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


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


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


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80