Hand and Wrist Trauma: Antimicrobials and Infection-Audit of Clinical Practice (HAWAII-ACP).

BACKGROUND: Surgical site infections (SSIs) are a common and costly complication following hand and wrist trauma surgery. They can result in patient harm and long-term functional impairment. We aimed to evaluate adherence to World Health Organization (WHO) guidelines for the prevention of SSIs in hand and wrist trauma surgery. METHODS: The study comprised an international, multicentre audit comparing antimicrobial practices in hand and wrist trauma to the standards outlined by the WHO. Through the Reconstructive Surgery Trials Network (RSTN), surgeons and members of the multidisciplinary team that manage hand and wrist trauma were invited to participate in the study. Data were collected from operation notes. Adherence to the WHO global guidelines for SSI was summarized using descriptive statistics across each criterion. RESULTS: We recruited 45 hospitals across 12 countries, resulting in data collected on 2167 patients who underwent hand and wrist trauma surgery over eight months. The majority were >18 years old (n=1887, 87%) and male (n=1564, 72%). The adherence to the WHO guidelines varied significantly across criteria. High compliance was observed for surgical hand preparation (91%), drapes and gowns (92%) and standard postoperative dressings (98%). However, adherence was low for other observed antimicrobial practices. CONCLUSIONS: This audit revealed substantial variability in the application of the WHO guidelines for SSI prevention in hand and wrist trauma surgery. In order to improve patient outcomes, there is a requirement for targeted and high-quality research evaluating established SSI reduction strategies in other surgical areas to determine their effectiveness in hand and wrist trauma surgery.