TPT 6.05 Breaking Routine Practice: Eliminating Unnecessary Pus Swabs and Antibiotic Use in Perianal Abscess Drainage — A Closed-Loop Audit Promoting Guideline Adherence

Abstract Aim ACPGBI consensus guidance on emergency surgery recommends against routine pus swabs and antibiotics in uncomplicated cases of perianal abscess. Despite the guidance, these practices remain common, increasing cost, workload, and antimicrobial resistance. In this audit, we aim to evaluate the impact of team-based interventions and targeted education on improving guideline adherence. Methods A retrospective closed-loop audit was conducted at a District General Hospital. In first cycle, 50 patients who had the procedure (October 2024–March 2025) were evaluated for pus swab and antibiotic use. Interventions included targeted education to the surgical team, theatre staff engagement, and guideline distribution. A re-audit was conducted (n=21, July–December 2025) to assess the changes in practice following the interventions. Results In the first cycle, pus swabs were taken in 70% (n=35/50) of cases, antibiotics were given in 54% (n=27/50) cases, with no effect on recurrence reduction. Only 6% (n=2/35) of cultures sent were reviewed. Therefore, the first cycle audit showed a lack of adherence to the current recommended guidelines. Following interventions, in second cycle, the use of pus swabs was reduced to 23% (n=5/21). Antibiotic use without a clear indication remained unchanged in both cycles. Conclusion This study demonstrates that routine pus swabs and antibiotics in uncomplicated cases of perianal abscess did not alter patient outcomes. Team-based interventions, including targeted teaching, improved adherence to guidance regarding pus swab use, enhancing patient safety and reducing unnecessary costs. Further emphasis on reducing antibiotic use is required to improve antibiotic stewardship.