Impact of a multifaceted intervention including a smart reminder system for intraoperative antibiotic re-dosing on surgical site infections in a Chinese tertiary care hospital

Cuiqiong Fan^1,2Guanwen Lin²Huiwen Zhao³Zhenyao Zhao⁴Baohong Liu²Tian Wang²Ya Zou²Lushi Huang⁵Zihuan Li^2*

• ¹Guangdong Second Provincial General Hospital, Guangzhou, China
• ²The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Gaungzhou, China
• ³Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University), Shenzhen, China
• ⁴Hong Kong Metropolitan University, Hong Kong, Hong Kong, SAR China
• ⁵Guangdong Provincial Social Welfare Service Center (Guangdong Jiangnan Hospital), Guangzhou, China

Background: Surgical site infections (SSIs) are among the most common healthcare-associated infections worldwide. This study evaluated the effectiveness of a multifaceted intervention, which included a smart reminder system for prophylactic intraoperative antibiotic re-dosing in the Anesthesia Information Management Systems, modifications to the preoperative application form, and enhanced review of medical orders, on improving prophylactic intraoperative antibiotic re-dosing and reducing SSIs. Methods: A retrospective study on the epidemiology of healthcare-associated SSIs was conducted to compare outcomes before and after the implementation of the bundled intervention, with a focus on compliance with intraoperative antibiotic re-dosing and the rate of SSIs. Results: The proportion of prophylactic antibiotic administration before surgery significantly increased after the intervention (p = 0.005). The timing of prophylactic antibiotic administration before surgery was shorter after the intervention, with a median (IQR) of 0.8 (0.6-1.0) hours , compared to the before intervention period (p < 0.001). The proportion of intraoperative additional antibiotic administration also increased significantly (p = 0.003). Furthermore, the rate of SSIs decreased significantly after the intervention (p = 0.038). Conclusions: The multifaceted intervention, comprising a smart reminder system for prophylactic intraoperative antibiotic re-dosing in the Anesthesia Information Management Systems, preoperative application form modifications, and enhanced medical order review, effectively improved intraoperative antibiotic re-dosing compliance and reduced surgical site infection rates.