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Published on: August 30, 2018
Beyond surgical care improvement program compliance: antibiotic prophylaxis implementation gaps
Russell B Hawkins1, Shauna M Levy, Casey E Senter
1Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX, USA; The Children's Memorial Hermann Hospital, Houston, TX, USA.
Insights
Documented compliance with antibiotic prophylaxis guidelines doesn't guarantee adherence. Actual adherence to antibiotic prophylaxis guidelines in pediatric surgery is low, potentially impacting surgical-site infection rates.
Area of Science:
- Pediatric Surgery
- Infectious Disease Control
- Healthcare Quality Improvement
Background:
- Surgical-site infections (SSIs) remain a challenge despite adherence to infection control measures.
- The effectiveness of the Surgical Care Improvement Project (SCIP) infection measures is questioned due to stagnant SSI rates.
Purpose of the Study:
- To evaluate if documented compliance with antibiotic prophylaxis guidelines on a pediatric surgery service reflects true implementation fidelity.
- To determine adherence to intended antibiotic prophylaxis guidelines in pediatric surgical cases.
Main Methods:
- An observational study was conducted over 7 weeks involving elective pediatric surgical cases.
- Adherence to antibiotic prophylaxis guidelines was assessed for administration, type, timing, weight-based dosing, and redosing.
Main Results:
- While 99% of cases had appropriate antibiotic administration, only 48% adhered to all 5 guideline components when prophylaxis was indicated.
- Documentation in electronic medical records showed 100% compliance, but actual adherence was significantly lower, mainly due to dosing and timing errors.
Conclusions:
- Suboptimal implementation fidelity of antibiotic prophylaxis guidelines may contribute to the persistence of SSIs.
- Future research on SCIP effectiveness should prioritize measuring adherence and implementation fidelity over mere documented compliance.
Background:
Despite increased compliance with Surgical Care Improvement Project infection measures, surgical-site infections are not decreasing. The aim of this study was to test the hypothesis that documented compliance with antibiotic prophylaxis guidelines on a pediatric surgery service does not reflect implementation fidelity or adherence to guidelines as intended.
Methods:
A 7-week observational study of elective pediatric surgical cases was conducted. Adherence was evaluated for appropriate administration, type, timing, weight-based dosing, and redosing of antibiotics.
Results:
Prophylactic antibiotics were administered appropriately in 141 of 143 cases (99%). Of 100 cases (70%) in which antibiotic prophylaxis was indicated, compliance was documented in 100% cases in the electronic medical record, but only 48% of cases adhered to all 5 guidelines. Lack of adherence was due primarily to dosing or timing errors.
Conclusions:
Lack of implementation fidelity in antibiotic prophylaxis guidelines may partly explain the lack of expected reduction in surgical-site infections. Future studies of Surgical Care Improvement Project effectiveness should measure adherence and implementation fidelity rather than just documented compliance.
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