Infection prevention
Tackling SSI: enhancing the skin’s barrier
Caterina Galani highlights the importance of following NICE guidelines and to adhering to care bundles for SSI prevention. She looks at the potential to enhance the skin’s barrier before, during and after surgery, to ensure effective SSI protection.
In England, healthcare-associated infections (HCAIs) remain a formidable challenge for the NHS, affecting approximately 300,000 individuals annually. It is an issue that not only affects patient well-being and safety but also carries a sizable economic burden, costing the NHS up to £2.8 billion each year.1,2
Among these
infections, surgical site infections (SSIs) stand out as particularly concerning, constituting one in seven HCAI cases and imposing both human and economic costs on patients and healthcare systems.3
Notably, in the UK, SSIs prolong
hospital stays on average by an additional four to eleven days, exacerbating resource strains and legal liabilities for the NHS.4 Recognising the urgency of this issue, the National Institute for Health and Care Excellence (NICE) has developed comprehensive guidelines to address and mitigate the risks of SSIs. Key among these recommendations is the use of chlorhexidine (CHG) body wash before certain procedures to reduce the likelihood ofStaphylococcus aureus-related SSIs.5 However, successful implementation of these guidelines depends on the meticulous attention and compliance of healthcare staff, often in environments marked by time constraints and competing priorities. This article examines the critical importance
of adhering to such protocols, so that we can uphold patient safety and alleviate the burden of SSIs on both individuals, and on our healthcare systems.
National guidance for SSI prevention care bundles Full and comprehensive evidence-based guidelines have been developed at both a national and international level to support the reduction of SSI rates. In the UK, NICE published guidance in 2019 for SSI prevention, titled Surgical site infections: prevention and treatment.6
It recommends hair removal,
antibiotic prophylaxis, maintenance of normothermia, and perioperative antiseptic
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skin preparation, as key evidence-based interventions. Moreover, the Department of Health and Social Care’s high impact intervention (DH HII) for SSI prevention highlights an 11-factor bundle which encompassed all three phases of surgery.7 At an international level, the World Health
Organization (WHO) has a surgical safety checklist, the Safe Surgery Saves Lives checklist.8
The checklist, primarily designed
to enhance patient safety, aligns closely with the pre-, intra-, and immediate post-operative phases outlined in both NICE and HII guidelines. Integrating the checklist with these guidelines, and ensuring widespread adoption or mandated adherence, could significantly amplify its effectiveness in reducing SSI rates. Adherence to national guidelines for the
prevention of SSIs is paramount in ensuring optimal patient outcomes and minimising the burden on healthcare systems. Despite the widespread availability of evidence-based guidelines, such as those outlined by the NICE and WHO, SSI rates have not measurably fallen.9
This suggests that there persists a concerning lack of compliance with care bundles across UK hospitals, representing a significant obstacle to enhancing patient hygiene.10 By prioritising and enhancing compliance with these guidelines, healthcare providers can uphold the highest standards of patient safety, thereby safeguarding against the potentially devastating consequences of SSIs and bolstering overall healthcare efficacy. The implementation of comprehensive care bundles, encompassing multiple evidence-based interventions, offers a holistic approach to SSI prevention. The successful implementation of care bundles relies heavily on the consistent adherence of multidisciplinary healthcare teams. By embracing a culture of accountability and continuous quality improvement, healthcare organisations can enhance compliance with national guidelines. One of the key barriers to improving compliance rates is the lack of appropriate data surveillance to allow each healthcare facility to understand the benefits that can be realised by
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