SURGICAL SITE INFECTIONS How clean is your theatre?
Kate Woodhead RGN, DMS, examines surgical site infections (SSI), which although largely preventable, are costly and constitute a considerable percentage of all healthcare associated infections affecting patients.
Surgical site infections are associated with increased morbidity and mortality as well as higher individual treatment costs, readmissions and prolonged length of stay. Patients are fortunate that we still have a range of antibiotics from which to choose, for treatment options; however, it also makes sense that we should be looking at all the preventative mechanisms as well. There is increasing emphasis being put on cleaning as part of the process of review and the data does not generally reflect well on perioperative cleaning standards. Most infections are acquired during the course of the patients’ surgical procedure, from the patients’ own microbial flora, the staff in the team and their microbial flora, and the environment in which the patients are having their surgery.
The essence of good cleaning is that things not only look clean afterwards, but that they are clean. All users of healthcare premises have a right to assume that the environment is one where infection hazards are adequately controlled.1
Perioperative
practitioners are responsible for ensuring that the environment is a safe one for patient care.
Surgical site infection and antimicrobial resistance The substantial burden which patients and healthcare endures, caused by post surgical infections is difficult to assess in detail. Surveillance is not mandated for many types of surgical intervention. The added issue of short turnaround time in hospital, before patients are discharged, means that many SSIs occur in the community and are thus unaccounted
for in the data that is collected. Tanner and colleagues assessed that the majority, up to 60%, were present but not counted as patients had already been sent home, as the surveillance data is reported by hospitals on in-patients.2 It is essential that in order to minimise the development of further antibiotic resistance we review the use of surgical prophylaxis and use no more or less than we need to protect patients and reduce post operative infection. In the UK it is said that 10 million patients each year are admitted for a surgical intervention, which is 60% of all admissions to healthcare.3
Evidence
from around the world indicates that antibiotics are delivered ineffectually during the surgical pathway, or are continued postoperatively for an
IntheUKitissaidthat10 millionpatientseachyear are admittedfor a surgical intervention,which is 60%ofalladmissionstohealthcare.
inappropriate duration. World Health Organization (WHO) global guidelines for SSIs made an evidence based recommendation that antibiotic usage should not be for longer than the surgical duration.4 However, there is a great deal more to the story of surgical site infection than prophylaxis and treatment. There is the whole gamut of surgical care practices. It is not a simple tale, it has many players, many variables and is undertaken in a host of different environments.
It is true that the culture of patient safety which has taken hold since the WHO Safe Surgery Saves Lives campaign has assisted in levelling some of the previous hierarchies and helped teams to focus on patient safety and infection prevention. There is still work to be done.
NICE guidance
The Clinical Guideline for Surgical Site Infection which NICE published in 2008
OPERATING THEATRE l JULY 2018 l 13
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