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A Multidisciplinary Approach to Improvements in Perioperative Antibiotic Prophylaxis at a Military Treatment Facility
Amelia L Baker1, Angela McElrath2, Stephanie E Giancola3
1Department of Anesthesiology, Eglin Air Force Base Hospital, Eglin AFB, FL 32542, USA.
Introduction:
Surgical site infections complicate 2%-5% of surgeries. According to the Centers for Disease Control and Prevention, half of all surgical site infections are preventable. Adherence to published recommendations regarding perioperative antibiotic administration decreases the incidence of surgical site infections. Members of the Department of Anesthesia noticed casual observations of inaccurate prescribing of antibiotics at our institution, Brooke Army Medical Center, and approached the Antimicrobial Stewardship Program to collaborate on this issue.
Materials And Methods:
A team of anesthesiologists, clinical pharmacists, and infectious disease specialists collaborated with the Department of Surgery to improve this effort as part of a multiyear project from 2018 to 2021. We first assessed adherence to recommended perioperative antibiotic use to establish a baseline and next, noticing gaps, created a project with the goal to improve compliance to >90% across surveyed measures. Our key interventions included educational initiatives, creation of facility-specific guidelines, peer benchmarking, updating order sets, interdisciplinary collaboration, creation of intraoperative reminders and visual aids, and tailored presentations to selected services.
Results:
Of 292 charts (2.3% of cases from January to October 2018) reviewed pre-intervention, compliance rates were 84% for antibiotic choice, 92% for dose, 65% for redosing, and 71% for postoperative administration. Of doses, 100% were timed correctly, and thus, this variable was not targeted. Post-intervention, our review of 387 charts (10% of cases from May to November 2020) showed no change in correct antibiotic choice (84%) and statistical improvement to 96% for correct dose, 95% for correct redosing, and 85% for correct postoperative administration (P < .05 for all).
Conclusions:
Our multidisciplinary approach of collaboration with multiple departments, creating guidelines and providing feedback, improved compliance with perioperative antibiotic administration recommendations.
Insights
Implementing a multidisciplinary strategy significantly improved adherence to perioperative antibiotic guidelines, reducing surgical site infection risks. This initiative enhanced antibiotic choice, dose, redosing, and postoperative administration compliance.
Area of Science:
- Healthcare Quality Improvement
- Infectious Disease Prevention
- Surgical Safety Protocols
Background:
- Surgical site infections (SSIs) affect 2%-5% of surgeries, with half being preventable.
- Poor adherence to perioperative antibiotic guidelines contributes to SSIs.
- Anesthesiology noted prescribing inaccuracies, prompting collaboration with the Antimicrobial Stewardship Program.
Purpose of the Study:
- To assess baseline adherence to perioperative antibiotic administration recommendations.
- To implement interventions aimed at improving compliance to over 90% for key measures.
- To reduce the incidence of surgical site infections through optimized antibiotic use.
Main Methods:
- A multidisciplinary team (anesthesiology, pharmacy, infectious diseases, surgery) collaborated from 2018-2021.
- Baseline adherence was assessed, followed by targeted interventions.
- Interventions included education, facility-specific guidelines, order set updates, and interdisciplinary collaboration.
Main Results:
- Pre-intervention compliance was 84% for choice, 92% for dose, 65% for redosing, and 71% for postoperative administration.
- Post-intervention, compliance improved to 96% for dose, 95% for redosing, and 85% for postoperative administration.
- Antibiotic choice compliance remained stable at 84%; timing was 100% accurate pre- and post-intervention.
Conclusions:
- A collaborative, multidisciplinary approach effectively improved adherence to perioperative antibiotic administration guidelines.
- Key interventions like guideline creation and feedback mechanisms were crucial for success.
- Optimized antibiotic use is vital for preventing surgical site infections.
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