The need for a national framework to optimise surgical antimicrobial use in Australia
Dr Courtney Ierano1,2, Prof Karin Thursky1,2,3,4
1National Centre for Antimicrobial Stewardship, Melbourne, Australia
2Department of Infectious Diseases- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
3Peter MacCallum Cancer Centre, Melbourne, Australia
4Royal Melbourne Hospital, Melbourne, Australia
Background
Surgical antimicrobial prophylaxis (SAP) is the most common indication for antimicrobial prescribing in Australian hospitals, and is associated with the lowest rates of appropriateness (~50%). The National Centre for Antimicrobial Stewardship (NCAS) is a ‘One Health’ research program supporting quality antimicrobial use and implementation of antimicrobial stewardship (AMS). There has been little improvement in appropriate SAP prescribing despite national prescribing guidelines and established hospital accreditation AMS frameworks.
Methods:
This NCAS doctoral program adopted a mixed-methods design integrating quantitative and qualitative research. Projects included; guideline implementability assessments, multiple logistic regression analyses of the Surgical National Antimicrobial Prescribing Survey dataset and a qualitative case study exploring the phenomenon of SAP decision-making across key professional groups.
Results
A framework to support surgical AMS (and outcome measures such as surgical site infection surveillance) in Australia does not currently exist. SAP prescribing practices continue to demonstrate high rates of inappropriateness across a range of surgical specialties and procedures. Qualitative research highlighted the need for resources to support adequate documentation and communication about SAP prescribing decisions, engagement with senior clinicians who significantly influence their juniors’ prescribing practices, and the need for meaningful data addressing common fears and misperceptions regarding SAP durations to generate prescribing behaviour change.
Conclusions
Recognising the complex structural, cultural, behavioural and technological challenges. We propose the next steps are to employ a learning health systems approach utilising health services research and implementation science methodologies to support the development and implementation of a surgical AMS framework that is adaptable for further scaling nationwide.
Biography:
Dr Courtney Ierano is an early-career pharmacist-researcher with a strong passion for infectious diseases, infection prevention, and antimicrobial stewardship. Her PhD program focused on understanding antimicrobial prescribing patterns and behaviour across the peri-operative setting. She aims to be a leader in this niche field of research and an advocate for pharmacists working across AMS in the peri-operative space. Dr Ierano is a post-doctorate fellow with the National Centre for Antimicrobial Stewardship (NCAS) and is also the first Society of Hospital Pharmacists (SHPA) Infectious Diseases Advanced Training Resident, expected to complete the novel program in March 2022.