Infection prevention
Surgical site infections surveillance report
Kate Woodhead RGN DMS explains why surgical site infection surveillance is an important element of practice development. She looks at the latest data and discusses the frameworks for best practice.
Surgical site infections (SSIs) continue to cause pain and suffering to patients following surgery, despite the many protocols and policies to reduce them. Regular surveillance reports the data annually.1
SSIs are defined as those which
occur up to 30 days after surgery or up to a year if patients have received implants during their surgery. They remain a significant problem for patients and all members of the surgical team. Around one fifth of all hospital associated infections (HCAIs) are SSIs and are associated with substantial mortality and morbidity creating severe demands on hospital resources. The report under consideration covers the
financial year 2022 to 2023, when 183 NHS hospitals in England submitted their data to the surveillance service at the UK Health Security Agency (UKSHA). Orthopaedic surgeries are mandated to report for at least three months of each year and other surgical procedure
reports are submitted voluntarily spanning thirteen other surgical specialties. The surgical specialties encompass general surgery, cardiothoracic, neurosurgery, gynaecology, vascular, gastroenterology and orthopaedics. Surveillance is targeted at open surgical procedures, which carry a higher risk of infection than minimally invasive procedures, although laparoscopic procedures are included from some surgical categories. Data is collected prospectively on a quarterly basis using a standard methodology. Patients are followed up thirty days after primary surgery and at the annual anniversary for implant surgery. Trusts can then download their confidential report which shows crude and risk-stratified SSI risk, together with the national corresponding benchmark by surgical specialism. It is at this stage that Trusts are identified as being high outliers or low outliers within the data. UKSHA
alerts the Trusts of their outlier status and encourages them to explore the reasons. Onsite visits can be arranged to assist with investigation and resolution, including in-depth bespoke analyses and clinical advice. Data from patients who have short hospital
stays is gathered using post-discharge questionnaires. They comprise systematic review and documentation of patients attending outpatient clinics or seen at home by hospital clinical staff trained to apply the case definitions, and also wound healing post- discharge questionnaires, which are completed by the patient at 30 days post-operatively.
Divergence in the four nations Increasingly, the different nations in the UK are taking a different approach to collecting HCAIs information and with surveillance of SSIs. In Scotland, for example, Health Protection Scotland collects and reports data on four mandatory operation categories, which are: Caesarean section, hip arthroplasty, large bowel and vascular surgery. For large bowel and vascular procedures, only elective procedures require data submission. There are, additionally, a list of voluntary procedures on which data are collected and sent to the Scottish Surveillance of Healthcare Infection Programme. Quarterly reports are made public although, currently, SSI surveillance has not resumed since the end of COVID-19.2 In Wales, the Healthcare Associated Infections team at Public Health Wales support the collection of data for surveillance and make regular reports. They state that it is important to remember that SSIs, can range from a relatively trivial wound discharge with no other complications, to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, persistent pain and itching, restriction of movement and a significant impact on emotional well-being. Surveillance is conducted on hip and knee arthroplasties, elective, as well as emergency surgery, together with C–sections
March 2024 I
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