Abstract
Few studies have addressed antibiotic guideline adherence in small island settings, such as Aruba. This study aimed to evaluate the appropriateness of perioperative antibiotic prophylaxis (PAP) and identify barriers for PAP guideline adherence. A mixed-methods study was carried out at the operating theatre (OT) in the Dr. Horacio E. Oduber Hospital (HOH) in Aruba. First, a prospective audit was performed on the appropriateness of guideline-derived quality indicators (QIs). Then, interviews based on the Flottorp framework were conducted to identify barriers for guideline adherence. Finally, a survey was distributed to verify the outcomes of the interviews. The appropriateness of QIs was measured: correct indication (50.6%); antimicrobial agent (30.8%); dose (94.4%); timing (55.0%); route of administration (100%); duration (89.5%); and redosing (95.7%). The overall appropriateness was 34.9%. The main barriers discovered were poor knowledge about PAP and the guidelines and professional interactions regarding PAP, specifically poor communication and lack of clarity about responsibilities regarding PAP. This study was the first to evaluate the appropriateness and to identify barriers for PAP guideline adherence in a small island hospital. The overall appropriateness of PAP was poor with just 34.9%. Future interventions should be focused on communication, education and awareness of the possibility to consult an ID physician or microbiologist.
Highlights
Surgical site infections (SSIs) are common surgical complications and continue to be a leading component of nosocomial morbidity and mortality [1]
This study aimed to evaluate the appropriateness of perioperative antibiotic prophylaxis (PAP) through a mixed-methods approach by first performing a prospective audit and subsequently conducting interviews and distributing a survey to identify barriers for PAP guidelineadherence
Little is known about barriers to appropriate PAP prescription in small island developing state (SIDS)
Summary
Surgical site infections (SSIs) are common surgical complications and continue to be a leading component of nosocomial morbidity and mortality [1]. SSI rates vary between 3 and 20%, dependent on the operative procedure and risk factors [2], and are associated with increased treatment costs, prolonged hospital stay and increased mortality [3]. The inappropriate use of PAP may reduce treatment efficacy and induce antimicrobial resistance (AMR) [7]. AMR leads to high healthcare costs, less effective treatment for infections and less success of major surgeries [8]. To delay the process of AMR, antibiotic stewardship programs (ASPs) are developed to improve appropriate antibiotic use and monitor AMR [9]. The primary goal of ASPs is to improve antibiotic utilization and optimise patient outcomes, with a secondary goal of cost reduction [10]. According to the WHO ASP guidelines, PAP should be included in these programs [11]
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