An effective post-discharge follow-up programme significantly increased the SSI rate. From the authors' experience and a literature survey, possible ways to achieve high follow-up rates were suggested. It was also recommended that professional and regulating bodies in Australia be encouraged to standardize methodology and set minimum follow-up rates for post-discharge SSI surveillance. Increasing use of computerized hospital database systems for automated data gathering and processing should make this more practicable.

C o m p lia n ce w ith G u id elin esK e rri A M cConachy, Sylvia C uell, P asch al J K ent, M alcolm I M cD onald ABSTRACT Objective: To prospectively evaluate the appropriate ness of prophylactic surgical antibiotic use and the cost of inappropriate surgical antibiotic prophylaxis in a 115bed private hospital. Method: Details of prophylactic antibiotic administra tion were recorded by operating theatre nursing staff and the clinical pharmacists assessed the appropriate ness of the indication, antibiotic choice and dose. Surgi cal antibiotic prophylaxis was considered appropriate if it met either the in-house Surgical Antimicrobial Pro tocol or the Antibiotic Guidelines 96197 9th edition. We assessed the timing of administration and analysed the cost of inappropriate drug use and laboratory monitor ing. Results: Surgical antibiotic prophylaxis was indicated in 92% of procedures (230/251) and used, or not used, appropriately in 86% of procedures (215/251). In the 197 cases in which antibiotics were indicated and used: only 62% of doses (122/197) were administered at or less than two hours before induction; and the correct antibiotic was chosen in 90% of cases (178/197). Dos age was correct in 77% of cases overall (192/251), but in 98% of cases when the appropriate antibiotic was chosen (174/178). Single doses were employed in only 68% of procedures (133/197). There was compliance with all five criteria in only 35% of cases. T he annual cost to this hospital of inappropriate antibiotic prophy laxis was estimated at over $40 000. Conclusion: This study demonstrated modest compli ance with current recommendations for surgical anti microbial prophylaxis. As a result, the in-house proto col is being revised to include E N T procedures and a new anaesthetic record form is being developed. Fur ther education is being targeted to anaesthetists, urolo gists, orthopaedic, colorectal and E N T surgeons. A ust J H osp Pharm 1999; 29: 5-9.

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