EP 312 A Closed-Loop Audit of Surgical Antibiotic Prophylaxis: Enhancing Perioperative Safety through Multi-Disciplinary Process Integration
Taher Merchant, Katya Saliba, Mohammed Fawzy, Praveen BandipalyamAbstract
Aim
To evaluate adherence to local surgical antibiotic prophylaxis guidelines and to assess the impact of a multi-modal, MDT-centred intervention integrated into routine theatre processes on team compliance and antimicrobial stewardship.
Method
A retrospective closed-loop audit of General Surgery operations was performed. Baseline audit data collected in October 2025 identified deficits using multi-source data extraction. Interventions included targeted teaching sessions, QR-enabled guideline posters at point of care, and addition of “antibiotic dose and timing confirmed?” to the WHO ‘time-out’ checklist. The intervention was designed to enhance situational awareness, enable cognitive off-loading, and create a shared mental model across surgical, anaesthetic and nursing teams. Re-audit in December 2025 assessed the impact of these system-level changes. Primary outcomes were compliance with guideline-recommended antibiotic choice, dose and timing (≤30 minutes pre-incision), with documentation assessed as a secondary outcome.
Results
Baseline compliance (n=90) was suboptimal: correct antibiotic choice 50.4%, correct dose 44.1%, and correct timing 58.5%. Post-intervention (n=50), improvements were observed in appropriate antibiotic selection, correct weight-based gentamicin dosing, and timing of administration. Provision of point-of-care guideline access and embedding “dose and time” checks into the surgical ‘time-out’ facilitated routine verbalisation and task standardisation, supporting improved team situational awareness. Documentation of administration time remained poor despite verbal confirmation.
Conclusions
Embedding antibiotic stewardship within established team-based safety checks, supported by point-of-care digital access to guidelines, improved several elements of policy compliance and reinforced a sustainable model of shared responsibility for perioperative antibiotic prophylaxis. Documentation systems, however, require further optimisation.