Evaluation of local guideline introduction on surgical antimicrobial prophylaxis prescribing for open reduction internal fixations at an Australian tertiary hospital

Abstract

AbstractBackgroundGuidelines advocate for the use of single‐dose prophylaxis in open reduction internal fixation (ORIF) procedures. The presence of local (institutional) guidelines may assist in the uptake of evidence‐based recommendations.AimTo determine the impact of local guideline introduction on prescribing practice for ORIF procedures at a metropolitan hospital in relation to our previous audit investigating adherence to national guidelines, which found that only 20.4% of ORIF patients received single‐dose prophylaxis.MethodAntibiotic prescribing was audited for patients undergoing ORIF of closed fractures from July–December 2021 at a metropolitan, tertiary hospital following guideline introduction in April 2021. Data on perioperative prescribing regimens were collected, with results compared to recommendations in local guidelines. Descriptive statistics, chi‐squared test, and Fisher's exact test were used to report categorical variables. Ethics approval was granted by Northern Health Office of Research, Ethics, and Governance (Reference no: NLR 72459) and registered with the RMIT University College Human Ethics Advisory Network (Reference no: RM 24642).ResultsData were collected for 165 patients. Almost all patients (93.5%) received cefazolin preoperatively as per guidelines. Only 22.6% of patients received single‐dose prophylaxis as per local guideline recommendations, with overall adherence to guidelines only 16.4%.ConclusionLittle change was observed in the proportion of patients who received single‐dose prophylaxis as compared to our previous audit. There is a need to understand why guidelines are not adhered to despite the availability of national and local guidelines. An evaluation of local barriers may assist with informing future implementation strategies.