Non-adherence to surgical antibiotic prophylaxis guidelines: findings from a mixed-methods study in a developing...

Area of Science:

• Obstetrics and Gynecology
• Infectious Disease Prevention
• Surgical Care Quality

Background:

• Surgical antibiotic prophylaxis (SAP) is crucial for preventing post-operative infections.
• Effective SAP relies on strict adherence to established guidelines.
• Inappropriate SAP use can lead to increased infectious morbidity.

Purpose of the Study:

• To evaluate adherence to SAP guidelines in an obstetrics and gynecology setting.
• To identify factors contributing to non-adherence to SAP protocols.
• To inform strategies for improving antibiotic stewardship in surgery.

Main Methods:

• A mixed-methods approach combining a cross-sectional survey and qualitative focus group.
• Data collected in real-time on antibiotic choice, timing, and duration for 280 surgical procedures.
• Qualitative analysis of focus group discussions to explore barriers to adherence.

Main Results:

• Zero percent full adherence to SAP guidelines observed across 280 procedures.
• Appropriate antibiotic prescribed in 62.5%, timely administration in 38.2%, and recommended duration in 6.1%.
• Major barriers identified: knowledge gaps, workflow inefficiencies, inadequate monitoring, and weak guideline enforcement.

Conclusions:

• High rates of non-adherence to SAP guidelines, especially concerning timing and duration.
• Systemic barriers must be addressed to enhance compliance.
• Enforcing SAP guidelines is critical for improving antibiotic stewardship in surgical care.