Auto-Substitutions to Optimize Perioperative Antimicrobial Prophylaxis: Pre-Post Intervention Study

Background: Appropriate administration of perioperative antibiotics can prevent antimicrobial resistance, adverse drug events, surgical site infections, and increased costs to the health care system for many surgeries in Otolaryngology-Head and Neck Surgery (OHNS).Objective: The objective of the study is to achieve 90% compliance with evidence-based perioperative antibiotic prophy-laxis guidelines among elective surgical procedures in OHNS.Methods: The pre-intervention group consisted of patients undergoing elective surgical procedures in the 13 months prior to the interventions (September 2019-2020) whereas the post-intervention group comprised patients undergoing elec-tive procedures during the 8 months following the implementation (October 2020-May 2021). The 4 Es of knowledge transla-tion and the Donabedian framework were used to frame the study. Components of the intervention included educational grand rounds and automatic substitutions in electronic health records. In June 2021, a survey of staff and residents assessed the self-reported perception of following evidence-based guidelines.Results: Compliance with antimicrobial prophylaxis guidelines were evaluated based on agent and dose. The overall com-pliance improved from 38.8% pre-intervention to 59.0% post-intervention (p < 0.001). Agent compliance did not improve from pre-to post-intervention, that is, 60.7% to 62.8%, respectively, (p = 0.68), whereas dose compliance improved from 39.6% to 89.2% (p < 0.001). Approximately 78.5% of survey respondents felt that they strongly agreed or agreed with always following evidence-based antimicrobial prophylaxis guidelines.Conclusion: Compliance with antimicrobial prophylaxis guidelines improved, primarily due to increased dosing compli-ance. Future interventions will target agent compliance and selected procedures with lower compliance rates.