A Prospective Quality Improvement Program to Reduce Prolonged Postoperative Antibiotic Prophylaxis in Ethiopia.
Maia R NofalAssefa TesfayeNatnael GebeyehuMisgana Negash MasershaIbrahim HayredinKinfemichael BelaynehBenti GetahunNichole StarrKaleb AbebeYonas SebsebeSenait Bitew AlemuTihitena Negussie MammoThomas G WeiserPublished in: Surgical infections (2024)
Introduction: Although postoperative antibiotic prophylaxis has not been shown to prevent surgical site infections, prolonged antibiotic administration is common in low- and middle-income countries. We developed a quality improvement program to reduce unnecessary postoperative antibiotics through hospital-specific guideline development and the use of a brief, multidisciplinary discussion of antibiotic indication, choice, and duration during clinical rounds. We assessed reduction in the number of patients receiving ≥24 h of antibiotic prophylaxis after clean and clean-contaminated surgery. Methods: We piloted the program at a referral hospital in Ethiopia from February to September 2023. After a 6-week baseline assessment, multidisciplinary teams adapted international guidelines for surgical prophylaxis to local disease burden, medication availability, and cost restrictions; stakeholders from surgical departments provided feedback. Surgical teams implemented a "timeout" during rounds to apply these guidelines to patient care; compliance with the timeout and antibiotic administration was assessed throughout the study period. Results: We collected data from 636 patients; 159 (25%) in the baseline period and 477 (75%) in the intervention period. The percentage of patients receiving ≥24 h of antibiotic prophylaxis after surgery decreased from 50.9% in the baseline period to 40.9% in the intervention period (p = 0.027) and was associated with a 0.5 day reduction in postoperative length of stay (p = 0.047). Discussion: This antibiotic stewardship pilot program reduced postoperative antibiotic prophylaxis in a resource-constrained setting in Sub-Saharan Africa and was associated with shorter length of stay. This program has the potential to reduce unnecessary antibiotic use in this population.
Keyphrases
- quality improvement
- patients undergoing
- healthcare
- patient safety
- primary care
- minimally invasive
- clinical trial
- heavy metals
- ejection fraction
- newly diagnosed
- clinical practice
- risk factors
- machine learning
- atrial fibrillation
- acute coronary syndrome
- big data
- electronic health record
- drinking water
- patient reported outcomes
- decision making
- adverse drug