# Adherence to Surgical Antimicrobial Prophylaxis Guidelines and Improvement Efforts: A Single‐Center, Pre‐ and Post‐Intervention Comparison Study

## TL;DR

A hospital improved adherence to surgical antibiotic guidelines by creating timing indexes, reducing infection rates and healthcare costs.

## Contribution

A novel antimicrobial initiation index was developed to improve adherence to surgical prophylaxis guidelines in low-performing departments.

## Key findings

- Adherence to proper antibiotic timing improved from 82.6% to 95.0% in low-adherence departments after intervention.
- Surgical site infections dropped to 0% in cardiovascular surgery post-intervention.
- Inappropriate drug selection and prolonged duration were the most common guideline deviations.

## Abstract

Adherence to surgical antimicrobial prophylaxis (SAP) guidelines reduces the incidence of surgical site infections (SSIs) and improves prognosis and healthcare economics. This single‐center, pre‐ and post‐intervention comparative study investigated SAP guidelines adherence. Accordingly, we intervened where improvements were required. Changes in SAP guidelines adherence and SSI incidence were then evaluated.

We assessed adherence to the appropriate antimicrobial administration timing within 1 h before skin incision in surgeries performed between April 2021 and June 2022. Regarding drug selection, dosage, and duration, we evaluated SAP protocols for 228 procedures across 18 departments and compared them with established guidelines.

Overall adherence to appropriate antimicrobial administration timing was 92.3% (4687/5076). Adherence was particularly low after gastroenterological surgery, cardiovascular surgery, orthopedic surgery, and neurosurgery, with a total adherence rate of 82.6% (1603/1941) across these four departments. Drug selection and duration deviated from guidelines in 25% (57/228) of procedures. The most common area requiring improvement was inappropriate drug selection in 57.9% (33/57), followed by unnecessarily long duration in 50.9% (29/57) of cases. In addition to an educational approach, a new antimicrobial initiation index, based on preoperative preparatory events, was established in low‐adherence departments. All protocols requiring improvement were revised to align with established guidelines. Consequently, adherence to the appropriate antimicrobial administration timing in departments with previously low adherence improved significantly (pre‐intervention: 82.6%; 95% confidence interval [CI]: 80.8%–84.2%; post‐intervention: 95.0%; 95% CI: 93.8%–96.0%; p < 0.001). Substantial reduction in SSI incidence was found in cardiovascular surgery (pre‐intervention: 6.9%; 95% CI: 3.2%–12.7%; post‐intervention: 0%; 95% CI: 0%–3.0%; p = 0.006).

Establishing department‐specific antimicrobial initiation indexes, based on the surgical preparation stage, might be an effective measure for improving adherence to the appropriate antimicrobial administration timing in patients receiving SAP. Changes in SSI incidence require further study.

Adherence to surgical antimicrobial prophylaxis guidelines reduces the incidence of surgical site infections and improves patient prognosis and healthcare economics.In this single‐center, pre‐ and post‐intervention comparison study, adherence to surgical antimicrobial prophylaxis guidelines was investigated. Based on the results, a department‐specific antimicrobial initiation index was established for departments with low adherence to the appropriate timing of antimicrobial administration, leading to significant improvement. All protocols that deviated from the guidelines were revised through antimicrobial stewardship.The establishment of department‐specific antimicrobial initiation indices could be an effective measure for improving adherence to the appropriate timing of antimicrobial administration.

Adherence to surgical antimicrobial prophylaxis guidelines reduces the incidence of surgical site infections and improves patient prognosis and healthcare economics.

In this single‐center, pre‐ and post‐intervention comparison study, adherence to surgical antimicrobial prophylaxis guidelines was investigated. Based on the results, a department‐specific antimicrobial initiation index was established for departments with low adherence to the appropriate timing of antimicrobial administration, leading to significant improvement. All protocols that deviated from the guidelines were revised through antimicrobial stewardship.

The establishment of department‐specific antimicrobial initiation indices could be an effective measure for improving adherence to the appropriate timing of antimicrobial administration.