Antimicrobial stewardship: 9c-Cessation of prophylactic antibiotics following surgery

Proportion of patients whose prophylactic antibiotics were discontinued within 24 hours following surgery.

One-third to one-half of antibiotic use in hospitals is for surgical antibiotic prophylaxis. Surgical antibiotic prophylaxis is used inappropriately 30–90 per cent of the time, especially with respect to timing and duration (Antibiotic Expert Group 2014).

The numerator excludes patients for whom longer antibiotic prophylaxis is indicated by the Therapeutic guidelines: antibiotic (Antibiotic Expert Group 2014) or locally-endorsed antibiotic prescribing guidelines, or for the treatment of specific conditions (e.g. a patient undergoing a complex operation, where antibiotic treatment is required for a pre-existing infection, or a patient who is immunocompromised).

The denominator excludes patients for whom longer antibiotic prophylaxis is indicated by the Therapeutic guidelines: antibiotic or locally-endorsed antibiotic prescribing guidelines, or for the treatment of specific conditions.

Presented as a percentage.

(Numerator ÷ denominator) x 100

Number of admitted patients who received prophylactic antibiotics prior to surgery whose antibiotics were discontinued within 24 hours following surgery.

Number of admitted patients who received prophylactic antibiotics prior to surgery for which there are documented guidelines for the administration of prophylactic antibiotics.

Prophylaxis is the use of antibiotics to prevent surgical site infection and, in some circumstances, bacteraemia (Antibiotic Expert Group 2014).

Deliberate continuation of antibiotics after 24 hours for the treatment of an infection does not constitute surgical prophylaxis.

Services may select specific procedures to focus on as part of the audit process, based on their own casemix and priorities.

This indicator is based on surgical antibiotic prophylaxis indicators developed by the then Victorian Hospital Acquired Infection Surveillance System Coordinating Centre (VICNISS) (Department of Human Services 2007) (now the Healthcare Associated Infection Surveillance Coordinating Centre), and the Western Australian Safety and Quality Investment for Reform (SQuIRe) Program (Department of Health WA 2009).

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Australian Commission on Safety and Quality in Health Care

Antibiotic Expert Group 2014. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited.

Department of Health WA 2009. SQuIRe 2 CPI guide: Surgical site infection prevention. Perth: DHWA.

Department of Human Services 2007. Type 2 surveillance manual version 10. Melbourne: Victorian Hospital Acquired Infection Surveillance System Coordinating Centre, DHS.