Implementing an Antimicrobial Stewardship Programme to Improve Adherence to a Perioperative Prophylaxis Guideline.

Nehad J. Ahmed,Abdullah A. Alfaifi,Ahmed M. Alshehri,Abdullah K. Alahmari,Amer H. Khan,Emad Elazab,Alaa Almansour,Ziyad S. Almalki,Abdul Haseeb,Mohamed F. Balaha

doi:10.3390/healthcare10030464

Abstract

Perioperative antimicrobial prophylaxis is effective in reducing the rate of surgical site infections (SSIs); however, non-adherence to surgical antimicrobial prophylaxis protocols can lead to several negative outcomes. We performed a before-and-after intervention study with the aim of improving the process outcome, including adherence to guidelines. Another objective of this study was to investigate improvement in patient outcomes as a result of adherence to a surgical antimicrobial prophylaxis programme. The indicators of improved patient outcomes were a reduction in overall SSI rate and the decreased cost of antibiotics. SSI rate was calculated as a percentage by dividing the number of SSIs by the total number of surgeries and then multiplying the value obtained by 100%. The interventions implemented in the surgical antimicrobial prophylaxis programme included establishment of a guideline, educational sessions, and a monthly revision of prescriptions. Our findings show that implementation of the interventions resulted in reduced antibiotic consumption, a considerable decrease in the cost of prophylaxis, and a decrease in the incidence of SSIs.

Highlights

Surgical site infections (SSIs) are the most common healthcare-associated infections that occur among surgical patients
Implementation of the surgical antimicrobial prophylaxis programme in the present study resulted in increased compliance of prescribers with the guideline recommendations
It led to improvements in the correct use of antibiotics, appropriate dose prescription, timing and duration of prophylaxis, and choice of route of administration

Summary

Introduction

Surgical site infections (SSIs) are the most common healthcare-associated infections that occur among surgical patients. SSIs are defined as postoperative infections that occur within 30 days after undergoing a surgical procedure, or within 1 year after placement of a permanent implant [2]. It is indicated in a European Centre for Disease Prevention and Control report that the cumulative incidence of SSIs mainly depends on the type of surgical procedure; the highest rates have been reported for open colorectal and laparoscopic colorectal operations (10.1% and 6.4%, respectively), followed by open cholecystectomy (3.9%) and coronary artery bypass graft (2.6%) [2]. Among the different types of gastrointestinal surgeries, colorectal surgery is the most concerning regarding the development of SSIs due to the presence of multiple microbes in the colon and rectum [3]

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