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The Development and Implementation of New Recommendations for Perioperative Antibiotic Prophylaxis Duration in
Nina Gorišek Miksić1, Zmago Krajnc2, Igor Novak2
1Department for Infectious Diseases and Febrile Conditions, University Clinical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia.
Insights
Implementing new guidelines for perioperative antibiotic prophylaxis (PAP) significantly reduced prolonged use in hip and knee surgeries. This change improved compliance and decreased overall antibiotic consumption, addressing concerns about antimicrobial resistance.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Prevention
- Antimicrobial Stewardship
Background:
- Perioperative antibiotic prophylaxis (PAP) is crucial for preventing infections in implant-related surgeries.
- Current guidelines recommend a single preoperative dose, yet over 50% of PAP use deviates from recommendations.
- This study addresses inappropriate PAP duration in primary hip and knee arthroplasty.
Purpose of the Study:
- To develop and implement new recommendations for PAP duration in primary hip and knee arthroplasty.
- To improve compliance with evidence-based PAP guidelines.
- To reduce overall antibiotic consumption and combat antimicrobial resistance.
Main Methods:
- A tailored implementation strategy was developed, including pre-interventional analysis and barrier identification.
- An educational group meeting facilitated the development of new, consented recommendations.
- Post-interventional analysis assessed compliance with new PAP duration guidelines six months later.
Main Results:
- Pre-intervention, 70% of PAP use exceeded the recommended 24-hour duration.
- Following implementation, 80% of PAP use adhered to the new recommendations, reducing prolonged use to 12%.
- This resulted in a significant decline in antimicrobial consumption.
Conclusions:
- A tailored strategy for developing and implementing new PAP recommendations is complex but essential for clinical practice change.
- Successful implementation can significantly improve antibiotic stewardship in orthopedic surgery.
- Addressing provider concerns, such as fear of prosthetic joint infection, is key to guideline adherence.
Abstract:
Background: Perioperative antibiotic prophylaxis (PAP) is effective for infection prevention in implant-related surgery, with infections being the most feared complications. A total of 15% of all antibiotics in hospitals are used for surgical prophylaxis but less than 50% of them are used according to the guidelines. International guidelines recommend only a single preoperative dose for all surgical procedures. We have developed and implemented new recommendations for PAP duration in primary hip and knee arthroplasty at the University Department for Orthopaedic Surgery. Methods: The development and implementation of new recommendations regarding PAP duration were performed via the following steps: pre-interventional analysis; identification of barriers and facilitators using the Flottorp framework; analyzing the data and preparation of a tailored implementation strategy based on an educational group meeting with the development of new consented to recommendations; and dissemination; followed by postinterventional analysis of PAP duration compliance 6 months later. Results: Before the intervention, 70% of PAP was used inappropriately (longer than 24 h). The major recognized barriers were fear of prosthetic joint infection (PJI) and a lack of concern regarding global antimicrobial resistance problems. Major facilitators were a low local PJI incidence rate (0.28%), etiology of PJI and existing local experience with a single-dose regime. After implementation of new recommendations regarding the duration of PAP, the postinterventional analysis showed that 80% of PAP was used according to the new recommendations, with a significant reduction in prolonged PAP use (from 70% to 12%), leading to an important decline in antimicrobial consumption. Conclusions: Our study showed that a tailored strategy in the development and implementation of new recommendations is complex and time consuming, although necessary for successful clinical practice change.
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