Perceptions of surgeons on surgical antibiotic prophylaxis use at aga khan hospital, Dar es Salaam.

Introduction: Surgical site infections are a major cause of morbidity and mortality among operated patients. The use of antibiotic prophylaxis in prevention and reduction of incidence of surgical site infection is widespread. In spite of the accessibility of universal and national guidelines for surgical prophylaxis, recent studies surveying the present routine of prophylaxis have demonstrated overutilization of a wide range antibacterial medications for a single patient. Few studies have shown qualitatively factors influencing this, and perceptions of surgeons on surgical antibiotic prophylaxis use. Unfortunately, none of these studies have been done in Tanzania.Objective: To describe the perceptions of surgeons on surgical antibiotic prophylaxis use at the Aga Khan hospital in Dar es Salaam.Methods: A qualitative study involving in-depth interviews with surgeons was conducted in English by the primary investigator. The interviews were audio-recorded and transcribed verbatim. Systematic data condensation was used for data analysis.Findings: A total of 14 interviews with surgeons and obstetricians and gynaecologists were conducted. Three major categories emerged: Inadequate data to support practice; the one who sees patient decides SAP; prolonged antibiotic use for fear of unknown. The subcategories were firstly no hospital data for bacterial resistance patterns, hospital guidelines are not well known and lack of hospital data for surgical site infection rates. Secondly surgeon or team decide surgical antibiotic prophylaxis. Lastly fear of getting infection and anticipating complications. Conclusion: The study identified factors associated with inappropriate use of antibiotic prophylaxis. To improve this, guidelines have to be made easily available, continuous education of those involved in decision making.Recommendations: Further qualitative research into perceptions of surgeons in different health centres and involving all stakeholders in antibiotic use is recommended. Using this study, a recommendation is made for hospital to improve data and make antibiotic guidelines easily available.