Background
Adherence to prophylactic antibiotics guidelines is challenging and poorly documented.
We hypothesized that a multiphase, multifaceted quality improvement initiative would
engage relevant stakeholders, address known barriers to adoption, and improve overall
adherence.
Methods
From 2011 to 2014, a series of interventions were introduced in the pediatric operating
rooms. After each interventional period, prospective assessments were performed to
record the antibiotic type, dose, timing, and redosing according to the guidelines.
Perioperative factors that may influence guideline adherence were analyzed. Spearman's
rank correlation, analysis of variance, and χ2 tests were performed.
Results
A total of 1,052 operations were observed, and 629 (60%) required prophylactic antibiotics.
Adherence to all 4 guideline components remained unchanged (54−55%, P = .38). Redosing significantly improved (7−53%, P = .02), but correct type decreased (98−70%, P < .01). The percentage of cases in which only one antibiotic guideline component
was missed remained unchanged (35−34%, P = .46). Adherence to guidelines was not significantly associated with American Society
of Anesthesiologists class, surgical specialty, patient weight, anesthesia provider,
or surgical wound class.
Conclusion
Despite multiple interventions to improve antibiotic prophylaxis, overall adherence
did not improve. Most interventions were directed at the point of administration in
the operating room; future implementation strategies should focus on the perioperative
setting.
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Article info
Publication history
Published online: June 05, 2015
Accepted:
April 10,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
