Antibiotic prophylaxis audit and questionnaire study: Traffic Light Poster improves adherence to protocol in gastrointestinal surgery.

OBJECTIVE: To measure adherence to antibiotic prophylaxis (AP) protocol amongst surgeons and anesthetists and explore their understanding of AP prescribing in practice. DESIGN: A prospective audit of AP in gastrointestinal surgery and re-audit after intervention. A questionnaire survey of practice. RESULTS: 58 (38%- clean; 62%- clean contaminated) operations were audited and 73 (48%-clean; 51%-clean contaminated) operations were re-audited after intervention with "Traffic Light Poster" (TFP) .55 colleagues (32 consultants and 23 trainees) were recruited for questionnaire survey in three West Midlands hospitals. Audit and Re-Audits. Only 31% of procedures followed the protocol correctly in the initial audit and this increased to 73% in the re-audit. 73% of patients undergoing clean procedures received AP inappropriately in the initial audit but reduced significantly to 20% (p < 0.002) in the re-audit. In the initial audit, 62% of clean contaminated procedures did not receive the appropriate first line AP but this fell to 35% (p < 0.05) in the re-audit. Questionnaire Survey- Only 30% of respondents would not give AP in clean surgery as recommended. 45% would use appropriate AP for clean-contaminated wounds. 73% of respondents will give AP at induction, 20% 1 h pre op and 7% just before incision. CONCLUSION: There is poor compliance with AP protocols in gastrointestinal surgery in part due to general lack of awareness. An educational intervention in the form of a 'Traffic Light Poster' improved adherence to AP protocol two fold. There was improved rationalizing of AP. Clean procedures, in particular, had less inappropriate prescribing.

A closed loop obstruction caused by entrapment of the fallopian tube and herniation through the broad ligament.

A 49-year-old female presented with one week history of severe abdominal pain, vomiting and constipation. Pertinent past surgical history consisted of caesarean section, laparoscopic right fallopian tube cystectomy and myomectomy. There was also recent left mastectomy and adjuvant chemotherapy for breast carcinoma. Clinical examination established a tensely distended abdomen with scanty bowel sounds but no clinical peritonism. Blood tests showed severe acute kidney injury and raised inflammatory markers. Computed tomography without intravenous contrast demonstrated small bowel obstruction of uncertain aetiology but with likely calibre change in the pelvis. At operation, the left fallopian tube had wrapped itself around ischemic bowel. A left salpingo-oophorectomy was performed to release the bowel. On closer inspection, an internal hernia caused by a defect in the broad ligament was diagnosed. This case report describes a differential of atypical small bowel obstruction to be considered when faced with a female acute abdomen.