Surgical site infection Resources

This article discusses the care of normally healing surgical wounds, together with key potential wound complications of surgical wound dehiscence (SWD) and surgical site infection (SSI). It also provides a brief overview of how fistulas and sinuses develop and
how to manage these complex wounds. Indeed, timely intervention and appropriate care of surgical wounds and any complications which may arise is vital to ensure optimal outcomes and prevent long-term issues.

This article looks at the cost and incidence of wound dehiscence, together with an overview of the most common operation sites where dehiscence is likely to occur. Patient factors predisposing to wound dehiscence are discussed, together with the most common cause, surgical site infection (SSI). The identification and management of SSI is explored, together with recommendations for wound management for both infected and non-infected dehisced wounds.

This article describes the wound infection continuum in surgical, acute and chronic wounds. The phases are: contamination, colonisation, local infection and finally spreading and systemic infection. Clinicians need to be familiar with the signs and symptoms of local infection in order to put strategies in place to prevent a ‘full blown’ wound infection and to recognise how the signs and symptoms differ by wound type. The article looks at the
most recent guidance on wound infection management strategies, together with the identification and treatment of suspected biofilms and the two-week challenge, used in clinical practice to disrupt biofilms. Wound cleansing and the use of antimicrobial dressings
and topical antiseptics are also discussed.

Surgical site infections (SSIs) are of serious concern for clinicians, patients and healthcare institutions worldwide. This study evaluated a new wound management pathway using Leukomed® Sorbact® (Essity) post-operative wound dressings in women with raised body mass index (BMI) undergoing lower uterine segment caesarean section (LUSCS) in the NHS Wrightington Wigan and Leigh Foundation Trust. Previous practice indicated use of a standard postoperative dressing for women with a BMI <35 and PICO™ single-use negative pressure wound therapy (NPWT) dressing for women with a BMI >35, following surgery. The new wound management pathway indicated that Leukomed Sorbact was suitable for women with a BMI ≥30–<50, gestational diabetes mellitus (GDM) or previous caesarean section with complications; NPWT dressings continued to be used for women with BMI ≥50, type 1 diabetes, previous numerous caesarean sections or at high risk of infection. Questionnaires were devised and disseminated for clinician and patient groups in relation to dressing use and patient satisfaction with the dressing.

Surgical site infections (SSIs) are the most common type of nosocomial infection, accounting for up to 20% of all hospitalacquired infections in Europe (European Centre for Disease Prevention and Control [ECDPC], 2013). There are varying SSI rates reported across the UK. In 2016, Public Health Wales reported an overall 14-day SSI rate for women undergoing caesarean section of 4.35% — 83% of which were superficial infections and 92.5% were detected after discharge (PHW, 2016). From 2015–2016, Aneurin Bevan University Health Board (ABUHB) services experienced an increase in the SSI rate for women birthing by caesarean section from 3.07% to 5.86% respectively. Therefore, a multifaceted approach to quality improvement (ABUHB organisational method) was adopted throughout the duration of 2017, with a view to implement by 2018. The aim was to reduce SSIs for women birthing by caesarean section in ABUHB. Interventions included the use of evidence-based practice and guidelines, education and engagement among clinicians, patients and staff, and the gradual implementation of Leukomed^® Sorbact^® (Essity) post-operative dressings.

Many community nurses will have to attend patients that have a surgical wound. The desired clinical outcome for any surgical wound will be to achieve closure and skin integrity with an acceptable cosmetic result, and to avoid any complications. Patients presenting to community nurses after discharge from hospital may well have experienced postoperative complications or may be at risk of complications following suture removal. Community nurses should be aware of wound problems that may arise following surgery and how to address them appropriately.