title: Surgical antibiotic prophylaxis in children: a mixed method study on healthcare professionals attitudes.
abstract: Qualitative and quantitative research investigating determinants of adherence to clinical guidelines (GLs) on surgical antibiotic prophylaxis (SAP) are scarce. We conducted a mixed-method study aimed at investigating barriers and at describing attitudes of healthcare professionals (HCPs) regarding SAP in three Italian children's hospitals.
  
  
  
  The study comprised two sequential phases: 1) collection of qualitative data through focus groups; 2) conduction of a survey on HCPs attitudes towards SAP. Focus groups were carried out in each hospital with a theoretical convenience sample of 10-15 HCPs. Categorical analysis was conducted. Emerging categories and additional topics derived by literature search were used to develop the survey questionnaire, which included 13 questions expressed through a 4-point Likert scale. Members of surgical teams were invited by e-mail to fill in the questionnaire. We summed up the points assigned to each 4-point Likert scale response and calculated a cumulative score expressing overall concordance to expected HCPs attitudes on SAP. We conducted univariate and multivariate analysis to evaluate the relationship among characteristics of respondents and concordance with expected attitudes.
  
  
  
  The main categories identified in the qualitative phase included determinants of general adherence to GLs (e.g., relevance of clinical judgment), individual determinants (e.g., poor knowledge on hospital data) and organizational/structural determinants (e.g., patient flows). A total of 357 HCPs participated in the survey (response rate: 82.1%). Among respondents, 75% reported that SAP should be performed with first or second-generation cephalosporins, 44% that 2-3 days of antibiotic administration are useful as a precaution after surgery, 32% that SAP is needed for all surgical procedures. At multivariate analysis, professional category (physicians vs nurses; OR: 3.31; 95%CI: 1.88-5.82), and hospital (hospital 1 and 2 vs hospital 3; ORs: 2.79, 95%CI: 1.22-6.36; 2.40, 95%CI: 1.30-4.43, respectively) were significantly and independently associated with higher concordance with expected attitudes on SAP.
  
  
  
  Results from this study were useful to identify obstacles to appropriate SAP use in children. In our setting, findings support that a quality-improvement intervention should take into account local contexts, with development of hospital policies, education on SAP recommendations, and dissemination of data on adherence to recommendations.
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Giusti
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Spila Alegiani
authors.affiliation: Clinical Epidemiology Unit, Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy. marta.ciofidegliatti@opbg.net.
authors.forename: Marta Luisa
authors.initials: ML
authors.lastname: Ciofi Degli Atti
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
authors.forename: Sofia
authors.initials: S
authors.lastname: Colaceci
authors.affiliation: National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Raschetti
authors.affiliation: Medical Direction, Ospedale Santobono Pausilipon, Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Arace
authors.affiliation: Medical Direction, Children's Hospital AO Spedali Civili, Brescia, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Spiazzi
authors.affiliation: Medical Direction, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Raponi
mesh_terms: D000328:Adult; D000368:Aged; D000072080:Anesthesiologists / Q000523:psychology; D019072:Antibiotic Prophylaxis / Q000523:psychology* / Q000592:standards; D001291:Attitude of Health Personnel; D002648:Child; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D006776:Hospitals, Pediatric / Q000592:standards; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000523:psychology*; D007558:Italy; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000379:methods / Q000523:psychology* / Q000592:standards; D036301:Qualitative Research; D066231:Surgeons / Q000523:psychology
keywords: Antibiotic prophylaxis; Attitude of health personnel; Children; Qualitative research