Sustainability and spread of best practices for peri-operative antimicrobial stewardship following discontinuation of mandatory public reporting: perceptions from the Society for Healthcare Epidemiology in America research network

BACKGROUND: A Joint Commission national program, the surgical care improvement project (SCIP), supported the adoption of evidence-based peri-operative antimicrobial use practices, including administration of antimicrobials prior to incision and early discontinuation after skin closure. With high compliance, in 2015, the public reporting requirement that provided external pressure to support practice improvements was discontinued. Since discontinuation, few studies have assessed the sustainment of best antimicrobial use practices and what procedures were developed to maintain improvements within facilities. OBJECTIVE: The aim of this study was to measure perceptions among antimicrobial stewardship experts about which policies and practices have been important and effective for sustainment. DESIGN: A 15-min survey was administered to the Society for Hhealthcare Epidemiology in America (SHEA) research network over the summer of 2023. The survey included questions about different SCIP measures such as prophylactic antibiotic use pre and post-surgery and about local policies and procedures that were implemented to support best practices. Simple descriptive statistics were utilized to analyze results. RESULTS: The survey was distributed to 112 members of the SHEA research network, with a 41% response rate. Most respondents perceived high rates of ongoing compliance with both pre- and post-operative prophylaxis guidelines, although ongoing surveillance and measurement is limited. Respondents perceived that the most important internal factors associated with ongoing compliance were electronic order sets, facility policies, time outs, and automatic stop orders. Substantial spread of best practices (eg, to surgical procedures and specialties not covered until the SCIP program) was reported. CONCLUSIONS: Despite discontinuation of mandated reporting, antimicrobial stewards perceived ongoing compliance with SCIP measures. Local policies and procedures implemented to support initial uptake of best practices have supported ongoing sustainment of practice improvements.