Surgical Antimicrobial Prophylaxis in the Netherlands Symposium/Gyssens Inge.pdfSurgical...

Surgical Antimicrobial Prophylaxisin the Netherlands

Inge C. Gyssens

Healthcare Budget system inDutch hospitals

introduced in 1983

budgets originally based on consumption ofresources of the previous year

the government has limited hospital costs inan external budget

drug costs for inpatients generate norevenues

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Complete Evaluation of Surgical Prophylaxisin University Hospital N, 1992

Beforeintervention

After intervention

Number of operations 258 262

Prophylaxis administered 31% 37%

Prophylaxis incorrect 23% 5%

Duration > 24 hours 25% 1%

Single Dose 20% 78%

Timing optimal 34% 62%

Gyssens et al. JAC 1996;38:1001-12

Gyssens et al. JAC 1996;

University Hospital N1992

Intervention onTiming of Prophylaxis

Dutch Working Party on Antibiotic Policywww.swab.nl

cefazolin 1g (+ metronidazole)

single dose

within 30 min before incision

Surgical prophylaxis (national guideline 2000)

U se o f F irst G eneratio n C ep halospo rins D D D /100 p atien t d ays

E rasm u s M C , 1999-2002

0

5

10

15

20

25

30

35

40

45

okt-99

dec-99

feb-00

apr-00

jun-00

aug-00

okt-00

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feb-01

apr-01

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dec-01

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jun-02

M edical Services Surgical Services

Cefazolin is restricted to prophylactic use insurgery in University Hospital R, 2001

department cefazolin use (g) %operating theatres 4266 64postop ICU 1507 23surgical wards 716 10medical wards 208 3total 6697 100

Use of cephalosporins in surgical departmentsUniversity Hospital R, DDD/100 patient days

05

1015202530354045

okt-9

9jan

-00ap

r-00

jul-00

okt-0

0jan

-01ap

r-01

jul-01

okt-0

1jan

-02ap

r-02

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sec. gencephalosporins

first gencephalosporins(SMOOTH)sec. gencephalosporins(SMOOTH)first generationcephalosporinsL

Intervention study on Surgical Prophylaxis The CHIPS study in The Netherlands

EDUCATIONAL INTERVENTION:• feedback of quality-of-use review• national guidelines:

• support of outcome data:surgical wound infections SSI

Postoperative wound infections (SSI)

CHIPSCHIPSn = 13hospitals n = 63

hospitals

CHIPS pre-intervention: 1763 procedures

Elective procedures for which prophylaxis is indicated

•clean: total hip implantation n = 1114 reconstruction of the aorta

femoropopliteal bypass•clean contaminated: vaginal hysterectomy

n = 649 abdominal hysterectomy colon resection and low-anterior resection

0%10%

20%30%

40%50%60%

70%80%

90%100%

efficacy

toxicity

costs

spectrum

therapeuticuse

Correct choice ofagentAlternative agentmore appropriate

CHIPS pre-intervention 2000, Choice of agent

Intestinalsurgery

Gynaecologicalsurgery

Orthopedicsurgery

Vascularsurgery

correct

too long

too short

Durationof Prophylaxis

92%

81%

98%

87%87%

CHIPSpre-intervention2000

timing optimaltiming suboptim.timing too latetiming too early 50%

22%

CHIPS pre-intervention 2000, Timing

27%

Timing in prophylaxis is the Achilles heel

CHIPS pre-intervention: Timing of prophylaxis

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orthopedicsurgery

vascularsurgery

gynaecologicalsurgery

intestinalsurgery

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correct

n = 890 n = 158 n = 350 n = 221

Conclusion:

There seems to be no majoroverconsumption of surgical prophylaxis inthe Netherlands

Where indicated, prophylaxis is virtually notomitted

Quality of surgical prophylaxis in theNetherlands is favourable, but there is stillroom for improvement

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