Acting as one to fight surgical site infections
Mölnlycke’s State of the Nation SSI Prevention Webinar proved to be a timely reminder as to the importance of a collaborated approach to stemming the dangerous tide of surgical site infections. UK General Manager Nick Rothwell analyses the key takeaways.
For too long, the impact of Surgical Site Infections (SSIs) on patients and the NHS has been undervalued and underappreciated in Westminster. We know that the cost of an SSI can vary between £10,000 and £100,000 per patient, yet due to the nature of reporting practices across the country, we do not have a full picture of the prevalence or the total effects of SSIs in the UK.
Mölnlycke has been working to draw attention to the impact of SSIs on patients, clinicians and the NHS, and put forward solutions to help reduce the risk of these infections. Our report, Time to Act: A State of the Nation report on Surgical Site Infections makes a series of recommendations to actors across the health system, including policymakers, hospital trusts, Royal Colleges, and, crucially, patients, outlining how we can work together as a nation to drive down the risk of SSIs across the UK.
To mark the launch of the Time to Act report, in late January we held a webinar roundtable in conjunction with our colleagues at the Association for Perioperative Practice. Chaired by Dr Steve Feast, the former CEO of the Eastern Academic Health Science Network, the goal of the webinar was to provide a forum for leading clinical voices and policy experts to discuss their professional priorities for SSI prevention and discuss the challenges faced locally and nationally.
Debating the recommendations from the report, the roundtable also sought to develop consensus on how we can all act to reduce the risks of infection before, during and after surgery. We received four excellent presentations from our guests:
- Helen Hughes, Chief Executive, Patient Safety Learning
- Lindsay Keeley, Patient Safety and Quality Lead, Association for Perioperative Practice
- Professor Mike Reed, Consultant trauma and orthopaedic surgeon, Northumbria Healthcare NHS Foundation Trust
- Anna Thompson, SSI Surveillance Lead, Ashford and St Peters NHS Trust
We were delighted to be joined by 360 attendees from the UK and around the world, with excellent participation from the audience who fielded questions and comments throughout.
The patient role
A key theme from the speakers’ presentations was the serious impact SSIs can have on patients. Speakers highlighted the importance of informing patients about the risks of SSIs before undergoing surgery, and providing them with accessible resources to understand their own role in mitigating the risk of SSIs throughout their care pathway. When patients are fully informed of the signs and risks, they can be active participants in their mitigation, in addition to raising and escalating issues if they arise.
One of the speakers noted that it was essential for patients to be involved in their care, adding that to drive wider system changes, it would be beneficial for patients to be able to participate in decision-making bodies to ensure that their voice was heard when SSI prevention measures are developed. Another panellist echoed this point, adding that patient stories can play a powerful role in raising awareness of SSIs, and can help drive engagement from healthcare professionals (HCPs) and trust leadership.
Another theme highlighted by the speakers was education, both at a trust and system level. One of the speakers stressed the importance of enhancing and improving knowledge amongst HCPs on how to prevent SSIs. Another speaker stated that in their hospital trust, educational tools provided by clinicians and industry were used to train staff and raise awareness of SSIs.
The importance of collaboration and communication between trusts was also discussed, highlighting the need for trusts which have established SSI programmes to share knowledge and best practice. One of the examples raised was the Quality Improvement for Surgical Teams initiative, which works with multidisciplinary teams to improve the practice and reduce MSSA, working in partnership with the Institute for Healthcare Improvement.
Responding to a question from the audience, panellists agreed that the more you involve patients, the better. Patients are happy to be engaged, but work needs to be done to develop accessible platforms through which they can improve their own knowledge and be empowered to ask questions about the delivery and optimisation of their care.
Driving changes from the board to the ward
Speakers emphasised that the most important factor in reducing SSIs in a trust is the backing of trust management, as well as the support of consultants from all specialities. It was agreed that the complete support of management made making changes easier and more efficient. A suggestion was made for each trust to have a Board-level champion to enable everyone to speak up and have any concerns addressed in order to prevent SSIs. It is essential if someone witnesses an issue to admit the problem and own it.
Collaboration with industry
On the role of industry in reducing the risk of SSIs, speakers noted that the quality of equipment was crucial and trusts needed to ensure their staff have access to high-quality supplies. They also discussed the importance of collaboration from procurement with clinical teams and that clinicians should be able to influence decisions on supplies. The end user should be responsible for evaluating and deciding which products they need as this can affect their performance, and in turn patient outcomes. One speaker explained that in their trust, they are working closely with procurement, where they build business cases, making sure they have clinical data to support their case.
The speakers also addressed the need to have and collect data on SSIs in order to reduce variation. One of the speakers highlighted that gathering data is an everyday task, which needs to be reported continuously. It was noted that if trusts do not investigate SSIs, they will of course not find any, and therefore seem to have good results while it might not be the case in reality. When reporting SSIs, one of the speakers highlighted the importance of informing HCPs and providing them with the information on how to analyse the data.
Developing the Time to Act report and holding this webinar are just the beginning of our work in this vital policy area. We know that the impact of Covid-19 on elective care has been significant, but it has also shone a light on the vital role of preventing infections of all kinds. As we move into the next stage of the UK’s fight against Covid-19 and begin to resume elective care, reducing the impact of healthcare associated infections such as SSIs will be essential in building the NHS back better than it has ever been, which will only serve to improve the outcomes and experiences of patients.
Our thanks go to all the speakers, the chair and the audience, and in particular the Association for Perioperative Practice for co-sponsoring the event, and GovConnect for hosting this vital discussion.
 Tanner J, Khan D, Aplin C, Ball J, Thomas M, Bankart J. Post discharge surveillance to identify colorectal surgical site infection rates and related costs. J Hosp Infect 2009;72:243e50
 Getting it Right First Time, SSI National Survey, April 2019, https://gettingitrightfirsttime.co.uk/wp-content/uploads/2017/08/SSI-Report-GIRFT-APRIL19e-FINAL.pdf)