A Closed-Loop Clinical Audit of Preoperative Antibiotic Prophylaxis Adherence for Surgical Procedures at Care Medical...

Background Preoperative antibiotic prophylaxis plays a vital role in preventing surgical site infections (SSIs) and supporting antimicrobial use. Although clear international guidelines exist, gaps in antibiotic selection, dosing, and timing persist in daily surgical practice. This closed-loop audit was conducted to evaluate current adherence to international prophylaxis guidelines in general surgery and assess the impact of targeted quality improvement interventions. Methods A retrospective clinical audit was performed at the General Surgery Department of Care Medical Hospital-Alrawabi, Saudi Arabia. A total of 130 surgical cases were evaluated, with 65 cases included in each audit cycle. The initial cycle assessed compliance with recommended antibiotic selection, appropriate weight-based dosing, and administration within 60 minutes before skin incision. After identifying key deficiencies, structured interventions were implemented, including staff education, reinforcement of guideline-based prescribing, and improved coordination between the surgical and nursing teams. A re-audit was subsequently undertaken to evaluate changes in practice, and compliance rates between cycles were compared statistically. Results Baseline findings demonstrated low adherence to preoperative antibiotic prophylaxis guidelines. A total of 65 patients were evaluated during the baseline audit cycle. Among patients eligible for assessment of prophylactic antibiotic administration, the correct antibiotic dose was administered in 21 (56.75%) patients, and appropriate timing within 60 minutes before skin incision was achieved in 25 (67.56%) patients. Preoperative prophylaxis was administered correctly in 15 (40.54%) patients, while overall adherence to guideline recommendations among all patients was 15 (23.07%). Following the quality improvement interventions, a second group of 65 patients was evaluated during the follow-up audit cycle. Significant improvements were observed. Correct dosing increased to 55 (96.49%) patients (p < 0.001), timely administration improved to 54 (94.73%) patients (p = 0.001), and correctly administered preoperative prophylaxis increased to 54 (94.73%) patients (p < 0.001). Overall guideline adherence increased significantly to 54 (83.07%) patients (p < 0.001). In addition, all patients in the second audit cycle received prophylactic antibiotics; cefazolin use increased substantially, and inappropriate broad-spectrum antibiotic use was eliminated. Overall, 130 patients were evaluated across the two audit cycles (65 patients in the baseline cycle and 65 patients in the follow-up cycle). Conclusion This audit demonstrated that structured education and coordinated system-based changes can significantly improve adherence to preoperative antibiotic prophylaxis standards. Continuous auditing and stewardship efforts are essential to sustain improvements, optimize surgical care, and enhance patient safety.