Surgical site infection The site of the incision is also a factor. The
groin is the most common site for an incision in vascular surgery and this area has a particularly high predisposition to SSI, as it is close to the anal canal and genital area. There are also challenges in decontaminating the area. In addition, patients with vascular ulcers often have bacteria growing in the wound and may have leg oedema – another infection risk factor. So, what strategies can we use to minimise
poor outcomes? There are lots of initiatives to reduce the risk of SSI. These include: l WHO 2018 – Doing the right thing at the right time to stop SSI
l NICE 125 Surgical site infections: prevention and treatment (last updated: 19 August 2020)
l UKHSA’s Surgical Site Infection Surveillance System
l Post discharge surveillance l Improving patient outcomes through benchmarking
l The National Wound Care Strategy recommendations (2024)
National Wound Care Strategy Programme recommendations Jane Todhunter went on to provide an overview of the National Wound Care Strategy Programme recommendations. These include: 1. At the pre-operative stage, the recommendations call for the identification of patients at high risk. They should be screened and optimised at the point that they are listed for inpatient surgery. Jane Todhunter pointed out that vascular patients are mainly high risk: “If they have a BMI higher than 35, and we are going into the groin for a second time, they are very high risk,” she commented. An Enhanced Recovery After Surgery (ERAS)
programme targeted at reducing surgical wound complications should be used for all
high-risk patients, using a multidisciplinary approach. A programme of prehabilitation should be considered to optimise the patient for forthcoming surgery, which may include interventions around smoking cessation and optimising nutrition, for example. “The difficulty, here, is that a lot of vascular
surgery is urgent. We don’t have that window of opportunity. If a patient comes in with a critical limb, we may have just days to save it,” she added. Patients should receive education on the
likely outcome of the wound to be created (primary, secondary, or tertiary closure) and the risks/benefits of the surgery, to enable informed decision making about care following surgery, and to prepare for possible outcomes. A perioperative pathway should be considered. 2. For the intra-operative phase, immediately following surgery and before a dressing is applied, a digital image of the wound should be captured in high-risk patients. The incision should be covered with an appropriate waterproof dressing and incisional negative pressure wound therapy (NPWT) should be considered for high-risk patients. The recommendation is also that NPWT should be considered for wounds healing by secondary intention. 3. For post-operative wound care, the recommendations differ for low-risk and high-risk patients. Low-risk patients, where the surgical wound is closed with sutures/clips/ glue, should have supported self-management. Digital images should be taken, and the patient should have a dressing and a wound passport. Patient initiated follow-up (PIFU) should be considered for all low-risk patients, where appropriate.
In high-risk patients, the post-operative
recommendation is: l Enhanced care – NPWT / Leukomed sorbact
28
www.clinicalservicesjournal.com I July 2025
l Adjunctive supports l Early review by a vascular nurse specialist
In high-risk patients, with surgical wound healing by secondary intention (SWHSI), the post-operative recommendation is: l Consider the use of NPWT. l Red flag awareness l Early review by vascular nurse specialist
Jane Todhunter pointed out that many of the recommendations state that these actions should be ‘considered’, and there is a lack of evidence around wound care in general. Furthermore, a recent study now challenges aspects of the recommendations – for example, the SWHSI-2 trial looked at negative pressure wound therapy versus usual care in patients with surgical wound healing by secondary intention. The findings did not support the use of NPWT to augment SWHSI healing.1
Local dressing initiatives to reduce SSI Jane Todhunter also discussed a local dressing initiative: patients with a BMI <45 use a Leukomed Sorbact film and pad dressing following wound closure, while patients with a BMI >45, or repeat groin surgery, have topical wound therapy following surgery. There is a small body of evidence to support this, but work is ongoing, she explained. Patients are offered an early review by
a vascular nurse specialist and there is a point of contact for patients and community nurses. They are offered a wound passport on discharge, which outlines what the wound has been closed with, when the sutures should be removed, if they are going to dissolve, when they can take a shower, when the dressing needs to be changed, and signs and symptoms to look out for.
arcyto -
stock.adobe.com
Studio Romantic -
stock.adobe.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60
