Implementing an Evidence-Based Guideline to Improve Perioperative Antimicrobial Prophylaxis Quality Among Patients...

Area of Science:

• Infectious Diseases
• Quality Improvement
• Pharmacology

Background:

• Updated guidelines recommend cefazolin for surgical antimicrobial prophylaxis (SAP) in patients with penicillin allergy labels (PwPAL).
• Previous practices may not have aligned with updated recommendations, potentially leading to suboptimal SAP.
• Penicillin allergy labels can lead to the use of alternative antibiotics with broader spectra or increased resistance potential.

Purpose of the Study:

• To implement a quality improvement project to promote cefazolin use for SAP in PwPAL.
• To align clinical practice with updated guidelines recommending cefazolin as a preferred agent for PwPAL.
• To evaluate the impact of system-based interventions on cefazolin utilization and patient safety.

Main Methods:

• An interdisciplinary quality improvement project was conducted across a large US healthcare system.
• Interventions included electronic health record enhancements, algorithm development, and point-of-care guidance for surgical clinicians.
• A data dashboard, educational modules, and communication strategies were employed to support the initiative.

Main Results:

• Cefazolin use for SAP in PwPAL increased by 38%, from 63.4% to 89.1% (P≤.001).
• Use of clindamycin and vancomycin for SAP significantly decreased (P≤.001).
• No increase in hypersensitivity surrogate markers or tryptase testing was observed post-intervention.

Conclusions:

• A comprehensive quality improvement project successfully increased cefazolin use for SAP in PwPAL.
• System-based interventions effectively promoted guideline-adherent prescribing without compromising patient safety.
• This initiative demonstrates a successful strategy for optimizing antibiotic prophylaxis in patients with allergy labels.