Background: Hand trauma often require surgical management. The overall risk for surgical site infection following hand trauma is consistent with other forms of surgery, at 5% (1). The WHO has produced guidelines to help prevent surgical site infections and it is unclear what variability exists in the adherence of these guidelines within hand trauma surgery. HAWAII-ACP (Hand and Wrist trauma, Antimicrobials and Infection - Audit of Clinical Practice) is an international study of current methods of antimicrobial practice following hand trauma surgery.
Methods: Patients who attended hand trauma service locally (Waikato Hospital) in February 2024 and deemed to require surgery following hand trauma were recruited. This data was compared to WHO standard guidelines and other participating hospitals worldwide. Data were managed using Research Electronic Data Capture (REDCap), hosted by University of Oxford. Descriptive analysis was performed for all captured data.
Results: Preoperatively, 18/31 (58.06%) had wound washout in the community, 29/31 (93.54%) had washout by the hand trauma team. There were 25/31 (80.64%) patients who had prophylactic antibiotics prescribed, with Augmentin being the most popular choice of antibiotics, and 54.84% of patients had antibiotics administered 120 minutes before incision. Only 2/31 (6.45%) cases had aqueous chlorhexidine preparation. Intraoperatively, 25/31 (80.65%) cases had full sterile drape and 28/31 cases (90.32%) had incisional wound irrigation with saline. Antimicrobial sutures were used for skin repair in 74.19% of cases and structural repair in 19.35%. Postoperatively, 51% of cases in our study had further course of antibiotics, which is against WHO recommendation of stopping the use of prolonged antibiotics after the operation.
Conclusion: The WHO guidelines have been designed for all surgical specialities, and not hand surgery specific. HAWAII-ACP gives us a better understanding of current antimicrobial interventions and can help develop a network of sites that can be harnessed in future studies.