How do professional relationships influence surgical antibiotic prophylaxis decision making? A qualitative study

Area of Science:

• Medical sociology
• Healthcare management
• Infectious disease epidemiology

Background:

• Surgical antibiotic prophylaxis (SAP) is crucial for preventing surgical site infections and combating antimicrobial resistance.
• Optimizing SAP practices is essential to mitigate the growing threat of antimicrobial resistance.
• This study investigates the influence of interpersonal relationships on SAP decision-making processes.

Purpose of the Study:

• To explore how interpersonal dynamics influence the prescribing of surgical antibiotic prophylaxis.
• To identify key relational factors affecting SAP decisions among surgical teams.
• To provide insights for developing more effective interventions for SAP optimization.

Main Methods:

• Conducted in-depth, semistructured interviews with 20 surgeons and anesthetists.
• Employed the framework approach for the analysis of qualitative interview data.
• Focused on understanding the nuances of SAP prescribing behaviors within surgical teams.

Main Results:

• Relationship dynamics between surgeons and anesthetists critically influence SAP appropriateness, especially regarding operative risk.
• Perceived hierarchies within and between surgical and anesthesia specialties impact antibiotic prescribing.
• Proximity to antimicrobial stewardship teams affects the adoption of stewardship principles in SAP.

Conclusions:

• Effective interventions for SAP optimization must address interpersonal and social contexts, including team cohesion and hierarchy.
• Relational dynamics, particularly concerning risk perception and ownership, are central to SAP decision-making.
• Sustainable optimization of SAP requires careful consideration of risk management within the healthcare team.