Surgical site infection
Reducing SSIs in vascular patients
Vascular patients are at higher risk of surgical site infection, so what can we do to ensure better outcomes following surgery? At IPC 2025, Jane Todhunter, President of the Society of Vascular Nurses, provided an insight into key initiatives and best practice aimed at reducing SSIs. Louise Frampton reports.
Surgical site infections (SSIs) affect up to 40% of vascular surgical procedures. The scale of the issue was brought to the fore at IPC 2025, by Jane Todhunter, Advanced Vascular Practitioner, at the North Cumbria Integrated Trust, and President of the Society of Vascular Nurses. She provided an insight into current prevention strategies, the risk factors for this patient group, as well as shining a light on the distress and financial costs associated with SSIs. Jane Todhunter explained that there can be
disruption to normal incisional wound healing, with 21% failing to heal within 12 months. Unfortunately, SSI is a leading cause of morbidity and places a significant burden on community services, yet many wound complications are preventable. Infections are categorised as ‘superficial
incisional’, ‘deep/open incisional’ and ‘organ/ space incisional’. l Superficial incisional occurs in the skin and subcutaneous tissue. Patients experience pain, swelling, heat and localised redness at the surgical site, and there may be purulent drainage.
l Deep/open incisional is characterised by pain, spreading swelling, heat and redness at the surgical site, purulent drainage, separation of the incision edges, and other systemic signs.
l Organ/space incisional is characterised by purulent drainage from the drain placed in the organ or space, abscess, and other systemic signs and symptoms.
Jane Todhunter said that a contributing factor is the ageing population – patients often present with excess comorbidities when undergoing complex surgery. “Around 10 million surgical wounds are
created each year. One-fifth of those will fail to heal in a timely fashion,” she commented. “One-fifth will take up to a year to
heal...It has a huge impact on patients’ morbidity. Not only does it affect their quality of life; it can also be life threatening,” she warned. Early diagnosis of SSI is key to avoiding
deterioration and long-term complications – tackling sub-optimal management of SSI is vital, therefore.
“There is unwarranted variation in care of wounds in the community. We know this from lower limb ulceration and wounds in general… But SSIs are no different – they are often left in the care of community colleagues. They don’t always have the back-up from the surgeon or surgical team that conducted the surgery in the first place,” she commented. “There also seems to be an underuse of
evidence-based practice and an overuse of non-evidence-based practice. Importantly, we don’t seem to have a handle on the actual scope of the problem – SSIs are a hidden but growing problem. Orthopaedics mandate follow- up for SSI, but we don’t do this in vascular. We may see them much further down the line as complications, but we do not have an understanding of the number of SSIs, currently,” she continued. She went on to discuss some of the risk
factors for SSI: “Vascular patients tend to be a challenging cohort. They are often older, the majority are male, and they have many comorbidities – such as diabetes, COPD, cardiac failure, ischaemic heart disease, and peripheral heart disease. Cardiac surgery itself is associated with high rates of SSI because of the nature of the patients. Perhaps one of the most beneficial things we can do is screen these patients adequately,” Jane Todhunter commented. She called for strategies to be implemented for high-risk patients, to lower their risk of SSI, using an SSI risk score as part of the screening process. Delegates were reminded that vascular patients are at higher risk of losing their limbs due to infection and are twice as likely to die in the postoperative period compared to those without infection. Furthermore, SSI is associated with a 98% increase in length of stay for patients and a four-fold increase in the risk of being readmitted once discharged.
July 2025 I
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