# De-Implementation of Unnecessary Surgical Antibiotic Prophylaxis in Children

> **NIH AHRQ R01** · WASHINGTON UNIVERSITY · 2021 · $483,212

## Abstract

PROJECT SUMMARY
Background: Antibiotics have revolutionized healthcare allowing clinicians the ability to treat life-threatening
infections and to prevent infections following life-saving surgery. Unfortunately, antibiotic overuse results in
antibiotic resistant bacteria and unnecessary adverse events including Clostridioides difficile infections (CDI).
Current data demonstrates that antibiotic resistant bacteria and CDI annually kill up to 150,000 and 29,000
Americans, respectively. Surgical antibiotic prophylaxis is a common area for unnecessary antibiotic use
among children. Recent CDC surgical site infection (SSI) guidelines and the AAP Choosing Wisely Campaign
recommend no postoperative antibiotic prophylaxis for procedures considered low risk for an SSI. A significant
gap exists on the best interventions for antimicrobial stewardship programs (ASPs) and surgeons to de-
implement (eliminate) unnecessary postoperative antibiotic prophylaxis in children.
Goal: To determine and test two evidence-based implementation strategies to de-implement unnecessary
postoperative antibiotic use in children while assessing important clinical outcomes including SSI and CDI.
Methods: First, we will develop evidence-based de-implementation strategies guided by the i-PARIHS
framework (Integrated Framework for Promoting Action on Research Implementation in Health Services).
Based on preliminary data from surgeon focus groups and current literature, standard order set review and
modification (control intervention) will be implemented in 9 Children's hospitals that are members of both the
SHaring Antimicrobial Reports for Pediatric Stewardship (SHARPS) and the National Surgical Quality
Improvement Program-Pediatric (NSQIP-P). Utilizing the iPARIHS framework to understand the key factors
involved with implementation, an enhanced ASP facilitation intervention will then be implemented. We will
study the impact of these interventions utilizing a stepped-wedge design that will sequentially deliver the
facilitation intervention over time to all hospitals. These interventions will be implemented and implementation
outcomes (e.g. penetration) will be assessed utilizing established ASPs from the SHARPS collaborative, a
large national collaborative dedicated to improving antibiotics in children. Clinical outcomes (e.g. postoperative
antibiotic use, SSI, CDI) will be assessed using data collected at each hospital by NSQIP-P.
Innovation and Impact: This study is innovative and impactful because it will: 1) combine expertise from
surgeons, antimicrobial stewards and implementation scientist to develop theory based strategies to improve
antibiotic use; 2) assess the impact of these strategies on surgeries in children, an underrepresented group; 3)
rigorously test two interventions utilizing a stepped-wedge design; 4) collect clinical outcomes (e.g. antibiotic
use, SSI, CDI) important to ASPs and surgeons; 5) collect implementation outcomes that will inform the
dissemination of ...

## Key facts

- **NIH application ID:** 10224616
- **Project number:** 5R01HS026742-03
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Jason Newland
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $483,212
- **Award type:** 5
- **Project period:** 2019-09-30 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10224616

## Citation

> US National Institutes of Health, RePORTER application 10224616, De-Implementation of Unnecessary Surgical Antibiotic Prophylaxis in Children (5R01HS026742-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10224616. Licensed CC0.

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