An interdisciplinary approach to improve surgical antimicrobial prophylaxis

Area of Science:

• Medical Quality Improvement
• Surgical Infection Prevention
• Pharmacology

Background:

• Optimizing surgical antimicrobial prophylaxis (SAP) is crucial for preventing surgical site infections in orthopaedic procedures.
• Existing prescribing practices may not consistently adhere to established guidelines, necessitating targeted improvement strategies.

Purpose of the Study:

• To enhance surgical antimicrobial prophylaxis (SAP) prescribing accuracy in orthopaedic surgery.
• To implement and evaluate a quality improvement (QI) initiative utilizing the model for improvement framework.

Main Methods:

• A prospective, interventional quality improvement project was conducted on 168 orthopaedic surgeries.
• Interventions included guideline updates, reminders, and tools, with data collected weekly via point prevalence design (PPD).
• Appropriateness of antimicrobial choice, dose, timing, and duration was assessed against local guidelines.

Main Results:

• Prescribing appropriateness for SAP improved substantially from a baseline of 20% to 78%.
• Continuous data feedback and interventions were vital, especially addressing junior doctor transitions.
• Challenges included weight estimation for dosing and workflow adjustments for antimicrobial preparation.

Conclusions:

• A continuous, prospective QI approach with rapid, cyclical interventions effectively improved SAP prescribing in orthopaedic surgery.
• Sustained compliance requires ongoing education, communication, and data monitoring, particularly in dynamic healthcare settings.
• The weekly PPD model proved pragmatic for sustaining QI efforts without additional resources.