Postsplenectomy Prophylaxis—Changes and Challenges in the Adherence to Standard Vaccination Guidelines Over Ten Years

Patients undergoing splenectomy are at risk of overwhelming infections by encapsulated organisms. The main prevention strategy includes vaccination and antibiotics. This study was carried out to assess the vaccination coverage in these patients and to identify the barriers in implementing the prophylaxis. An audit of postsplenectomy vaccination over 10 years (2008–2017) was undertaken, with data retrieved from hospital records and assessed for factors affecting the vaccination status. The impact of knowledge, attitude, and practices (KAP) was assessed among 50 surgical residents using the questionnaire format, and a performed key-informant interview was carried out for four surgical residents to identify the perceived barriers to vaccination. A total of 106 patients were included, of which, 49/106 (46.2%) were vaccinated with at least one vaccine. Thirty-seven out of forty-nine completed vaccination and antibiotic prescription. Fifty-six out of one hundred six (52.8%) patients had appropriate documentation in the discharge summary. Vaccination was significantly better in 2017 (91%) than in 2008 (28.6%). Logistics, cost, and poor documentation were discerned to be the major hindrances. Among the 50 surgical residents, 35 (70%) had knowledge about appropriate vaccination; residents at 3rd-year level responded correctly than 1st- and 2nd-year residents (88% vs 52%, p=0.005). Postsplenectomy prophylaxis coverage was poor; however, the trend showed a significant upswing in coverage over the years. High cost, poor availability, and scanty documentation were the major impediments for vaccination. Seniors had better knowledge about postsplenectomy prophylaxis than their junior colleagues emphasizing the need for more training and awareness in the early clinical years of surgical residents.