30 Jun 2015 | Health Quality Intelligence
The Health Quality & Safety Commission’s newest Atlas of Healthcare Variation domain offers a look into the rate of infection and community antibiotic use after surgery.
This Atlas raises interesting questions as to whether rates of antibiotic use following surgery are a possible area for quality improvement.
While 34 percent of New Zealand patients were prescribed an antibiotic in the community within 30 days of a major surgery in a public hospital, the rate of recorded infections in hospital inpatients was just 2.6 percent. Of those given antibiotics, almost half were dispensed antibiotics on the same or next day of discharge following surgery. This varied 1.6 fold between DHBs from 25 to 42 percent of patients.
“These findings are surprising. In the first instance, we need to take a closer look at these data,” says Clinical Lead for the Commission’s Infection Prevention and Control programme Dr Sally Roberts.
As might be expected due to a higher risk of infection, antibiotic dispensing rates were slightly higher following acute surgery (37.1 percent) than elective procedures (31 percent).
“The most common complication following surgery is infection,” says Dr Roberts. “Post-operative sepsis is at the more severe end of the scale as an example of this.”
Post-operative sepsis is a serious complication of surgery, which occurred in 1.2 percent of surgeries. There was limited variation between DHBs. The latest report of the Perioperative Mortality Review Committee found that 80 percent of mortality related to sepsis occurred in acute admissions.
For elective surgery, a single pre-operative dose of antibiotics 0 – 60 minutes before knife to skin procedures is recommended. It is not best practice for antibiotics to be administered routinely post-operatively.
More analysis is needed to understand these findings; for example, how many of the prescriptions were for infections unrelated to surgery; how many were hospital as opposed to primary care driven; and how many antibiotics were prescribed as a precaution but not used by the patient.
“Countries with a high rate of prescribing antibiotics also have a high rate of antimicrobial resistance,” says Dr Roberts.
“There is increasing concern around the possibility of over-prescription in both the community and New Zealand hospitals.”
The Commission has a range of programmes to reduce healthcare associated infections, including improving hand hygiene, preventing central-line associated bloodstream infections and reducing surgical site infections.