Evidence-based guidelines for perioperative antimicrobial prophylaxis (PAP) are well established. It is unknown whether PAP practice in Gaza Strip hospitals follows those guidelines. This study aimed to assess the adherence of PAP practice at surgical wards in Gaza Strip hospitals to the American Society of Health-System Pharmacists (ASHP) guidelines for antimicrobial surgical prophylaxis. Data were collected over a 6-month period by direct observation and chart review methods. Aspects of PAP (indication, selection, duration, dosing, and first dose timing) were assessed against ASHP guidelines. The study enrolled 444 surgical patients, of whom 94.8% received PAP. The overall adherence rate was 7.4%. Adherence rates for indication, selection, dosing, the timing of the first dose, and duration were 70.7%, 56.3%, 17.7%, 59%, and 58%, respectively. Patients who underwent clean surgeries were less likely to be given the recommended antibiotic than those who underwent clean-contaminated surgeries (OR 0.480, 95% CI 0.375–0.615, p-value 0.021). Nurses were less likely to adhere to the right first dose timing than anesthesiologists (OR 0.132, 95% CI 0.051–0.374, p-value 0.011). This study showed poor adherence to guidelines in all aspects of PAP use, particularly dosing. Strategies to improve PAP practice should be adopted and implemented.
Key words: Adherence, perioperative antibiotic prophylaxis, guidelines, Gaza Strip, Palestine
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