PE R IOPE RAT IVE PRACT ICE
Tackling the barriers to reducing SSIs
The ‘OneTogether’ conference was recently held at Vox Conference Centre in Birmingham and was a welcome return to face-to-face education for delegates, offering an insight into surgical site infection (SSI) improvement strategies. Kate Woodhead RGN DMS provides an overview of the key highlights.
OneTogether is a partnership between leading professional organisations with an interest in the prevention of SSIs. Their mission is to promote and support the spread and adoption of best practice to prevent SSIs across the surgical patient pathway. By connecting UK infection prevention and perioperative associations, key industry partners and the healthcare community, they strive to improve overall patient care.
The organisations represented and working in partnership on OneTogether resources are the Association for Perioperative Practice, The Infection Prevention Society, The College of Operating Department Practitioners, the Royal College of Nursing, the Central Sterilising Club, as well as 3M, who support and co-ordinate activities. OneTogether aims to:
l Raise the profile of infection prevention and the scientific data supporting the practice.
l Engage healthcare professionals and institutions to make a difference at every
level to reduce SSI and improve patient outcomes.
l Share best practice across all specialties. l Leverage the strength and reach of professional associations, industry partners and online platforms to educate and engage.
Surgical Site Infections SSIs account for 16% of healthcare associated infections and are associated with mortality and morbidity, as well as increased costs of care. It was recently identified that the annual cost of wound care to the NHS was £8.3 billion of which £2.7 billion and £5.6 billion were associated with managing healed and unhealed wounds, respectively.1 This is a staggering sum which is largely out of sight of acute care, as the dressings and management is undertaken in both primary and domiciliary care. This annual prevalence has increased by 71% since the last evaluation between 2012/ 2013 and 2017/2018.
There was a substantial increase in
resource use over this period and patient management cost increased by 48% in real terms. There is a serious issue for healthcare to deal with as the number of patients with wounds that need active regular management is increasing and this represents a great deal of misery for the patient, reduced mobility or ability to work, as well as pain and suffering for the individual.
One team working in acute care, from the Oxford University Hospitals, won the Small Steps Award in 2019. As a team they were concerned about the level of SSIs following neurosurgery and decided, as a group, to review their practice and make some changes. At the recent conference, Dr. Jane
Halliday, consultant neurosurgeon at the John Radcliffe Hospital, gave a presentation reporting on the activities which had led to the award and an update on their progress. Key stakeholders were involved in the process from the beginning, from cleaners to consultants, and included maintenance staff of theatre equipment and ventilation. Human factors for change management were reviewed, along with ideas from all team members on what needed to be changed to reduce infection rates. They used the OneTogether toolkit2
to assist with the
development of other aspects of practice, as it was well researched and evidence based. One of the key findings, locally, was that many of the elements of best practice were not clearly identified, either in practice or policy, so common steps were identified and targets set. They instituted clear signs to reduce traffic in and out of theatre – and while this has improved, it is still a work in progress. They developed an SSI checklist. They hold a Root Cause Analysis if there is an infection and reports are given regularly at their Morbidity and Mortality Meetings. Their results, to date, have halved their return to theatre rate from 4% to 2%, which is a
JANUARY 2022
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