Why is surgical prophylaxis a focus area of improvement?
The Hospital National Antimicrobial Prescribing Survey (NAPS) is a voluntary survey that enables Australian hospitals to assess the appropriateness of their antimicrobial use. This data is also able to be aggregated and analysed to provide an overall picture of the appropriateness of antibiotic use in participating hospitals.
In 2018, the Hospital NAPS showed that, on average, 28.0% of surgical antimicrobial prophylaxis prescriptions extended 24 hours beyond the time of surgery. This is an improvement compared with the first Hospital NAPS in 2013, when the overall proportion of surgical prophylaxis given for greater than 24 hours was 41.1%.
What is being done about it?
The Australian Commission on Safety and Quality in Health Care convened a Surgical Antimicrobial Prophylaxis Working Group with representatives from the Royal Australasian College of Surgeons; the Australian and New Zealand College of Anaesthetists; the Australian College of Perioperative Nursing; the Australian Private Hospitals Association; the National Centre for Antimicrobial Stewardship; and, state and territory health department representatives.
Antimicrobial Stewardship Clinical Care Standard
Clinical Care Standards play an important role in delivering appropriate care and reducing unwarranted variation, as they identify and define the care people should expect to be offered, or receive, regardless of where they are treated in Australia.
The Antimicrobial Stewardship Clinical Care Standard requires that, if a patient having surgery requires prophylactic antibiotics, the prescription is made in accordance with the current Therapeutic Guidelines (or local antibiotic formulary), in addition to considering the patient’s clinical condition.
Suggested indicators for surgical prophylaxis include:
- Proportion of patients for whom surgical prophylactics antibiotics were prescribed in accordance with guidelines
- Proportion of patients who are administered indicated prophylactics antibiotics within 1 hour before a surgical procedure
- Proportion of patients whose prophylactics antibiotics were discontinued within 24 hours after surgery, or 48 hours for vascular surgery.
Antimicrobial Stewardship Advisory
The Antimicrobial Stewardship Advisory was developed to draw attention to the issue of surgical antimicrobial prophylaxis in relation to the health service organisations’ requirements for the National Safety and Quality Health Service (NSQHS) Preventing and Controlling Healthcare-Associated Infection Standard.
Commission resources to support effective Surgical Antimicrobial Prophylaxis
- Addressing the inappropriate use of antibiotics in surgery – RACS Podcast
- Surgical antibiotic prophylaxis for the anaesthetic audience - ANZCA Bulletin
- Surgical antibiotic prophylaxis for the nursing audience - ACORN Journal
- Australian and New Zealand College of Anaesthetists (ANZCA)
- Australian College of Perioperative Nursing (ACORN)
- Australian Private Hospitals Association (APHA)
- National Centre for Antimicrobial Stewardship (NCAS)
- NPS Medicinewise Antimicrobial modules
- NSW CEC Surgical Antibiotic Prophylaxis Resources
- Royal Australasian College of Surgeons (RACS)
- Surgical National Antimicrobial Prescribing Survey (SNAPS)
- World Health Organisation (WHO) Global guidelines on the prevention of surgical site infection
- World Health Organisation (WHO) – Handle Antibiotics with Care in Surgery Infographic