# A Clinical Audit of Perioperative Antibiotic Prophylaxis and Intraoperative Monitoring in Orthopaedic Trauma Surgery: An Audit Cycle

## TL;DR

This study audits antibiotic use and monitoring in orthopedic trauma surgeries, finding good timing but poor compliance with antibiotic choice and temperature documentation.

## Contribution

The paper presents a clinical audit cycle to evaluate and improve antibiotic and monitoring practices in orthopedic trauma surgery.

## Key findings

- 65.4% of cases used the correct intraoperative antibiotic choice.
- Only 35% of cases documented intraoperative temperature.
- 100% of patients received antibiotics within the recommended 60-minute window.

## Abstract

Introduction

Surgical site infections (SSIs) are a major cause of morbidity following orthopaedic trauma surgeries. Effective perioperative antibiotic prophylaxis, alongside intraoperative blood pressure and temperature monitoring, is essential to reduce infection risk and postoperative complications.

Methods

This retrospective audit was carried out at a National Health Service (NHS) hospital over a three-month period (November 2024 to January 2025). A total of 104 trauma orthopaedic surgical cases were reviewed. The audit assessed adherence to the Local Orthopaedic Surgery Antibiotic Prophylaxis Guidelines and the National Institute for Health and Care Excellence (NICE) standards for intraoperative blood pressure and temperature management.

Results

The audit found that 65.4% (n = 68) of cases were compliant with the recommended intraoperative antibiotic choice. However, 100% (n = 104) of patients received antibiotics within the recommended 60-minute window prior to incision. Postoperative antibiotic compliance was noted in 64.4% (n = 67) of cases, while 24% (n = 25) of patients were prescribed antibiotics for longer than the guideline-recommended duration. Blood pressure monitoring met the National Institute for Health and Care Excellence (NICE) compliance in all cases. In contrast, intraoperative temperature documentation was found in only 35% (n = 36) of cases.

Conclusion

While the timing of antibiotic administration was reliably adhered to, overall compliance with antibiotic selection and postoperative use was suboptimal. Documentation of temperature was particularly poor. A multifaceted quality improvement plan, including electronic patient record (EPR) alerts, mandatory documentation prompts, clinical education, and feedback dashboards, is being implemented. A re-audit is planned in six months to assess the impact of these interventions.