Surgical Antimicrobial Prophylaxis Guidelines Research Articles

Adherence to Antimicrobial Prophylaxis Guidelines in Endourologic Procedures: Frequency and Related Outcomes.

Background: Surgical antimicrobial prophylaxis (SAP), when used appropriately based on evidence-based guidelines, can reduce the rate of infectious complications following endourologic procedures without compromising patient outcomes. Objectives: To investigate the appropriateness of the current SAP used in endourologic surgeries based on international guidelines and report their associated outcomes (urinary tract infection [UTI] and blood stream infection [BSI]). Design: Prospective cross-sectional study. Methodology: The medical records of patients undergoing endourologic procedures were reviewed to assess healthcare providers' adherence to international guideline recommendations. Assessed parameters included indication, duration, choice, and dose of the antibiotics used in endourologic procedures in two medical centers in Amman/Jordan. Furthermore, patients were asked to conduct laboratory urine tests to determine the rate of infectious complications within one month post-procedure. Results: Three hundred and sixty-one patients were recruited for the study. The adherence rates to guidelines regarding indication, choice, and dose of pre-operative antibiotics were 90.3%, 2.8%, and 77.8%, respectively. The duration was concordant with guidelines in only 3.4% of participants. A total of 41.8% of patients completed follow-up. Among those, 4.6% developed bacterial UTIs, and 0.7% developed BSI. Conclusion: Adherence to SAP guidelines in endourologic procedures was far from optimal. Primary deviations in the implementation of guidelines' recommendations were pinpointed. These results are crucial for planning interventions that optimize SAP utilization.

Surgical antimicrobial prophylaxis in Japanese hospitals: Real status and challenges

BackgroundInformation regarding the status of surgical antimicrobial prophylaxis (SAP) in Japanese hospitals is lacking. This study aimed to explore the status of SAP prescriptions for surgeries and adherence to Japanese SAP guidelines. MethodsFrom February to July 2020, a 1-day multicentre point prevalent survey was conducted at 27 hospitals in Aichi Prefecture, Japan. Patients prescribed SAP were included in this study. The appropriateness of the SAP was evaluated based on the guidelines for selection of antimicrobials and their duration. Surgery was defined as appropriate when all the items were appropriate. ResultsA total of 728 patients (7.1 %; 728/10,199) received antimicrobials for SAP. Among them, 557 patients (76.5 %, 557/728) underwent the surgeries described in the guidelines.The overall appropriateness of all surgeries was 33.9 % (189/557). The appropriate selection of antimicrobial before/during and after surgery and their durations were 67.5 % (376/557), 67.5 % (376/557), and 43.3 % (241/557), respectively. The overall appropriateness ranged from 0 % (0/37, oral and maxillofacial surgery) to 58.7 % (88/150, orthopaedic surgery) and 27.7 % (36/130, community hospitals with 400–599 beds) to 47.2 % (17/36, specific hospitals).Cefazolin was the most prevalent antimicrobial prescribed before/during (55.5 %, 299/539), and after (45.1 %, 249/552) surgery. In total, 101 oral antimicrobials were prescribed postoperatively. ConclusionsSAP adherence by specific surgical fields and hospitals was shown in this study. Intensive intervention and repeated surveillance are necessary to improve SAP prescriptions in Japanese hospitals.

Appropriateness of Surgical Antimicrobial Prophylaxis in a tertiary care hospital: A prospective observational study

Surgical site infections (SSIs) are a significant concern in global healthcare, particularly in middle and low-income countries, leading to increased hospitalizations, morbidity, mortality, and financial strain. Ranked third in the CDC's National Nosocomial Infections Surveillance System, SSIs have prompted a focus on preventive measures, notably surgical antimicrobial prophylaxis (SAP). However, SAP is often used inappropriately, contributing to the rise of Antimicrobial Resistance (AMR). Addressing this, a six-month prospective observational study was conducted in a tertiary care hospital to assess the adherence to SAP guidelines among 386 patients undergoing surgeries in various specialties. The study aimed to evaluate the appropriateness of SAP practices and identify factors leading to non-compliance. Results showed that only 58.3% of patients fully adhered to the guidelines. While 100% compliance was observed in SAP indication, lower adherence was noted in the timing of administration (97.7%), choice of SAP (85%), and duration of prophylaxis (70.2%). These findings underscore a significant gap between recommended SAP practices and actual implementation. This gap highlights the need for stronger Institutional Antimicrobial Stewardship (AMS) programs and the critical role of clinical pharmacists in regularly evaluating SAP and prescribing practices. To combat the rise of antibiotic resistance while ensuring patient safety, enhancing SAP practices in line with national and international recommendations is essential. The study advocates for more active interventions at the time of order to optimize antibiotic use, thereby addressing the challenge of compliance in SAP guidelines.

Compliance with Antimicrobial Prophylaxis Guidelines in Endourological Procedures: Frequency and Related Outcomes

Introduction: Surgical antimicrobial prophylaxis (SAP), when used appropriately based on evidence-based guidelines, reduces the rate of infectious complications following endourological procedures without compromising patient outcomes.
 Aims: to audit the appropriateness of the current SAP used in endourological surgeries based on international guidelines and report their associated outcomes (urinary tract infection (UTI) and bloodstream infection (BSI)).
 Methodology: The adherence to international guidelines recommendations; AUA 2019 and EAU 2020, regarding indication, duration, choice, and dose of the antibiotics used in endourological procedures were assessed in two medical centers in Amman/Jordan. Also, patients were asked to conduct laboratory urine test to determine the rate of infectious complications within one-month post-procedure.
 Results: Three hundred sixty-one patients were recruited for the study. The adherence rate to guidelines regarding indication, choice, and dose of pre-operative antibiotics was 90.3%, 2.8%, and 77.8% respectively. The duration was concordant with guidelines in only 3.4% of participants. A total of 41.8% of patients completed follow-up. Among those, 4.6% developed bacterial UTIs, and 0.7% developed BSI.
 Conclusion: Adherence to SAP guidelines in endourological procedures is far from optimal, especially by an inappropriate selection of broad-spectrum antibiotics as the agent of choice and prolonged use of antibiotics after the procedure in the absence of any documented infectious complication.

Sustained Improvement of Appropriateness in Surgical Antimicrobial Prophylaxis with the Application of Quality Control Circle.

Quality control circle (QCC) has acquired success in many fields in healthcare industry as a process management tool, whereas its efficacy in surgical antimicrobial prophylaxis (SAP) remains unknown. This study aimed to implement QCC interventions to improve the appropriateness of SAP. A QCC activity team was established to grasp the current situation of SAP in clean surgery procedure, set target, formulate corresponding countermeasures and implement and review them in stages. The plan-do-check-act (PDCA) method was cyclically applied. The appropriateness of antibiotic prophylaxis before (January to December 2020) and after (January to December 2021) the implementation of QCC activities were evaluated based on relevant international and Chinese SAP guidelines. The overall SAP appropriateness was significantly improved from 68.72% before QCC to 93.7% post QCC implementation (P<0.01). A significant improvement (P<0.05) was also determined for each category: selection (from 78.82% to 96.06%), duration (from 90.15% to 96.46%), indication (from 94.09% to 97.64%), timing of first dose (from 96.55% to 99.21%), antimicrobial usage (from 96.8% to 99.41%), re-dosing of antimicrobial (from 96.55% to 99.21%). Implementation of a QCC program can optimize the use of antibiotics and improve the appropriateness of SAP and is of practical importance to their standardization.

Adherence to Antimicrobial Prophylaxis Guidelines for Elective Surgeries Across 825 US Hospitals, 2019-2020.

There are limited US data assessing adherence to surgical antimicrobial prophylaxis guidelines, particularly across a large, nationwide sample. Moreover, commonly prescribed inappropriate antimicrobial prophylaxis regimens remain unknown, hindering improvement initiatives. We conducted a retrospective cohort study of adults who underwent elective craniotomy, hip replacement, knee replacement, spinal procedure, or hernia repair in 2019-2020 at hospitals in the PINC AI (Premier) Healthcare Database. We evaluated adherence of prophylaxis regimens, with respect to antimicrobial agents endorsed in the American Society of Health-System Pharmacist guidelines, accounting for patient antibiotic allergy and methicillin-resistant Staphylococcus aureus colonization status. We used multivariable logistic regression with random effects by hospital to evaluate associations between patient, procedural, and hospital characteristics and guideline adherence. Across 825 hospitals and 521 091 inpatient elective surgeries, 308 760 (59%) were adherent to prophylaxis guidelines. In adjusted analysis, adherence varied significantly by US Census division (adjusted OR [aOR] range: .61-1.61) and was significantly lower in 2020 compared with 2019 (aOR: .92; 95% CI: .91-.94; P < .001). The most common reason for nonadherence was unnecessary vancomycin use. In a post hoc analysis, controlling for patient age, comorbidities, other nephrotoxic agent use, and patient and procedure characteristics, patients receiving cefazolin plus vancomycin had 19% higher odds of acute kidney injury (AKI) compared with patients receiving cefazolin alone (aOR: 1.19; 95% CI: 1.11-1.27; P < .001). Adherence to antimicrobial prophylaxis guidelines remains suboptimal, largely driven by unnecessary vancomycin use, which may increase the risk of AKI. Adherence decreased in the first year of the COVID-19 pandemic.

Barriers to Optimal Surgical Antimicrobial Prophylaxis for Methicillin-Resistant Staphylococcus aureus-Colonized Patients at an Australian Tertiary Teaching Hospital

Background: Surgical antimicrobial prophylaxis (SAP) is a leading indication for antibiotic use in Australian hospitals with established high rates of inappropriate prescribing. Optimal administration of SAP for patients at high risk of methicillin-resistant Staphylococcus aureus (MRSA) infections presents additional complexities. A greater understanding of barriers to optimal SAP in this cohort is required to inform targeted antimicrobial stewardship strategies, optimize SAP, and reduce the rate of surgical site infections (SSIs). Methods: A multiple-choice questionnaire appraising knowledge and barriers to optimal SAP was electronically distributed to key stakeholders. Data from the questionnaire were collated and analyzed using Survey Monkey® (Momentive Inc., San Mateo, CA) data analysis tools. Results: Eighty-three persons provided full or partial responses to the questionnaire. There were 19% of respondents who considered MRSA colonization status of patients to be only "somewhat important" when selecting appropriate SAP. Additionally, 62% of responses did not correctly identify the appropriate SAP regimen for patients who are colonized with MRSA. Several barriers to optimal SAP were identified including poor understanding of SAP guidelines, lack of timely identification of patients confirmed to be colonized with MRSA, inaccurate documentation of antibiotic and surgical start times, and limitations of the current operating room management software program. Conclusions: The high level of engagement from most key stakeholders demonstrates accountability and an overall desire to improve SAP. Barriers identified in this audit should be considered by facilities wishing to optimize compliance with SAP guidelines and consequently reduce SSIs, in particular for patients who are at high risk of MRSA infections.

557. Improving Surgical Antimicrobial Stewardship with Quarterly Audit and Feedback Scorecards

Abstract Background Adherence to national surgical antimicrobial prophylaxis (SAP) is of utmost importance to prevent antimicrobial resistance. Guideline development does not always confer compliance with changes. This report describes an ongoing process of quarterly SAP audit and feedback using individualized scorecards. Methods Our hospital participates in local data collection for the National Surgery Quality Improvement Program- Pediatric (NSQIP-P). We implemented changes to local SAP guidance to better align with national recommendations and collected data regarding baseline SAP beginning in January 2019. Using these data, we initiated an audit and feedback program of quarterly scorecard reports beginning in January 2020 regarding surgical adherence to national SAP guidelines at our children’s hospital. This scorecard gives each surgeon a quarterly, private, individual report, allowing them to review cases that deviated from SAP guidance, and compare their scores to the surgical team as a whole. NSQIP-P cases are adjudicated manually for SAP adherence. The program aimed to improve adherence to SAP guidance, promote collaborative discussion, and identify areas for improvement in prescribing practices and local guidelines. The goal was to reach &amp;gt;90% compliance with SAP guidance. Results Baseline adherence to SAP guidance was 50-85%. After introducing the audit and feedback program in January 2020, SAP compliance rates increased overall. In the most recent 3 quarters (2021 Q1-3), adherence was 95%, 89%, and 95%, respectively. Figure 1.Antimicrobial stewardship report by quarter among the pediatric surgery teamFigure 2.Example of individual audit &amp; feedback scorecard Conclusion We have seen an improvement overall in SAP compliance and have reached the goal of &amp;gt;90% compliance. One drawback to this program is the need for manual case review. Feedback using scorecards has led to better communication regarding process changes for SAP prescribing. Disclosures All Authors: No reported disclosures.

Partnerships Between Anesthesiology and Hospital Infection Prevention and Control Teams

Features| August 2022 Partnerships Between Anesthesiology and Hospital Infection Prevention and Control Teams Dustin R. Long, MD; Dustin R. Long, MD Search for other works by this author on: This Site PubMed Google Scholar Vanessa Makarewicz, RN, MN, CIC; Vanessa Makarewicz, RN, MN, CIC Search for other works by this author on: This Site PubMed Google Scholar Chloe Bryson-Cahn, MD; Chloe Bryson-Cahn, MD Search for other works by this author on: This Site PubMed Google Scholar Arman Dagal, MD, FRCA, MHA Arman Dagal, MD, FRCA, MHA Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor August 2022, Vol. 86, 19–20. https://doi.org/10.1097/01.ASM.0000855656.97932.62 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Dustin R. Long, Vanessa Makarewicz, Chloe Bryson-Cahn, Arman Dagal; Partnerships Between Anesthesiology and Hospital Infection Prevention and Control Teams. ASA Monitor 2022; 86:19–20 doi: https://doi.org/10.1097/01.ASM.0000855656.97932.62 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: nosocomial infection, partnerships, prevention Infection prevention and control (IPC) are critical elements of perioperative quality and safety. Healthcare-associated infection is the leading cause of postoperative complications and hospital readmissions (asamonitor.pub/3tk4yG9). Perioperative teams and pre-anesthesia clinics are uniquely positioned to implement interventions that reduce postoperative infection (Anesthesiology June 2022). However, anesthesiologists have not historically partnered with IPC (or “hospital epidemiology”) teams, and conflicting perspectives have occasionally produced discord between these groups (asamonitor.pub/3p3IgVo). Despite the role of anesthesiologists as perioperative physicians, representation from our specialty is lacking in national guidelines for surgical antimicrobial prophylaxis and the prevention of surgical site infection (Am J Health Syst Pharm 2013;70:195-283; JAMA Surg 2017;152:784-91). This is now changing, as reflected in the work of Randy Loftus, David Birnbach, and Andrew Bowdle (AMA Netw Open 2020;3:e201934; Anesth Analg 2020;131:37-42; Br J Anaesth 2019;123:531-4; Anesth Analg 2015;120:853-60; Anesth... You do not currently have access to this content.

Appropriateness of surgical antimicrobial prophylaxis in Japanese university hospitals

Surgical antimicrobial prophylaxis (SAP) is one of the major purposes of antimicrobial use. To determine the adherence to the Japanese SAP guidelines in Japanese university hospitals. This was a retrospective cohort study including 15 general hospitals and one dental university hospital. Up to three cases of 18 designated surgeries were evaluated regarding adherence to Japanese SAP guidelines: selection of antibiotics, timing of administration, re-dosing intervals, and duration of SAP. When all items were appropriate, surgery was defined as 'appropriate'. In total, 688 cases (22-45 cases per surgery) were included. The overall appropriateness was 46.8% (322/688), and the appropriateness of each surgery ranged from 8.0% (2/25, cardiac implantable electronic device implantation) to 92.1% (35/38, distal gastrectomy). The appropriateness of each item was as follows: pre/intraoperative selections, 78.5% (540/688); timing of administrations, 96.0% (630/656); re-dosing intervals, 91.6% (601/656); postoperative selection, 78.9% (543/688); and duration of SAP, 61.4% (423/688). The overall appropriateness of hospitals ranged from 17.6% (9/51) to 73.3% (33/45). The common reasons for inappropriateness were the longer duration (38.5%, 265/688) and choice of antibiotics with a non-optimal antimicrobial spectrum before/during, and after surgery (19.0%, 131/688 and 16.9%, 116/688, respectively), compared to the guideline. Adherence to the guidelines differed greatly between the surgeries and hospitals. Large-scale multi-centre surveillance of SAP in Japanese hospitals is necessary to identify inappropriate surgeries, factors related to the appropriateness, and incidences of surgical site infections.

Antimicrobial Prophylaxis for Urologic Procedures in Paediatric Patients: A RAND/UCLA Appropriateness Method Consensus Study in Italy.

The main aim of surgical antimicrobial prophylaxis (SAP) in urologic procedures is to prevent bacteraemia, surgical site infections (SSIs), and postoperative urinary tract infections (ppUTIs). Guidelines for SAP in paediatric urology are lacking. Only some aspects of this complex topic have been studied, and the use of antibiotic prophylaxis prior to surgical procedures seems to be more often linked to institutional schools of thought or experts’ opinions than to rules dictated by studies demonstrating the most correct and preferred management. Therefore, the aim of this Consensus document realized using the RAND/UCLA appropriateness method is to provide clinicians with a series of recommendations on SAP for the prevention of bacteraemia, SSIs, and ppUTIs after urologic imaging and surgical procedures in paediatric patients. Despite the few available studies, experts agree on some basilar concepts related to SAP for urologic procedures in paediatric patients. Before any urological procedure is conducted, UTI must be excluded. Clean procedures do not require SAP, with the exception of prosthetic device implantation and groin and perineal incisions where the SSI risk may be increased. In contrast, SAP is needed in clean-contaminated procedures. Studies have also suggested the safety of eliminating SAP in paediatric hernia repair and orchiopexy. To limit the emergence of resistance, every effort to reduce and rationalize antibiotic consumption for SAP must be made. Increased use of antibiotic stewardship can be greatly effective in this regard.

Surgical antimicrobial prophylaxis in open reduction internal fixation procedures at a metropolitan hospital in Australia: a retrospective audit

BackgroundOpen reduction internal fixation (ORIF) of closed fractures is a required indication for surgical antimicrobial prophylaxis (SAP). Guidelines contain recommendations on how best to prescribe SAP, however, adherence to SAP guidelines remains suboptimal. The Australian Therapeutic Guidelines: Antibiotic v16 (updated April 2019) advocates for single dose prophylaxis for ORIF procedures. There is a paucity of information on how SAP is prescribed for ORIF of closed fractures in Australian hospitals. The aim of this study was to identify prescribing practice and to evaluate guideline adherence pre- and post-guideline update.MethodsA retrospective audit was conducted for patients undergoing an ORIF of closed fractures at a metropolitan teaching hospital in a 6-month period during 2018 (pre-guideline update) and 2019 (post-guideline update). Data were collected on prescribing practice (perioperative antibiotics prescribed, dose, time and route of administration and duration of prophylaxis) and compared to SAP recommendations in Therapeutic Guidelines: Antibiotic v15 (2018) and v16 (2019). Descriptive statistics and Chi square tests were used to report categorical variables. Binary logistic regression was used to identify factors associated with guideline adherence. A p-value < 0.05 was deemed statistically significant.ResultsData were collected for a total of 390 patients (n = 185, 2018; n = 205, 2019). Cefazolin was the most commonly prescribed antibiotic as per guideline recommendations, with variable, yet appropriate doses observed across the two audit periods. While 78.3% of patients received SAP for the correct duration in 2018, only 20.4% of patients received single dose prophylaxis in 2019. Overall adherence to guidelines was 63.2% in the 2018, and 18.0% in the 2019 audit periods respectively. Patient age was significantly associated with an increase in overall guideline adherence, while lower limb fractures, an American Society of Anesthesiologists (ASA) score of 3 and emergency admissions were associated with decreased overall adherence to SAP guidelines.ConclusionAdherence to guidelines was greater with v15 (2018) compared with v16 (2019). Patient factors, including limb fracture site and ASA score, had little impact on guideline adherence. Further research is required to understand what influences guideline adherence in the orthopaedic setting.

1080 An Audit on Compliance with Recommended Duration of Surgical Antimicrobial Prophylaxis in St. Vincent’s University Hospital, Dublin, Ireland

Abstract Aim Surgical site infection (SSI) is a common healthcare-associated infection, and a frequent cause of post-operative morbidity. SSI comprises any infection of the operative incision, cavity or involved organ, that occurs within the 30-day post-operative period. Antimicrobial prophylaxis is critical in reducing SSIs. Our aim was to assess adherence to the recommended surgical antimicrobial prophylaxis guidelines in St. Vincent’s University Hospital (SVUH), as part of the hospital antimicrobial stewardship programme. Compliance of surgical services was measured against the recommended regimens described in the SVUH Antimicrobial Guidelines. Method Data on duration and choice of prophylaxis were prospectively gathered on inpatients undergoing elective surgery during a three-week period between August-September 2020. Patients undergoing transplant procedures, inpatients in the intensive care unit, and patients who moved off-site postoperatively were excluded. Results Eighty-one patients were included. Sixty-four (79%) were compliant with prophylaxis duration, while seventeen (21%) were not. Reasons for extended prophylaxis included three (18%) cases where there were intra-operative complications and five (29%) cases of routine prescribing of an additional 24-hour coverage. Nine (53%) did not document the reason for extended cover. Conclusions Compliance with recommended duration of prophylaxis improved in comparison to prior audits. Among patients receiving extended prophylaxis, documentation of the indication was poor. Patients with evidence of post-operative infection may be better served with targeted antimicrobial therapy rather than extended prophylaxis. One reason for extended prophylaxis may be due to difficulty accessing guidelines on recommended prophylaxis duration, hence a targeted smartphone application was introduced to improve accessibility.

The Impact of a Multidisciplinary Approach Protocol and Integrated Guidelines for Antibiotic Prophylaxis in Plastic Surgery Procedures.

BACKGROUNDSurgical antibiotic prophylaxis has been widely used for prevention of surgical site infections (SSI’s). World Health Organization (WHO) global guidelines strongly recommend the administration of pre-operative prophylactic antibiotic, depending on the type of surgery, to reduce SSI’s. However, within Gulf Cooperation Council (GCC) countries, antibiotic resistance has been rising due to unregulated prescribing practice. We aimed to assess adherence to local/international guidelines in the plastic surgery unit of Salmaniya Medical Complex.METHODSThis study was a retrospective review of adults’ undergoing plastic surgery between the dates of 1st of January 2019 to 30th of April 2019. Recommendations and guidelines were provided by South Australian Guidelines for Surgical Antimicrobial Prophylaxis, NHS Greater-Glasgow Foundation Trust. Salmaniya Medical Complex Guidelines were also taken into consideration. This was followed by an implementation of standardized guidelines and a re-assessment period for another four months.RESULTSThere were 106 patients who met the inclusion/exclusion criteria throughout the primary cohort. With respect to choice and dose of antibiotics, only 21 (19.8%) of the procedures were adherent to global/local guidelines. Similarly, only 11.5% of those cases have met the recommended timing for pre-operative antibiotic administration. After the implementation period, adherence to guidelines regarding choice and time of antibiotic administration has increased to 36.8% and 32.6% respectively. SSI decreased from 1.8% to 0.08%.CONCLUSIONPractice in SMC in plastic surgery pre-operative antibiotic prophylaxis shows poor compliance to both local and international guidelines in terms of choice, dose, and time of administration. We were able to significantly improve adherence to international/local practice in both areas by implementing an integrated protocol in liaison with the medical staff involved in the plastic surgery unit and operating theatres.

Surgical antimicrobial prophylaxis

Introduction: Surgical antimicrobial prophylaxis (SAP) is considered vital for reducing surgical site infection, however, if inappropriate, it prolongs the hospital stay of patients, increases morbidity, promotes antimicrobial resistance and puts an economic burden on the health system. This study was carried out to assess the knowledge and compliance of SAP among surgeons in a hospital. Methods: A quantitative, non-interventional study was done among surgeons from a tertiary teaching hospital. First, we evaluated participant knowledge from different surgical specialities by the pre-designed questionnaire, and second, we audited surgeries during the study period of 3 months for a compliance rate of SAP. The score of responses and compliance to SAP variables during surgeries was studied. Results: We assessed a total of 184 participants for knowledge and 271 surgeries were audited. Among the variables of surgical prophylaxis, majority of the participants answered correctly about the route and timing of administration of SAP in 179 (97.3%) and 145 (78.8%) respectively. Only 66 (35.9%) knew about the correct choice of SAP while 78 (42.4%) responded correctly about the duration within which it should be stopped. However, two-third 138 (75%) were aware of the assessment of beta-lactam allergy before administration. Among the surgeries audited, 83.7% compliance was noted for the timing of administration of antibiotics, however, in only 42 (26.7%) cases SAP was stopped within 24 h of surgery and in only 38 (24.2%) cases cefazolin/cefuroxime was given as prophylaxis. Conclusion: This study highlighted the importance of knowledge and awareness of SAP guidelines among surgeons. There is a need to train surgeons regarding this important issue.

Factors that influence adherence to surgical antimicrobial prophylaxis (SAP) guidelines: a systematic review

BackgroundDespite the extensive research that has been conducted to date, practice often differs from established guidelines and will vary between individuals and organisations. It has been noted that the global uptake of local and international surgical antimicrobial prophylaxis (SAP) guidelines is poor with limited research investigating factors that affect guideline adherence. The purpose of this systematic review was to determine the reported barriers and enablers to the adherence of SAP guidelines.MethodsA search of the literature was performed using four electronic databases (CINAHL, EMBASE, PubMed and SCOPUS) for articles published in the English language from January 1998 to December 2018. Articles were included if they were solely related to SAP and discussed the barriers or enablers to SAP guideline adherence. Articles that assessed the adherence to a range of infection control measures or discussed adherence to antibiotic treatment guidelines rather than SAP guidelines were excluded from this review. Barriers and enablers were mapped to the Theoretical Domains Framework (TDF). The Mixed Methods Appraisal Tool was used to assess the quality of included studies.ResultsA total of 1489 papers were originally retrieved, with 48 papers meeting the eligibility criteria. Barriers and enablers were mapped to 11 out of 14 TDF domains: knowledge, skills, social/professional role and identity, beliefs about capabilities, beliefs about consequences, reinforcement, memory, attention and decision processes, environmental context and resources, social influences, emotion and behavioural regulation. Barriers were further categorised into personal or organisational barriers, while enablers were arranged under commonly trialled interventions.ConclusionsThere are numerous factors that can determine the uptake of SAP guidelines. An identification and understanding of these factors at a local level is required to develop tailored interventions to enhance guideline adherence. Interventions, when used in combination, can be considered as a means of improving guideline use.

Qualitative Thematic Analysis of Knowledge and Practices of Surgical Antimicrobial Prophylaxis at a Tertiary Care Teaching Hospital.

Background: Surgical antimicrobial prophylaxis (SAP) refers to the utilization of antibiotic agents for the prevention of surgical site infections (SSI), to prevent SSI-associated morbidity and mortality, reduce duration and cost of healthcare, and cause minimal adverse drug effects. The adherence rate among surgeons for the available international and national guidelines and optimal practice remains considerably low in many hospitals, especially in developing countries. The objective of this study was to assess the knowledge and compliance rate for SAP guidelines among various surgical specialties and those involved in providing SAP. Methods: An institution-based exploratory, multi-specialty, collective, mixed method approach (qualitative and quantitative) was used to assess the knowledge and compliance rate for SAP guidelines among the consultants and residents of surgical specialties. Quantitative analysis was performed using a pre-tested questionnaire. For qualitative analysis, focus group discussions were conducted. Thematic analysis was conducted by the Theoretical Domains Framework (TDF) and the Capabilities, Opportunities, Motivation and Behaviour (COM-B) model. Results: Twenty-eight focus groups and 16 paired interviews were undertaken. On thematic analysis six significant themes were noted and mapped to the COM-B model, and subthemes mapped to the relevant TDF domains in a combined framework. Key themes recognized were: (1) solitary focus on surgical skills; (2) following the hierarchy is more important than guideline compliance; (3) doubts and overcautious attitude of surgeons hinders appropriate SAP prescribing; (4) non-availability in-hospital supply of antimicrobial agents; (5) patient characteristics and type of surgery play a role in prescribing SAP; and (6) lack of national and local guidelines. Conclusions: The knowledge and attitudes of surgeons toward appropriate SAP prescribing are crucial factors for execution of guidelines. Including them in policy making decisions can help in strong execution of the same.

Usage Pattern of Antimicrobial Agents in Surgical Patients of a Tertiary Care Teaching Hospital in Ajman, United Arab Emirates

The extensive use of AMAs has paved the pathway for antibiotic resistance among commonly encountered microorganisms. Additionally, rational use of antimicrobial agents (AMAs) is extremely vital for positive patient outcomes. Hence, we aimed to analyse the pattern of use of AMAsin patients who had undergone surgery at Thumbay Hospital, Ajman, United Arab Emirates and to study the incidence of adverse drug reactions in the same group of patients. The data were collected over a one-year period after Institutional Ethics Committee approval. Case record analysis of AMAsprescribed to surgical patients was done with the help of a questionnaire.Most surgeries were related to ano-rectal (24%),obstetrics (23.5%)and ENT (14%) problems.AMAs were prescribed to86.5% of the patients as surgical antimicrobial prophylaxis (SAP), with the majority being prescribed only one AMA (45.8%). Metronidazole (40.9%), Ceftriaxone (21.2%) and Cefuroxime (10.8%) were the leading AMAs for SAP. Almost all the patients (91.5%) were prescribed AMAs at discharge and Cefuroxime (23.2%), Metronidazole (20.7%) and Amoxicillin-Clavulanic acid combination (17.7%) were the principal AMAs recommended. The average duration of prescription of AMAs at discharge was 6.4 days. Mild adverse drug reactions were encountered, which did not pose any serious health risk to the patients. Proactive interventions focusing on the surgical team like formal educational sessions on antimicrobial stewardship, consistent auditing and regular updates about current SAP guidelines are the need of the hour

Adherence to the guidelines for surgical antimicrobial prophylaxis in a Saudi tertiary care hospital.

ObjectiveThe study evaluated the adherence to the guidelines for surgical antimicrobial prophylaxis in a Saudi tertiary care hospital.MethodsThe medical records of 707 patients from the surgical units over a selected 3-month period were selected. The data were reviewed and statistically analysed.ResultsOf the 707 respondents, 51.2% were women and most were older than 50 years. The most common surgical procedures involved orthopaedics (28.3%), followed by vascular surgery (15.1%). One hundred and thirty-eight (19.5%) patients received antibiotics according to the guidelines for surgical prophylaxis. More than half of the patients (399/56.4%) received antibiotics for more than 24 h and 129 (18.2%) received antibiotics for less than 24 h. Single dose antibiotic therapy was used in 179 (25.3%) patients. Two hundred and ninety-seven (42%) patients underwent clean surgery, 284 (40%) clean-contaminated and 128 (18%) contaminated surgery. A significant difference was evident between the antibiotics administered according to the recommended guidelines and the duration of antibiotic therapy (p = 0.001), duration (p = 0.001) and the type of surgical procedure (p = 0.00).ConclusionThe findings of this study suggest that healthcare professionals do not strictly adhere to the guidelines for surgical antibiotic prophylaxis. Physicians are therefore encouraged to follow the recommendations appropriately and to regularly implement surgical antimicrobial prophylaxis for patient safety.

PROSPECTIVE OBSERVATIONAL STUDY ON ANTIBIOTIC-PRESCRIBING PATTERN AND MEDICATION ERRORS IN SURGICAL PROPHYLAXIS IN A SPECIALTY HOSPITAL

Objective: The objective was to study the antibiotic-prescribing patterns, identify the medication errors and impact of surgical antimicrobial prophylaxis (SAP) in preventing surgical site infection (SSI), and to understand the prescribers’ adherence to surgical prophylaxis guidelines.&#x0D; Methods: The study was conducted for a period of 6 months in all surgical departments of a specialty hospital. Data were collected from inpatients records. Australian guideline for SAP was used to assess the appropriateness in prescribing pattern. The sample size was calculated using Raosoft sample size calculator.&#x0D; Results: A prospective observational study was carried out among 178 patients. Of which, 100 were male and 78 were female. Four hundred and thirty-three antimicrobials were prescribed as pre- and post-operative surgical prophylaxis, among that 87% prescribed by brand name and 13% by generic. Seventy-one percent received single antimicrobial agent preoperatively, of which 99.5% prescribed as parenteral and 0.5% as oral formulation. Most often prescribed antibiotic was cefoperazone (28%) of cephalosporin group. Only 5.6% of cases had compliance with SAP guidelines. In this study, 11 patients affected with SSI due to inappropriate antibiotic selection and non-adherence to prophylactic antibiotic guidelines.&#x0D; Conclusion: The present study revealed that there is a poor compliance to SAP guidelines in terms of inappropriateness in antibiotic drug selection, dose, duration, and omission of drugs. Inappropriateness and non-compliance are mainly due to unavailability of clinical pharmacist to assist the physicians in the selection and administration of correct choice of prophylactic drug and unavailability of proper national or local guidelines. Hence, there is dire need to make local SAP guidelines to improve SAP-prescribing pattern.