Perioperative antibiotic prophylaxis: tools, results and reflections from a 6-year monitoring.

Background Perioperative antimicrobial prophylaxis is a key practice to prevent surgical site infection. The Udine Healthcare and University Integrated Trust has defined its features in a specific procedure, available on the hospital Intranet. Compliance with the procedure has been monitored on a semi-annual basis. Methods Between July 2013 and December 2018 15 clinical records per semester for each one of the 16 surgical units were randomly extracted, including ordinary admissions with clean or clean/contaminated surgery. Compliance with the procedure was monitored for all the items considered: drug, dosage, timing of administration, redosing and duration of prophylaxis. A first comparison analysis both between semesters and for longer time frames was performed with the chi-square test; to evaluate the presence of a linear trend all over time (in semestres), the Pearson linear correlation coefficient was calculated; in case of correlation, a simple two-variable linear regression analysis was performed. Statistical significance was assessed for p < 0.05. Results A sample of 2775 records was evaluated. Focusing on the first and last semester of monitoring, overall compliance increased in 9 of the 16 units, although there is a drop, when extending the analysis to the whole sample (72% vs 70.8%) with no statistical significance. Otherwise a statistically significant difference is recorded between the first and the last two years of analysis (p <0.007), with an increase of overall compliance from 64.2% (2013-2014) to 69.7% (2017-2018). Finally a strong and significant negative correlation between time and overall compliance to redosing emerges (r = -0.79; p = 0.004). Conclusions Compliance with hospital procedure has substantially improved over time reaching a stable performance value. However the linear regression analysis highlights the need to implement new intervention strategies in order to increase overall compliance to redosing. Key messages Overall compliance with hospital procedure has improved over time. Results highlight the need to implement new intervention strategies.