Improving Prophylactic Antibiotic Selection for Type 3 Open Fractures in the Trauma Setting

The purpose of this quality improvement study was to implement a standardized prophylactic antibiotic protocol for type 3 open fractures and to evaluate changes in both subjective comfort and objective knowledge of open fracture management among trauma team personnel.

A simplified protocol for antibiotic selection in open fractures was developed and implemented at two regional Level 1 trauma centers. We used pre-intervention surveys to assess participants' ability to select the preferred antibiotic regimen for open fracture clinical scenarios and their comfort with open fracture management. The intervention consisted of instructional posters displayed in trauma bays showing the Gustilo classification for open fractures and the approved prophylactic antibiotic regimen for each fracture type. After a six-week intervention period, unmatched post-education survey responses were compared with pre-intervention responses using Fisher's Exact Test or the Fisher-Freeman-Halton Exact Test, with significance set at p <0.05.

Participants included 16 orthopedic residents and 18 trauma staff members. The proportion of respondents who reported being very comfortable selecting antibiotics for type 3 open fractures increased from 6% to 68% (p <0.001). Correct identification of the preferred antibiotic regimen across three clinical scenarios involving type 3 open fractures increased by an average of 58%, with all improvements reaching statistical significance (p <0.001).

Implementation of a simplified antibiotic prophylaxis protocol, reinforced with instructional posters in the emergency department, significantly improved participants' knowledge and confidence in antibiotic selection for type 3 open fractures. These findings support the adoption of standardized treatment algorithms in trauma care settings.