C. M. Chang1,6, L. R. Putnam2,5,6, J. M. Podolnick1,5, S. Sakhuja1,5, M. Matuszczak3,6, M. T. Austin2,5,6, L. S. Kao4,5, K. P. Lally3,5,6, K. Tsao2,5,6 6Children’s Memorial Hermann Hospital,Houston, TX, USA 1University Of Texas Health Science Center At Houston,Medical School,Houston, TX, USA 2University Of Texas Health Science Center At Houston,Department Of Pediatric Surgery,Houston, TX, USA 3University Of Texas Health Science Center At Houston,Department Of Pediatric Anesthesia,Houston, TX, USA 4University Of Texas Health Science Center At Houston,Department Of General Surgery,Houston, TX, USA 5Center For Surgical Trials And Evidence-based Practice,Houston, TX, USA
Introduction:
Proper prophylactic antibiotic administration includes adherence to all components: appropriate administration, type, dose, timing, and redosing. We previously demonstrated that 52% of operations suffered from at least one incorrect component of proper administration. In response, a multiphase, multifaceted prophylactic antibiotic program was created with the hypothesis that overall adherence to prophylactic institutional guidelines would increase.
Methods:
From 2011-2014, three 10-month interventional periods were conducted which implemented adoption of Surgical Care Improvement Project-based pediatric antibiotic prophylaxis guidelines (2011), integration of checkpoints into the pre-incision surgical safety checklist/creation of a computerized physician order entry module (2012), and role assignment to anesthesiology for administration (2013); audit/feedback was performed throughout. Following each period, an 8-week direct-observational assessment was performed. Perioperative factors that may influence guideline adherence including wound class, surgical specialty, patient weight, and anesthesia provider were analyzed. Spearman’s rank correlation and chi-squared analysis were performed, p<0.05 was considered significant.
Results:
1,052 operations were observed. Prophylactic antibiotics were indicated in 629 (60%) in which 625 (99%) received them. Conversely, antibiotics were not indicated in 421 cases (40%) in which 358 (85%) did not receive antibiotics. For cases requiring antibiotics, adherence to the four administration components remained unchanged (54% to 55%, p=0.99). Only redosing significantly improved (7% to 53%, p=0.02), whereas correct type declined (98% to 70%, p<0.01, Table). This decline was mostly attributed to two surgeons who were unaware of updated 2013 institutional guidelines, but utilized an acceptable antibiotic. Otherwise, correct type and overall adherence in 2014 would have been 89% and 72%, respectively. Adherence to guidelines did not differ significantly based on ASA class, surgical specialty, patient weight, anesthesia provider, or surgical wound class (all p>0.05).
Conclusions:
Despite multiple interventions to improve antibiotic prophylaxis, overall adherence did not significantly increase. Although most interventions were directed at point of administration in the operating room, proper dissemination of institutional guidelines remains a challenge. Future strategies will require additional educational initiatives as well as a perioperative approach towards process standardization to improve adherence to antibiotic prophylaxis administration.
