Surgical antibiotic prophylaxis at - PowerPoint Presentation

Slide1

Surgical antibiotic prophylaxis at Moi Teaching & Referral Hospital

Rose Kakai

1

, Barrack Ayumba

2

,

Damaris

Lagat

2

,

Eveline

Wesangula

3

, Sam Kariuki

4

1

Maseno University,

2

Moi University,

3

Ministry of Health

4

Kenya Medical Research InstituteSlide2

Introduction

Worldwide, over 230m operations performed annually

SSIs one of the most important causes of healthcare associated infections

SSI is an infection occurring at the operation site within 30

dys

of the procedure

In GARP-Kenya situation analysis

(2011)

, hospital antibiotic use was one of the critically important areas of policy action

Rationale is, in order to control AMR in hospitals, the most important steps are to reduce and rationalize hospital prescribingSlide3

Introduction --------

Why give pre-operative antibiotics?

The operation is the major period of bacterial contamination of the site

There is a strong evidence base for single dose from

Experimental (animal) studies

Clinical research in East Africa

International research + recommendations

National Clinical Guidelines recommend itSlide4

Introduction --------

Potential benefits of single dose

regimen

Reduce

rate of wound infections

Reduce costs to pts + hospital

Reduce overall usage of

antibiotics cf. R

Better injection safety

Less nursing time giving antibiotics in wardsSlide5

Introduction --------

Statement of the problem:

Surgical prophylaxis is beneficial in prevention of SSIs

identified as one of the areas where antibiotics are often overused

Objective:

To rationalize use of surgical AP at MTRH

Specific objectives:

Determine:

Use

of antibiotics in surgical pts

Rate of SSI

Pathogens

AMR in

pts with SSI

Outcome measure:

Proportion of pts receiving rational (correctly timed and dosed) APSlide6

Methods

Study site:

MTRH surgical patients

Design:

L

ongitudinal

observational

study

Inclusion criteria:

Surgical wound class I (clean) and II (clean/contaminated)

Dependent variable:

Pre-operative single dose regimen

Independent variables:

Use of antibiotics in surgical pts, Rate of SSI, Pathogens and

AMR in

pts with SSI

Limitation:

Failure to follow up and detect post operative infections after pts were discharged

Ethical consideration:

Approval obtained from IRECSlide7

Methods -- Data collection procedure

First seminar

for planning

Immediately after ethical and other relevant

approvals

Review of:

research findings

Kenya national clinical guidelines (2009)

Kenya national IPC guidelines (2010)

Experiences of other hospitals e.g.

Thika

Level 5

(June 2010 – Feb 2011)

Show strong evidence to support pre-operative single-dose (AP), using similar antibiotics

Agreed that there was need for locally appropriate AP policy at MTRH, hence

develop a

process chart

and

drug regime

for the proposed policy

Process chart describes; r

responsibilities’ for different hospital staff, materials needed and sequence of events

Collection of lab and bio data from date of 1

st

seminar to end of study is ongoing to monitor

antibiotic use, changes in SSIs,

pathogens and resistance

ratesSlide8
Slide9
Slide10

Methods -- Data collection procedure

Second seminar

for Planning

2 months after 1

st

seminar

Process chart and drug regime drafts presented and discussed

Main drug for AP is

Ampicillin

b

ecause it

Has good bacterial coverage

Is (relatively) cheap

Has no major side-effects or interactions

Is safe in high doses

Formal application to

Hospital Director

requesting approval to implement use of the proposed process chart and drug regime

Approval granted to proceed with the implementation and it is ongoingSlide11

Methods -- Data collection procedure

Third seminar

for Monitoring and Evaluation

Expected to be held 11 months after implementation of proposed surgical AP policy

To evaluate effects of the change in the policy with regard to;

Use of antibiotics in surgical pts

Rate of SSI

Pathogens

AMR

in pts with SSISlide12

Methods -- Data collection procedure

Fourth final seminar

for Sustainability

3 months write up

Discuss:

Final

results and challenges

Hence long term sustainability of the policySlide13

Preliminary resultsTotal of 446 surgical pts sampled

160 (58.35) females

193 (43%) aged 40 – 65 yrs old

Most common surgeries were 164 (36.8%) general and 147 (32.9%) CS

SSI reported in 8 (1.8%) pts

Post operative AP prescribed for 136 (30.5%) pts ranging from 3 – 5 days duration

Inconsistent access to

ampicillinSlide14

Conclusion

Pre-operative single dose beneficial

Main

challenges

Drug stock outs

Prescription of post-operative antibioticsSlide15

RecommendationMeasures e.g. CME on AMR aimed at rational use of surgical prophylactic drugs is necessary

to strengthen sustainable practices regarding APSlide16

AcknowledgementRamanan

Laxminarayan

, CDDEP

Thank

you