ABSTRACT Background: Surgical site infections (SSIs) are among the most preventable hospital-acquired infections, yet adherence to surgical antibiotic prophylaxis (SAP) SOPs remains inconsistent in tertiary care settings. Aims and Objectives: To assess compliance with institutional SAP SOPs across major surgical departments, identify operational/systemic drivers of noncompliance, and develop a practical, sustainable improvement framework. Materials and Methods: A mixed-methods quality improvement study (April–June 2025) at a tertiary hospital in southern India audited 400 eligible surgical cases across five departments against six SAP SOP parameters. Quantitative audit findings were complemented by 26 key-informant interviews (surgeons, anaesthetists, OT nurses, infection control nurses, nursing supervisors) and root-cause analysis structured under people, process, technology, and environment. Results: Only 58.75% of cases received SAP within the recommended 30–60-min pre-incision window; 24.75% were administered too early (60 min before incision or long after (>120 min). Broad-spectrum antibiotic use predominated: 83.25% received ceftriaxone instead of guideline-recommended first-line agents. Documentation was incomplete and discordant across sources, with overall documentation completeness of 49.5%. Key barriers included recurrent stock-outs of recommended antibiotics, inter-departmental communication gaps, and fragmented multi-source documentation. Conclusion: Despite existing SOPs, substantial policy–practice gaps persist in SAP delivery. A Four-Pillar SAP Compliance Framework—process standardization, capacity building, technology enablement, and governance—was developed to embed compliance into surgical workflows, strengthen antimicrobial stewardship, and improve patient safety.
Prabhune et al. (Mon,) studied this question.