The appropriate use of prophylactic antibiotics in surgeries is essential for the prevention of surgical site infections, one of the main complications related to surgical procedures. However, antibiotic prophylaxis still faces difficulties, such as low adherence to protocols and inappropriate antibiotic use. Sustaining improvements remains a challenge, with the complexity of the intervention and perceived impact being critical factors for its continuity. This study describes the implementation and sustainability of a quality improvement project in surgical antibiotic prophylaxis in a hospital, using the Improvement Cycle. The objective is to evaluate the effect of a multifaceted intervention on improving the quality of antibiotic prophylaxis in surgeries in a regional public hospital located in Palmares, Pernambuco. In addition, the influence of context on the outcomes achieved will be evaluated. This is an intervention study with a quasi-experimental design and before-and-after analysis, conducted in a public hospital managed by a social organization, between January 2023 and May 2024, with sustainability assessment in December 2024. The improvement intervention was participatory, multifaceted, and based on data from a prior assessment and on context analysis using the Model for Undestanding Sucess in Quality (MUSIQ). Absolute and relative improvements in the compliance rate of surgical antibiotic prophylaxis were estimated. The MUSIQ score (106.42) indicated that the intervention had potential for success, although it faced contextual barriers. The interventions included the creation of a Surgical Antibiotic Prophylaxis Protocol, its dissemination through physical and digital means, discussion of indicators with anesthesiologists, and individual approaches with prescribers responsible for non-compliance. After implementation of these interventions, the compliance rate of surgical antibiotic prophylaxis increased from 58% (95% CI: 50%–68%) to 94% (95% CI: 89%–98%), representing an absolute improvement of 36% and a relative improvement of 85% (p < 0.001). The sustainability assessment showed a compliance rate of 91% (95% CI: 86%–97%), confirming maintenance of the improvement achieved in the project. The use of quality methods and tools is a promising strategy for implementing quality improvement projects in healthcare, and periodic monitoring is essential to ensure their sustainability.
Melo et al. (Sun,) studied this question.