Surgical antibiotic prophylaxis administration practices in a referral hospital in Nepal: how are we doing?

Abstract Setting: Dhulikhel Hospital, a referral hospital in Kavre, Nepal. Objectives: Among patients who underwent surgery in the department of general surgery (July-December 2019), to report on: 1) eligibility and ineligibility for initial and redosing of surgical antibiotic prophylaxis (SAP); 2) administration and non-administration of initial dose of SAP; 3) administration and non-administration of redosing of SAP in accordance with National Antibiotic Treatment Guidelines (NATG); and 4) development of surgical site infections (SSIs). Design: Retrospective cohort analysis. Results: 846 patients were included in the analysis. Of which 717(85%) patients were eligible for SAP, and 129(15%) were ineligible for any dose. Of those eligible, 708(99%) received initial dose; while 65(50%) who were ineligible did not receive any dose. Of those received initial dose, 164(23%) were eligible for redosing. Of which, only 23(14%) received it and 141(86%) did not receive it. Overall compliance with NATG was achieved in 75% (632/846) of patients. SSIs occurred in 23(3%) patients. Of which, SAP was administered according to NATG in 7(30%) patients. Conclusion: A relatively high overall compliance with NATG for SAP administration was observed. Recommendations were made to improve compliance among those who were ineligible for SAP and those who were eligible for redosing.