Surgical site infections (SSI) represent a significant complication of surgery by increasing costs, length of stay, and mortality. Although surgical antimicrobial prophylaxis (SAP) decreases SSI, adherence to guidelines is often variable. We assessed the effect of persuasive interventions, delivered by an antimicrobial stewardship program (ASP), on SAP global conformity improvement according to clinical guidelines.
A multicenter, quasi-experimental study was performed, assessing global SAP conformity pre- and post- persuasive interventions delivered by ASP for nine different surgical services (general surgery, thoracic, cardiac, vascular, hepatobiliary/graft, orthopedic, obstetrics and gynecology, urology, and neurology). Pre- and post-intervention data were collected retrospectively using patients’ files from April 2012 to March 2013 and from March 2014 to June 2014, respectively, to assess the effect of persuasive interventions delivered by ASP on SAP global conformity score based on choice of agent, dose, timing and prophylaxis duration, and to verify whether conformity varies between surgical services and aforementioned SAP criteria.
1585 audited surgeries were included in the primary analysis. The global conformity score pre-intervention was 62.4% and increased to 77.6% post-intervention (p<0.001). This difference remained statistically significant with sub-analysis per criterion, except for timing and readministration. A statistically significant difference was also observed in global conformity for all surgical services except urology, vascular, and obstetrics and gynecology. In the multivariate analysis, improvement in SAP conformity remained similar, accounting for potential confounders —notably sex, type of surgery (elective or urgent), the American Society of Anesthesiologists (ASA) score, duration of surgery, surgical service, methicillin-resistant staphylococcus aureus, and allergy.
For surgical antimicrobial prophylaxis, changes in practice occur best through an antimicrobial stewardship program. Persuasive interventions delivered through an antimicrobial stewardship to the surgical team, including a collaborative publication of internal guidelines, improves surgical antimicrobial prophylaxis prescription.
A. A. Longpré,
R. Kénol-Maurrasse, None
S. Vujanovic, None
D. Thirion, None
S. Carle, None
C. Guévremont, None
C. Frenette, None