Perioperatif Antimikrobiyal Profilaksi Uygulamalarında Rehberlere Uyum: Çok Merkezli Bir Çalışma

Year 2017, Volume: 22 Issue: 1, 8 - 15, 30.12.2016

Funda Koçak İlker İnanç Balkan , Aygül Doğan Çelik Bülent Durdu Aslıhan Demirel , Serap Gençer , Hava Yılmaz Fatma Ekşi Polat Bahri Teker Aziz Öğütlü Aynur Engin , Alper Şener Mesut Yılmaz Serpil Öztürk Özkan İlknur Esen Yıldız Derya Öztürk Engin Muhammed Emin Doğan Oğuz Karabay

https://doi.org/10.21673/anadoluklin.268873

Cited By: 1

Abstract

Amaç:
Perioperatif Antimikrobiyal Profilaksi (PAP) uygulamalarında güncel rehberlere
uyum oranlarını ve bu oranı etkileyen faktörleri belirlemek.

Gereç
ve Yöntemler: Çoktan
seçmeli ve açık uçlu 40 soruluk anket hazırlanarak farklı branşlardan
cerrahlara bire-bir görüşme yöntemiyle uygulandı. Anket çıktıları uygun
istatistiksel yöntemlerle analiz edildi.

Bulgular: 30
Mayıs - 30 Haziran 2013 tarihleri arasında 15 farklı merkezde uygulanan ankete yedi
farklı branştan 410 cerrah katıldı. Ortalama yaş 38,01±9.1, %83.4’ü erkek idi. Ankete
katılan cerrahların %46.2’si "kurumlarında cerrahi profilaksi rehberi
varlığı hakkında bilgisi olmadığını", %34’ü ise "rehberin bulunduğunu
ve profilaksi uygulamalarının rehbere uygun olduğunu" belirtti. Ankete
katılan cerrahların %56.1’inin kurum içinde cerrahi profilaksi konusunda herhangi
bir eğitim toplantısına katılmadığı, son üç yıl içinde cerrahi profilaksi
eğitimi alanlarda rehbere uyumun istatistiksel olarak daha yüksek olduğu
belirlendi (p <0.001). Kardiyovasküler cerrahlarda uyum diğer cerrahi
branşlara göre anlamlı olarak daha yüksek saptandı (p=0.012). Profilaksi süresi
katılımcıların % 56’sında 24 saatten uzun idi. Dren kullanılan girişimlerde
cerrahların %63.7’sinin cerrahi profilaksiyi dren çekildikten sonra
sonlandırdığı belirlendi. Ürologların 2. kuşak ve 3. kuşak sefalosporinleri
anlamlı olarak (p<0.001, p=0.002) daha sık kullandığı belirlendi.
Cerrahların %87,6’sı cerrahi profilakside kullanılan antibiyotikte rotasyonel
değişiklik yapmadığını ifade etti. Merkezlerin %33’ünde 24 saat enfeksiyon
konsültasyonu ve mikrobiyoloji laboratuvarı olanağı bulunmadığı belirtildi. “Cerrahi
profilaksi rehberlerine uyumu engelleyen en önemli nedenler nelerdir?” sorusu
%50 oranında yanıtsız bırakıldı. En önemli nedenler; “çalışılan kurumdaki
hastane enfeksiyonları ve etken mikroorganizmalar hakkında düzenli bilgi
verilmemesi” (%30), "profilaktik ilacın sağlık personeli tarafından
planlanan zaman ve dozda uygulanmaması" (%27) ve "kurum içi PAP
rehberinin hekim tarafından yetersiz bulunması" (%17) şeklinde belirlendi. 

Tartışma ve Sonuç: Kanıta dayalı
PAP uygulamalarının yerleşebilmesi için bilimsel rehberler ve kurum içi
kılavuzların varlığı kadar bu kılavuzların hazırlık aşamasında cerrahi
birimlerin etkin katılımı, düzenli eğitim ve geri bildirim toplantıları ile
branşlar arası aktif iletişimin mutlaka sürdürülmesi de son derece önemlidir.

Keywords

Perioperatif, antimikrobiyal, profilaksi

Compliance with Guidelines for Practices of Perioperative Antimicrobial Prophylaxis: A Multicenter Survey

Abstract

Aim: We aimed to determine the rates of compliance with current guidelines for practices of
perioperative antimicrobial prophylaxis (PAP) and the factors affecting these rates.

Materials and Methods: Four hundred and ten surgeons from seven different branches attended
the survey conducted between May 30 and June 30, 2013, in fifteen different centers. A 40-question questionnaire consisting of multiple choice and open-ended questions was prepared and applied by interviewing
the surgeons.

Results: The mean age was 38.01 ± 9.1 years; and 83.4% of the participants were male. Of the surveyed surgeons 46.2%
stated that they had no information about the existence of any guidelines for surgical prophylaxis in their institutions and 34%
stated that institutional guidelines were available and their prophylaxis practices were in accordance with them. Surgeons
who were trained on surgical prophylaxis within the last three years were found to have a statistically higher (p<0.001) rate
of compliance with the guidelines. Compared to surgeons from other branches, compliance rates in cardiovascular surgeons
were statistically significantly higher (p=0.012). The duration of prophylaxis applied was longer than 24 hours in 56% of the
participants. In procedures involving drains, 63.7% of the surgeons stated that they preferred to terminate surgical prophylaxis
after removing the drainage tube. It was found that urologists used second and third generation cephalosporins statistically
significantly more frequently (p<0.001; p=0.002). Of the surgeons 87.6% stated that they did not rotationally change the
antibiotics they used for surgical prophylaxis. It was found that 33% of the centers did not have 24-hour infection consultation
and microbiology laboratory facilities. The question “What are the most important reasons for failure in compliance with
surgical prophylaxis guidelines?” was left unanswered by 50% of the participants. The most important reasons of incompliance
were found to be “lack of regular feedback about hospital infections and the pathogenic microorganisms” (30%), “failure
in application of the prophylactic agent in accordance with the timing and dosing determined by the healthcare personnel”
(27%), and physicians’ view that institutional PAP guidelines were insufficient (17%).

Discussion and Conclusion: Besides the existence of institutional guidelines for the establishment of evidence-based PAP
practices, it is also crucial to provide active participation of surgical healthcare units in the preparation of these guidelines
and to maintain regular training and feedback meetings and active communication between medical branches.

Keywords

perioperative, antimicrobia, prophylaxis

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