Surgical site infection
early as the first transmission, and to give signals and detect whether outbreaks are occurring. “The model is then able to identify those patients that have been exposed and rank them according to their likelihood of acquiring an infection. The next stage feeds into the ability to intervene and develop bundles of care that may have an impact on outcomes for patients,” Dr. Price continued.
He explained that a front-end programme could support the IPC team to better understand outbreaks, the scale of these outbreaks, the epidemiology, who is more likely to get infection, their risk over time and how it changes. So, what could this tool look like for SSIs? He explained that this technology could help to characterise risk prior to admission and incorporate community data, in order to understand risk as early as possible. It could also help respond to risk changes during admission. The team are currently developing a ‘3D digital twin’ of hospital settings to understand how patients interact and move around the environment, and how this may contribute towards infection. This could therefore contribute towards implementing targeted measures. It could also enable teams to optimise post-
op follow up, using telemedicine techniques. This might enable patients who are identified as being at risk in the community to be targeted. He acknowledged that there are challenges
ahead and that not all data are perfect. The infrastructure of data systems is also imperfect, and there is a need to “harmonise between primary and secondary care”, as often “data sits between them”. Dr. Price added that we need to assess the
clinical impact of these technologies and they must be cost-effective. It is also important to understand the views, experiences and attitudes of the users of such systems. It is already challenging to consistently implement SSI care bundles when we know someone has an infection, let alone when they are predicted to get an infection but don’t yet have one – so stakeholder perceptions will be key, he advised. Finally, it is important to future proof this
technology by integrating advances in pathogen and human genomics. This could have the potential to help understand additional risk factors. Dr. Price concluded: “These new technologies
have the potential to show us how we can enhance prediction and obtain more accurate data, to identify those patients that are more likely to develop infections, but we need to understand the impact of these, and we need to navigate the challenges – which are not inconsequential.”
Aiding best practice Lindsay Keeley, Patient Safety & Quality Lead, The Association for Perioperative Practice (AfPP), gave an overview of the many One Together
We applied these models at different points during the pandemic and found that this AI infection prediction tool was able to accurately predict which patients were more likely to get hospital-onset COVID [to an accuracy of around 90%].
resources and tools that have been developed to help aid best practice. These include: l The OneTogether Maintaining Asepsis Quality Improvement Resource.
l Surgical Environment Quality Improvement Resource.
l Surgical Skin Preparation Quality Improvement Resource.
l Perioperative Warming Quality Improvement Resource.
l OneTogether Assessment Toolkit. l Incision Management Quality Improvement Resource.
There are also guides and posters such as: l The Surgical Skin Preparation: Decision Guide Poster.
l Surgical Pathway Poster (Updated 2019). l Perioperative Warming Decision Guide. l OneTogether Electronic Assessment Toolkit. l Assessment Toolkit Training Video.
The OneTogether assessment toolkit helps to check that vital steps are being followed and are being performed correctly, enabling theatre teams to identify key areas for improvement in their practice. Lindsay went on to discuss some of the key
areas covered by the resources, including hair removal, for example. She highlighted the need for better education on correct hair removal technique, ensuring there are no abrasions, as this can have the potential to lead to SSIs. Understanding how to prevent recolonisation
of the patient is also important, along with patient warming. Often patients arrive in theatre and haven’t been warmed enough – equally, when they leave the theatre and go back to the ward, there needs to be greater consideration given to maintaining normothermia. She pointed out that surgical teams may be
doing everything they need to do in theatre, but if the ward staff and patients are not educated on the importance of staying warm, there is the potential for increased risk in developing an SSI.
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