WOUND MANAGEMENT
outcomes.10
Resolution of this described
dichotomy places a clear emphasis on the practical implementation of NICE Medical Technologies Guidance (MTG43) for use of Pico sNPWT on closed surgical incisions7 to maximise clinical efficacy and resource saving, which can deliver cost savings back into healthcare budgets.
The 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.11
Despite the unit cost of Pico
sNPWT far exceeding the cost of a standard surgical dressing, the Trust were able to save approximately £83,271 during the study period, representing a 31% reduction in cost when compared with the costs of treating SSIs recorded during the baseline audit.11 Sarah Battaglia, the lead tissue viability nurse at the University Hospital Bristol NHS Foundation Trust and responsible for the publication reporting on the use of Pico sNPWT in the Trust’s cardiac surgery care,11
grouped patients as either low, medium or at high risk of an SSI12
(Figure 2). Patients
identified as high risk received a red sticker on their notes to ensure all the staff in the care pathway were aware Pico was going to form part of the patient’s post-operative wound care regimen (Figure 3). This was a rudimentary method to help ensure SSI risk patients were easily identifiable pre-, intra- or post-operatively to all HCPs involved in patient care. Moreover, it helped us optimise clinical and health economic outcomes quickly and safely.” A previous study reporting on the effects of protocolled used of sNPWT prophylaxis following C-sections observed an eight- month time lag from inception to 100% adherence.9
Pragmatic approaches were
Figure 3: Cardiac incision pathway used at Hospital Bristol NHS Foundation Trust. (Adapted from Ref 11.)
explains the measures they employed during the practical implementation of NICE Medical Technologies Guidance (MTG43) for use of Pico sNPWT on closed surgical incisions:8 “The outcomes from our study highlight
the clinical effectiveness of both Pico and the NICE recommendations, which benefited both patients and our hospital Trust. Before we started using Pico, we set-up a pre- operative patient risk scoring process as part of the pre-operative assessment. We used the Brompton and Harefield Infection Score (BHIS) as an SSI predictive tool, which
used to help differentiate behaviours and improve adherence to the newly established sNPWT protocol for surgical incisions over time.9
These included physical posters and flyers to inform and remind staff as well as continual feedback and support. “Regular training was important to help drive the correct adoption of Pico and embed the change of practice. We trained all healthcare professionals directly involved in the implementation and patient care to ensure safe and effective use of the new technology. This included the importance of not removing the dressing unless it was full,
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