Infection prevention SSI reduction: a sustainable solution
At the recent Infection Prevention & Control conference, held in Birmingham at The National Conference Centre, surgical site infection (SSI) was high on the agenda – from infection prevention in theatres and the importance of care bundles, to antibiotic stewardship within the surgical pathway, and SSI surveillance. Louise Frampton reports on some of the highlights.
The Infection Prevention & Control conference recently provided a stark a reminder of the threat posed by antimicrobial resistance – the message from NHS England and Improvement was loud and clear: we may no longer be able to fall back on antibiotics, in the future, if resistance continues along its current path. Speaking at the event were top NHS thought leaders: the National clinical director for prescribing, Professor Tony OBE; pharmacy and prescribing clinical lead, Dr. Kieran Hand, from NHS England & NHS Improvement; and infection prevention and control improvement lead, NHS England, Esther Taborn. The discussions highlighted the importance of tackling preventable healthcare-associated infections, to preserve our armoury of antibiotics going forward. Throughout the event, it was clear that SSI
prevention strategies will have an important role to play in reducing avoidable prescribing of antibiotics – but what exactly can be achieved and how? Furthermore, how can we reduce SSIs ‘sustainably’? Giles Bond Smith, a consultant HPB and emergency surgeon, at the Oxford University Hospitals NHS Foundation Trust, sought to address some of these questions, with a valuable insight into how an eight- point care bundle, along with the use of digital technologies, are driving significant improvement at the Trust. He opened his session with an image of a serious, deep organ space SSI – underscoring the devastating impact that SSIs can have on patients’ lives. “No patient should suffer with a superficial
SSI, let alone this deep organ space catastrophe,” he asserted. There is an increasing body of evidence on solutions to the problem and the WHO and NICE guidelines on preventing SSIs are widely known. However, in addition to these guidelines, infection prevention care bundles have a vital part to play, as Mr. Bond Smith pointed out.
Operating theatre teams also need to be thinking about sustainability and – with this in mind – he went on to look at the strategies that can be implemented that are sustainable, the evidence to support these strategies, and their impact overall. There are some significant benefits in implementing SSI improvement strategies. In addition to reducing harm, they can bring teams together, across specialties and across professional groups – from nurses, surgeons, IP&C, and microbiology, to financial directors and procurement. Patients with an SSI are 60% more likely to end up in ITU and take up critical care resources, which are expensive and in short supply. “Why should someone take up valuable space, with a preventable problem?” he commented, pointing out that the mortality risk doubles for an operation if the patient gets an SSI. “In addition, you cannot administer chemotherapy if the patient has an infection. If I perform a liver or pancreatic cancer resection, that
operation is only a success if the patient gets their chemotherapy post-operatively within a six-week window. If they miss this optimal time to chemotherapy, that operation is almost redundant,” he warned. Mr. Bond Smith reported that, by introducing
SSI care bundle strategies, his department has halved the SSI rate for HPB (Hepato- Pancreatico-Biliary) surgery, and the SSI rates are now well below the national average. Patients are also now experiencing increased longevity as they are receiving the optimum time to chemotherapy. He further pointed out that an SSI increases the risk of post-operative morbidity and also increases the length of stay. Saving time and beds (by preventing SSIs) could also enable extra operations to be performed – relieving pressure on the system. Explaining why reducing SSI rates is a sustainable ‘win’, he added that this: l Reduces re-admission rates. l Enables beds to be turned around more efficiently.
June 2023 I
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