WOUND MANAGEMENT
how to use the second dressing, trouble- shooting the pump and making sure there is a good seal, and dressing removal prior to patient discharge. Over the study period, compliance was not at 100%. It took several months to embed the BHIS system and Pico sNPWT into everyday practice. The tissue viability team continues to run regular training and checks as we strive for optimal pathway compliance.” For hundreds of years, scientist and clinicians have strived to control and manage the development and spread of infectious material – names such as Pasteur and Fleming immediately spring to mind. Seismic shifts in clinical outcomes were observed with the discovery and appropriate use of antibiotics. Healthcare professionals are now faced with an arsenal of medical technology, techniques and understanding that can successfully help prevent colonisation of infectious material. This is true for those HCPs working in the surgical care pathway. SSIs can devastate patient lives and spiral healthcare budgets out of control.3
The NICE MTG43
recommendations for use of Pico sNPWT8 are based upon a substantial, evidence- based rationale. Prevention of SSIs is no longer a question of what technology or techniques to employ. The challenge faced by HCPs is how to optimise use of selective technology and techniques to obtain the best clinical results for the most appropriate patient groups, while realising the cost benefits of infection prevention. There is a perception that this may add complexity to service delivery. Recent studies9,11
clearly
demonstrate that practical, pragmatic approaches can optimise patient outcomes in a responsible and affordable manner. The accurate identification of appropriate patients, based upon a pre-operative risk assessment, can drive sNPWT prophylaxis best practice and, ultimately, continue to reduce SSI prevalence closer to zero.
8 Banasiewicz T, Becker R, Bobkiewicz A,et al. Prevention and therapy of acute and chronic wounds using NPWT devices during the COVID-19 pandemic, recommendation from The NPWT Working Group. Negative Pressure Wound Therapy Journal. 2020;7(2):4-9.
9 Bolte M, Knapman B, Leibenson L, Ball J, Giles M. Reducing surgical site infections post-caesarean section in an Australian hospital, using a bundled care approach. Infect Dis Health. 2020;25(3):158- 167.
10 Nagpal K, Arora S, Vats A,et al. Failures in communication and information transfer across the surgical care pathway: interview study. BMJ Qual Saf. 2012;21(10):843-9.
Pico single-use negative pressure wound therapy system
2016;16(12):e276-e287.
2 Allegranzi B, Zayed B, Bischoff P, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e288-e303.
3 Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33.
4 Weiser TG, Haynes AB, Molina G,et al. Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. Lancet. 2015;385:S11.
5 Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009;360(5):491-9.
CSJ
References 1 Allegranzi B, Bischoff P, de Jonge S, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence- based global perspective. Lancet Infect Dis.
Acknowledgement
The author would like to thank Sarah Battaglia, tissue viability lead nurse from University Hospitals Bristol NHS Foundation Trust, for her valued insight and input into the article. Her recent involvement in University Hospitals Bristol Implementation of Pico Incision Management Negative Pressure Wound therapy in the high-risk Cardiac Surgery Patient Group11
can be accessed at:
https://www.nice.org.uk/sharedlearning/university-hospitals-
bristol-implementation-of-pico-incision-management-negative-pressure-wound-therapy- in-the-high-risk-cardiac-surgery-patient-group, or via the NICE website, along with NICE Medical Technologies Guidance (MTG43) for use of PICO sNPWT on closed surgical incisions7
:
https://www.nice.org.uk/guidance/MTG43. 74 l
WWW.CLINICALSERVICESJOURNAL.COM
6 Sugrue M, Ciprandi G, Djohan R, et al. World Union of Wound Healing Societies (WUWHS) Consensus Document. Closed surgical incision management: Understanding the role of NPWT. Wounds Int [online]. 2016.
www.woundsinternational.com/ wuwhs/view/consensus-documentclosed-surgical- incision-management-understanding-the-roleof- npwt (last accessed Sept 2020)
7 NICE (2019) PICO negative pressure wound dressings for closed surgical incisions [online] available from:
https://www.nice.org.uk/guidance/ mtg43 (last accessed Sept 2020)
11 NICE (2019) University Hospitals Bristol Implementation of PICO Incision Management Negative Pressure Wound therapy in the high-risk Cardiac Surgery Patient Group [online] available from: https://
www.nice.org.uk/sharedlearning/university-hospitals- bristol-implementation-of-pico-incision-management- negative-pressure-wound-therapy-in-the-high-risk- cardiac-surgery-patient-group (last accessed Sept 2020)
12 Raja SG, Rochon M, Jarman JW. Brompton Harefield Infection Score (BHIS): development and validation of a stratification tool for predicting risk of surgical site infection after coronary artery bypass grafting. Int J Surg. 2015;16(Pt A):69-73.
About the author
Robert Dowling PhD MBA is a senior manager in global marketing within the Advanced Wound Management franchise at Smith and Nephew. His work focuses on helping prevent patients suffering surgical site complications with the use of PICO sNPWT following surgical procedures. Prior to Smith and Nephew, Robert held sales and marketing roles in various orthopaedic disciplines. Previously, he obtained a PhD, investigating wound healing processes to seal the skin around a transcutaneous titanium implant for a novel intraosseous transcutaneous amputation prosthesis, from University College London. Email:
robert.dowling@
smith-nephew.com
OCTOBER 2020
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