Successful implementation of surgical antibiotic prophylaxis (SAP) in three Georgian hospitals

Author(s):
Marika Tsereteli; Gloria Cordoba; Giorgi Chakhunashvili; Dilip Nathwani; Annick Lenglet; David Tsereteli; Ketevan Goginashvili; Ketevan Kavtaradze; David Chakhunashvili; Robert Skov; Paata Imnadze

Background:

Surgical site infections (SSIs) are one of the leading healthcare-associated infections (HAIs) in low- and middle-income countries (LMICs), which can be prevented using surgical antibiotic prophylaxis (SAP). Establishment and compliance to SAP guidelines leading to appropriate use of antibiotics is safe, reduces SSI rates and antimicrobial resistance (AMR). In Georgia, inappropriate use of antibiotics for SAP is an important source of excessive use of antibiotics. In 2022, the Ministry of Health approved a new national SAP guideline. We implemented an Antimicrobial Stewardship (AMS) program for SAP in three hospitals in Tbilisi Georgia and report here on its effectiveness.

Hypothesis:

Successful implementation of SAP guideline that leads to reduced inappropriate antibiotic use and reduced length of stay is possible in Georgia.

Methods:

An AMS quality improvement program targeting health care professionals –treating patients with hernia surgery and hip replacement between December 2021- February 2023. The program included bi-monthly feedback to health care personnel on compliance to the guidelines and surveillance of SSIs. We measured compliance with SAP guideline (before-and-after-intervention) using four indicators: Right antibiotic, dose, timing, and duration of prophylaxis; full compliance was the sum of these. SSIs pre-and-post intervention and length of stay was monitored. Data collected was verified using regular point prevalence studies. Data was analyzed using SPSS 22.0.

Results:

During the intervention 1040 surgeries were performed; 595 hip replacements and 445 hernia surgeries. Overall indicator-based compliance improved in all hospitals during the implementation period. Full compliance with SAP guidelines increased from pre-to-post intervention from 0% to 81% in Hospital 1, from 0% to 75% in Hospital 2 and from 83% to 94% in Hospital 3. Twelve months post intervention, full compliance remained above 70% in all three hospitals. It should be noted that compliance of individual components at the end of the study in all hospitals was over 80%. With the improved compliance to SAP guideline the SSIs rate did not increase during the intervention and remain at approximately 1%. Length of stay was shortened on average 1 day.

Conclusions:

A combination of introducing SAP guideline supported by education and regular feedback with action led to significant improvement in SAP practice – better compliance with antibiotic choice and shorter duration of prophylaxis are key steps in reducing inappropriate use. Sustaining and scaling these interventions remain future priorities.