637 Standardising Flexor Sheath Treatment and Hand Therapy in a Regional Hand Surgery Unit

Aim This project aims to compare management of flexor sheath infections in a regional hand surgery unit against guidelines set by British Society for Surgery of the Hand (BSSH). Method A retrospective audit of management of flexor sheath infections compared with BSSH standards between March - August 2023. Data was collected retrospectively from electronic patient records and analysed in Microsoft Excel. Data collected included pre-operative splinting, early IV antibiotics, time to theatre, return to theatre, microbiology results, tendon rupture and access to hand therapy. Results 13 patients filled the audit criteria within the 6-month timeframe.100% of patients had appropriate early antibiotics. 92% of patients had washouts within 24 hours, with 46% of patients requiring return to theatre. Most microbiological cultures showed no growth, of those with positive swabs 21% were gram positive cocci. No tendons ruptures were observed. No patients had pre-operative splinting. Early referral to hand therapy was inconsistent, only 46% of patients had evidence of hand therapy (variable between day 5-14 post op). Hand therapy was documented in post op instructions for 1 patient. Conclusions Patients received good operative care with prompt antibiotics and washout. However, we were not meeting access to hand therapy targets. To standardise post operative care, we created an electronic operation note template on flexor sheath infections with specific post operative instructions as per the BSSH guidelines. A patient information leaflet with exercises is provided immediately post operatively to guide early mobilisation. A further audit cycle is underway to see the effects of intervention.