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de Vries et al. Patient Safety in Surgery 2010, 4:6 http://www.pssjournal.com/content/4/1/6


Open Access

The SURgical PAtient Safety System (SURPASS) checklist optimizes timing of antibiotic prophylaxis
Eefje N de Vries1,2, Lucia Dijkstra1,2, Susanne M Smorenburg2, R Peter Meijer3 and Marja A Boermeester*1

Abstract Background: Surgical site infection (SSI) is anadverse event in which a close relation between process of care and outcome has been demonstrated: administration of antibiotic prophylaxis decreases the risk of SSI. In our tertiary referral centre, a SURgical PAtient Safety System (SURPASS) checklist was developed and implemented. This multidisciplinary checklist covers the entire surgical pathway and includes, among other items, administration ofantibiotic prophylaxis before induction of anaesthesia. The aim of this study was to determine the effect of SURPASS implementation on timing of antibiotic prophylaxis. Methods: A retrospective analysis was performed on two cohorts of patients: one cohort of surgical patients that underwent surgery before implementation of the checklist and a comparable cohort after implementation. The intervalbetween administration of antibiotic prophylaxis and incision was compared between the two cohorts. Results: A total of 772 surgical procedures were included. More than half of procedures were gastro-intestinal; others were vascular, trauma and hernia repair procedures. After implementation, the checklist was used in 81.4% of procedures. The interval between administration of antibiotic prophylaxisand incision increased from 23.9 minutes before implementation of SURPASS to 29.9 minutes after implementation (p = 0.047). In procedures where the checklist was used, the interval increased to 32.9 minutes (p = 0.004). The proportion of patients that did not receive antibiotics until after the incision decreased significantly. Conclusion: The use of the SURPASS checklist leads to bettercompliance with regard to the timing of antibiotic prophylaxis administration. Introduction Surgical site infection (SSI) is a common complication of surgery: reported incidence rates range from 2% to 20%, the variation largely depending on case mix [1-3]. SSIs are a major cause of morbidity, mortality and healthcare costs [4-6]. While in many adverse events, the connection between process of care andoutcome is hard to define, this is not the case with SSI. Among many process measures that decrease SSI rates, the effect of preoperative administration of antibiotic prophylaxis (AP) has been demonstrated most extensively [7-10]. Much has been written about the optimal time frame of AP. Studies suggest that AP administration should be as close to the incision as possible, while agreeing that sometime must be allowed for adequate tissue concentration
* Correspondence: m.a.boermeester@amc.uva.nl

Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands
Full list of author information is available at the end of the article

to be built up [11-13]. In 1992, Classen et al showed that the greatest risk reduction for SSI occurred when antibiotics were administered withintwo hours before the incision, as opposed to administration after incision or more than two hours prior to the incision [14]. Since then, a number of studies have been published that attempted to further define this interval [15-18]. A recent publication by Weber et al included 3,836 general surgical procedures; the greatest risk reduction occurred when antibiotics were administered between 30 and60 minutes prior to the incision [18]. In contrast, a study by Steinberg et al, including 4,472 cardiac, orthopaedic and gynaecological patients, showed that the risk of SSI was lowest when antibiotics were administered within the final 30 minutes pre-incision, a difference that did not reach statistical significance [16]. Most guidelines recommend administration within one to two hours of...
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