Objective: To assess self-reported adherence to measures for preventing infection in patients registered in the Victorian Spleen Registry (VSR). Design, participants and setting: Cross-sectional survey in May 2010 of all patients who had been registered on the VSR for at least 5 months, were able to speak English, and were not living in an institution. Main outcome measures: Rates of prophylactic antibiotic use, having an emergency supply of antibiotics available, receipt of any recommended booster vaccination (in patients at > 5 years since splenectomy) and receipt of 2009 influenza vaccination. Results: 1175 patients were sent questionnaires, of whom 889 (75.7 ) responded. Self-reported adherence to taking prophylactic antibiotics was lower with time since splenectomy (82.9 for <2 years since splenectomy, 27.4 for = 30 years), as was having an emergency supply of antibiotics available (74.4 for <2 years and 60 for = 30 years since splenectomy). The proportion receiving the seasonal influenza vaccine and recent booster vaccines (for those at > 5 years since splenectomy) was high. Of patients registered for more than 12 months, 37.0 reported an infection requiring additional antibiotics within the prior year, and 26.1 of these required hospitalisation (including one with a case of overwhelming postsplenectomy infection [OPSI]). Use of prophylactic antibiotics was inversely associated with the rate of infections requiring additional antibiotic therapy (odds ratio, 0.75; 95 CI, 0.57?0.98; P = 0.036). Conclusions: The proportion of VSR registrants adhering to current postsplenectomy guidelines was higher than rates reported elsewhere, and over a third reported infections requiring a course of antibiotics within the prior 12 months. However, only one OPSI occurred. These results support the view that a spleen registry can promote health maintenance behaviour in asplenic patients, which is likely to help prevent serious infections.