Abstract：
Background: Surgical antimicrobial prophylaxis (SAP) is a leading indication for antibiotic use in Australian hospitals with established high rates of inappropriate prescribing. Optimal administration of SAP for patients at high risk of methicillin-resistant Staphylococcus aureus (MRSA) infections presents additional complexities. A greater understanding of barriers to optimal SAP in this cohort is required to inform targeted antimicrobial stewardship strategies, optimize SAP, and reduce the rate of surgical site infections (SSIs). Methods: A multiple-choice questionnaire appraising knowledge and barriers to optimal SAP was electronically distributed to key stakeholders. Data from the questionnaire were collated and analyzed using Survey Monkey® (Momentive Inc., San Mateo, CA) data analysis tools. Results: Eighty-three persons provided full or partial responses to the questionnaire. There were 19% of respondents who considered MRSA colonization status of patients to be only \"somewhat important\" when selecting appropriate SAP. Additionally, 62% of responses did not correctly identify the appropriate SAP regimen for patients who are colonized with MRSA. Several barriers to optimal SAP were identified including poor understanding of SAP guidelines, lack of timely identification of patients confirmed to be colonized with MRSA, inaccurate documentation of antibiotic and surgical start times, and limitations of the current operating room management software program. Conclusions: The high level of engagement from most key stakeholders demonstrates accountability and an overall desire to improve SAP. Barriers identified in this audit should be considered by facilities wishing to optimize compliance with SAP guidelines and consequently reduce SSIs, in particular for patients who are at high risk of MRSA infections.
摘要：
背景：在澳大利亚医院中，外科抗菌药物预防（SAP）是抗生素使用的主要指征，不适当处方的发生率很高。对于耐甲氧西林金黄色葡萄球菌（MRSA）感染高风险的患者，SAP的最佳给药存在额外的复杂性。需要更好地了解本队列中最佳SAP的障碍，以告知针对性的抗菌药物管理策略。优化SAP，并降低手术部位感染率（SSIs）。方法：以电子方式将评估最佳SAP知识和障碍的多项选择问卷分发给关键利益相关者。使用SurveyMonkey®(MomentiveInc.，圣马特奥,CA)数据分析工具。结果：83人对问卷提供了全部或部分答复。在选择合适的SAP时，有19%的受访者认为患者的MRSA定植状态“有点重要”。此外,62%的应答没有正确确定定植于MRSA的患者的合适的SAP方案。确定了实现最佳SAP的几个障碍，包括对SAP指南的理解不足，缺乏对确诊为MRSA定植的患者的及时识别，不准确的抗生素文件和手术开始时间，以及当前手术室管理软件程序的局限性。结论：大多数关键利益相关者的高度参与表明了问责制和改善SAP的总体愿望。希望优化SAP准则的合规性并因此减少SSI的机构应考虑本审核中发现的障碍。特别是对于MRSA感染高风险的患者。
