Since the discovery of penicillin in the late 1920s, antibiotics have saved millions of people and made surgery safer. Healthcare systems’ capacity to perform safe surgery is strictly based on access to effective antibiotics both for preventing and treating infections. However, antibiotics are often misused. The overuse and misuse of these medications remain an area of concern in surgical settings. Surgeons play a crucial role in preventing and treating infections, and their clinical practice should be evidence-based. However, surgeons very often consider antibiotic prescription secondary to their role, leading to poor adherence to guidelines for preventing and treating surgical infections. Although surgeons are common prescribers of antibiotics in hospital settings, the relationship between antimicrobial stewardship and surgeons, and their role in ASPs in hospital settings, have been little discussed.
Methods
The study will be promoted by the Global Alliance for Infections in Surgery (GAIS). The project has been named SAFESURG (Sustainable Antimicrobial stewardship For Effective Surgical patient safety Globally). We will conduct a cross-sectional web-based survey. The population target will be represented by the healthcare professionals included in the database of the GAIS who regularly work in a healthcare facility. The survey will be open for 4 weeks between 27 January 2024 and 24 February 2024. A reminder will be sent after about 14 days. The self-administered questionnaire has been developed by a multidisciplinary team of investigators (including a surgeon, a Public Health specialist, and an Infectious Disease specialist) after searching the medical literature for comparable studies, and adapting or modifying questions phrased in other physicians’ surveys previously performed by the GAIS. The survey was written in English, and it has been piloted among three physicians for face and content validity. Participation will be voluntary, but not anonymous. Nevertheless, the confidentiality of respondents and their choices will be ensured by de-identifying responses before data analysis. No incentives for participation will be given. Data will be automatically entered into an Excel database (Microsoft Corporation, Redmond, Washington, USA). The questionnaire starts with a characterization of the participants’ professional profiles (profession, years of experience), and their working setting (country of primary practice, type of hospital, hospital inpatient beds). The existence and characteristics of the antimicrobial stewardship team (AST), the participant’s membership of the AST, and interventions implemented by antimicrobial stewardship programs (persuasive, restrictive, structural) will be collected. Implementation of protocols (for prevention of specific healthcare-associated infections [HAIs], surgical antibiotic prophylaxis [SAP], and antimicrobial treatment of surgical infections), the existence of monitoring systems of used antimicrobials, availability of reports on local antimicrobial resistance data, and implementation of systematic surveillance of surgical site infections will be also explored. The questionnaire includes also questions about participants’ perceptions of the helpfulness of measures to indicate appropriate antimicrobial stewardship in surgery. Finally, information about the importance of teamwork culture, patient safety culture, evidence-based culture, and the contribution of artificial intelligence will be explored. Questions about participants’ perceptions were designed using the 4-point Likert scale with response options from very helpful/important to very unhelpful/unimportant.
Statistical analysis
Descriptive analysis for categorical variables will be presented in absolute frequency and percentage. The two-sided chi-square or Fisher’s exact test will be used for categorical variables, as appropriate. All tests will be two-sided, and p-values of 0.05 or lower will be considered statistically significant. Statistical calculations assessed on final data will be performed using the Stata 11 software package (StataCorp, College Station, TX, USA).
Aims
The survey has two objectives. The first aim is to describe the characteristics of antimicrobial stewardship teams and interventions worldwide and evaluate healthcare workers’ perceptions towards measures of appropriate antimicrobial stewardship in surgery, to obtain a better understanding of these processes in different working contexts. The second aim, strictly related to the first one and based on the results of the survey is to empower the design and implementation of a model of an ASP directly involving the surgical teams.
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Global Alliance for Infections in Surgery 