Implementation of Antibiotic Use Guidelines for Fresh Traumatic Wound at Siriraj Hospital
Rujipas Sirijatuphat MD*, Tanatchon Choochan MD*, Preecha Siritongtaworn MD**, Vipaporn Sripojtham RN***, Visanu Thamlikitkul MD*
Affiliation : * Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *** Department of Nursing, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To determine the effectiveness of implementing a clinical practice guideline (CPG) on antibiotic use for adults
with fresh traumatic wounds who attended the trauma center at Siriraj Hospital, Bangkok.
Material and Method: A prospective study of 600 adult patients who had fresh traumatic wounds (≤6 hours) was conducted
at Siriraj Trauma Center from March 2013 to March 2014. The CPG was introduced to physicians, nurses and medical
students by posting the CPG at the patient care areas of the trauma center. The outcomes were an appropriate classification
of wounds according to the CPG recommendations, prevalence of antibiotic prescribing, incidence of wound infection and
compliance with the CPG.
Results : Clean-contaminated wounds that did not need antibiotic treatment and clean-contaminated and contaminated
wounds that required antibiotics were observed in 63.2, 6.7, and 30.1% of the patients, respectively. Antibiotics were given
to 512 patients (85.3%). Infections occurred in six patients (1.0%). Antibiotic prescription according to CPG recommendations
was observed for 243 patients (40.5%). The prevalence of antibiotic use in the CPG-compliant group (65.8%) was significantly
less than that in the CPG-noncompliant group (98.6%) (p<0.001). The patients in the CPG-compliant group had more
contaminated wounds than those in the CPG-noncompliant group (51.4 vs. 15.7%, p<0.001). The incidences of wound
infection were very low in both groups and not significantly different (1.2 vs. 0.8%, p = 0.690).
Conclusion : Antibiotic prophylaxis was necessary in less than 36.8% of adults with fresh traumatic wounds who attended
Siriraj Trauma Center. Compliance to CPG implementation using simple intervention seemed to be low. Adhering to CPG
recommendations for antibiotic prophylaxis in adults with fresh traumatic wounds can reduce the unnecessary prescribing
of antibiotics without increasing the rate of wound infection.
Keywords : Clinical practice guideline, Implementation, Antibiotic prophylaxis, Traumatic wound
