Hand and Wrist Trauma: Antimicrobials and Infection-Audit of Clinical Practice (HAWAII-ACP)

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Global Health Auditing

Background:

• Surgical site infections (SSIs) are a significant complication in hand and wrist trauma surgery, leading to patient harm and functional deficits.
• Evaluating adherence to World Health Organization (WHO) guidelines is crucial for mitigating SSIs in this surgical population.

Purpose of the Study:

• To assess international adherence to WHO guidelines for preventing SSIs in hand and wrist trauma surgery.
• To identify areas of high and low compliance with established SSI prevention protocols.

Main Methods:

• An international, multicentre audit involving the Reconstructive Surgery Trials Network (RSTN).
• Data collection from operation notes across 45 hospitals in 12 countries, analyzing antimicrobial practices against WHO standards.
• Descriptive statistics were used to summarize adherence across various SSI prevention criteria.

Main Results:

• Data from 2167 patients undergoing hand and wrist trauma surgery were analyzed.
• High compliance was noted for surgical hand preparation (91%), drapes/gowns (92%), and postoperative dressings (98%).
• Significant variability and low adherence were observed for other antimicrobial practices.

Conclusions:

• Substantial variability exists in implementing WHO guidelines for SSI prevention in hand and wrist trauma surgery.
• Further research is required to evaluate established SSI reduction strategies for efficacy in this specific surgical context.
• Improving patient outcomes necessitates targeted research and consistent application of evidence-based SSI prevention measures.