الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Resources in the health care system are limited, and it is important to maximize the health benefits to patients within the resources available. It’s important as the demand for services grows and the costs associated with treatment increase. Economics involve the measurement of costs for alternative interventions, the determination of the benefits associated with the interventions, and the subsequent combination of these costs and benefits despite modern surgical techniquesand the use of antibiotic prophylaxis, surgical site infection (SSI) is one of the most common complications encountered in surgery.
Infections are often associated with significant morbidity, mortality, increased length of hospital stay and costs. Antibiotic prophylaxis is one of the preventive measures for SSIs recommended by current guidelines. The important elements of antibiotic prophylaxis: the selection of an antibiotic regimen, timing of administration, and duration of prophylaxis, are still not well established, and hospital compliance to these preventive recommendations is not routinely followed in most institutions of low- and middle-income countries. Surgeons continue to give additional doses of antibiotics after surgery, if the patient is believed to be at a high risk of SSI. On the other hand, the prolonged use of antibiotics increase the antibiotic-resistant infections, exposes patients to more adverse drug reactions, and increases overall health care costs.Implementation of guidelines yields improvements in antibiotic use and the cost of surgical prophylaxis.This study was done to conduct Cost Effectiveness Analysis of antibiotic use for prophylaxis of surgical site infections, and to assess the impact of clinical pharmacy team interventions.
This study was an interventional study at one of the Ministry of Health hospitals in Egypt that was carried out in two phases, pre intervention phase that includes 285 patients in the clean surgery department in the period from January 2015 till June 2015 and post intervention phase that was in the period from July 2015 till December 2015(sample size was calculated using G power software at alpha of 0.05 and power 80%), the two phases were separated by intervention that includes a settlement of a local protocol audited from International guidelines, lectures were given by the clinical pharmacy team in the hospital where some recommendations were made concerning every member in the setting staff. Data needed for calculation of the cost of antibiotics, were collected from ministry of health tender. The results were statistically analyzed by SPSS program version 21.
The cases collected were 570 patients from the two phases(285 patient in each phase). The number of patients received antibiotics before the surgical procedure was significantly reduced by 20.7 % after implementation of intervention (p=0.001).The proper use of antibiotics during surgeries (60 minutes before the surgery time) was significantly increased by 22.8 % (p=0.001), the right antibiotic choice (first generation cephalosporins) was significantlyincreased by 4.4% (p=0.001).The proper duration of antibiotics use pattern after surgery (for the first 24 hours) was significantly increased by 47.3% (p=0.001).
Cost of Antibiotics used before the operation was significantly lower in the post intervention group than the pre intervention group (3.9± 17.5versus 13.2 ± 27.9 LE) (p<0.005).Cost of Antibiotics used during the operation has increased in the group of post intervention than the pre intervention group (mean 15 ± 12.3 versus 8.2± 11), (p<0.005).Cost of Antibiotics used after the operation was significantly reduced in the post intervention group than the pre intervention group (62.8± 75.9versus67.4±80.9), (p<0.005).
The group of pre intervention was at risk 9 times more than those of post intervention group for SSI (CI 95%=1.1– 73.5).The SSI cases were 10, 70% of them in the PM shift and 30% in AM shift (p<0.005).
from the study we can conclude that the intervention of the clinical pharmacy team has minimized the cost of antibiotics and assured adequate type of antibiotics used, consequentially it is expected that the resistance for broad spectrum antimicrobials will decrease, surgical site infection rate also has decreased, and the commitment of the physicians to the guidelines has increased,with the following recommendations:
1) Established guidelines must be continued to get a more sustained effect and the physician to be committed to those guidelines, anti biogram and cultures follow up must be done to know the pattern of the resistance to antibiotics.
2) check list made by the clinical pharmacy should be attached to the operation sheet to confirm proper use of antibiotic given
3) The cost of treatment of a surgical site infection must be calculated and integrated in cost effectiveness evaluation.
4) Third phase must be conducted to evaluate the constancy of physician’s attitude in antibiotic prescription.
5) A clinical pharmacy opinion must be provided during shifts other than morning as to evaluate the usage of antibiotics and consequently reduction of resistance pattern.