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

Area of Science:

• Trauma Surgery
• Infectious Disease Management
• Quality Improvement in Healthcare

Background:

• Open fractures, particularly type 3, require prompt and appropriate antibiotic prophylaxis to prevent infection.
• Current practices for antibiotic selection in open fractures can be variable, leading to suboptimal outcomes.
• Standardized protocols are essential for consistent and effective trauma care.

Purpose of the Study:

• To implement a standardized prophylactic antibiotic protocol for type 3 open fractures.
• To evaluate the impact of this protocol on trauma team personnel's knowledge and subjective comfort with open fracture management.
• To assess changes in objective knowledge regarding appropriate antibiotic selection for open fractures.

Main Methods:

• A simplified prophylactic antibiotic protocol was developed and implemented across two Level 1 trauma centers.
• Instructional posters detailing the Gustilo classification and approved antibiotic regimens were displayed in trauma bays.
• Pre- and post-intervention surveys assessed participants' comfort and knowledge of open fracture management, with statistical analysis using Fisher's Exact Test (p <0.05).

Main Results:

• Participant comfort in selecting antibiotics for type 3 open fractures increased significantly, from 6% to 68% (p <0.001).
• Correct identification of preferred antibiotic regimens for type 3 open fractures improved by an average of 58% (p <0.001).
• The study included 16 orthopedic residents and 18 trauma staff members.

Conclusions:

• A simplified, standardized antibiotic prophylaxis protocol, supported by visual aids, effectively enhances trauma team knowledge and confidence.
• The findings support the integration of standardized treatment algorithms into emergency department trauma protocols.
• This quality improvement study demonstrates a successful strategy for optimizing antibiotic use in complex fracture management.