TY - JOUR T1 - Rational use of antibiotics for major elective gynaecological and obstetrical surgical procedures: quality improvement journey from a tertiary care public facility JF - BMJ Open Quality JO - BMJ Open Qual DO - 10.1136/bmjoq-2021-001438 VL - 11 IS - Suppl 1 SP - e001438 AU - Manju Puri AU - Shilpi Nain AU - Akriti Gautam AU - Vidhi Chaudhary AU - Nishtha Jaiswal AU - Triveni GS AU - Deepika Meena AU - Meenakshi Singh AU - Kanika Chopra AU - Poornima Sharma AU - Ekta Chhillar AU - Harpreet Verma AU - Richa Mahato Y1 - 2022/10/01 UR - http://bmjopenquality.bmj.com/content/11/Suppl_1/e001438.abstract N2 - Background Antibiotic resistance is a global problem. Irrational use of antibiotics is rampant. Guidelines recommend administration of single dose of antibiotic for surgical antimicrobial prophylaxis (SSAP) for elective obstetrical and gynaecological surgeries. However, it is not usually adhered to in practice. Majority of women undergoing elective major gynaecological surgeries and caesarean sections in the department of obstetrics and gynaecology of our tertiary level heavy case load public health facility were receiving therapeutic antibiotics (for 7–10 days) instead of recommended SSAP. Our aim was to increase the SSAP in our setting from a baseline 2.1% to more than 60% within 6 months.Methods After root cause analysis, we formulated the departmental antimicrobial policy, spread awareness and sensitised doctors and nursing officers regarding antimicrobial resistance and asepsis through lectures, group discussions and workshops. We initiated SSAP policy for elective major surgeries and formed an antimicrobial stewardship team to ensure adherence to policy and follow processes and outcomes. The point of care quality improvement (QI) methodology was used. Percentage of patients receiving SSAP out of all low-risk women undergoing elective surgery was the process indicator and percentage of patients developing surgical site infection (SSI) of all patients receiving SSAP was the outcome indicator. The impact of various interventions on these indicators was followed over time with run charts.Results SSAP increased from a baseline 2.1%–67.7% within 6 months of initiation of this QI initiative and has since been sustained at 80%–90% for more than 2 years without any increase in SSI rate.Conclusion QI methods can rapidly improve the acceptance and adherence to evidence-based guidelines in a busy public healthcare setting to prevent injudicious use of antibiotics.Data are available upon request. ER -