An Evaluation of effectiveness of Antibiotic Prophylaxis Protocols for Pediatric Surgical Procedures in an Egyptian Teaching Hospital

Background: Postoperative wound infection is an infection in the tissues of the incision and operative area. It can occur from 1 day to many years after an operation but commonly occurs between the fifth and tenth days after surgery. Keeping in view the prevalence of the wound infections in our set up, this study was designed to evaluate the frequency, the antimicrobial prophylactic regimen, the hospital guidelines for surgical site infection prophylaxis and its adherence, to the internationally published guidelines. Patients and settings: An observational Prospective study is used to detect the prescription, dosage, administration, interactions, and errors of peri-operative antibiotics. The study proceeded at Ain Shams University hospitals, pediatric surgery department which consists of three units the ward, the ICU, and the operation unit. There is no pharmacy inside the unit. Drugs are dispensed weekly from the floor pharmacy to the nurse and stored in the stock cabinet. Hundred surgical pediatric patients (major and minor surgeries) were enrolled. Clinical information in physician’s orders, laboratory test results, physician’s progress notes, anesthesia reports were reviewed. Verbally communicated information from the parents about the medical history of patients was included. Medical records were screened for evidence of medication error and interactions occurrence taking into consideration that all the medication orders were handwritten. The data was obtained either directly from the patient, or by observations or from the patient’s file. The following data were recorded: gender, age, dates of admission, surgery and discharge. Results: The study results showed that 26 patients had acquired surgical site infections (26%).The infected cases are divided according to wound class as 4(8.9%) of the clean wound class, 13(39.4%) of the clean contaminated, 8(47.1%) of the contaminated wound class and 1(20%) of the dirty wound class have got surgical site infection. The adherence to the hospital protocol was 71% but 0% to the international protocols. Conclusion: Adherence to the international guidelines is recommended to minimize the high rate of surgical site infections. Hospital should follow the recommended doses, regimen, and drug choice. Physicians, pharmacists, and nurses must be revised their roles in minimizing the infection rate.