Infection prevention
for the whole year. Step Five: The next step is to reassess the
30-day SSI rate. The HPB department at Oxford University Hospital NHS Foundation Trust saw a 60% reduction in SSIs. Step Six: Finally, it is important to report the success back to the team, to ensure everyone is aware and that everyone receives recognition for their efforts.
The success of this simple bundle approach has now been replicated across multiple specialties at the Trust. Orthopaedics, for example, moved from being an outlier, prior to the bundle, to an SSI rate below 1% following the implementation of a bundle. Spine surgery already had a very low SSI rate, below the national average, and the department was initially sceptical that this could be reduced even further. However, they successfully halved their SSI rate to 1.4%. “When we talk about ‘zero SSIs’, it is tough. But I think it is achievable,” Mr Bond-Smith asserted. He added that it is “not a passive process” and team members turn over. But there are also challenges around 30-day surveillance – it can be labour intensive and costly. Surveillance needs to be carried out by the same person to avoid inconsistencies in identifying and classifying SSI, and there needs to be quarterly reports to identify any unexpected changes. To address the surveillance challenge, Johnson and Johnson has developed a digital solution that allows patients to give feedback, in real time, if they have any concerns. “If there is an issue, you want ‘early eyes on it’,” he explained. The digital solution provides the team with an early warning of any problems and avoids inappropriate prescribing of antibiotics in primary care, due to incorrect assessment of the wound by the GP, for example.
Procurement Gary Welch, director of procurement and supply chain, at Oxford University Hospital, went on to discuss the topic of ‘Procurement for the Patient’. He commented that the mission for procurement departments should be about supporting clinicians and ensuring better patient care; it shouldn’t be solely about price reductions. Some of the key challenges currently facing healthcare include money, staffing and the backlog. There are also issues around supply chain disruption and inflation, meeting the demands of an ageing population, and problems concerning ‘flow’ – caused by pressures on social care. “Procurement should be working with the rest of the Trust to tackle some of these problems;
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not spending £100k on an SSI is just one example where cost savings can be achieved,” he commented. Gary Welch gave an insight into some of the
ways in which the Oxford University Hospital procurement team has helped with the mission to improve patient care, while also achieving savings, through the procurement of innovative solutions. This included the introduction of a solution to enable patients to self-administer IV antibiotics at home. The latter released 2,000 bed days per annum and freed £630,640 in financial benefits. The device also improved efficiency,
reduced the demands on staffing, and helped with the hospital’s response to COVID. He revealed that other value-based procurement projects include: beds to reduce the incidence of healthcare-acquired pressure ulcers, antibacterial sutures to reduce SSIs, 3D surgical guides, and spinal robot-assisted surgery to improve the safety and accuracy of surgery. “It is important to make the best commercial
decisions. However, first and foremost, the conversation must be: ‘how can we use procurement to transform patient care by working with our clinical colleagues?’ We need to be part of the team delivering patient care,” he concluded. Ultimately, the Burden of Infection
Symposium provided delegates with some useful tools and insights to help drive improvement in their own surgical departments. Sharing this knowledge with colleagues, provided a valuable opportunity for surgical teams to reflect and discuss how these proven
tools and strategies might be applied and adapted in their own Trusts and specialties. It is hoped that, by exchanging knowledge and best practice, in this way, outcomes for patients can be improved, unnecessary costs associated with SSI can be reduced, and extra capacity may be freed – at a time when the NHS is facing some of its greatest challenges while tackling the backlog.
References 1 Leaper DJ, Holy CE, Spencer M, Chitnis A, Hogan A, Wright GWJ, Po-Han Chen B, Edmiston CE Jr. Assessment of the Risk and Economic Burden of Surgical Site Infection Following Colorectal Surgery Using a US Longitudinal Database: Is There a Role for Innovative Antimicrobial Wound Closure Technology to Reduce the Risk of Infection? Dis Colon Rectum. 2020 Dec;63(12):1628-1638. doi: 10.1097/ DCR.0000000000001799. PMID: 33109910; PMCID: PMC7774813.
2 Leaper D, Tanner J, Kiernan M. Surveillance of surgical site infection: more accurate definitions and intensive recording needed. J Hosp Infect. 2013 Feb;83(2):83-6. doi: 10.1016/j. jhin.2012.11.013. Epub 2013 Jan 13. PMID: 23332350.
3 Tanner J, Padley W, Assadian O, Leaper D, Kiernan M, Edmiston C. Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients. Surgery. 2015 Jul;158(1):66-77. doi: 10.1016/
j.surg.2015.03.009. Epub 2015 Apr 25. PMID: 25920911.
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