115 Identifying barriers to compliance with surgical antibiotic prophylaxis (SAP) guidance through mixed-methods interviews

Abstract Introduction Despite research highlighting the importance of Surgical Antimicrobial Prophylaxis (SAP) in surgical site infection prevention, compliance with guidelines remains problematic. We aimed to identify barriers to compliance with SAP guidance via mixed-methods interviews. Methods Semi-structured interviews were conducted over a period of eight-months. Purposive sampling was used for recruitment of participants. Quantitative questions firstly established demographics of participants including job role, specialty and clinical experience. Likert scales assessed knowledge of SAP guidance and use of institutional antimicrobial guidelines. Interview prompts based on the Consolidated Framework for Implementation Research (CFIR) were employed to facilitate thematic analysis of qualitative data. Results Fifty-nine participants were included for interview, of which 64.4% (38/59) were SAP prescribers and 35.6% (35.6%) were SAP administrators. Within the prescriber cohort, surgeons accounted for 63.2% (24/38) of participants, with anaesthetists accounting for 23.7% (9/38). Anaesthetists were significantly more likely to use SAP guidelines when compared with surgical colleagues (p = 0.008). On thematic analysis a lack of self-efficacy was established amongst less experienced clinicians (≤3 years clinical practice), with 76.9% (10/13) claiming they would be reluctant to decide which SAP agent to use. Other themes identified included; a reluctance to discontinue antibiotics early, a lack of clarity surrounding ownership of SAP prescribing and differing practices according to institution. Conclusion Increasing compliance with SAP prescribing has numerous barriers. A lack of self-efficacy and varying practices in each institute may contribute to non-compliance. Future work should focus on higher level, systems-based, quality improvement initiatives.