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- Title
Surgical antibiotic prophylaxis in children: a mixed method study on healthcare professionals attitudes.
- Authors
Giusti, Angela; Spila Alegiani, Stefania; Ciofi Degli Atti, Marta Luisa; Colaceci, Sofia; Raschetti, Roberto; Arace, Pasquale; Spiazzi, Raffaele; Raponi, Massimiliano; Apache Study Group
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
ITALY; INAPPROPRIATE prescribing (Medicine); ATTITUDE (Psychology); CHILDREN'S hospitals; FOCUS groups; MEDICAL personnel; MEDICAL protocols; PSYCHOLOGY of nurses; PREOPERATIVE care; QUESTIONNAIRES; SURGEONS; SURVEYS; QUALITATIVE research; ANTIBIOTIC prophylaxis; PSYCHOLOGY; PREVENTION
- Publication
BMC Pediatrics, 2016, Vol 16, p203
- ISSN
1471-2431
- Publication type
journal article