Implementation of a Plan-Do-Study-Act framework to reduce unindicated surgical antimicrobial prophylaxis

Area of Science:

• Healthcare Quality Improvement
• Infectious Disease Prevention
• Surgical Safety Protocols

Background:

• Unindicated surgical antibiotic prophylaxis (SAP) is a common issue in healthcare settings.
• Reducing unnecessary SAP is crucial for antimicrobial stewardship and preventing resistance.
• Clean surgical cases without foreign body implantation are prime targets for SAP reduction.

Purpose of the Study:

• To implement and evaluate a Plan-Do-Study-Act (PDSA) framework to decrease the utilization of unindicated SAP.
• To specifically target clean cases without foreign body implantation for SAP reduction efforts.

Main Methods:

• A pre-post intervention study design was employed at a children's hospital.
• Interventions included guideline dissemination, faculty consensus meetings, and compliance audits.
• A second PDSA cycle incorporated targeted education for trainees with mandatory feedback.

Main Results:

• The rate of unindicated SAP decreased from 40.4% preintervention to 6.2% postintervention, an 85% reduction.
• The intervention demonstrated sustained effectiveness over a 10-month period.
• No significant difference in surgical site infection rates was observed between pre and postintervention groups.

Conclusions:

• The PDSA intervention effectively reduced unindicated surgical antibiotic prophylaxis.
• Targeting both faculty and trainees is key to successful implementation.
• This approach offers a scalable model for improving antibiotic prescribing practices in surgery.