WOUND MANAGEMENT
SSI prevention: how can we strive for zero?
Clinical decision-makers are continuously forced to make tradeoffs. This includes limiting the use of new technologies that could benefit wider patient groups, despite proven clinical efficacy. As a result, new care pathways are required to ensure the rationalised use of new technology for specific patients and procedures. Robert Dowling discusses strategies to optimise the implementation of new technology, as we strive for zero SSIs.
Disease prevention is a widely accepted principle within clinical practice. The principle of prevention has also been applied to SSIs within the surgical care pathway, where numerous tactics have been defined and subsequently adopted as standard practice to improve patient safety and care quality standards pre-1 operatively.2
, intra-2 and post-
SSIs are prevalent among inpatients, making up over 15% of all healthcare- associated infection, in England. Moreover, their effects are associated with prolonged hospital stays, additional surgical procedures and significant morbidity and mortality.3 Without effective SSI prevention strategies, the cumulative cost to global healthcare services is likely to rise as the estimated global volume of surgical procedures increases.4
However, despite
a 27% increase in surgical admissions between 2003/4 and 2013/4,5
surgical care
became safer, with significant reductions in mortality and complications, globally. These significant gains in safety were attributed to standardising specific prevention tactics in peri-operative practice and, crucially, ensuring staff adherence to the new protocols.5
Despite such prevention strategies, the incidence of post-operative SSIs still exists following a variety of surgical procedures, many of which are prevalent procedures performed within the NHS.3,11,12
University Hospital Bristol NHS Foundation Trust was able to reduce the incidence of SSIs in people undergoing coronary bypass grafting (CABG) surgery by 50% following the adoption of Pico sNPWT for use on closed surgical wounds in high risk patients.
OCTOBER 2020
Traditionally, NPWT has been used therapeutically to facilitate closure in both acute and chronic wound pathologies.
WWW.CLINICALSERVICESJOURNAL.COM l
Furthermore, specific patient and procedural risk factors, as outlined in Figure 1, can put people undergoing a surgical procedure at greater risk of developing a surgical site complication.6 Prophylactic negative pressure wound therapy (NPWT) has been shown to help reduce the incidence of SSIs compared with standard dressings when used prophylactically following a variety of surgical procedures.6 NPWT is a sealed system which creates and maintains sub-atmospheric pressure. This environment has been shown to improve wound healing through the removal of wound exudate and infectious material.6
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