Proactive Prevention beats Reactive Control Post-Surgery

Ms Suzanne Lovell-Smart1, Mr Ged Hawthorn1

1Orange Health Service Western NSW LHD, Orange, Australia


Background: A surgical antibiotic prophylaxis (SAP) audit  was conducted as part of the Orange Health Service’s clinical indicator program in July 2014. The audit showed poor compliance with best practice for prophylactic use of antibiotics and the use of indwelling urinary catheters in orthopaedic surgical procedures.

Inappropriate use of antimicrobials drives an increase in multi-resistant organisms and prolonged use of indwelling catheters contributes to increased healthcare associated infections, leading to increased morbidity, mortality and length of stay.


Aim: To proactively prevent healthcare associated infections in elective orthopaedic surgery and preserve the miracle of antibiotics, by optimising the  use of antimicrobial prophylaxis and indwelling catheters to a capped duration of 24 hours post-surgery within 6 months.


Method:  A multi- disciplinary team was established to improve performance, standardise care, provide education and monitor progress. We implemented an antimicrobial prophylaxis flowchart, conducted regular auditing  and provided regular feedback to clinicians, which included frank conversations regarding performance.

Results: Before implementation of this project the SAP audit results showed 10% of our patients were prescribed appropriate antibiotic and the average dwell time for catheters was three days. The appropriateness of prophylactic antibiotics has dramatically improved, increasing compliance from 10% to 90% and the dwell time for catheters has shortened from an average of 96 hours to 24 hours.


Conclusion: This is an excellent example of how healthcare associated surveillance results and a motivated team can address unwanted clinical variation and undue harm by improving the patient’s journey with cost savings for the health service.


Currently employed at Orange Health Service as Clinical Nurse Consultant – Infection Prevention and Control

Clinical experience is varied from critical acute care, remote, community and public health.

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