Abstract :
[en] Background
Among different approaches to prevent surgical site infections, antibiotic prophylaxis is substantially important. According to previous published papers, surgical antibiotic prophylaxis (SAP) practices could be optimized by the implementation of isolated strategies.
Purpose
. To identify risk factors associated with non-compliance towards prophylactic antibiotic guidelines.
. To test the impact of a combined intervention strategy on compliance towards prophylactic antibiotic guidelines.
Material and methods
A quasi-experimental study with a pre-test-post-test evaluation was carried out on five types of intervention: hip prosthesis, coronary artery bypass grafting, colorectal surgery, transurethral resection of the prostate and endoscopic retrograde cholangiopancreatography. Compliance to guidelines was evaluated on eleven criteria within pre-test and intervention groups.
. In order to identify risk factors associated with non-compliance, a retrospective observational transversal study was carried out on the pre-test group using a multivariate statistical analysis (Wald test). Odds ratios for the relationships between each independent variable and the outcome variable were then determined.
. We tested a combined intervention strategy that included : the pre-operative delivery of nominative kits containing the antibiotics with a recommendation paper adapted to patient factors; a pharmacist participating in antibiotic stewardship team for compilation of guidelines and their distribution for implementation, audits, feedback, educational seminar and outreach visits; the development of an internal computer-based decision tool. For comparison between the 2 groups (pre-test and intervention groups), data were analyzed using χ2 and t tests for, respectively, categorical and continuous data.
Results
The pre-test group (11 January 2016 - 22 April 2016) and the intervention group (9 January 2017 - 21 April 2017) included, respectively, 130 and 118 interventions.
. The multivariate statistical analysis showed, as in previous studies, that true penicillin allergy, certain types of surgery and some practitioners were associated with non-compliance within the pre-test group.
. Compared with the pre-test group, the compliance was significantly increased in the test group for all eleven criteria (p(p<0,05) and in terms of global compliance (42.4 % vs 16.9 %; p<0,001). This positive impact revealed a culture change, an interest and an awareness observed within the practitioner's teams.
Conclusion
This study shows that optimization of SAP practices is achievable within a proactive multidisciplinary approach.
References and/or Acknowledgements
Wiffen P. Eur J Hosp Pharm 2018;25:1.
https://ejhp.bmj.com/content/25/1/1
