Abstract
Background
Despite increased compliance with Surgical Care Improvement Project infection measures,
surgical-site infections are not decreasing. The aim of this study was to test the
hypothesis that documented compliance with antibiotic prophylaxis guidelines on a
pediatric surgery service does not reflect implementation fidelity or adherence to
guidelines as intended.
Methods
A 7-week observational study of elective pediatric surgical cases was conducted. Adherence
was evaluated for appropriate administration, type, timing, weight-based dosing, and
redosing of antibiotics.
Results
Prophylactic antibiotics were administered appropriately in 141 of 143 cases (99%).
Of 100 cases (70%) in which antibiotic prophylaxis was indicated, compliance was documented
in 100% cases in the electronic medical record, but only 48% of cases adhered to all
5 guidelines. Lack of adherence was due primarily to dosing or timing errors.
Conclusions
Lack of implementation fidelity in antibiotic prophylaxis guidelines may partly explain
the lack of expected reduction in surgical-site infections. Future studies of Surgical
Care Improvement Project effectiveness should measure adherence and implementation
fidelity rather than just documented compliance.
Keywords
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Article info
Publication history
Published online: June 28, 2013
Received in revised form:
January 9,
2013
Received:
September 6,
2012
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
