PE R IOPE RAT IVE PRACT ICE
leaders ensure that surgical pathways are thoroughly scrutinised for compliance with SSI prevention alongside other COVID-19 infection prevention activities. This will ensure that recommended protocols and pathways are closely followed so patients and staff get it right the first time and thus prevent any avoidable SSIs. Preventing avoidable readmissions is a must as healthcare professionals must ensure that the risk of COVID-19 and other hospital acquired infections is reduced to a minimum.
Lillian has found no change in attitude from colleagues committed to collecting essential SSI data during the pandemic. She acknowledges that staff have been under immense pressure to deliver consistent standards of care during COVID-19. She said: “From my own experience of working in critical care during the peak of the pandemic, staff were incredibly busy, and effort was invested in making sure personal protective equipment (PPE) was correctly worn. There is an added emphasis on PPE in critical care and theatre settings which requires an equally increased focus and attention of other infection control aspects, including SSI prevention.”
Conclusion: today and moving care forward The NICE (NG125) Surgical Site Infections: prevention and treatment document concludes that an alcohol-based solution of chlorhexidine is associated with the lowest number of SSIs and, as a result, dominates all other comparators. Following awareness of the significant reductions of SSIs, due to the use of this product, many Trusts have now implemented it as part of their SSI
protocol. SSI causes are multifactorial; every stage of the surgical pathway must always be carefully addressed. The voice of the patient should be remembered as well, and it is critical now more than ever for patients to contribute to SSI prevention programmes, during a time when most pre-assessment work and post-operative wound care is done virtually.
Clinicians must come up with smarter and better ways of engaging patients – particularly those at an increased risk of developing SSIs. They must ensure adequate planning and implementation of potential risk mitigation strategies.
Alternative training methods, such as
virtual options for training frontline staff, need to be developed to ensure prevention gains from the right SSI methods are protected. As a whole, a Trust, and a healthcare network can be part of surgical pathway reviews, seizing opportunities for development and improvement in the future.
(2011).
https://webarchive.nationalarchives.
gov.uk/20120118171639/http://
hcai.dh.gov.uk/ files/2011/03/2011-03-14-HII-Prevent-Surgical- Site-infection-FINAL.pdf.
5 National Institute for Health and Care Excellence, 2019; Surgical site infections: prevention and treatment.
6 ‘Successful implementation of NICE guidance and quality standard for prevention and treatment of surgical site infection’;
https://www.nice.org.uk/ sharedlearning/successful-implementation-of-nice- ssi-guidance-and-quality-standard
CSJ
We would like to acknowledge the support and information provided by Lillian Chiwera and Guy’s and St Thomas’ NHS Foundation Trust.
References: 1 Chiwera L, Wigglesworth N, McCoskery C, Newsholme W (2018). Reducing adult cardiac surgical site infections and the economic impact of using multidisciplinary collaboration. Journal of Hospital Infection: 100(4):428-436.
https://pubmed.ncbi.nlm.
nih.gov/29604297/
2 HPA 2011 3 Darouiche, R.O., Wall, M.J.J., Itani, K.M., Otterson, M.F., Webb, A.L., Carrick, M.M., et al. (2010) Chlorhexidine-Alcohol versus Povidone-Iodine for Surgical-Site Antisepsis. The New England Journal of Medicine, 362, 18-26.
Lillian Chiwera, Guy’s and St Thomas’ NHS Foundation Trust.
4 High Impact Intervention Care bundle to prevent surgical site infection. Department of Health
30 l
WWW.CLINICALSERVICESJOURNAL.COM
About the author
Rachel Harding works as a communications and medical writer for BD (Becton Dickinson). She has more than 20 years’ experience in communications, having worked as a journalist, a copywriter and, in the defence sector, as a media relations manager.
OCTOBER 2020
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