Infection, disease & health · 2026
Management, use and documentation of off-label antimicrobials in the operating theatre: A survey of Australian hospital pharmacists.
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Hillock Nadine T, Rawlins Matthew, Raby Edward, Ierano Courtney
Аннотация
BACKGROUND: Optimising antimicrobial use during surgery is essential for preventing surgical site infections, ensuring patient safety and minimising the risk of antimicrobial resistance. To investigate the management, use and documentation of 'off-label' antimicrobials in Australian operating theatres (OT).
METHODS: A cross-sectional online survey of hospital pharmacists with expertise in antimicrobial stewardship, surgery or and/or medication safety. Demographic and quantitative questions were analysed using descriptive statistics. Free-text responses underwent reflexive thematic analysis.
RESULTS: Responses from 61 Australian hospital pharmacists were analysed. 83 % of survey participants reported that ceftriaxone was stocked in OT, with 70 % and 62 % stocking IV amoxicillin-clavulanate and piperacillin-tazobactam respectively. Vancomycin (34 %), rifampicin (18 %) and gentamicin (16 %) were the most commonly used antimicrobials for wound irrigation. Over half (51 %) of participants reported seeing vancomycin powder applied directly to surgical sites. Thematic analysis of free-text responses generated three dominant themes: surgical staff work-arounds, risks to patient safety, and detached or unclear pharmacist role in OT.
CONCLUSION: Broad-spectrum antimicrobials are used topically as washes, soaks, and applied directly to surgical sites, however the extent of this practice is unclear due to poor documentation. There is wide variation between hospitals regarding which antimicrobials are kept in OT, with inconsistent compliance to systems restricting use in this setting. Opportunities to improve the use of broad-spectrum antimicrobials include: better utilisation of automated dispensing cabinets to track use and facilitate audits, embedding of pharmacists in OT to improve management, and policies to ensure documentation and patient consent for use outside of evidence-based guidelines.
METHODS: A cross-sectional online survey of hospital pharmacists with expertise in antimicrobial stewardship, surgery or and/or medication safety. Demographic and quantitative questions were analysed using descriptive statistics. Free-text responses underwent reflexive thematic analysis.
RESULTS: Responses from 61 Australian hospital pharmacists were analysed. 83 % of survey participants reported that ceftriaxone was stocked in OT, with 70 % and 62 % stocking IV amoxicillin-clavulanate and piperacillin-tazobactam respectively. Vancomycin (34 %), rifampicin (18 %) and gentamicin (16 %) were the most commonly used antimicrobials for wound irrigation. Over half (51 %) of participants reported seeing vancomycin powder applied directly to surgical sites. Thematic analysis of free-text responses generated three dominant themes: surgical staff work-arounds, risks to patient safety, and detached or unclear pharmacist role in OT.
CONCLUSION: Broad-spectrum antimicrobials are used topically as washes, soaks, and applied directly to surgical sites, however the extent of this practice is unclear due to poor documentation. There is wide variation between hospitals regarding which antimicrobials are kept in OT, with inconsistent compliance to systems restricting use in this setting. Opportunities to improve the use of broad-spectrum antimicrobials include: better utilisation of automated dispensing cabinets to track use and facilitate audits, embedding of pharmacists in OT to improve management, and policies to ensure documentation and patient consent for use outside of evidence-based guidelines.