Clínical Audit of Primary Treatment of Open Fractures: Antibiotic Treatment and Tetanus Prophylaxis^[*]

Abstract

Objective To evaluate whether the conducts involving antimicrobial treatment and prophylaxis against tetanus have been performed according to the Clinical Protocol of the Institution.

Methods Descriptive and retrospective study conducted in patients of both genders, > 18 years old admitted to a public hospital specialized in emergency and trauma, to treat primary open fracture. The data of interest were surveyed in medical records, drug prescriptions, report of patients admitted in the Surgical Block and tetanus prophylaxis requests.

Results A total of 241 patients were selected, mostly male (81.7%), young adults (64.3%), victims of motorcycle accidents (53.5%). Infectious complications were present in 18.7% of the fractures, the mean time for the surgical approach was 4 hours and 12 minutes, and 91.7% of the patients had preoperative antimicrobial prescription. The main inadequacies identified were: period of prescription of antimicrobial treatment (63.5%); choice of the antimicrobial scheme (59.3%) and antimicrobial dose (58.0%). Only 14.1% of the patients were immunized against tetanus.

Conclusion The greatest divergences with the Clinical Protocol were observed in the issues involving the antimicrobial regimen used, doses and time of prescription, as well as in tetanus prophylaxis.

Keywords

open fracture - antibiotic prophylaxis - infection - tetanus

^* Study performed at Fundação Hospitalar de Minas Gerais (Fhemig), Hospital João XXIII, Belo Horizonte, Minas Gerais, Brazil.

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