PE R IOPE RAT IVE PRACT ICE
– March 2011) to 1.3% (January – March 2012) after introducing ChloraPrep as the main SSI prevention intervention.1 Lillian said: “We believe the decrease is attributed to this intervention, although the team acknowledges other factors may have influenced outcomes too.”
SSI incidences have continued to improve from this time with variations noted when data collection methods improved. Current trends in SSI incidences are shown in Figure 2, with the rest of the SSI prevention interventions also included.
Overcoming initial setbacks in C-section SSIS and boosting morale Because the surveillance methods were enhanced, there was an initial increase in SSI incidence – because more cases post patient release were being captured. Apparent increases in SSI incidence in 2013 were a result of enhanced SSI surveillance methods, and reporting of data, which now included telephone surveys. When the SSI surveillance programme was introduced, an attempt was made to engage all key stakeholders to ensure robust data collection. Meetings were held at least monthly initially and then quarterly to discuss SSI surveillance data and proposed SSI prevention interventions. The different professional groups within obstetrics showed significant interest in the SSI prevention patient safety initiative. However, Lillian saw that the team’s morale was dampened when results for the
Since 2013, the overall C-section SSI rates reduced by 62%. This went from 13.3% in 2013 to just 5.1% in 2019. This change... is attributed to the whole package approach to SSI interventions, which also incorporated ChloraPrep.
initial telephone survey data validation in 2013 were presented. SSI incidences at that time were 13.3%, which was a significant increase from the 6-8% SSI incidences that had been presented in previous quarters. Lillian said: “At first, clinical teams were unhappy that our CS SSI rate was that high (13.3%). But they were fully behind the desire to implement further SSI prevention measures because they had seen this working. “The multidisciplinary teams were fully engaged; when you telephone patients you pick up more infections compared with when you rely on returned postal questionnaires. Those return rates are around 45-50%. The same is true if you only look at inpatient readmission data. For SSIS to work, we want to see the whole picture.”
Lillian added that this data also highlights a lack of joined up care after a patient leaves the hospital setting, when they are back in the community, and this is an area the team wants to look at in detail for future projects. Lillian said: “Since 2013, the overall CS
SSI rates reduced by 62%. This went from 13.3% in 2013 to just 5.1% in 2019. I, and the team, believe this change can be attributed to the whole package approach to SSI interventions, which also incorporated ChloraPrep.”
Data is collected using SSI surveillance forms in the hospital, prior to discharge, and then community midwives take up the reporting up to ten days post operation, or discharge from their care. A questionnaire is sent in the post 25 days after birth, and telephone surveys are carried out if there is no response, or to validate information on a returned form. Clinical directorates receive monthly and quarterly SSI reports.
Why SSI surveillance matters even more in a pandemic
The unprecedented pressures brought about by COVID-19 could impact compliance with established evidence-based SSI prevention care processes in most surgical settings. For this reason, it is vital that all healthcare
Figure 2. Trends in SSI incidences. Note: This data represents total SSI incidence – inpatient readmission and post discharge SSIs. (Data courtesy of Guy’s and St Thomas’ NHS Foundation Trust).
OCTOBER 2020
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