To The Editor:
We read with interest the article “Ensuring Appropriate Timing of
Antimicrobial Prophylaxis”(1).
Despite promulgation of appropriate guidelines, proper antibiotic timing is still
thwarted by substantial obstacles that include individual values, professional
conflicts, and organizational conflicts. These factors must be addressed in order
to achieve optimal practice in this domain(2).
Intensive educational effort
using group interviews and resource crew management principles have been shown to improve
communication among surgeons, anesthetists, and operating room
personnel(2,3). Interventions for improvement included reinforcement of use
of preoperative antibiotic order forms, eliminating administration of
antibiotics in the preoperative admission area, and sending appropriate
antibiotics and IV tubing with the patient to the operating room(4).
Completion of the pre-operative checklist and surgical timeout protocol by the OR nurse
is an innovative approach to ensure compliance in
antibiotic prophylaxis timing by non physician personnel.
The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
References:
1. Rosenberg AD, Wambold D, Kraemer L, Begley-Keyes M, Zuckerman SL, Singh N, Cohen MM, Bennett MV. Ensuring appropriate timing of a ntimicrobial prophylaxis. J Bone Joint Surg Am. 2008;90:226-232.
2. Tan JA, Naik VN, Lingard L. Exploring obstacles to proper timing
of prophylactic antibiotics for surgical site infections Quality and
Safety in Health Care 2006;15:32-38.
3. Awad SS, Fagan SP, Bellows C, et al. Bridging the communication gap in
the operating room with medical team training. Am J Surg 2005;190:770–4.
4. Parker BM, Henderson MJ, Vitagliano S et al. Six sigma methodology can
be used to improve adherence for antibiotic prophylaxis in patients
undergoing noncardiac surgery. Anesth Analg 2007;104:140-146
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