Post-operative infection following hand surgery. Guidelines for antibiotic use.

An audit was designed to analyse the risk factors for developing post-operative wound infection following hand surgery. 249 consecutive patients were prospectively entered into the study. 236 (95%) patients were available for follow-up. Infection was diagnosed by clinical criteria. There was an infection rate of 10.7% in elective operations and 9.7% in emergency operations. There was no significant reduction in infection rate in the elective group with the use of antibiotics (P = 0.5). In the emergency group of patients peri-operative antibiotic administration was associated with an 8.5-fold reduction in infection rate (P = 0.014). The presence of a dirty wound was associated with a 13.4-fold increase in post-operative wound infection rate (P = 0.002). A postal questionnaire of members of the British Society for Surgery of the Hand revealed a wide variation in antibiotic usage. Guidelines for antibiotic use in patients undergoing hand surgery are presented.