Pre-operative Antibiotics Prophylaxis in Women’s Elective Surgeries in KKH

Project team members: Dr Ng Yifan, Dr Stella Rizalina Sasha, Dr He Song, Dr Siew Jia Yun Shayna.

A common complication of surgery is wound infection. The administration of appropriate surgical antibiotic prophylaxis 15 to 60 min before knife-to-skin time has been associated with lower rates of surgical site infections. An internal audit showed that although antibiotic is routinely given, only 70% of pre-operative surgical antibiotic prophylaxis for elective cases was given in the appropriate window (15 to 60 min before knife-to-skin). The Quality Improvement team sought to improve this to 95% over a 6 month period.

A pre-operative surgical antibiotic prophylaxis protocol was created and both surgeons and anaesthetists were educated about the importance of its timely administration. Surgeons with low compliance rates were identified and were approached to find out the reasons for low compliance. Reminder cards were placed at the holding area where plugs are set and where anaesthetic consent are taken. Finally the sign-in procedure was modified to include the question of whether pre-op surgical antibiotic prophylaxis was administered in the appropriate time window.

At the end of the QI period, 82% of pre-operative surgical antibiotic prophylaxis were given 15 to 60 min before knife-to-skin. To carry the momentum of this change, the implementation of a common SDA ward should help, and an upcoming ‘hard stop’ on new anaesthetic machines could be implemented to disallow surgery to proceed if 15 min has not elapsed since antibiotic administration for elective cases.