Surgery
Surgical site infection surveillance
At the recent OneTogether conference held at the National Conference Centre in Birmingham, insights were shared by experts and professionals interested in reducing the occurrence of surgical site infection. Kate Woodhead RGN DMS provides an overview of some of key learning points shared at the event.
OneTogether is a partnership between the leading professional organisations; Infection Prevention Society, Solventum, Central Sterilising Club, Association for Perioperative Practice and College of Operating Department Practitioners with an enhanced interest in the prevention of Surgical Site Infections (SSIs). Their mission is to promote and support the spread and adoption of best practice to prevent SSIs across the surgical patient pathway. By connecting interested professionals in surgery, infection prevention and key industry partners for the healthcare community, the objective is to strive to improve overall patient care. The scene was set by Joanne Taylor, the Deputy Director of Infection Prevention and Infection Prevention Consultant Nurse from the Royal Cornwall Hospital NHS Trust together with the Cornwall Partnership NHS Foundation Trust. Joanne spoke to delegates on the need for an explanation of what surveillance helps professionals do and for patients to understand. She had titled her talk ‘What surveillance is and where to start’ to emphasise that she would explain the basics. She identified that surveillance is a term from French, using ‘sur’ meaning over, and ‘veillance’ to watch. The reasons we need to watch over our post-
surgical patients is to gain a baseline to ensure that their wound is not changing and therefore might possibly be harbouring the beginnings of an infection. The baseline enables review of whether it is necessary to change practice in some way to prevent future infections. SSIs are defined by the UK Health Security Agency (UKHSA) based on definitions established by the US Centres for Disease Control and Prevention (CDC).1 l Superficial incisional infection: affecting the superficial tissues – skin and subcutaneous layer of the incision.
l Deep incisional infection: affecting deeper tissues – fascial and muscle layers.
l Organ or space infection: any part of the surgical field /anatomy other than the incision.
It is necessary to understand the cause and incidence of Surgical Site Infection so that we may reduce the pain and suffering by patients, prolonged hospitalisation or re-admission, protracted antibiotic courses and possibly revision surgery. The surveillance service, to whom the data is submitted is an agency run by the UK government and feeds back to NHS Trusts in England their results of infections, in order that they can use this to review or change practice as necessary. Joanne specified that the results enable
Trusts to review their own practice and change it, if they see their results getting worse, or identify whether the changes need to stay in place. They also enable Trusts to benchmark with other Trusts across the country who may be in the same position. This process of data collection and return allows for the sharing of perioperative and surgical best practice, between specialties or with other hospital facilities. However, she also offered a warning that the feedback data is only as good as the
data entry. In addition, it helps patients choose the hospital they wish to have their surgery in, as the results are published and available. General Practice also need this information, so they can guide their patients to an informed choice.
UK Health Security Agency The UKSHA healthcare-associated infection and antimicrobial resistance department run the surgical site infection surveillance service in England. It supports both the mandatory surveillance of SSI in four categories of orthopaedics, and voluntary surveillance in thirteen categories of surgical procedures. To date, the SSI service has accumulated surveillance data for almost 3 million operations and 58,000 SSIs since its inception in 1997. The UKSHA provides hospitals with the protocol and tools to collect and analyse data on SSI using the minimum data set required to take account of key risk factors. The online data collection provides hospitals
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