Knowledge and practice of surgical antimicrobial prophylaxis at a tertiary academic hospital in a low-middle income country

Abstract

Introduction: Surgical site infections (SSI) remain a leading cause of hospital-acquired infections globally. Despite proven efficacy of surgical antimicrobial prophylaxis (SAP) in the reduction of SSI, adherence to SAP guidelines is inconsistent.

Methods: A single centre cross-sectional survey study was conducted using a peer-reviewed questionnaire to assess the knowledge, practice and awareness of SAP guidelines among perioperative clinicians at a tertiary hospital in South Africa.

Results: Of the 273 invitations sent, 153 responses were completed for analysis. The mean (SD) knowledge score was 72.5% (8.1) but knowledge on dosage, timing and redosing was poor. SAP practices among participants were adequate, except for procedures that are controversial or require complex antimicrobial cover. Registrars and specialists scored significantly higher mean knowledge scores compared to medical officers. There was no statistically significant difference in the mean knowledge scores of different disciplines. Only 50% of participants reported using a SAP guideline. More than 80% of the participants agreed that their practice would improve if guidelines were readily accessible in the operating theatre and if an effective SSI surveillance system was in place.

Conclusion: This study demonstrates that the overall SAP knowledge and practice was fair, but core principles such as dosing, timing and duration of SAP were inadequate and need urgent attention. We recommend that through a multidisciplinary collaborative effort, a recognised guideline should be adapted and introduced, and awareness of correct SAP practices promoted at Tygerberg Hospital. Furthermore, the introduction of a surveillance system will help improve the quality of surgical care.