Improving compliance with surgical antibiotic prophylaxis guidelines: A multicenter evaluation

Author(s)

Schmitt, Cristiane ^[1] ; Lacerda, Rubia Aparecida ^[1] ; Teresa Turrini, Ruth Natalia ^[1] ; Padoveze, Maria Clara ^[2]

Affiliation

^[1] Univ Sao Paulo, Dept Enfermagem Saude Adulto, Av Dr Eneas de Carvalho Aguiar 419, BR-05403000 Sao Paulo, SP - Brazil

^[2] Univ Sao Paulo, Escola Enfermagem, Dept Enfermagem Saude Colet, Sao Paulo, SP - Brazil

• Document type: Journal article
• Source: AMERICAN JOURNAL OF INFECTION CONTROL; v. 45, n. 10, p. 1111-1115, OCT 1 2017.
• Web of Science Citations: 6

Abstract

Background: Improving surgical antibiotic prophylaxis (SAP) use is an important element in the control of antimicrobial resistance. However, compliance with SAP guidelines is unsatisfactory. This study investigated the level of compliance with SAP guidelines in neurosurgery, and institutional characteristics associated with compliance. Methods: This study assessed surgeries in 9 Brazilian hospitals. Medical record reviews and a structured questionnaire were used to assess compliance and to describe institutional characteristics. Six attributes of compliance with SAP guidelines were evaluated; full compliance was defined whenever all these attributes were met. Logistic and linear regressions were used to investigate the association between compliance, patients, and hospital characteristics. Results: Full compliance was 10% and was associated with weekly hours of infection control personnel per intensive care unit bed (95% CI, 0.2-0.1), hospital-wide dissemination of SAP guidelines (95% CI, 1.225.1), monitoring (95% CI, 1.2-25.1), and feedback of compliance rates (95% CI, 3.8-25.2). Daytime procedures had greater compliance regarding drug dose (odds ratio {[}OR], 3.38; 95% confidence interval {[}CI], 1.726.65) and initial time (OR, 2.30; 95% CI, 1.24-4.25). Spinal procedures achieved greater compliance with initial time (OR, 1.83; 95% CI, 1.12-3.01) and duration (OR, 1.59; 95% CI, 1.7-2.16). Conclusions: A low level of compliance was identified, which pointed out the need for an innovative stewardship approach to improve adherence to SAP guidelines. Targeted training programs need to be developed to ensure dissemination of guidelines among surgeons. Monitoring, feedback, and closer interaction between the infection control personnel and the surgical team are key factors for better compliance rates of SAP. (C) 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. (AU)

• FAPESP's process: 12/01358-3 - Impact assessment of institutional initiatives aiming to improve surgical antibiotic prophylaxis use
• Grantee: Rubia Aparecida Lacerda
• Support Opportunities: Regular Research Grants