European Archives of Oto-Rhino-Laryngology

, Volume 265, Issue 9, pp 1109–1112 | Cite as

Using information technology to reduce the inappropriate use of surgical prophylactic antibiotic

  • Shih-An Liu
  • Yung-Tsung Chiu
  • Whe-Dar LinEmail author
  • Shu-Jan Chen


Despite implementation of practical guidelines, continuing education programs in our hospital, the percentage of inappropriate prophylactic antibiotic usage remains high. The aim of this study was to investigate whether information technology can reduce the misuse of surgical prophylactic antibiotic. We started physician continuing education programs in January 2005 and initiated feedback system in July 2005. The computerized reminder system was implemented in April 2006. Relevant data about the surgical prophylactic antibiotic usage were collected and was separated into three groups. Group 1 consisted of data from January 2005 to June 2005, while group 2 and group 3 consisted of data from July 2005 to March 2006 and April 2006 to December 2006, respectively. The percentage of no prophylactic antibiotic in clean procedures and the duration of prophylactic antibiotic in clean-contaminated procedures were recorded and analyzed. Furthermore, the surgical wound infection rates were also collected. In clean procedures, the percentage of no prophylactic antibiotic after surgery decreased in the long run. In parotidectomy, submandibular gland surgery and thyroidectomy patients, the percentage even reached 100% at the end of this study. In clean-contaminated procedures, the duration of prophylactic antibiotic after surgery was also reduced except in laryngectomized patients at the end of this study. Information technology such as feedback and reminder systems is an effective method to reduce inappropriate usage of surgical prophylactic antibiotic.


Information technology Prophylactic antibiotic Abuse Medical error Patient safety 



This study was supported by grants from Taichung Veterans General Hospital and Overseas Chinese Institute Technology (TCVGH-OCIT958403) Taichung, Taiwan, Republic of China. The authors have no potential conflict of interest in this research. The authors thank Ms Hui-Ching Ho for statistical consulting.


  1. 1.
    McDonald LC, Yu HT, Yin HC, Hsiung AC, Ho M; Antibiotic Use Working Group (2001) Use and abuse of surgical antibiotic prophylaxis in hospitals in Taiwan. J Formos Med Assoc 100:5–13PubMedGoogle Scholar
  2. 2.
    Ramsay C, Brown E, Hartman G, Davey P (2003) Room for improvement: a systemic review of the quality of evaluations of interventions to improve hospital antibiotic prescribing. J Antimicrob Chemother 52:764–771PubMedCrossRefGoogle Scholar
  3. 3.
    Davey P, Brown E, Fenelon L, Finch R, Gould I, Hartman G, Holmes A, Ramsay C, Taylor E, Wilcox M, Wiffen P (2005) Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev (4):CD003543 ReviewGoogle Scholar
  4. 4.
    Harrison JW, Svec TA (1998) The beginning of the end of the antibiotic era? Part I. The problem: abuse of the “miracle drugs”. Quintessence Int 29:151–162PubMedGoogle Scholar
  5. 5.
    Harrison JW, Svec TA (1998) The beginning of the end of the antibiotic era? Part II. Proposed solutions to antibiotic abuse. Quintessence Int 29:223–229PubMedGoogle Scholar
  6. 6.
    Kawamoto K, Houlihan CA, Balas EA, Lobach DF (2005) Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 330:765PubMedCrossRefGoogle Scholar
  7. 7.
    Guidelines for the use of prophylactic antibiotics in surgery in Taiwan. (2004) J Microbiol Immunol Infect 37:71–74Google Scholar
  8. 8.
    Knight R, Charbonneau P, Ratzer E, Zeren F, Haun W, Clark J (2001) Prophylactic antibiotics are not indicated in clean general surgery cases. Am J Surg 182:682–686PubMedCrossRefGoogle Scholar
  9. 9.
    Belongia EA, Schwartz B (1998) Strategies for promoting judicious use of antibiotics by doctors and patients. BMJ 317:668–671PubMedGoogle Scholar
  10. 10.
    Patel VL, Currie LM (2005) Clinical cognition and biomedical informatics: issues of patient safety. Int J Med Inform 74:869–885PubMedCrossRefGoogle Scholar
  11. 11.
    Sibley JC, Sackett DL, Neufeld V, Gerrard B, Rudnick KV, Fraser W (1982) A randomized trial of continuing medical education. N Engl J Med 306:511–515PubMedCrossRefGoogle Scholar
  12. 12.
    Lewis CE, Hassanein RS (1970) Continuing medical education—an epidemiologic evaluation. N Engl J Med 282:254–259PubMedCrossRefGoogle Scholar
  13. 13.
    Seven H, Sayin I, Turgut S (2004) Antibiotic prophylaxis in clean neck dissections. J Laryngol Otol 118:213–216PubMedCrossRefGoogle Scholar
  14. 14.
    Davis DA, Taylor-Vaisey A (1997) Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. CMAJ 157:408–416PubMedGoogle Scholar
  15. 15.
    Rodrigo JP, Alvarez JC, Gomez JR, Suarez C, Fernandez JA, Martinez JA (1997) Comparison of three prophylactic antibiotic regimens in clean-contaminated head and neck surgery. Head Neck 19:188–193PubMedCrossRefGoogle Scholar
  16. 16.
    Cloke DJ, Green JE, Khan AL, Hodgkinson PD, McLean NR (2004) Factors influencing the development of wound infection following free-flap reconstruction for intra-oral cancer. Br J Plast Surg 57:556–560PubMedCrossRefGoogle Scholar
  17. 17.
    Penel N, Fournier C, Lefebvre D, Lefebvre JL (2005) Multivariate analysis of risk factors for wound infection in head and neck squamous cell carcinoma surgery with opening of mucosa. Study of 260 surgical procedures. Oral Oncol 41:294–303PubMedCrossRefGoogle Scholar
  18. 18.
    Righi M, Manfredi R, Farneti G, Pasquini E, Cenacchi V (1996) Short-term versus long-term antimicrobial prophylaxis in oncologic head and neck surgery. Head Neck 18:399–404PubMedCrossRefGoogle Scholar
  19. 19.
    Carroll WR, Rosenstiel D, Fix JR, de la Torre J, Solomon JS, Brodish B, Rosenthal EL, Heinz T, Niwas S, Peters GE (2003) Three-dose vs extended-course clindamycin prophylaxis for free-flap reconstruction of the head and neck. Arch Otolaryngol Head Neck Surg 129:771–774PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Shih-An Liu
    • 1
    • 2
  • Yung-Tsung Chiu
    • 3
  • Whe-Dar Lin
    • 4
    Email author
  • Shu-Jan Chen
    • 4
  1. 1.Department of OtolaryngologyTaichung Veterans General HospitalTaichungTaiwan, ROC
  2. 2.Faculty of Medicine, School of MedicineNational Yang-Ming UniversityTaipeiTaiwan, ROC
  3. 3.Department of Education and ResearchTaichung Veterans General HospitalTaichungTaiwan, ROC
  4. 4.Department of Information TechnologyOverseas Chinese Institute of TechnologyTaichungTaiwan, ROC

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