Purpose: The WHO has produced guidelines to help prevent surgical site infections, but not hand specific.It is unclear what variability exists in the adherence of these guidelines within hand trauma surgery (1).HAWAII-ACP (Hand and Wrist trauma, Antimicrobials and Infection - Audit of Clinical Practice) is a study of current antimicrobial practice and evaluate adherence to WHO guidelines in hand trauma surgery. Methodology: Patients who required hand trauma surgery at Te Whatu Ora Waikato from 1st till 28th February 2024 were recruited.This study involved collecting anonymized data with no change to clinical care pathways.Data were managed using Research Electronic Data Capture, hosted by University of Oxford. This study has been approved by research office and ethics approval is not required. Results: Preoperatively,19/40 (47.5%) patients had wound washout in the community,31/40 (77.5%) patients had wound washout by hand trauma team.There were 30/40 (75%) patients who had prophylactic antibiotic prescribed by hand trauma team.22/40 (55%) patients had surgical antibiotic prophylaxis (SAP). Intraoperatively, 31/40 cases (77.5%) had full sterile drape.31 cases had sterile saline for irrigation. Antimicrobial sutures were used for skin repair in 8/40 (20%) cases and structural repair in 10/40 (25%) cases. 10/40 (25%) patients had antibiotics discontinued after the operation. Conclusion: HAWAII-ACP gives us a better understanding of current antimicrobial intervention in hand trauma surgery in our hospital.This is compared to WHO guidelines.It can help develop a network of sites that can be harnessed in future studies. References: 1. WHO. Global Guidelines for the Prevention of Surgical Site Infection, second edition. World Health Organization 2016:27–37.