Surgical and procedural prophylaxis

Quality statement 8

A patient having surgery or a procedure is prescribed antimicrobial prophylaxis in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines. This includes recommendations about the need for prophylaxis, choice of antimicrobial, dose, route and timing of administration, and duration.

Purpose

To reduce the risk of surgical site infections from procedures including surgery, dental procedures, gastrointestinal endoscopic procedures, implantable cardiac device insertions, diagnostic interventions, cleaning and debridement of traumatic wounds, and ophthalmic surgery including cataract removal.

To ensure appropriate antimicrobial prophylaxis, including avoiding the use of antimicrobials when not required.

For patients

Before a surgical procedure, medicines may be given to you to reduce the risk of an infection. The prescription will be based on national or local recommendations. After having a surgical procedure, antimicrobials are not usually needed unless you have an infection.

For clinicians

Prescribe, dispense and administer surgical antimicrobial prophylaxis according to the recommendations outlined in the current Therapeutic Guidelines or locally endorsed guidelines. Consider the patient’s clinical condition (for example, colonisation with a multidrug-resistant organism, or patient allergies).

Avoid prescribing antimicrobials post-procedurally, as prolonged antimicrobial use is not usually required. Prescribe according to guidelines with respect to the choice of antimicrobial, dose and optimal timing and consider the route of administration; topical antimicrobials are not recommended for surgical prophylaxis.1 Avoid using off-label routes of administration for antimicrobials such as irrigations, pastes, washes or topical applications for surgical prophylaxis without evidence-based guidelines.

For health service organisations

Ensure systems are in place for clinicians to provide appropriate antimicrobial therapy to patients undergoing surgery or a procedure. Ensure these systems are based on the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines.

Ensure systems and processes are in place to allow for the clear documentation of peri-procedural antimicrobial active ingredient, dose, administration time and incision time.

Assess adherence to guidelines regularly as part of a quality improvement approach. Ensure systems are in place to meet the health service organisation’s requirements for surgical antimicrobial prophylaxis in the Antimicrobial Stewardship Advisory, as part of the National Safety and Quality Health Service Preventing and Controlling Healthcare-Associated Infection Standard.

For patients

Before a surgical procedure, medicines may be given to you to reduce the risk of an infection. The prescription will be based on national or local recommendations. After having a surgical procedure, antimicrobials are not usually needed unless you have an infection.

For clinicians

Prescribe, dispense and administer surgical antimicrobial prophylaxis according to the recommendations outlined in the current Therapeutic Guidelines or locally endorsed guidelines. Consider the patient’s clinical condition (for example, colonisation with a multidrug-resistant organism, or patient allergies).

Avoid prescribing antimicrobials post-procedurally, as prolonged antimicrobial use is not usually required. Prescribe according to guidelines with respect to the choice of antimicrobial, dose and optimal timing and consider the route of administration; topical antimicrobials are not recommended for surgical prophylaxis.1 Avoid using off-label routes of administration for antimicrobials such as irrigations, pastes, washes or topical applications for surgical prophylaxis without evidence-based guidelines.

For health service organisations

Ensure systems are in place for clinicians to provide appropriate antimicrobial therapy to patients undergoing surgery or a procedure. Ensure these systems are based on the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines.

Ensure systems and processes are in place to allow for the clear documentation of peri-procedural antimicrobial active ingredient, dose, administration time and incision time.

Assess adherence to guidelines regularly as part of a quality improvement approach. Ensure systems are in place to meet the health service organisation’s requirements for surgical antimicrobial prophylaxis in the Antimicrobial Stewardship Advisory, as part of the National Safety and Quality Health Service Preventing and Controlling Healthcare-Associated Infection Standard.

Quality statement 8 has indicators for local monitoring.

Locally endorsed guidelines

For more information about the requirements of locally endorsed guidelines, refer to page 9 of the Antimicrobial Stewardship Clinical Care Standard.

References

1. eTG complete [digital]. Melbourne: Therapeutic Guidelines Limited.