VICNISS updates: Surgical Antibiotic Prophylaxis (SAP)

From January 2021

These updates are relevant to the following VICNISS surveillance modules:

• Surgical Site Infection (SSI)
• Signal Event – Surgical Infection (SESI) (small hospitals)
• Surgical Antibiotic Prophylaxis (SAP) (small hospitals)
• Colorectal Surgery Process Adherence Monitoring (COLOPAM)

Background

The major activity of the VICNISS Coordinating centre is to collate and analyse data and information (surveillance) from hospitals in Victoria.  All Victorian public and private hospitals are required to perform appropriate surveillance for healthcare associated infections and relevant processes including surgical prophylaxis compliance (antibiotic choice, timing, duration). Procedures include (but are not limited to) hip and knee prosthetic insertion, colorectal, coronary artery bypass and Caesarean section. VICNISS reports are available to submitting health services to access their own data using a self-serve portal, including line listing of re-identifiable source data.

Changes to SAP compliance assessments

From January 2021, changes that have been made to data collection for surgical prophylaxis will allow data on treatment antibiotics that patient is prescribed in 24 hours prior to the procedure to be included in compliance assessment of antibiotic choice. Compliance assessments around choice, timing and duration have also been updated to ensure consistency with Therapeutic Guidelines: Antibiotics. Further information on compliance assessments is available on the VICNISS site and includes summary information on Surgical antibiotic prophylaxis: Timing of redosing interval for commonly used agents (based on Therapeutic Guidelines: Antibiotics and expert consensus) on which compliance with redosing will be assessed.

Changes to data collection: summary

Data field changes

• Added:
  • Route of antibiotic administration
  • Was antibiotic continued after surgery
• Removed:
  • Was SAP withheld because patient already on antibiotics sufficient for prophylaxis

Reporting changes

• Antibiotics administered within 24hours prior to surgery will be included in assessment of prophylaxis
• Appropriateness will be reported using all three compliance measures of choice, timing and duration

These changes to data collection have been flagged in previous VICNISS communications to health services since 2019 to allow hospitals, including those collecting data using software, to prepare.  We continue to do our best to keep data collection changes to annual updates and allow preparation for sites to implement.

These changes are being made to update surgical prophylaxis reports so they are:

• significantly more useful for hospital antimicrobial stewardship activities
• updated for consistency with Therapeutic Guidelines: Antibiotics

NOTE: To ensure accurate assessment of SAP timing it is important that the surgery ‘start time’, i.e. skin incision (or equivalent such as mucous membrane incision in patient with non-primary closure of wound in previous operation) is recorded correctly on the SSI, SAP and SESI web form. ICPs should make sure that the ‘start time’ recorded in the operation notes is ‘knife to skin’ or equivalent.  In some operating theatres staff will record entry to theatre, handover to surgeon, etc. as the start time. If this is the case at your hospital we recommend working with your Operating Theatre personnel to ensure that skin incision or equivalent is also recorded in the operation notes. 

For more information, contact VICNISS@mh.org.au; Phone: 61 3 9342 9333