Quality statement 2: Antibiotic prophylaxis

Quality statement

People having surgery for which antibiotic prophylaxis is indicated receive this in accordance with the local antibiotic formulary.

Rationale

Antibiotic prophylaxis is effective for preventing surgical site infections in certain procedures. However, the use of antibiotics for prophylaxis carries a risk of adverse effects (including Clostridium difficile-associated disease) and increased prevalence of antibiotic-resistant bacteria. The choice of antibiotic prophylaxis should cover the organisms most likely to cause infection and be influenced by the strength of the association between the antibiotic used and these adverse effects. Using a local antibiotic formulary should ensure that the most appropriate antibiotic, dose, timing of administration and duration are used for effective prophylaxis.

Quality measures

Structure

Evidence of local arrangements to ensure that people having surgery for which antibiotic prophylaxis is indicated receive this in accordance with the local antibiotic formulary and that this is recorded.

Data source: Local data collection.

Process

Proportion of surgical procedures for which antibiotic prophylaxis is indicated for which the person having surgery receives antibiotic prophylaxis in accordance with the local antibiotic formulary and that this is recorded.

Numerator – the number in the denominator for which the person having surgery receives antibiotic prophylaxis in accordance with the local antibiotic formulary and that this is recorded.

Denominator – the number of surgical procedures for which antibiotic prophylaxis is indicated.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that they develop or have access to a local antibiotic formulary and that their staff understand and act on the need to prescribe and administer antibiotic prophylaxis in accordance with this to people having surgery for which antibiotic prophylaxis is indicated. This includes having systems in place to record when antibiotic prophylaxis has been given.

Healthcare professionals offer antibiotic prophylaxis to people having surgery for which antibiotic prophylaxis is indicated, in accordance with the local antibiotic formulary and record when this has been given.

Commissioners ensure development of, or access to, a local antibiotic formulary and commission services from service providers that can demonstrate arrangements to prescribe and administer antibiotic prophylaxis to people having surgery for which antibiotic prophylaxis is indicated in accordance with the local antibiotic formulary.

What the quality statement means for patients, service users and carers

People having certain types of operation for which there is a higher risk of infection are given antibiotics before surgery to help prevent infection.

Source guidance

Surgical site infections: prevention and treatment (2008) NICE clinical guideline 74, recommendation 1.2.13 (key priority for implementation)

Definitions of terms used in this quality statement

Antibiotic formulary

An antibiotic formulary is a local policy document produced by a multi-professional team, usually in a hospital trust or commissioning group, combining best evidence and clinical judgement [adapted from NICE clinical guideline 74 – full guideline]. See also the Department of Health's UK five year antimicrobial resistance strategy 2013 to 2018 and Antimicrobial stewardship 'Start smart – then focus': guidance for antimicrobial stewardship in hospitals (England) published by the Department of Health Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI).

Surgery that requires antibiotic prophylaxis

Surgery that requires antibiotic prophylaxis is:

  • clean surgery involving the placement of a prosthesis or implant

  • clean-contaminated surgery

  • contaminated surgery

  • surgery on a dirty or infected wound (requires antibiotic treatment in addition to prophylaxis). [NICE clinical guideline 74 recommendations 1.2.11 (key priority for implementation) and 1.2.16]

Surgical site infections (NICE clinical guideline 74) also recommends that antibiotic prophylaxis should not be used routinely for clean non-prosthetic uncomplicated surgery because of the risk of adverse events, Clostridium difficile-associated disease, resistance and drug hypersensitivity [recommendation 1.2.12 (key priority for implementation)].

See the glossary of terms in NICE clinical guideline 74 for definitions of surgical wound classification.