Dissertation (MMED General Surgery)Background: Surgical site infections (SSIs) are preventable complications following surgery cause significant burden in terms of patient morbidity, mortality and increased cost of treatment. Very few studies have been published on the efficacy of surgical antibiotic prophylaxis in the prevention of SSIs in our country and the practice is mostly not well established in our hospitals including DRRH. Objective: To determine association between surgical antibiotic prophylaxis practices and occurrence of surgical site infections among operated surgical patients at DRRH. Methodology: Prospective Cohort study was conducted at DRRH. 162 Operated patients with different trends of antibiotic prophylaxis were followed up for one month to assess for their risk of developing SSIs. Analysis of data was done by SPSS version 20 program using frequency tables, chi square test, Kaplan-meier methods. Significance level of < 0.05 was taken to establish associations between variables Results; Surgical Site Infections rate was 14.8%. Only 60.5% of patients received preoperative antibiotic prophylaxis, most of them within 1hour of skin incision. There was no significant difference between these patients and those who did not receive preoperative antibiotic prophylaxis (p=0.88) in SSIs occurrence .Almost all patients received postoperative antibiotics for five days or longer. Enterococcus species were predominant isolates and majority of isolates showed multi drug resistance. Conclusion: Surgical Site Infection is common complication in the surgical department at DRRH. Preoperative Antibiotic Prophylaxis within one hour before incision remains a standard practice. Establishment of local protocol on Antibiotic Prophylaxis and improvement of other infection strategies can improve the prevailing situation.