Infection prevention
0.3% black), and vascular surgery (0.4% Asian, 0.2% black). It is possible, the report states, that these analyses are affected by the low volume of surgery when stratified by ethnic group and prescribes caution when interpreting the data. In addition, the data are reviewed to demonstrate Indices of Multiple Deprivation but are not reported here, due to a further warning of uncertainty in confidence intervals.
Causative microorganisms The report specifies, over a ten-year period, the microbial trends within the inpatient and re-admission detected superficial and deep or organ and space SSIs, across all surgical specialisms. According to the surveillance protocol, it is not essential to report positive microbiology provided that there are other clinical indicators. Enterobacterales remain the most commonly
reported microorganisms for all SSIs in the year 2022- 2023 but show a decreasing trend, over the ten-year timespan, for deep incisional SSIs. Enterobacterales were indicated in 32.6% of superficial SSIs and 26.8% of deep incisional or organ and space SSIs. The most common causative organism was Escherichia coli. The second most commonly identified
organism was Staphylococcus aureus for both superficial SSIs (19.3%) and deep incisional or organ and space SSIs (20.6%). S. aureus incidence increased over the time of the report from 18.4% to 19.3% in superficial SSIs and also in deep incisional or organ and space SSIs from 20.2% to 20.6%. It is interesting to note that methicillin-sensitive
S.aureus represents a much greater proportion of the S. aureus infections than methicillin-resistant S. aureus (MRSA).6
Frameworks for best practice In the light of the continuing concern regarding antimicrobial resistance and the number of harmful SSIs, it is the responsibility of every surgical team member to review their practice and to keep up to date with new evidence- based recommendations to mitigate, as far as possible, any post-operative infections. The surgical team must also be prepared to change and develop practice. There is no greater responsibility than on each member of the team to report to others and to make changes. The teams have a range of policies (national
and international) to review, including the WHO global guidelines7
, NICE,8,9 as well as detailed the more local
NATsIPPs, the new National Infection Prevention and Control Manual,10
guidance for specialisms such as Standards and Recommendations for Safe Perioperative Practices.11
It could be argued that there are
too many frameworks for practitioners to keep up to date with and that, when there were a set of evidence-based practices in the shape of a bundle for care to reduce SSI, it was simpler to do the right things and to keep practice in line with recommended practices. However, it is this author’s view that we do
not identify what comprises our practice often enough, using audit and other possible tools and frameworks to provide quality assurance that what we are doing is correct and works to reduce patient harm. In addition, we need the evidence from national surveillance systems to feedback locally, so that we all own the data. Surveillance is an important element of practice development. There are many elements of complex care,
especially perioperative, that may or may not reflect evidence-based practice, but we shy away from looking at it in depth. What we need is a multidisciplinary review locally in each Trust and hospital (the independent sector should not be immune to this), to audit and observe practice, according to published best practice. Audit tools such as those published and freely available by the OneTogether Group12
can be
used, which are specifically focused on SSI prevention, breaking down surgical practice into manageable chunks.
Conclusion There is no shortage of expertise and evidence of good practice, to guide changing practice, and we should all take note of the outcomes of the annual surveillance data. It is just another thing that practitioners need to keep up to speed with, in order to deliver the best possible care to patients and to have the whole team agree to make changes, if they are necessary. It is up to us.
References 1. UK Health Security Agency. 2023 Surveillance of surgical site infections in NHS hospitals in England. Accessed at:
https://www.gov. uk/government/publications/surgical-site- infections-ssi-surveillance-nhs-hospitals-in- england#Overview
2. Scottish Surveillance of Healthcare Infection Programme 2019 Surgical Site Infection surveillance protocol. Accessed at: https://
www.nss.nhs.scot/media/3456/ssi-protocol- edition-7-1.pdf
3. Public Health Wales HCAI Surveillance (no date) Accessed at:
https://phw.nhs.wales/ services-and-teams/harp/healthcare- associated-infections-hcai/healthcare- associated-infection-hai-surveillance/ clinical-surveillance/surgical-site-infection- ssi-surveillance/
About the author
Kate Woodhead, Technical Editor for CSJ, spent many years working in Operating Theatres in the NHS before setting up her own consultancy business. She was Chair of National Association of Theatre Nurses and President of the International Federation of Perioperative Nurses. In her spare time, she Chairs Friends of African Nursing, a UK based charity.
March 2024 I
www.clinicalservicesjournal.com 17
4. Public Health Agency Northern Ireland 2014. Surgical Site Infection surveillance protocol. Accessed at:
https://www.publichealth.hscni. net/sites/default/files/directorates/files/ Generic_SSI%20MANUAL_v2014_1.pdf
5. European Centre for Disease Prevention and Control. Healthcare -associated infections: surgical site infections. Annual Epidemiological Report for 2018-2020. Accessed at: https://
www.ecdc.europa.eu/en/publications-data/ healthcare-associated-infections-surgical- site-annual-2018-2020
6. Ibid 7. WHO Global guidelines for the prevention of surgical site infection. 2nd edition 2018. Accessed at:
https://www.who.int/ publications/i/item/9789241550475
8. NICE Guideline NG180 Perioperative Care in Adults 2020. Accessed at:
https://www.nice.
org.uk/guidance/ng180
9. NICE Quality Standard. NG 125. Surgical Site Infections: prevention and treatment, 2020. Accessed at
https://www.nice.org.uk/ guidance/NG125
10. National Infection prevention and control Manual 2023. Accessed at: https://www.
england.nhs.uk/wp-content/uploads/2022/04/ PRN00908-National-infection-prevention-and- control-manual-for-England-version-2.8.pdf
11. Association for Perioperative Practice, Harrogate 2022 Standards and Recommended Practices for Safe Perioperative Practice. 5th Edition.
12. OneTogether Resources. No date. Accessed at:
https://www.onetogether.org.uk/resources/
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