Audit of Surgical Antibiotic Prophylaxis Compliance in a Teaching Hospital in Rivers State

Surgical antibiotic prophylaxis (SAP) is a critical measure for preventing SSIs, yet its correct application in terms of drug choice, timing, and dosing is frequently suboptimal in Nigerian hospitals. This study audits compliance with SAP guidelines among surgical patients at a teaching hospital in Rivers State, South South Nigeria, in 2022 to 2023. A prospective clinical audit reviewed 240 elective and emergency surgical procedures, evaluating antibiotic selection, timing of administration relative to incision, re-dosing practice for prolonged surgeries, and appropriateness according to local antibiogram data. Compliance with SAP timing (within 60 minutes of incision) was achieved in only 47% of cases. Inappropriate antibiotic selection occurred in 31% of procedures. Re-dosing for surgeries exceeding 3 hours was performed in fewer than 20% of eligible cases. Ceftriaxone was the most commonly used agent regardless of surgical site or contamination classification. Awareness of SAP guidelines among junior surgical staff was poor. The audit recommends immediate institutional implementation of standardized SAP protocols integrated into the surgical safety checklist, antibiotic stewardship committee oversight of theatre prescribing, and structured pharmacology training for all surgical residents in Rivers State teaching hospitals. Keywords: antibiotic prophylaxis, SSI prevention, surgical audit, Rivers State, antibiotic stewardship