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SURGICAL S I T E INF ECTION


While there are clear guidelines in place to help hospitals reduce the number of SSIs, hospitals have experienced difficulty implementing these into practice. Time to Act identifies a number of factors which can lead to this, including awareness, training, education and the provision of high-quality infection prevention equipment, which, as the Ashford and St Peters case study demonstrates, can be so vital in driving SSI reductions. The report calls for hospital Trusts to deliver compulsory training and education programmes for HCPs on the importance of infection prevention, and ensure that multi-disciplinary protocols are introduced pre, peri and post-operatively, assessing the level of risk across the patient pathway to determine what steps should be taken to reduce infection. As highlighted by the Getting it Right


First Time programme, there is a lack of awareness of SSI rates in their Trust by some frontline clinicians.18


This must be


tackled as a priority if best practice is to be embedded across the system in order to reduce the impact of SSIs in the UK. HCPs have a key role to play in addressing this. Time to Act calls for HCPs to ensure that all possible evidence-based preventative steps throughout a patient’s journey are implemented to reduce SSIs. It is also vital that HCPs receive


support from Royal Colleges and other HCP organisations, who are uniquely positioned to mobilise their membership to better understand and deliver best practice in SSI prevention. The establishment of dedicated ‘infection prevention hubs’, supported and sponsored by Royal Colleges and other HCP organisations, which could share best practice and set out best practice and clear, accessible information on guidelines, surveillance data and policy initiatives to reduce SSIs, would do much to raise the profile of SSI awareness and reduction. Patients, who are of course, the most affected by SSI prevalence, unfortunately tend to have a low-level awareness of SSIs. A greater understanding of the key symptoms of an SSI would likely mean higher awareness from patients on how they can reduce their own risk of developing an SSI. It is vital that patients are empowered to ask their HCP for more information on spotting the key signs and symptoms of an SSI, and the actions that they can take to help reduce the risk of infection before surgery, and after being discharged from hospital. Patient organisations, as trusted, reliable sources of information and best practice must also play their part in signposting patients to clear information about the range of preventative measures that may be taken before and after surgery to reduce SSIs.


Conclusions The Time to Act report highlights that across the UK, despite the welcome steps and ground-breaking initiatives that have been introduced at ward, Trust and national levels, there is still much to be done to further reduce the impact of SSIs. COVID-19 has clearly demonstrated the vital role of infection prevention for all of our safety and, equally, we all have a part to play in reducing all forms of infection, not least SSIs. We will be playing our part and to keep the conversation going, hosting a webinar in the New Year for HCPs in collaboration with the AfPP, to highlight the recommendations and discuss what more can be done to make a difference. It is clear that it is time for us all to act, whether this is the general public, HCPs, hospital management or policymakers. This is a challenge we must all address and we will continue to do all we can to support those on the front line in the NHS.


References 1 NICE guideline [NG125]. Surgical site infections: prevention and treatment. April 2019. Available from: https://www.nice.org.uk/guidance/ng125/ chapter/Context


2 Gloucestershire Hospitals NHS Foundation Trust. 2020. Keep Calm. Stay Warm. A Quality Improvement Initiative to prevent Surgical Site Infection (SSI) through Perioperative Temperature Management. Accessed at:


3 https://www.gloshospitals.nhs.uk/work-for-us/ training-staff/gsqia/quality-improvements/ KeepCalm-StayWarm/


4 Getting It Right First Time. GIRFT SSI National Survey. 2019. https://gettingitrightfirsttime.co.uk/ wp-content/uploads/2017/08/SSI-Report-GIRFT- APRIL19e-FINAL.pdf


5 National Institute of Healthcare Excellence (NICE), Surgical site infections: prevention and treatment, (NG125), 11 April 2019


6 Getting It Right First Time. GIRFT SSI National Survey. 2019. https://gettingitrightfirsttime.co.uk/ wp-content/uploads/2017/08/SSI-Report-GIRFT- APRIL19e-FINAL.pdf


7 Getting It Right First Time. GIRFT SSI National Survey. 2019. https://gettingitrightfirsttime.co.uk/ wp-content/uploads/2017/08/SSI-Report-GIRFT- APRIL19e-FINAL.pdf


8 V.Diaz, J.Newman. Surgical Site Infection and Prevention Guidelines: A primer for certified registered nurse anesthetists. 2015. Available from: https://www.aana.com/docs/default-source/ aana-journal-web-documents-1/jcourse6-0215- pp63-68.pdf?sfvrsn=1ad448b1_6


9 Public Health England. Surveillance of surgical site infections in NHS hospitals in England: April 2018 to March 2019. 2019. .https://assets. publishing.service.gov.uk/government/uploads/ system/uploads/attachment_data/file/854182/ SSI_Annual_Report_2018_19.pdf


10 Public Health Wales. Orthopaedic Surgical Site Infection Surveillance: 2018 Report. 2019. https://


62 l WWW.CLINICALSERVICESJOURNAL.COM About the author


Nick Rothwell is the general manager of Mölnlycke in the UK and Ireland. Nick has been working in the healthcare sector for over 20 years across strategic, commercial and operational functions. He has worked for a number of leading medical device manufacturers in Global, EMEA and UK roles as well as senior leadership roles for the UK’s largest acute private hospital provider.


JANUARY 2021


phw.nhs.wales/services-and-teams/harp/ healthcare-associated-infections-hcai/hcai- reports-and-dashboards/orthopaedic-all-wales- annual-report-2018/


11 Health Protection Scotland. Healthcare Associated Infection: Annual Report 2018. 2019. https:// hpspubsrepo.blob.core.windows.net/hps-website/ nss/2776/documents/1_HAI-Annual-Report-2018- final-v1%201.pdf


12 Public Health Agency. Northern Ireland Point Prevalence Survey of Hospital-acquired Infections and Antimicrobial Use 2017. 2017. https://www. publichealth.hscni.net/sites/default/files/2019-07/ PPS%202017%20Final_Report.pdf


13 World Health Organisation. Global Guidelines for the Prevention of Surgical Site Infection. November 2016. Available from: https://www.who.int/gpsc/ ssi-prevention-guidelines/en/


14 Ibid. 15 National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment. NICE guideline [NG125]. April 2019


CSJ


16 Medical technologies guidance [MTG43] PICO negative pressure wound dressings for closed surgical incisions, May 2019


17 Getting it Right First Time, SSI National Survey, April 2019, https://gettingitrightfirsttime


18 QIST, QIST: Anaemia and MSSA Collaborative, 2019, https://qist.org.uk/ Getting it Right First Time, National SSI survey Frequently Asked Questions. Available from: https://gettingitrightfirsttime.co.uk/ wp-content/uploads/2017/08/SSI-survey-FAQs- FINAL.pdf


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