Surgery


The five pillars of SSI surveillance


Guy’s and St Thomas’ NHS Foundation Trust’s Surgical Site Infection (SSI) Team provide an insight into patient-reported SSI surveillance, using the latest smart-phone technology. The team have identified ‘five pillars of post-discharge surveillance’, as part of the ‘SWIFT’ approach (Smart, Well-connected, Inclusive, Flexible, and Therapeutics).


Worldwide, surgical wound complications (SWCs) are a significant healthcare concern, disrupting the normal healing process of wounds following surgery and leading to delayed recovery. These complications are associated with considerable morbidity and a mortality rate that affects approximately 1-4% of patients.1 Among these, surgical site infections (SSIs) represent a form of SWC caused by pathogens, typically bacteria. SSI may affect only the skin and subcutaneous tissue (called superficial incisional SSI), or they can be more severe. Deep incisional infections involve tissue located beneath the skin and subcutaneous fat, including structures that support and surround bones, joints, and internal organs), or organ/ space SSI (involving organs, or implanted materials).2 The cost of an SSI corresponds with its


severity, reflecting the staffing, diagnostics and treatment involved, and whether antibiotic resistant bacteria were involved.3


Treatment costs per patient for one deep orthopaedic


SSI have been estimated at £100,000 when re-operation; extended length of stay; high- cost, long-term antibiotics; and new high-cost replacement protheses are included.4 A significant proportion of SSI are believed


to be preventable through meticulous surgical technique, combined with evidence-based practices to prevent infection.5


As part of a


broader strategy, surveillance helps identify infection trends, evaluate prevention strategies, and improve overall patient care. Surveillance involves the systematic collection, analysis, and interpretation of health data. Linked to this is the feedback to stakeholders. Systematic monitoring combined with feedback to surgeons and staff has been shown to reduce SSI rates by up to 35%.6 One of the key challenges in managing SSIs is that the majority of cases arise after patients have been discharged from the hospital, often requiring management within the community setting.7


This has made accurate recording of


SSIs, surgical wound dehiscence (SWD), and the use of new antibiotics difficult, particularly


when patients reside in diverse geographical locations.8


Post-discharge surveillance


methods, such as telephone follow-ups and postal questionnaires, have been found to be time-consuming, expensive, and ultimately not directly beneficial to patient care.9, 10 The emerging role of using patient smartphones for post-operative follow-up presents a significant advancement in the management of surgical wounds, particularly in enhancing the efficiency and accessibility of care.11


As smartphones are widely accessible and


equipped with advanced cameras, they offer an ideal platform for remote digital surgical wound monitoring.12


By enabling patients to capture and send images of their surgical sites, as well as complete questionnaires about their healing process, healthcare providers can remotely assess wound recovery, detect complications early, and reduce the need for in-person visits.11 This technology not only provides convenience for patients but also facilitates more frequent and accurate follow-ups, helping to detect issues like SSI before they escalate. The integration of patient smartphones into post- operative care pathways supports a shift toward more proactive, patient-centred monitoring that aligns with the growing demand for telemedicine solutions.


Using patient smartphones for post-discharge surveillance Following a competitive tender process, Isla Care was procured for our proactive surveillance programme at Guy’s and St Thomas’ NHS Foundation Trust (GSTT). Based on patient preference, Isla sends secure, weekly pre- programmed SMS texts or emails to the patient or their nominated carer, without the need for dedicated apps or accounts. Patients can also initiate follow-up (PIFU) if


they notice a change in their wound in between scheduled requests. We have worked with Isla to make the surgical wound surveillance process


May 2025 I www.clinicalservicesjournal.com 19


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