Compliance with a new quality standard regarding administration of prophylactic antibiotics before cesarean section

Abstract

Objective

Administering prophylactic antibiotics before cesarean section (CS) decreases postpartum infections significantly. They should be administered within 60 min prior to CS. In 2014 the Israeli Ministry of Health introduced the administration of pre-operative antibiotic prophylaxis for CS as a quality criterion. This was immediately adopted by the Galilee Medical Center (GMC). This study aimed to examine the compliance to this quality standard in the GMC under 3 criteria: the type of antibiotics, timing of administration, and use of one dose only.

Study design

Data of women who underwent CS from the day of introducing the new quality standard on January 1, 2014, to July 31, 2015, were retrospectively analyzed.

Results

The study included 1790 women who delivered by elective (24.4%) or emergency CS. In general, the medical staff’s compliance to this quality standard was 90.9; 95.6% of the patients received the correct antibiotic, 94.6% had it within 65 min before surgery to 5 min after it, and 100% received it in less than 24 h. There was an increase in the overall compliance rate with time (logistic regression, p = .001). During the day shift, 60.4% of CS were emergency surgeries while during the on-call shift (evening and night) almost all (99%) of the CS were emergencies (p < .001, 2-sided). In morning shift’s emergency CS, only 4.1% of the cases were not given prophylactic antibiotics as against 7.8% in the on-call shift (p = .005).

Conclusion

Over a period of 18 months, the compliance to the new quality standard of administering prophylactic antibiotics before CS was 90.9%. It was particularly high in the subgroup of elective CS during the morning shift. This high compliance rate may be attributed to the introduction of clear guidelines and assignment of a specific team member, the anesthesiologist, to administer the medication.

Key points

1. Compliance rate to the guideline was 90.9%.

2. Compliance was better in the morning shift.

3. Compliance was better for elective cesarean section.

4. Compliance was not affected by time.

Keywords:

• Prophylactic antibiotics
• Cesarean section
• post-partum infections
• pre-operative antibiotic

Acknowledgment

The authors wish to thank Mrs. Orly Yakir, MA, for assistance with the statistic evaluation of the findings.

Disclosure statement

No potential conflict of interest was reported by the author(s).