Continuing Medical Education and Its Application to Timing of Perioperative
Antibiotic Prophylaxis
Claude D. Brunson MD*, Jun Pan MD*, Wanda J Keahey PharmD†, Hui Han MD‡, Stephen Tafor MD†, Derek Marshall MD*
*Department of Anesthesiology, †Department of Pharmacy; ‡Department of Medicine, University of Mississippi Medical Center

Study Objective: To assess the timing of perioperative antibiotic prophylaxis (PAP) for surgical procedures before and after an intervention program.
Design: A prospective study design in which a random sample of 87 patients in 1994 in the preintervention phase were reviewed. A comparative sample of 562 patients from 1995 through 2003 was selected. For each prophylactic course, PAP details were classified as early (>2 h prior to incision), on time (0-2 h prior), delayed (0-3 h after), or late (>3 after). To determine the impact of intervention on the timing of PAP, logistic regression model was used. Three conditions before and after intervention were analyzed: early, on time, and delayed
Setting: 722-bed teaching hospital
Patients: 739 randomly selected patients who received PAP.
Interventions: Education of all members of surgical services, and the subsequent implementation of new protocols of PAP were administered in the preoperative holding area.
Measurements: The use of PAP in surgical patients were tracked by using survey techniques
Results: In the preintervention phase, 80.5% of PAP courses were on time, 16.1% were early, and 3.4% were delayed. The incidence of on-time prophylaxis increased to 97.4% during the postintervention phase (p<0.01), which the incidence of early and delayed decreased to 1.5% (p<0.01) and 1.1% (p<0.05), respectively. There was no patient that received PAP late in both groups.
Conclusion: This study demonstrates that by specifically targeting members of the Department of Anesthesiology as a part of the perioperative management of patients, there was a significant improvement of the timing of PAP.

For the administration of antibiotics, “early” denotes 2 to 24 hours before the incision, “on time” 0 to 2 hours before the incision, “delayed” within 3 hours after the incision, and “late” more than 3 hours after the incision.

Figure 1. Distribution of patients (%) for whom the time from completion of antibiotic infusion to surgical incision was on time. Intervention: education program and switching of protocol.

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