Impact of a Guideline-Driven Quality Improvement Intervention on Intraoperative Antibiotic Redosing Compliance and Surgical Site Infections

Surgical site infections (SSIs) continue to occur due to improper perioperative antibiotic choice, timing, inadequate dosing or redosing. Internal data revealed that appropriate intraoperative antibiotic redosing rates in 2014 were low. Our multidisciplinary team implemented a quality improvement intervention in January 2016 to increase compliance with surgical prophylaxis guideline recommendations, with a focus on appropriate intraoperative antibiotic redosing. A retrospective, observational study was conducted for all surgeries performed at the University of Iowa Hospitals and Clinics between September 1, 2014 and April 30, 2017. Two months of data before and after the intervention were censored for analysis. The primary outcome was failure to meet intraoperative antibiotic redosing criteria for procedures lasting greater than 4 hours in the pre- and post-intervention period, analyzed by Chi-square test. Monthly total procedures and the number lasting greater than 4 hours were analyzed between periods by independent-samples t-test. Hospital SSI rates were trended throughout the study period. There were 14 months of data both pre- and post-intervention and 48,781 total surgical procedures were analyzed. The mean total number of surgical procedures monthly were 1,733 pre- and 1,750 post-intervention (P = 0.55). The monthly mean number of procedures lasting greater than 4 hours were 235 pre- and 249 post-intervention (P = 0.06). For surgeries lasting greater than 4 hours, 1,968 (59.7%) failed to meet redosing criteria pre- and 1,407 (40.2%) post-intervention (P < 0.01). Hospital SSI rates for fiscal year 2015, 2016, and 2017 (data through December) were 2.4, 2.1, and 1.8 infections per 100 procedures, respectively. The quality improvement intervention significantly reduced the number of intraoperative antibiotic redosing failures in procedures lasting greater than 4 hours. The number of procedures performed in the pre- and post-intervention periods were not significantly different. Trends in SSIs declined during the study period. Further study is warranted to determine the direct impact of improved antibiotic redosing compliance on SSI rates. All authors: No reported disclosures.