What is surgical antimicrobial prophylaxis?

Surgical antimicrobial prophylaxis is the use of antimicrobials to prevent infections that can occur as a result from a surgical procedure.

Why is it 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 used in participating hospitals.

In 2017, the Hospital NAPS showed that, on average, 30.5% of surgical antimicrobial prophylaxis prescriptions extended 24 hours beyond the time of surgery (= 26,227 prescriptions). This is an improvement compared with the first Hospital NAPS in 2013 (= 12,800 prescriptions), when the overall proportion of surgical prophylaxis given for greater than 24 hours was 41.8%.

The Hospital National Antimicrobial Prescribing Survey (NAPS) is a key component of the AURA Surveillance System.

What is being done about it?

The Australian Commission on Safety and Quality in Health Care has 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.

The group is supporting the Commission in the development of a range of resources to improve the prescribing of surgical antimicrobial prophylaxis.

Antimicrobial Stewardship Clinical Care Standard

Clinical Care Standards can 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 consideration the patient’s clinical condition.

Suggested indicators for surgical prophylaxis include:

  • Proportion of patients for whom surgical prophylaxis antibiotics were prescribed in accordance with guidelines.
  • Proportion of patients who are administered indicated prophylactic antibiotics within 2 hours of a surgical procedure.
  • Proportion of patients whose prophylactic 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 Preventing and Controlling Health Care Associated Infections Standard in the National Safety and Quality Health Service (NSQHS).

Commission resources to support effective Surgical Antimicrobial Prophylaxis

  • PowerPoint presentation (PPTX  7,828 KB)
  • Infographic (link to come)
  • Poster (link to come)
  • Royal Australasian College of Surgeons (RACS) – Managing infections no longer as simple as selecting another antibiotic – article
  • Approaches to Surgical Site Infection Surveillance – document

Other resources