In the Journals

Survey shows low uptake of surgical antimicrobial prophylaxis guidelines

A survey conducted within the Society for Healthcare Epidemiology of America Research Network showed that only 30.8% of hospitals have fully adopted recommendations against the use of surgical antimicrobial prophylaxis after an incision has been closed.

“There are three main guidelines that health care providers can now use to prevent surgical site infections: WHO, the CDC and the American College of Surgeons,” research scholar Mireia Puig-Asensio, MD, PhD, and assistant professor of medicine Daniel J. Livorsi MD, MSc, — both from the University of Iowa Carver College of Medicine — told Infectious Disease News. “All of them were updated in 2016-2017, and they all agree on discontinuing surgical antimicrobial prophylaxis for clean and clean-contaminated procedures once the incision is closed.”

According to Puig-Asensio, Livorsi and Eli N. Perencevich MD, MS, professor of internal medicine and epidemiology at the University of Iowa Carver College of Medicine, “there is no evidence that prolonging [surgical antimicrobial prophylaxis (SAP)] after the surgery is completed prevents surgical site infections,” but extending SAP has been associated with an increased risk for adverse drug events, emergence of antimicrobial resistance and Clostridioides difficile infection.

The authors conducted a survey within the SHEA Research Network between Nov. 8, 2018, and Dec. 21, 2018, to determine the rate of implementation of the updated guideline recommendations.

Out of 112 members of the SHEA Research Network, 39 completed the survey, for a 34.8% response rate. Of these, 29 hospitals were located in the United States and 10 were from outside of the country. According to the researchers, 87.2% of respondents reported having an antimicrobial stewardship program.

For some procedures, 25.6% (n = 10) of sites reported a policy for stopping SAP once the incision is closed, whereas 30.8% (n = 12) reported a duration policy for all clean and clean-contaminated procedures covered by the guidelines. Of these 22 sites, 59.1% said they performed audit-and-feedback for compliance and 18.2% said they exclusively audited antimicrobial prescriptions without providing feedback. Audit-and-feedback related to SAP was not performed at 22.7% of responding sites, according to the survey results.

The authors also investigated barriers to implementation. Across all 39 responding hospitals, 56.4% reported physician skepticism about the evidence supporting the recommendation, 43.6% cited that SAP was not a priority for the institution and 30.8% had a “lack of familiarity with updated guidelines on preventing surgical site infections.”

Survey respondents included academic and nonacademic centers, and hospitals of different sizes and in different locations, making the data generalizable, the authors said.

“These results underscore that promoting guideline-concordant surgical antimicrobial prophylaxis discontinuation might be a good target for future antimicrobial stewardship interventions.,” Puig-Asensio and Livorsi said.

“Future research should investigate in detail barriers for guideline implementation in this area. Minimally invasive procedures that are performed outside the operating room are not covered by the above guidelines, so it’s unclear whether shorter courses of surgical antimicrobial prophylaxis are appropriate in these situations. However, more compelling evidence about the duration of antimicrobial prophylaxis for high-risk patients, such as those with joint prostheses or prosthetic heart valves, might be needed to convince health care providers to change their antimicrobial-prescribing behaviors.”– by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.

A survey conducted within the Society for Healthcare Epidemiology of America Research Network showed that only 30.8% of hospitals have fully adopted recommendations against the use of surgical antimicrobial prophylaxis after an incision has been closed.

“There are three main guidelines that health care providers can now use to prevent surgical site infections: WHO, the CDC and the American College of Surgeons,” research scholar Mireia Puig-Asensio, MD, PhD, and assistant professor of medicine Daniel J. Livorsi MD, MSc, — both from the University of Iowa Carver College of Medicine — told Infectious Disease News. “All of them were updated in 2016-2017, and they all agree on discontinuing surgical antimicrobial prophylaxis for clean and clean-contaminated procedures once the incision is closed.”

According to Puig-Asensio, Livorsi and Eli N. Perencevich MD, MS, professor of internal medicine and epidemiology at the University of Iowa Carver College of Medicine, “there is no evidence that prolonging [surgical antimicrobial prophylaxis (SAP)] after the surgery is completed prevents surgical site infections,” but extending SAP has been associated with an increased risk for adverse drug events, emergence of antimicrobial resistance and Clostridioides difficile infection.

The authors conducted a survey within the SHEA Research Network between Nov. 8, 2018, and Dec. 21, 2018, to determine the rate of implementation of the updated guideline recommendations.

Out of 112 members of the SHEA Research Network, 39 completed the survey, for a 34.8% response rate. Of these, 29 hospitals were located in the United States and 10 were from outside of the country. According to the researchers, 87.2% of respondents reported having an antimicrobial stewardship program.

For some procedures, 25.6% (n = 10) of sites reported a policy for stopping SAP once the incision is closed, whereas 30.8% (n = 12) reported a duration policy for all clean and clean-contaminated procedures covered by the guidelines. Of these 22 sites, 59.1% said they performed audit-and-feedback for compliance and 18.2% said they exclusively audited antimicrobial prescriptions without providing feedback. Audit-and-feedback related to SAP was not performed at 22.7% of responding sites, according to the survey results.

The authors also investigated barriers to implementation. Across all 39 responding hospitals, 56.4% reported physician skepticism about the evidence supporting the recommendation, 43.6% cited that SAP was not a priority for the institution and 30.8% had a “lack of familiarity with updated guidelines on preventing surgical site infections.”

Survey respondents included academic and nonacademic centers, and hospitals of different sizes and in different locations, making the data generalizable, the authors said.

“These results underscore that promoting guideline-concordant surgical antimicrobial prophylaxis discontinuation might be a good target for future antimicrobial stewardship interventions.,” Puig-Asensio and Livorsi said.

“Future research should investigate in detail barriers for guideline implementation in this area. Minimally invasive procedures that are performed outside the operating room are not covered by the above guidelines, so it’s unclear whether shorter courses of surgical antimicrobial prophylaxis are appropriate in these situations. However, more compelling evidence about the duration of antimicrobial prophylaxis for high-risk patients, such as those with joint prostheses or prosthetic heart valves, might be needed to convince health care providers to change their antimicrobial-prescribing behaviors.”– by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.