Increasing Compliance With an Antibiotic Prophylaxis Guideline to Prevent Pediatric Surgical Site Infection

Abstract

In Brief Objectives: To evaluate an intervention for improving antibiotic prophylaxis (AP) guideline compliance to prevent surgical site infections in children. Background: Although appropriate AP reduces surgical site infection, and guidelines improve quality of care, changing practice is difficult. To facilitate behavioral change, various barriers need to be addressed. Methods: A multidisciplinary task force at a pediatric hospital developed an evidence-based AP guideline. Subsequently, the guideline was posted in operating rooms and the online formulary, only recommended antibiotics were available in operating rooms, incoming trainees received orientation, antibiotic verification was included in time-out, computerized alerts were set for inappropriate postoperative prophylaxis, and surgeons received e-mails when guideline was not followed. AP indication and administration were documented for surgical procedures in July 2008 (preintervention), September 2011 (postintervention), and April–May 2013 (follow-up). Compliance was defined as complete—appropriate antibiotic, dose, timing, redosing, and duration when prophylaxis was indicated; partial—appropriate drug and timing when prophylaxis was indicated; and appropriate use—complete compliance when prophylaxis was indicated, no antibiotics when not indicated. Compliance at preintervention and follow-up was compared using χ2 tests. Results: AP was indicated in 43.9% (187/426) and 62.0% (124/200) of surgical procedures at preintervention and follow-up, respectively. There were significant improvements in appropriate antibiotic use (51.6%–67.0%; P < 0.001), complete (26.2%–53.2%; P < 0.001) and partial compliance (73.3%–88.7%, P = 0.001), correct dosage (77.5%–90.7%; P = 0.003), timing (83.3%–95.8%; P = 0.001), redosing (62.5%–95.8%, P = 0.003), and duration (47.1%–65.3%; P < 0.002). Conclusions: A multifaceted intervention improved compliance with a pediatric AP guideline. Appropriate antibiotic prophylaxis reduces surgical site infections and practice guidelines improve quality of care, but changing physician behavior is difficult. Compliance with a pediatric surgical antibiotic prophylaxis guideline was assessed before and after a multifaceted intervention. Appropriate antibiotic use, compliance (complete, partial), dosage, timing, redosing, and duration improved after the intervention.