Diane Holland, Deputy Director of Infection Prevention and Control
Chesterfield Royal Hospital NHS Foundation Trust
Surgical site infection is a type of healthcare-associated wound infection affecting the incision site after an invasive (surgical) procedure.
Surgical site infections (SSI) are associated with considerable morbidity and extended hospital stay resulting in a considerable financial burden to healthcare providers.
The majority of SSI are preventable and yet they account for 20% of HCAI (HPA, 2012) and as many as 5% of patients who have surgery will acquire an SSI
Surveillance of Surgical Site Infection
Surveillance of SSI is essential to track patient outcomes and to measure the effect of interventions on reducing SSI rates.
The majority of SSI will occur after the patient has been discharged so while there is some merit in recording SSI during the inpatient period, the requirement for post discharge follow up of some kind is well recognised.
The gold standard for surveillance of SSI involves review by a clinician during the post-operative period.
Some organisations follow the patient post discharge with a questionnaire, others with a phone call.
Follow up of out-patient appointments and notification and follow up of re-admits all play their part in collecting the most accurate data.
Medical Audits have developed an audit tool specifically to support Infection prevention and control nurses (IPCN) and surveillance scientists in the collection of surveillance data for the monitoring of Surgical Site Infection Rates
Regardless of the definitions used, CONSISTENCY in the definitions used and in the method to collect numbers of infections is essential to ensure you have data that can be compared locally and benchmarked internationally.
The definitions and standards used in the Medical Audits surgical site infection prevention system includes both CDC and ECDC definitions of Surgical Site Infection in order to facilitate national and local requirements for data collection.
Feedback of data should be prompt and issues identified should be notified to staff at the time of audit to improve learning and reduce risks for patients.
Definitions of surgical site infections can be based on CDC (2014) and are classified as incisional (superficial or deep), or organ/space infection.
Superficial incisional infection
This is defined as a surgical site infection that occurs within 30 days of surgery and involves only the skin or subcutaneous tissue of the incision, and meets at least one of the following criteria:
Criterion 1:
Purulent drainage from the superficial incision.
Criterion 2:
The superficial incision yields organisms from the culture of aseptically aspirated fluid or tissue, or from a swab and pus cells are present.
Criterion 3:
At least two of the following symptoms and signs:
- pain or tenderness
- localised swelling
- redness
and a. the superficial incision is deliberately opened by a surgeon to manage the infection, unless the incision is culture-negative
or b. the clinician diagnoses a superficial incisional infection (with clinical signs of infection).
Deep incisional infection
This is defined as a surgical site infection involving the deep tissues (i.e. fascial and muscle layers) that occurs within 30 days of surgery if no implant is in place, or within 3 months if an implant is in place and the infection appears to be related to the surgical procedure, and meets at least one of the following criteria:
Criterion 1:
Purulent drainage from the deep incision but not from the organ/space component of the surgical site.
Criterion 2:
The deep incision yields organisms from the culture of aseptically aspirated fluid or tissue, or from a swab and pus cells are present.
Criterion 3:
A deep incision that spontaneously dehisces or is deliberately opened by a surgeon when the patient has at least one of the following symptoms or signs (unless the incision is culture-negative):
- fever (>38oC)
- localized pain or tenderness
Criterion 4:
An abscess or other evidence of infection involving the deep incision that is found by direct examination during re-operation, or by histopathological or radiological examination.
Criterion 5:
Diagnosis of a deep incisional surgical site infection by an attending clinician (with clinical signs of infection).
Organ/space infection
This is defined as a surgical site infection involving any part of the anatomy (i.e. organ/space), other than the incision, opened or manipulated during the surgical procedure, that occurs within 30 days of surgery if no implant is in place, or within one year if an implant is in place and the infection appears to be related to the surgical procedure, and meets at least one of the following criteria:
Criterion 1:
Purulent drainage from a drain that is placed through a stab wound into the organ/space.
Criterion 2:
The organ/space yields organisms from the culture of aseptically aspirated fluid or tissue, or from a swab and pus cells are present.
Criterion 3:
An abscess or other evidence of infection involving the organ/space that is found by direct examination, during re-operation, or by histopathological or radiological examination.
Criterion 4:
Diagnosis of an organ/space infection by an attending clinician (with clinical signs of infection).
HELICS and ECDC definitions can also be used.
Medical Audits TS+ ensures standardised audit processes to enable benchmarking of data locally and internationally.
Benchmark against
- Hospitals in Europe Link for Infection Control through Surveillance (HELICS) databases;
- Surgical site infection surveillance service (SSISS);
- Centre for Disease Control (CDC) databases;
- National hospital Surveillance Network (NHSN);
Monitor
Risks, Rates and Trends to enable fast, efficient identification of possible outbreaks or breaches in best practice.
Evidence
- Compliance with best practice standards
- Care Quality Commission (CQC) requirements
- Health Information and Quality Authority (HIQA) recommendations
- Health Protection Scotland (HPS) standards
- And more
Monitoring and Assessment of Compliance with Best Practice Bundles to Reduce Surgical Site Infection Rates using Medical Audits Technology System.
Improve practice and reduce surgical site infection rates Using TS+ to audit compliance with
International guidelines and standards including:
✔ High Impact Intervention Care bundle to prevent surgical site infection (NHS, 2017)
✔ Key recommendations to Prevent Surgical Site Infections Royal College of Physicians in Ireland (2012)
✔ National Institute of Health and Clinical Excellence (NICE) clinical guideline number 74 (2008)
✔ Centre for Disease Control (CDC) guidelines and definitions (2012)
✔ EPIC 3 Guidelines on prevention of HCAI in England (2012)
✔ NICE SSI Evidence update 43 (2013)
Auditing practice is essential to measure performance, evidence compliance and identify gaps in practice that may increase the risk of SSI.
- Medical Audits develop our systems with reference to National standards for Infection prevention across the EU and the UK.
- You can audit against all the newest standards and be confident you will identify issues quickly and efficiently.