Antibiotic stewardship in simple hand trauma: an audit and literature review

INTRODUCTION: Antibiotic prescribing in simple hand trauma is variable, and poor documentation may undermine antimicrobial stewardship. This study combined a closed-loop audit with a literature review to evaluate prescribing practices and current evidence regarding prophylactic antibiotic use in hand trauma. METHODS: A retrospective closed-loop audit of adult patients presenting with simple hand trauma to a tertiary plastic surgery trauma clinic was performed over two 2-week cycles. Uncomplicated lacerations and nail bed injuries were included, while bite wounds, crush injuries, and open fractures were excluded. Data collected included wound characteristics, antibiotic prescribing practices, and documentation quality. Following cycle one, a departmental teaching session on antimicrobial stewardship and a revised trauma clinic proforma with mandatory prescribing prompts were introduced prior to re-audit. A literature review of PubMed, Scopus, and Google Scholar was also conducted. RESULTS: Twenty-two patients were included in cycle one and 15 in cycle two. In cycle one, antibiotics were prescribed in 72% (15/22) of cases, with poor documentation of indication (6.7%), wound status (6.7%), antibiotic choice and route (40%), and duration (20%). Following intervention, prescribing reduced to 60% (9/15; p=0.099). Documentation of indication, wound status, duration, and appropriate antibiotic choice improved to 100%. The literature review demonstrated substantial variation in prescribing practices and limited evidence supporting routine prophylactic antibiotics in uncomplicated hand trauma. CONCLUSION: Antibiotic prescribing and documentation in simple hand trauma were suboptimal at baseline. Targeted education and redesign of the trauma proforma improved documentation quality and adherence to antimicrobial stewardship principles, highlighting the value of simple, low-cost interventions in supporting evidence-based prescribing.