Several factors are believed responsible in helping facilitate the low rates of bacterial antibiotic resistance in the Netherlands as compared with other European countries and the USA. These factors include, the influential position of the medical microbiology and infectious diseases profession, the establishment of elaborate infection control programs, and cultural influences (including the traditional prudent use of antimicrobials). Furthermore, in a recent survey, the majority of Dutch physicians reported no reluctance to clinical guidelines. Evidence-based guidelines on surgical prophylaxis have been developed to improve the quality of care and to reduce inappropriate prescribing in many countries. Various authors still report frequent overuse. The Dutch Working Party on Antibiotic Policy (SWAB), issued national guidelines for surgical prophylaxis in the year 2000, and these have been used as a framework for the development of local policies. The goal of these guidelines (besides reducing the incidence of surgical site infections), was to limit the spectrum of the antibiotics (based upon microbiology data from the Netherlands), promoting single dose administration and optimising the timing to within 30 min preoperative. The Surgical Prophylaxis and Surveillance Study (Chirurgische Profylaxe en Surveillance, CHIPS) investigated the implementation of this SWAB guideline in a prospective intervention study involving 13 Dutch hospitals. The intervention consisisted of feedback, educational and logistic support. Process outcome was documented both several months before and after intervention, by recording the choice, duration, dose and timing of antibiotic prophylaxis. SSI were monitored as the patient outcome indicator, with the Dutch national surveillance network (PREZIES) providing the SSI data. The study succeeded in increasing the use of first generation cephalosporins as a single dose and in improving the timing of prophylaxis, while maintaining efficacy in terms of preventing SSI. At present, further national projects are ongoing and are especially targeted towards the timing of prophylaxis (a factor particularly sensitive to organisational constraints). The guideline program of SWAB, the PREZIES network, the CHIPS study and the ongoing quality improvement program are supported by the Dutch government. In this presentation, quality indicators of process and outcome of surgical prophylaxis will be compared with international data from the literature.