Multidisciplinary Collaboration to Optimize Antimicrobial Use for Clean Incision Surgery in Primary Hospitals

Excessive and irrational antimicrobial use in clean incision surgery, especially in primary hospitals, drives drug resistance and wastes healthcare resources. This single-center retrospective before-after quality improvement study aimed to explore the impact of a multidisciplinary Plan-Do-Check-Act (PDCA) management system on prophylactic antibiotic use in a primary hospital, with consideration of potential confounding from case-mix changes.

Baseline data from 2023 were retrospectively analyzed, followed by a year-long PDCA intervention in 2024. Post-intervention data were compared with baseline data to assess the effectiveness of the intervention on prophylactic antimicrobial use and prescription rationality.

Among 1786 clean incision cases, the prophylactic medication rate dropped to 33.18%, and the rationality rate rose to 92.59% after intervention. Rates of excessive duration, incorrect drug selection, improper first-dose timing, and prophylaxis without indication fell to 4.38%, 0.67%, 0.67%, and 1.35%, respectively.

The clinical pharmacy-led, multidisciplinary collaborative system established a closed-loop cycle of assessment, intervention, monitoring, and improvement, which was associated with improved standardization of perioperative antimicrobial use in this primary care setting. This approach provides preliminary reference value for curbing antimicrobial resistance and promoting rational drug use in resource-limited primary care settings, though further multicenter studies across different healthcare systems are required to confirm its generalizability and replicability.