Infection prevention
Tackling the burden of surgical site infection
Simple, and relatively inexpensive, steps to implement care bundles can have a dramatic impact on rates of surgical site infection. The Burden of Infection Symposium provided an insight into the latest evidence and guidance around best practice, as well as offering expert advice on ‘overcoming the challenges of change’. Louise Frampton reports.
Surgical site infections (SSI) are among the most reported healthcare-associated infections (HCAIs). They have an adverse economic impact on hospitals, as well as on the patient. In addition, they are responsible for increasing the length of stay for patients – resulting in social and economic loss to the patients and family. To further theatre teams’ understanding of SSIs, their associated socio-economic burden, the risk factors, and guidelines for prevention, the J&J Institute and Ethicon recently held a ‘Burden of Infection Symposium’, at its Pinewood Campus in Wokingham, UK. The symposium opened with a powerful account from a patient on the devasting impact of SSI – reminding clinicians of the human cost to patients. Following surgery for fibroids, the patient contracted an infection which developed into necrotising fasciitis. She described the immense pain associated with this “flesh eating disease” and how the “black dot above her wound” led to seven surgical interventions, nine blood
transfusions and being in the hospital for two months. “I never imagined that [the surgery] would
turn into that. But if it can happen to me, it can happen to anyone. I have gone from survivor to patient advocate, to put a face to the harm… One surgical site infection is one too many… I want surgeons to know that they don’t just hold one person’s life in their hands; they hold a family in their hands; they hold a community in their hands. If you can add another layer of protection for the patient, why wouldn’t you?” she exclaimed. Having placed the focus firmly on the patient,
the symposium went on to provide an insight into SSI definitions, the evidence base, and clinical guidelines. Professor Leaper, an Emeritus professor of surgery with University of Newcastle Upon Tyne and Clinical Sciences at the University of Huddersfield, previously chaired the NICE guideline development group on SSI. He gave a stark reminder that healthcare-associated
infections can prove fatal. Against a backdrop of increasing antimicrobial resistance (AMR) and a lack of new antibiotics in our armoury, prevention has become more important than ever. There has been significant progress in
reducing Meticillin-resistant Staphylococcus aureus (MRSA), in the UK, but Meticillin- susceptible Staphylococcus aureus (MSSA) remains a problem. He added Coagulase- negative staphylococci/Meticillin-Resistant Staphylococcus epidermidis (MRSE) is also problematic in orthopaedic and other prosthetic surgery. A key message of the session was the importance of prevention rather than cure – antibiotics can have significant side effects, including renal damage and problems with coagulation. However, there has also been a historic failure to ‘preserve’ new antibiotics that have entered the market, though injudicious prescribing. This means that some infections are becoming fatal, once again, through antimicrobial restistance (AMR). In a world without effective antibiotics,
chemotherapy and transplantation will become “too risky”. Furthermore, some surgical procedures may also become high risk – Prof. Leaper warned that there could be a significant increase in deep incisional infections, following colorectal surgery, for example. In joint replacement surgery, untreatable infection could also lead to devasting amputations. “Antibiotic stewardship is simple, but it is
a team effort. The right antibiotic must be administered at the right time, at the right dose, for the right length of time,” Prof. Leaper commented.
In particular, he emphasised that simple
clinical markers – such as white blood cell count and temperature – should guide the length of the course of antibiotics when treating infections, to avoid unnecessary prolongation. He said that resistance with antiseptics, on the other hand, was “not a concern” – although it was prudent to continue surveillance in this area
February 2023 I
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