Adherence to Surgical Antimicrobial Prophylaxis Guidelines and Improvement Efforts: A Single-Center, Pre- and Post-Intervention Comparison Study

Chie Yamamoto; Yoko Nukui; Tadashi Kosaka; Kazuhiro Aoto; Rina Kozen; Kayo Hasegawa; Chikae Ota; Yuki Inoue; Masashi Taniguchi; Ryosuke Hamashima; Keitaro Furukawa; Keisuke Kikuchi; Ayami Nakanishi; Satoshi Teramukai; Yasuhiko Horii; Teiji Sawa

doi:10.1002/hsr2.71516

Adherence to Surgical Antimicrobial Prophylaxis Guidelines and Improvement Efforts: A Single-Center, Pre- and Post-Intervention Comparison Study

Health Sci Rep. 2026 Jan 7;9(1):e71516. doi: 10.1002/hsr2.71516. eCollection 2026 Jan.

Authors

Affiliations

¹ Department of Infection Control and Laboratory Medicine Kyoto Prefectural University of Medicine Kyoto Japan.
² Department of Pharmacy, University Hospital Kyoto Prefectural University of Medicine Kyoto Japan.
³ Central Surgical Unit/Local Anesthesia Surgery Center Kyoto Prefectural University of Medicine Kyoto Japan.
⁴ Department of Infectious Disease Kyoto City Hospital Kyoto Japan.
⁵ Department of Infection Control, University Hospital Kyoto Prefectural University of Medicine Kyoto Japan.
⁶ Department of Biostatistics, Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto Japan.
⁷ Department of Anesthesiology Kyoto Prefectural University of Medicine Kyoto Japan.

Abstract

Background and aims: Adherence to surgical antimicrobial prophylaxis (SAP) guidelines reduces the incidence of surgical site infections (SSIs) and improves prognosis and healthcare economics. This single-center, pre- and post-intervention comparative study investigated SAP guidelines adherence. Accordingly, we intervened where improvements were required. Changes in SAP guidelines adherence and SSI incidence were then evaluated.

Methods: We assessed adherence to the appropriate antimicrobial administration timing within 1 h before skin incision in surgeries performed between April 2021 and June 2022. Regarding drug selection, dosage, and duration, we evaluated SAP protocols for 228 procedures across 18 departments and compared them with established guidelines.

Results: Overall adherence to appropriate antimicrobial administration timing was 92.3% (4687/5076). Adherence was particularly low after gastroenterological surgery, cardiovascular surgery, orthopedic surgery, and neurosurgery, with a total adherence rate of 82.6% (1603/1941) across these four departments. Drug selection and duration deviated from guidelines in 25% (57/228) of procedures. The most common area requiring improvement was inappropriate drug selection in 57.9% (33/57), followed by unnecessarily long duration in 50.9% (29/57) of cases. In addition to an educational approach, a new antimicrobial initiation index, based on preoperative preparatory events, was established in low-adherence departments. All protocols requiring improvement were revised to align with established guidelines. Consequently, adherence to the appropriate antimicrobial administration timing in departments with previously low adherence improved significantly (pre-intervention: 82.6%; 95% confidence interval [CI]: 80.8%-84.2%; post-intervention: 95.0%; 95% CI: 93.8%-96.0%; p < 0.001). Substantial reduction in SSI incidence was found in cardiovascular surgery (pre-intervention: 6.9%; 95% CI: 3.2%-12.7%; post-intervention: 0%; 95% CI: 0%-3.0%; p = 0.006).

Conclusion: Establishing department-specific antimicrobial initiation indexes, based on the surgical preparation stage, might be an effective measure for improving adherence to the appropriate antimicrobial administration timing in patients receiving SAP. Changes in SSI incidence require further study.

Keywords: antibacterial agents; antimicrobial stewardship; surgical antimicrobial prophylaxis; surgical site infections.