Surgical antibiotic prophylaxis in children: a mixed method study on healthcare professionals attitudes

Angela Giusti, Stefania Spila-Alegiani, Marta Luisa Ciofi Degli Atti, Sofia Colaceci, Roberto Raschetti, Pasquale Arace, Raffaele Spiazzi, Massimiliano Raponi, Apache Study Group

Research output: Contribution to journalArticle

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Original languageEnglish
Pages (from-to)203
JournalBMC Pediatrics
Volume16
Issue number1
DOIs
Publication statusPublished - Dec 5 2016

Fingerprint

Antibiotic Prophylaxis
Delivery of Health Care
Focus Groups
Multivariate Analysis
Health Care Surveys
Guideline Adherence
Qualitative Research
Policy Making
Postal Service
Cephalosporins
Quality Improvement
Nurses
Surveys and Questionnaires
Guidelines
Anti-Bacterial Agents
Physicians
Education

Keywords

  • Journal Article

Cite this

Surgical antibiotic prophylaxis in children : a mixed method study on healthcare professionals attitudes. / Giusti, Angela; Spila-Alegiani, Stefania; Ciofi Degli Atti, Marta Luisa; Colaceci, Sofia; Raschetti, Roberto; Arace, Pasquale; Spiazzi, Raffaele; Raponi, Massimiliano; Apache Study Group.

In: BMC Pediatrics, Vol. 16, No. 1, 05.12.2016, p. 203.

Research output: Contribution to journalArticle

Giusti, A, Spila-Alegiani, S, Ciofi Degli Atti, ML, Colaceci, S, Raschetti, R, Arace, P, Spiazzi, R, Raponi, M & Apache Study Group 2016, 'Surgical antibiotic prophylaxis in children: a mixed method study on healthcare professionals attitudes', BMC Pediatrics, vol. 16, no. 1, pp. 203. https://doi.org/10.1186/s12887-016-0739-y
Giusti, Angela ; Spila-Alegiani, Stefania ; Ciofi Degli Atti, Marta Luisa ; Colaceci, Sofia ; Raschetti, Roberto ; Arace, Pasquale ; Spiazzi, Raffaele ; Raponi, Massimiliano ; Apache Study Group. / Surgical antibiotic prophylaxis in children : a mixed method study on healthcare professionals attitudes. In: BMC Pediatrics. 2016 ; Vol. 16, No. 1. pp. 203.
@article{c20d7f3720874e8793aba0d58a01765c,
title = "Surgical antibiotic prophylaxis in children: a mixed method study on healthcare professionals attitudes",
abstract = "BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.",
keywords = "Journal Article",
author = "Angela Giusti and Stefania Spila-Alegiani and {Ciofi Degli Atti}, {Marta Luisa} and Sofia Colaceci and Roberto Raschetti and Pasquale Arace and Raffaele Spiazzi and Massimiliano Raponi and {Apache Study Group}",
year = "2016",
month = "12",
day = "5",
doi = "10.1186/s12887-016-0739-y",
language = "English",
volume = "16",
pages = "203",
journal = "BMC Pediatrics",
issn = "1471-2431",
publisher = "BMC",
number = "1",

}

TY - JOUR

T1 - Surgical antibiotic prophylaxis in children

T2 - a mixed method study on healthcare professionals attitudes

AU - Giusti, Angela

AU - Spila-Alegiani, Stefania

AU - Ciofi Degli Atti, Marta Luisa

AU - Colaceci, Sofia

AU - Raschetti, Roberto

AU - Arace, Pasquale

AU - Spiazzi, Raffaele

AU - Raponi, Massimiliano

AU - Apache Study Group

PY - 2016/12/5

Y1 - 2016/12/5

N2 - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

AB - BACKGROUND: 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.METHODS: 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.RESULTS: 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.CONCLUSIONS: 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.

KW - Journal Article

U2 - 10.1186/s12887-016-0739-y

DO - 10.1186/s12887-016-0739-y

M3 - Article

C2 - 27919244

VL - 16

SP - 203

JO - BMC Pediatrics

JF - BMC Pediatrics

SN - 1471-2431

IS - 1

ER -