EP.FRI.469 A closed-loop audit regarding the practice of sending Pus Swab for culture and sensitivity in Pilonidal abscess drainage

Abstract

Aim The purpose of this study was to determine the role of Microbiological swabs taken during an Incision and drainage for Pilonidal abscess in patient management. Method We performed a closed-loop audit to determine the role of pus swabs in the management of pilonidal abscess. Parameters like patient demographics, date of surgery, whether or not pus sent for microbiological examination, the subsequent report, the time required for sample processing, antibiotics prescribed were considered. The data was collated, analysed, and presented at clinical governance. We then implemented in our treatment protocol to stop the practice. This data was again, prospectively collected to complete the audit cycle. Result A total of 250 patient were included in this study. Prior to the change of practice, swabs were sent in 77% of the cases. The average reporting time of the swabs was 4.3 days and 92% of the patients were discharged on antibiotics. After conducting multiple teaching sessions for the trainees and educating the theatre staff, the percentage of swabs sent was brought down to 58%. Conclusion The pilonidal abscess has high infection and recurrence rate. Hence, the management involves incision, drainage and antibiotics cover in most cases. In our study, the swab results did not alter patients management. Most of them were treated with Co-Amoxiclav and some required additional Metronidazole. Hence, we suggested the routine use of swab for culture in pilonidal abscess cases are unwarranted. This change of practice resulted in huge cost savings at our hospital.