INFECTION CONTROL
check list, operative urgency, length of surgery, blood products used, wound type (clean or contaminated tissue encountered), closure method (primary or delayed closure), any vasopressors or inotropes required.
• Prolonged intubation or re-intubation.
• Respiratory, vascular, mobility or nutritional issues.
• Underlying illness and management. • Chronic (non-topical) opioid use (Martin et al 2010) and/or prolonged non-steroidal anti- inflammatory drugs (Krischak et al 2007).
• Fluid balance. • Patient compliance issues and support/information provided.
• Evidence of haemotoma, mechanical dehiscence or wound breakdown or delayed healing.
• Wound management – proactive, timely and appropriate.
• Community input (contactGP and/or hospital for microbiology results and examination findings). • Patient story, if appropriate.
Reoccurring themes identified via the RCA process are also circulated to surgical teams and managers along with SSI rates on a monthly basis. Quality improvements may be brought about by amending the integrated care pathway, changing or improving electronic systems and/or access to the system, providing staff and patient education through a variety of methods, changing or introducing a service (such as specialist to place PICC line), resources (such as
theatre slots for managing deep SSI), product (new dressing that can remain in situ while patient showers) or practice (such as reinforcing sutures at top and bottom of incision).
SSI prevention care bundle As part of the high impact intervention (HII) programme, the care bundle for SSI is based on NICE guidance. It promotes regular review and improvement of patient care via the audit cycle. Box 1 lists the evidence-based practices which, when collectively and consistently adopted, have demonstrated a reduction of SSI incidences (McHugh and Corrigan 2012, Moinuddin et al 2005). ‘At its core are principles aimed to improve host immunity (by optimising tissue perfusion and warmth), reduce number of pathogens from endogenous and exogenous sources (patient wash and skin preparation, effective preparation to prevent bacterial ingress into the open wound, hand hygiene, keeping the wound covered until it is sealed) and screening for a significant, virulent pathogen in hospital acquired infection’ (Rochon 2012, p80). Care bundle compliance is a snapshot
of care in order to produce an overview or trend for the patient group being examined and is a good starting point for improving patient care. (Joint Commission Perspectives on Patient Safety 2006) The RCA procedure drills down on the processes and systems. For
‘From a surgeon’s perspective, ‘a deep wound infection is a serious and preventable complication with substantialcosts associated.’
example, regular non-compliance with the element ‘blood glucose control Day 0 (day of operation)’ can use information drawn out from the RCA process to draw attention to the policy/guidelines in place for patients with diabetes. The RCA explores underlying illness such as diabetes in more detail – such as, was there a pre-admission assessment of diabetic control? Is there a HbA1c result (which has been acted upon if necessary,
MEDICAL DEVICE INNOVATION
Talk to P3 about its development of new medical and surgical devices, or visit:
www.p3-medical.com to see the extensive range of products available.
1 Newbridge Close, Bristol BS4 4AX Tel: +44 (0)117 972 8888 | Fax: +44 (0)117 972 4863
info@p3-medical.com www.p3-medical.com
NOVEMBER 2012 THE CLINICAL SERVICES JOURNAL 27
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