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

Background

Guidelines 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.

Aim

To 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.

Method

Antibiotic 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).

Results

Data 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%.

Conclusion

Little 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.