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Increasing Compliance With an Antibiotic Prophylaxis Guideline to Prevent Pediatric Surgical Site Infection: Before
Jeannette P So1, Ilyas S Aleem, Derek S Tsang
1*Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada †Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada ‡Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada §Center for Patient Safety, University of Toronto, Toronto, Ontario, Canada ¶Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.
Insights
A multifaceted intervention significantly improved antibiotic prophylaxis (AP) guideline compliance in children, reducing surgical site infections. This study highlights effective strategies for enhancing adherence to critical care guidelines.
Area of Science:
- Pediatric Surgery
- Infectious Disease Prevention
- Healthcare Quality Improvement
Background:
- Surgical site infections (SSIs) are a significant concern in pediatric surgery.
- Adherence to antibiotic prophylaxis (AP) guidelines is crucial for reducing SSIs.
- Implementing and changing clinical practice based on guidelines presents challenges.
Purpose of the Study:
- To assess the effectiveness of a multifaceted intervention aimed at improving antibiotic prophylaxis guideline compliance in pediatric surgical patients.
- To reduce the incidence of surgical site infections through enhanced AP practices.
Main Methods:
- A multidisciplinary team developed an evidence-based AP guideline for a pediatric hospital.
- Intervention strategies included guideline dissemination, formulary control, trainee education, time-out verification, and electronic alerts.
- Antibiotic prophylaxis indication and administration were audited pre- and post-intervention.
Main Results:
- Significant improvements were observed in appropriate antibiotic use (51.6% to 67.0%), complete compliance (26.2% to 53.2%), and partial compliance (73.3% to 88.7%).
- Key areas like correct dosage, timing, redosing, and duration of AP also showed statistically significant improvements.
- The proportion of procedures requiring AP increased from 43.9% to 62.0% post-intervention.
Conclusions:
- A comprehensive, multifaceted intervention effectively enhanced compliance with pediatric antibiotic prophylaxis guidelines.
- The study demonstrates that targeted strategies can overcome barriers to guideline implementation in clinical practice.
- Improved AP compliance is a critical step towards reducing surgical site infections in children.
Objectives:
To evaluate an intervention for improving antibiotic prophylaxis (AP) guideline compliance to prevent surgical site infections in children.
Background:
Although appropriate AP reduces surgical site infection, and guidelines improve quality of care, changing practice is difficult. To facilitate behavioral change, various barriers need to be addressed.
Methods:
A multidisciplinary task force at a pediatric hospital developed an evidence-based AP guideline. Subsequently, the guideline was posted in operating rooms and the online formulary, only recommended antibiotics were available in operating rooms, incoming trainees received orientation, antibiotic verification was included in time-out, computerized alerts were set for inappropriate postoperative prophylaxis, and surgeons received e-mails when guideline was not followed. AP indication and administration were documented for surgical procedures in July 2008 (preintervention), September 2011 (postintervention), and April-May 2013 (follow-up). Compliance was defined as complete--appropriate antibiotic, dose, timing, redosing, and duration when prophylaxis was indicated; partial--appropriate drug and timing when prophylaxis was indicated; and appropriate use--complete compliance when prophylaxis was indicated, no antibiotics when not indicated. Compliance at preintervention and follow-up was compared using χ(2) tests.
Results:
AP was indicated in 43.9% (187/426) and 62.0% (124/200) of surgical procedures at preintervention and follow-up, respectively. There were significant improvements in appropriate antibiotic use (51.6%-67.0%; P < 0.001), complete (26.2%-53.2%; P < 0.001) and partial compliance (73.3%-88.7%, P = 0.001), correct dosage (77.5%-90.7%; P = 0.003), timing (83.3%-95.8%; P = 0.001), redosing (62.5%-95.8%, P = 0.003), and duration (47.1%-65.3%; P < 0.002).
Conclusions:
A multifaceted intervention improved compliance with a pediatric AP guideline.
