Improvement of intraoperative antibiotic prophylaxis in prolonged cardiac surgery by automated alerts in the operating room

Infect Control Hosp Epidemiol. 2003 Jan;24(1):13-6. doi: 10.1086/502109.


Objective: To assess the impact of an automated intraoperative alert to redose prophylactic antibiotics in prolonged cardiac operations.

Design: Randomized, controlled, evaluator-blinded trial.

Setting: University-affiliated hospital.

Patients: Patients undergoing cardiac surgery that lasted more than 4 hours after the preoperative administration of cefazolin, unless they were receiving therapeutic antibiotics at the time of surgery.

Intervention: Randomization to an audible and visual reminder on the operating room computer console at 225 minutes after the administration of preoperative antibiotics (reminder group, n = 137) or control (n = 136). After another 30 minutes, the circulating nurse was required to indicate whether a follow-up dose of antibiotics had been administered.

Results: Intraoperative redosing was significantly more frequent in the reminder group (93 of 137; 68%) than in the control group (55 of 136; 40%) (adjusted odds ratio, 3.31; 95% confidence interval, 1.97 to 5.56; P < .0001). The impact of the reminder was even greater when compared with the 6 months preceding the study period (129 of 480; 27%; P < .001), suggesting some spillover effect on the control group. Redosing was formally declined for 19 of the 44 patients in the reminder group without redosing. The rate of surgical-site infection in the reminder group (5 of 137; 4%) was similar to that in the control group (8 of 136; 6%; P = .42), but significantly lower than that in the pre-study period (48 of 480; 10%; P = .02).

Conclusion: The use of an automatic reminder system in the operating room improved compliance with guidelines on perioperative antibiotic prophylaxis.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antibiotic Prophylaxis*
  • Automation*
  • Cardiovascular Surgical Procedures / adverse effects*
  • Drug Administration Schedule
  • Guideline Adherence*
  • Humans
  • Intraoperative Care
  • Odds Ratio
  • Quality Assurance, Health Care
  • Reminder Systems*
  • Single-Blind Method
  • Surgical Wound Infection / prevention & control*