Multi-disciplinary quality improvement project on adherence to surgical antibiotic prophylaxis guidelines in Saudi Kingdom Armed Forces Hospital Southern Region

Non-adherence to Antibiotic surgical prophylaxis guidelines can be through many aspects including inappropriate timing of prophylactic antibiotic administration, inappropriate selection of the antibiotics, incorrect weight-based dosing, excessive use of antibiotic without proper indication, duration of the prophylaxis, and concerns of re-dosing during the long operation. Usually all of these factors lead to increased incidence of surgical site infections, excessive use of resources, and extra cost burden. Regular updating of antibiotic policy and awareness of such process require a dedicated professional team. The main aim of the presented quality improvement project was to improve adherence at every possible aspect involved within the administration of the antibiotics through adopting evidence-based multi-disciplinary intervention approaches. A before-after interventional study was conducted on patients undergoing elective surgery between February to November 2023 at a tertiary healthcare facility in Saudi Kingdom Southern Region. Out of 543 total patients undergoing surgical operations, 93.8% ( n = 244) and 46.6% ( n = 132) patients received antibiotics at respective before and after intervention stages. The most administered antibiotics in pre- and post-intervention phases was cefazolin with 157 (66.24%) vs. 125 (94.7%) respectively. Following interventions, total compliance increased from 12.6% (95% CI: 8.6–16.6%; n = 33) of patients compared with 77.3% (95% CI: 72.4–82.2%; n = 219) post-intervention, representing a massive effect size (OR: 23.54; p < 0.01). Patients of appropriate administration timing increased 81.82% (95% CI: 75.2–88.4%; n = 108) vs. 23.77% (95% CI: 18.41–29.13%; n = 58) in the post and pre-intervention groups (OR: 14.4; p < 0.01). Appropriate selection was in 95.4% of patients (95% CI: 91.8–99.0%; n = 126) vs. 74.05% of patients (95% CI: 67.7–80.4%; n = 137) in post and pre intervention group (OR: 7.38; p < 0.01). While appropriate dosing was in 91.67% (95% CI: 87.0–96.4%; n = 121) vs. 76.65% (95% CI: 71.2–82.1%; n = 174) of patients in post and pre-intervention phase (OR: 3.35; p < 0.01); 130 of patients (98.48%; 95% CI: 96.4–100.0%) vs. 161 of patients (70.61%; 95% CI: 64.7–76.5%) in the post-intervention group were prescribed antibiotics for the appropriate duration (OR: 27.1; p < 0.01). Only 55.5% (95% CI: 23.1–87.9%; n = 5) versus 71.4% (95% CI: 37.9–100.0%; n = 5) (OR: 2.0; p < 0.05) were re-dosed appropriately in pre- and post-intervention phase, respectively. Indication appropriateness was 90.8% (95% CI: 86.9–93.7%; n = 257) vs. 88.07% (95% CI: 83.6–91.5%; n = 229) in post- and pre-intervention phases (OR: 1.34; p > 0.05). Oral antibiotic continuation post-operatively showed 78.08% (95% CI: 72.7–82.7%; n = 203) vs. 50.17% (95% CI: 44.4–56.0%; n = 142) for discharged patient with inappropriate oral antibiotic in pre- and post-intervention phase (OR: 3.53; p < 0.01). The implementation of the multidisciplinary intervention resulted in a significant reduction in direct hospital costs. The estimated net saving was 22,633.11 Saudi Riyal per 1,000 patients, calculated as the difference between the total continuation costs in the pre-intervention phase (46,733.31 SAR) and the post-intervention phase (24,100.20 SAR). Significant improvement was observed in adherence to all aspects of antibiotic prophylaxis guidelines compliance through targeted multidisciplinary interventions, which helped in improved prescribing practices of antibiotic for surgical prophylaxis.