title: Adherence to surgical antibiotic prophylaxis remains a challenge despite multifaceted interventions.
abstract: BACKGROUND
  Adherence to prophylactic antibiotics guidelines is challenging and poorly documented. We hypothesized that a multiphase, multifaceted quality improvement initiative would engage relevant stakeholders, address known barriers to adoption, and improve overall adherence.
  
  
  METHODS
  From 2011 to 2014, a series of interventions were introduced in the pediatric operating rooms. After each interventional period, prospective assessments were performed to record the antibiotic type, dose, timing, and redosing according to the guidelines. Perioperative factors that may influence guideline adherence were analyzed. Spearman's rank correlation, analysis of variance, and χ(2) tests were performed.
  
  
  RESULTS
  A total of 1,052 operations were observed, and 629 (60%) required prophylactic antibiotics. Adherence to all 4 guideline components remained unchanged (54-55%, P = .38). Redosing significantly improved (7-53%, P = .02), but correct type decreased (98-70%, P < .01). The percentage of cases in which only one antibiotic guideline component was missed remained unchanged (35-34%, P = .46). Adherence to guidelines was not significantly associated with American Society of Anesthesiologists class, surgical specialty, patient weight, anesthesia provider, or surgical wound class.
  
  
  CONCLUSIONS
  Despite multiple interventions to improve antibiotic prophylaxis, overall adherence did not improve. Most interventions were directed at the point of administration in the operating room; future implementation strategies should focus on the perioperative setting.
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX; The Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Putnam
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Courtney M
authors.initials: CM
authors.lastname: Chang
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Nathan B
authors.initials: NB
authors.lastname: Rogers
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Podolnick
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Shruti
authors.initials: S
authors.lastname: Sakhuja
authors.affiliation: Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX; The Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Maria
authors.initials: M
authors.lastname: Matusczcak
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX; The Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Austin
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Houston, TX; Department of Surgery, University of Texas Medical School at Houston, Houston, TX.
authors.forename: Lillian S
authors.initials: LS
authors.lastname: Kao
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX; The Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Houston, TX; Department of Pediatric Surgery, University of Texas Medical School at Houston, Houston, TX; The Children's Memorial Hermann Hospital, Houston, TX. Electronic address: Kuojen.Tsao@uth.tmc.edu.
authors.forename: KuoJen
authors.initials: K
authors.lastname: Tsao
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D057189:Checklist; D002648:Child; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D058996:Quality Improvement; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013781:Texas
chemical_list: D000900:Anti-Bacterial Agents