Surgical Antimicrobial Prophylaxis
Surgical antimicrobial prophylaxis is the use of antimicrobials to prevent infections that may occur as a result of a surgical procedure. This page provides information on the appropriateness of this prescribing.
Why is surgical prophylaxis a focus area of improvement?
The Hospital National Antimicrobial Prescribing Survey (NAPS) is a voluntary survey coordinated by the National Centre for Antimicrobial Stewardship 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 antimicrobial use in participating hospitals.
In 2019, the Hospital NAPS showed that, on average, 30% 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%.
The Surgical NAPS provides more granular data on surgical prophylaxis in Australian hospitals, including use of procedural and post-procedural surgical antimicrobial prophylaxis for a range of surgical specialties. In 2019, antimicrobial prescribing was assessed as appropriate in 56.7% of all surgical episodes submitted for the Surgical NAPS.
Data from the Hospital NAPS and the Surgical NAPS, and examples of how these data are used for quality improvement, are included in the analyses presented in AURA 2021 Fourth Australian report on antimicrobial use and resistance in human health.
What is being done about it?
The Commission worked 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 to develop resources to support improved prescribing of surgical antimicrobial prophylaxis.
Work is currently under way with a range of surgical specialty societies to develop targeted resources.
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 includes a quality statement and indicators specific to surgical prophylaxis.
The Antimicrobial Stewardship Advisory was developed to draw health service organisations’ attention to surgical prophylaxis in relation to the requirements for the National Safety and Quality Health Service (NSQHS) Preventing and Controlling Infections 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) - including Surgical NAPS
- NPS Medicinewise Antimicrobial modules
- NSW CEC Surgical Antibiotic Prophylaxis Resources
- Royal Australasian College of Surgeons (RACS)
- World Health Organisation (WHO) Global guidelines on the prevention of surgical site infection
- World Health Organisation (WHO) – Handle Antibiotics with Care in Surgery Infographic