PE R IOPE RAT IVE PRACT ICE
GSTT reduces infections with SSI protocol
Good, progressive surgical site infection pathways at Guy’s and St Thomas’ NHS Foundation Trust (GSTT) have helped protect patients and reduce the risk of SSIs. Rachel Harding offers an insight into the implementation of an effective protocol for skin preparation, which has helped improve patient outcomes.
Surgical site infections (SSIs) have devastating outcomes for patients, families and organisations. An SSI may be superficial, involving the skin, or more serious involving tissues under the skin, organs, or implanted material. Not only can SSIs delay patients’ recovery and a natural return to normal activities, they can result in serious long-term complications. Corrective surgery may be needed in an attempt to remove the source of infection. Every SSI is an additional use of NHS resources, and increases the discomfort of the patient. It reduces the quality and safety
of patient care (National Institute for Health and Care Excellence [NICE] 2014). The additional time patients spend in the hospital due to an SSI varies from three to 54 days, depending on the surgical specialty and procedure. In some cases, the infection is so debilitating, a patient may never be able to return to work. Working alongside nurses, doctors and surgeons as an infection prevention expert, has given Lillian Chiwera, infection control surveillance team leader at Guy’s and St Thomas’ NHS Foundation Trust (GSTT), a different perspective on how surgical site
infection surveillance (SSIS) pathways can be created and the most effective measures to put in place.
Lilian is a member of the Infection
Prevention Society (IPS) Scientific Programme Committee (SPC) and the Hospital Infection Society (HIS) Guidelines Development Committee. She was also a member of the National Institute of Care Excellence (NICE) SSI quality standard Topic Expert Group (TEG) in 2013, and a former IPS Education and Professional Development Committee. Her passion for her subject is evident, with several awards to her name, including the prestigious Nightingale Nurse Award 2019. She has presented SSIS work at various local and international conferences, including at previous Infection Prevention Society (IPS) conferences and on behalf of NICE. The NICE Shared Learning Initiative has highlighted Guy’s and St Thomas’ Hospital as one of the NHS Trusts, which has implemented ChloraPrep as part of its SSI protocol. By including the solution within their protocol and through robust SSI surveillance they demonstrated a reduction in SSIs for C-Sections from 13.3% to 6.8% (2009-2016).1
They concluded that
including BD ChloraPrep enabled a reduction in SSI rate without adding financial burden to the hospital. Furthermore, a reduction in adult cardiac SSIs was also demonstrated when ChloraPrep was used as part of an SSI prevention bundle in adult cardiac surgery.1 The chances of acquiring an SSI are
Following awareness of significant reductions of SSIs, many Trusts have now implemented an alcohol-based chlorhexidine solution as part of their skin preparation protocols, prior to performing surgery.
OCTOBER 2020
still worryingly high, as they remain the third most common healthcare-associated infection (HCAI) in the UK. One of the most recent surveys, carried out in UK hospitals, indicates that, at any one time, between 6% and 8% of patients have an HCAI and that SSIs account for up to 16% of all HCAIs.2 In this article, Lillian examines the history of SSI control at Guy’s and St Thomas’ NHS Foundation Trust and focuses on Caesarean
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