A new standard of care: administration of preoperative antibiotics in the operating room.

Surgical site infections increase total hospital expenses and extend the length of hospital stay. Properly administered antibiotics are successful in minimizing postoperative subcutaneous wound infection secondary to perioperative bacterial contamination at the surgical site and are effective in most clean-contaminated surgical procedures. It is imperative that therapeutic levels of antibiotics be present during the time when the wound is open to maximize their effect to prevent the development of surgical wound infections. Only 32 per cent of 97 patients sampled from 1992 to 1994 at the Louisville Veterans Affairs Medical Center were administered preoperative antibiotics within 1 hour prior to surgical incision. Changing the responsibility for preoperative antibiotic administration from ward or holding room nurses to the anesthesiologist in the operating room rendered such antibiotics delivered closer to the induction of anesthesia and subsequent incision. Eighty-eight per cent of 220 patients sampled in 1995 had antibiotics administered within 1 hour of incision. This change in institutional policy of antibiotic administration maximizes the likelihood of appropriate antibiotic tissue levels and thereby their potential efficacy. Routine prophylaxis should be administered as close to the time of induction of anesthesia as possible to provide the best chance for appropriate tissue levels above the minimum inhibitory concentration for potential bacterial contamination.