Audit of major colorectal and biliary surgery to reduce rates of wound infection.

OBJECTIVE: To reduce the rates of wound infection for major colorectal and biliary surgery. DESIGN: Prospective audit of antibiotic prophylaxis by keeping copies of typed notes of operations and annotating them at discharge and at first follow up visit and annual review of prophylactic regimen according to yearly rate of wound infection and modification if necessary. SETTING: The work of one consultant surgeon working in a district general hospital. PATIENTS: All patients having major colorectal resection during 1976-89 (400) and cholecystectomy during 1981-9 (500). MAIN OUTCOME MEASURES: Wound infection, defined as any discharge from the wound as detected by observation during inpatient stay and by specific questioning at the first follow up visit six weeks later. RESULTS: Serial changes in prophylaxis for colorectal surgery resulted in a progressive reduction in the rate of wound infection from 43% in 1976, with no prophylaxis, to 1% during 1986-9 with single intravenous doses of metronidazole and cefuroxime intraoperatively and with lavage of the peritoneal cavity and wound with 0.1% tetracycline. During 1981-7, with no prophylaxis, the rate of infection in biliary surgery was 12% whereas in 1988-9, after the introduction of lavage with tetracycline alone, the rate was reduced to 2%. IMPLICATIONS AND ACTION: Simple prospective audit identified the need for changes in antibiotic prophylaxis; successive rounds of audit resulted in improved rates of wound infection, and lavage with 0.1% tetracycline seemed to be a major factor in achieving this.