A Self-Sustaining Antibiotic Prophylaxis Program to Reduce Surgical Site Infections

Jessie Codner; Elissa Falconer; Eli Mlaver; Jyotirmay Sharma; Grant Lynde

Our multi-institutional healthcare system was observed to have a higher-than-expected surgical site infection rate. A gap analysis identified three opportunities to improve preoperative prophylactic antibiotic administration: standardized antibiotic selection, standardized antibiotic administration, and feedback regarding antibiotic administration compliance. 

Implementation of a multifaceted quality improvement initiative including a near-real-time preoperative antibiotic compliance feedback tool will improve compliance with antibiotic administration protocols and surgical site infection rate. 

A compliance feedback tool designed to provide monthly reports to all anesthesia and surgical personnel was implemented at two facilities, in 09/2017 and 12/2018. Internal case data was tracked for antibiotic compliance, and these data were merged with ACS NSQIP data at the case level to provide process and outcome measures for surgical site infections. Implementation success was evaluated by comparing protocol compliance and risk-adjusted rates of superficial and deep SSI before and after the quality improvement implementation. 

A total of 20,385 patients were included in this study; 11,548 patients in the pre-implementation and 8,837 in the post-implementation groups. Baseline patient and operative characteristics were similar between groups, except the post-implementation group had a higher median expected SSI rate (2.2% vs 1.6%). Post-implementation, antibiotic protocol compliance increased from 86.3% to 97.6%, and superficial and deep SSIs decreased from 2.8% to 1.9% (p<0.001). The odds of superficial and deep SSI in patients in the implementation group was 0.69 (0.57, 0.83) times the odds of superficial and deep SSI in pre-implementation patients while adjusting for age, sex, diabetes mellitus, ASA class, wound class, smoking, and COPD. Observed-to-expected ratios of superficial and deep SSI decreased from 0.82 to 0.48 after the intervention.

Surgical antibiotic prophylaxis standardization and providing near-real-time individualized feedback resulted in sustained improvement in antibiotic compliance rates and reduced superficial and deep surgical site infections.