Rational use of antibiotics for major elective gynaecological and obstetrical surgical procedures: quality improvement journey from a tertiary care public facility

BMJ Open Quality

article

Manju Puri¹  Shilpi Nain¹  Akriti Gautam¹  Vidhi Chaudhary¹  Nishtha Jaiswal¹  Triveni GS¹  Deepika Meena¹  Meenakshi Singh¹  Kanika Chopra¹  Poornima Sharma¹  Ekta Chhillar¹  Harpreet Verma¹  Richa Mahato¹ 

[1] Obstetrics and Gynaecology , Lady Hardinge Medical College

关键词: obstetrics and gynecology;    antibiotic management;    standards of care;    clinical practice guidelines;    continuous quality improvement;   

DOI  :  10.1136/bmjoq-2021-001438

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background Antibiotic resistance is a global problem. Irrational use of antibiotics is rampant. Guidelines recommend administration of single dose of antibiotic for surgical antimicrobial prophylaxis (SSAP) for elective obstetrical and gynaecological surgeries. However, it is not usually adhered to in practice. Majority of women undergoing elective major gynaecological surgeries and caesarean sections in the department of obstetrics and gynaecology of our tertiary level heavy case load public health facility were receiving therapeutic antibiotics (for 7–10 days) instead of recommended SSAP. Our aim was to increase the SSAP in our setting from a baseline 2.1% to more than 60% within 6 months.Methods After root cause analysis, we formulated the departmental antimicrobial policy, spread awareness and sensitised doctors and nursing officers regarding antimicrobial resistance and asepsis through lectures, group discussions and workshops. We initiated SSAP policy for elective major surgeries and formed an antimicrobial stewardship team to ensure adherence to policy and follow processes and outcomes. The point of care quality improvement (QI) methodology was used. Percentage of patients receiving SSAP out of all low-risk women undergoing elective surgery was the process indicator and percentage of patients developing surgical site infection (SSI) of all patients receiving SSAP was the outcome indicator. The impact of various interventions on these indicators was followed over time with run charts.Results SSAP increased from a baseline 2.1%–67.7% within 6 months of initiation of this QI initiative and has since been sustained at 80%–90% for more than 2 years without any increase in SSI rate.Conclusion QI methods can rapidly improve the acceptance and adherence to evidence-based guidelines in a busy public healthcare setting to prevent injudicious use of antibiotics.

【 授权许可】

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