O162: A Surgically Led Quality Improvement Initiative in Surgical Antibiotic Prophylaxis (SAP): A One-year Review of Practice and Change in an Irish Context

Abstract

Abstract Introduction Amongst growing concerns of antimicrobial resistance, surgical site infection (SSI) remains one of the most common healthcare associated infections. Optimal use of Surgical Antibiotic Prophylaxis (SAP) is critical. Quality Improvement (QI) in this area is often led by pharmacists or infection specialists. Methods A two-year, surgically led QI initiative was established in two Irish hospitals in July 2022. Baseline level of compliance with local guidelines with regard four aspects of SAP (indication, agent, timing, and duration) was audited. Change interventions aimed at specific aspects of compliance were trialled. Interventions included; guideline education for prescribers, process changes (editing the sign in/time out sheet) and the application of prescribing nudges (antibiotic duration sticker in post-operative drug chart). Results A total of 620 patient records were audited over one year. Pre-intervention compliance with all four aspects of SAP was observed in only 72/303 patients (23.7%). Educational interventions with surgical prescribers led to improved compliance with agent choice (43.5% (71/165) to 65.3% (94/144)). Education of anaesthetists showed improved timing of administration with 10.8% (14/129) of SAP administered post-incision post-intervention compared to 18.9% (21/111) pre-intervention. Application of the SAP duration sticker showed an overall decrease in mean SAP duration from 70.4 hours to 28.2 hours in those patients requiring more than a single SAP dose. Overall compliance levels have improved, thus far, from 23.7% to 39.8%. Conclusion Increasing compliance with SAP guidance is a challenge. A multi-faceted, institution specific, surgically led approach grounded in QI methodology shows promise.