Summary
Surgical site infection (SSI) is the third most common hospital acquired infection, affecting 250,000 people a year in England with an estimated 34-226% increase in associated costs.
SSI is more common after colorectal surgery, where wounds are frequently contaminated by bowel content and rates are reported between 8-30%.
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We had our challenges …. but we have demonstrated that a care bundle developed in a single hospital can be adopted and spread, and that the original outcome of a 50% reduction in SSI after elective colorectal surgery can be replicated in other hospitals and deliver results within just 18 months.
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Dr Lesley Jordan, Consultant Anaesthetist and Patient Safety Lead, Royal United Hospitals Bath NHS Foundation Trust
What the project involved
PreciSSIon (Preventing Surgical Site Infection across a region) is a collaborative involving all hospitals in the West of England.
Their collective aim was to reduce SSIs after elective colorectal surgery by implementing a four-point evidence-based bundle of care developed at North Bristol NHS Trust in February 2013.
From November 2019, the West of England AHSN supported the PreciSSIon collaborative to spread use of the care bundle to other hospital trusts (Royal United Hospitals Bath, University Hospitals Bristol and Weston, Gloucestershire Hospitals and Great Western Hospital) through project management, provision of resources, and funding of collaborative events.
The PreciSSIon bundle, includes: 2% chlorhexidine skin preparation; a second dose of antibiotics four hours after operating; use of dual ring wound protectors; and antibacterial sutures for wound closure.
The collaborative also set out to establish more reliable SSI measurement after elective colorectal surgery, using a validated patient reported outcome questionnaire at 30 days.
The West of England AHSN supported the PreciSSIon collaborative using the IHI Breakthrough Collaborative model and produced materials to aid data collection and implementation of the care bundle. These included quality improvement (QI) resources, an implementation toolkit, posters and videos.
The AHSN also ran learning and sharing events for the collaborative, which were an opportunity to share successes, challenges, and discuss data collection. One face-to-face meeting occurred before the COVID-19 pandemic, but all subsequent events were virtual.
Outcomes
PreciSSIon has almost halved local SSI rates after elective colorectal surgery.
Before the project started, the regional average baseline SSI rate was 18%. By March 2021 this dropped to 9.5%.
This equates to preventing 115 patients from having an SSI and an estimated cost saving of £566,720.
Compliance with bundle elements was 92% for antibiotics, 87% for chlorhexidine, 79% for antibacterial sutures and 68% for wound protectors.
In 2021 PreciSSIon won Quality Improvement Team of the Year at the BMJ Awards and the Infection Prevention and Control Award at the HSJ Patient Safety Awards.
In September 2022, the Journal of Hospital Infection published ‘PreciSSIon – a collaborative initiative to reduce surgical site infection after elective colorectal surgery’. This concluded a care bundle developed in a single hospital can be adopted and spread, and the reduction in SSI after elective colorectal surgery can be replicated and deliver results within 18 months.
Next steps
Encouraging wider spread of PreciSSIon, the AHSN is sharing the learning with organisations such as the Royal College of Surgeons and the Association of Surgeons of Great Britain.
In October 2022 the AHSN launched a new PreCiSSIon collaborative with six local maternity hospitals, focusing on reducing SSI after caesarean birth.
