Protocol implementation in hospital infection control practice: an Italianexperience of preoperative antibiotic prophylaxis

This study evaluates the effectiveness of a protocol implemented to induce behavioural modifications in healthcare workers (HCWs). A preoperative anti biotic prophylaxis protocol for surgical procedures in clean and clean-cont aminated wounds was used. The study was conducted in a 300-bed Italian univ ersity hospital between 1998 and 1999. The protocol's impact was analysed b y retrospective examination of the clinical records for selected common sur gical procedures. The study also investigated the reasons for the low compl iance with the protocol through a focus group methodology. We examined 723 surgical procedures and the overall compliance was 30.8% (56/182) before th e implementation of the protocol and 45.2% (76/168) after 1 year (P <0.01). During the same period compliance with the use of antibiotics increased wh en antibiotics were recommended by the protocol (5/115 vs. 19/109, P <0.01) and use decreased when they were not (51/67 vs. 57/59, P <0.01). As report ed in the focus groups, reasons for low compliance included hospital policy weaknesses in protocol definition and implementation and the cultural beha viour of HCWs. Our results reinforce previous findings that monitoring the effectiveness of protocol implementation in the medical care setting is ess ential Critical points that might increase the effectiveness of protocol im plementation have also been identified. (C) 2001 The Hospital Infection Soc iety.