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SURGICAL S I T E INF ECTION


and orthopaedic surgeon, and Lucy Everett, a lead nurse for infection prevention, as well as Lindsay Keeley, the Patient Safety and Quality Lead at The Association of Perioperative Practice (AfPP). This enabled us to understand the impact of SSIs on the NHS and patients first-hand, and assess what more can be done to prevent these infections from happening in the first place. In England, rates of surgical site infections have been gradually declining since 2014, but 1,183 SSIs were still recorded in 2018/19 alone.8


In its latest


data collection from orthopaedics, Wales found that 1 in 458 procedures had an SSI reported in 2018,9


while in Scotland,


a total of 8,707 procedures were recorded through the hip arthroplasty SSI surveillance programme during 2018, and SSIs were reported in 62 cases.10


In Northern Ireland’s


2017 Point Prevalence Survey, SSIs were shown to account for 17% of HCAIs.11 However, there are notable challenges with regards to reporting and surveillance of infections, making it difficult to make a full assessment of SSI incidence across the UK. For some surgical specialties, such as orthopaedics, and for some specific operations, such as Caesarean sections, surveillance is mandatory across the UK. Elsewhere, the reporting is non-mandated and therefore variable. The availability and scope of the data makes it difficult to get a clear picture of the prevalence of SSIs across the UK, which itself is a cause for concern. Based on the limited information available, we found that although progress has been made in recent years, there is too


Time to Act calls for policymakers to both introduce mandatory reporting of SSIs across all surgical specialties across all four nations of the UK, and clear, deliverable targets to reduce SSIs across all surgical specialties to be set within the lifetime of the five-year, and subsequent 20-year AMR plans.


much variation and much more needs to be done to reduce the rates of infection. This is despite the presence of clear guidelines on how to reduce SSIs.


Steps can be taken at all stages of a patient’s journey through surgery to reduce the risk of infection. For example, when the patient arrives at hospital for a pre- assessment, they may be provided with an antimicrobial whole-body wash to use prior to surgery. The WHO recommends that the patient should wash with soap or the antimicrobial whole-body wash to remove bacteria from the skin.12


During


surgery, double gloving is recommended by HCPs during higher risk procedures13


but


this can help reduce the risk of infection in any procedure. After the operation has taken place, NICE recommends covering the surgical incision with an appropriate interactive dressing designed to promote the wound healing process.14


It is also


recommended that negative pressure wound dressings are considered as an option for


closed surgical incisions in patients who are at high risk of developing an SSI.15 Despite this extensive set of guidelines and preventative steps that can be taken to reduce the risk of SSIs, there is still a challenge in implementing these measures into clinical practice. Variation in practice needs to be reduced across all four nations of the UK and, to tackle this, policymakers, Trusts, HCPs, Royal Colleges and other professional groups, patient organisations and patients themselves all have a role to play.


Learning from best practice The challenges that we face from SSIs are clear and, without consistent, targeted action, there is a significant risk that they will only increase in the coming years. However, there are numerous examples from across the NHS demonstrating that, when a multidisciplinary approach is taken to prevention at every level, everyone across the health system can develop highly effective interventions both to prevent and actively drive down SSI rates. Time to Act profiles some of the very best examples of SSI prevention and interventions taking place within the NHS and around the world. Promisingly, some of the most effective measures to reduce SSIs have been taken by hospitals experiencing significant challenges in terms of SSI prevalence. Ashford and St Peter’s Hospitals NHS Foundation Trust, which was identified by Public Health England’s Surgical Site Infection Surveillance Service to be an outlier compared to the national benchmark, put in place a range of measures to reduce the 5% infection rate for hip fracture patients. By examining the whole patient journey, the Ashford and St Peters team were able to assess the risk across the care pathway, identifying and implementing multi-tier, simultaneous changes to care across at every stage of the patient journey. Ahead of surgical procedures, Ashford and


St Peter’s introduced pre-operative bathing in a chlorhexidine wash to reduce skin bacterial load, in addition to pre-operative warming. The team also put in place a range of inter-operative measures, including tight controls on patient temperature in the theatre, in addition to employing strict


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