a condition that may adversely affect factors such as mortality, morbidity, cost in the health institution, and antibiotic resistance status. In order to increase compliance, it is necessary to create a SP team to review local guidelines, to develop hospital-based specific electronic systems, and to increase efforts to establish continuous training and control programs.