Infection prevention
and colorectal operations, although the data is not yet reported on the latter. The last report available publicly is the C-section report on data collected in 2021.3 The Public Health Agency (Northern Ireland) identifies its own protocol for SSI surveillance in order to provide information, definitions and instructions for hospitals that participate in the data collection following surgery, to ensure standardisation of data collection, analysis and reporting procedures. In 2012, a point prevalence survey was undertaken in Northern Ireland and shockingly reported that SSIs accounted for 19% of all HCAIs among hospitalised patients. The protocol states that advances have been made in infection control practices including: improved operating room ventilation, sterilisation methods, barriers, surgical technique and availability of antimicrobial prophylaxis. However, SSIs remain a substantial cause of
morbidity and prolonged hospitalisation and death.4
Data are not shared publicly but are fed
back to each hospital and also to the European Centre for Disease Control (ECDC). It is understood that the European Centre for Disease Control are undertaking a point prevalence survey, at present, which will give an interesting snapshot of surgical site infections across the region, in due course. The last report on HCAIs is a set of pooled information including 2018-2020 data on SSIs. Particular points made in the report are that SSIs are among the most common HCAIs. They are associated with longer post-operative hospital stays, additional surgical procedures, treatment in intensive care units and higher mortality. They add that, in 2018-2020, 12 EU Member
States and one EEA country reported 19,680 SSIs from a total of 1,255,958 surgical procedures for nine types of surgical procedures. The percentage of SSIs varied from 0.6% in knee
prosthesis surgery to 9.5% in open colon surgery, depending on the type of surgical procedure.5
Assessing SSI risk The English Report reviews the cumulative SSI incidence over a period of five years, 2018- 2023, although it must be recognised that surgery was greatly decreased during the pandemic, so the current data may not reflect the whole picture. However, the highest risk was observed in bile duct, liver or pancreatic surgery at 18.3% followed by large bowel surgery at 8.5%, then small bowel at 7.8%. The procedures are each carried out at body sites with high bacterial contamination, which contributes to a higher level of SSI risk. Hip and knee replacement surgery carried the lowest risk rate at 0.5% and 0.4% respectively. An elevated Body Mass Index (BMI) has been
shown to increase the risk of developing an SSI, particularly among CABG (coronary artery bypass graft) patients. The classification of obesity is a body mass equal to or greater than 30kg/m2
and cardiac surgery (non-CABG), an increased risk of SSI was seen for the obese patient group relative to the underweight, normal or overweight group.
Data found in the Hospital Episodes Statistics
to record ethnicity was based on five-year information although not all the data was complete. There are tables within the report which identify the proportion of patients by ethnic group and surgical category. For instance, the proportion of white ethnicity ranged from 73% (CABG) to 93% for repair of neck of femur. The proportion of non-white patients varied
with proportions markedly different for CABG (18.2% Asian patients), cardiac surgery (non- CABG) (8.5% Asian, 3.1% black), cranial surgery (4.9% black) hip replacement (0.9% Asian), knee replacement (Asian 5.2%), large bowel surgery (1.3% Asian), repair of neck of femur (1.0% Asian,
16
www.clinicalservicesjournal.com I March 2024
. In all surgical categories except spinal
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
