Monitoring of surgical antibiotic prophylaxis brings results

An initiative to ensure that all patients undergoing hip and knee procedures at Auckland City Hospital are given the correct amount of prophylactic antibiotics during surgery has had excellent results.

As part of the Health Quality & Safety Commission Surgical Site Infection Improvement (SSII) Programme that began in March this year, the Infection Prevention and Control (IPC) team at Auckland District Health Board (DHB) began collecting data on hip and knee joint replacements. One component of the data collected was around surgical antimicrobial prophylaxis. Cefazolin is administered before the operation to reduce the risk of surgical site infection (SSI).

It is recommended that two grams of Cefazolin are given for orthopaedic surgery, regardless of the patient’s age or weight. The Cefazolin should be given 0-60 minutes before ‘knife to skin’ to ensure that the antibiotic concentration in the tissue is maximal when the surgical incision is made.

Reducing harm from SSIs is a focus area for the Northern region patient safety campaign, First, Do No Harm, and the national patient safety campaign, Open for better care, which is being coordinated nationally by the Health Quality & Safety Commission. First, Do No Harm and Open for better care are working together to reduce patient harm in the Northern region.

When IPC nurse specialists began collecting data at the beginning of the programme, they discovered some patients were being given only one gram of Cefazolin.

Dr Sally Roberts, clinical head of microbiology at the DHB and clinical lead of infection prevention and control at the Commission, shared the results soon after the data collection began with Dr Charles Bradfield, clinical director adult anaesthesia, with the aim of ensuring all patients received the recommended two grams.

IPC nurse Camilla McGuinness says the team has since provided monthly feedback on the number of patients who received one gram of Cefazolin and those who received two grams. More patients are now receiving two grams of the antibiotic.

“We’re now close to having every patient given the recommended two grams of Cefazolin,” she says. The team is also monitoring other data on hip and knee replacement surgery in the DHB, including the use of skin antisepsis.