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  • Writer's pictureLilian Chiwera

Did you just say someone else is more passionate about SSI prevention than the #SSIQueen?

I have been promoting surgical site infection (SSI) surveillance for more than 13 years and have been dreaming of a day when the profile of this important patient safety initiative would reach new heights. In fact, some of my friends had started calling me #SSIQueen because of my ever-increasing SSI prevention passion. I accepted the ‘Queen’ title and can say now that I will always be the undisputed #SSIPrevention ‘heavyweight champion’ AKA #SSIQueen. At one point, I lived and breathed SSI surveillance and prevention, it was the first thing I thought of when I woke up & the last thing I thought of before going to bed loool! Well, it’s true, I just wanted to do everything I could to give each patient an opportunity to receive harm-free surgical care. That’s why I came into healthcare in the first place right? Of course, I always want to make a difference to someone’s life.

Covid & SSI Prevention

In early 2020 we were all hit by an unprecedented global Covid pandemic which brought the whole world ‘to a halt’. For me, it felt like all the SSI prevention work over the years was thrown away! They say everything happens for a reason, so perhaps it’s time to revamp SSI surveillance and prevention. It’s time to raise the profile of SSI surveillance to new heights. COVID led to severe surgery disruptions but now that things are starting to improve owing to the success of vaccination programs, organizations must do the best they can to safely clear backlogs. SSIs which lead to poor patient/organization outcomes (increased discomfort, readmissions, reoperations, increased antibiotic usage & consequently antimicrobial resistance, poor reputations for organizations which impact patient choice etc.) must be prevented whenever possible. Everyone has already been through a lot during this pandemic, therefore avoidable SSI related devastation for patients/families and organizations is unwelcome. Could the impact of this pandemic be a turning point in our quest to get the public and politicians to finally recognize SSI prevention as a priority, necessitating urgent debate? Well, I’m aware that the SSI prevention agenda and upcoming SSI surveillance initiatives are already being discussed with politicians and others to a certain extend. This is very positive & welcome news but we must continue to do more.

Raising the SSI prevention bar

I attended a 3-day Infection Prevention Society (IPS) conference in Liverpool at the end of September 2021. I was very much looking forward to the SSI sessions. Could SSI surveillance & prevention reach new heights at this event? Could this be the time I have been waiting for all these years? Well, perhaps it was. Interestingly, it was the first time in a very long time that I didn’t submit a conference abstract. I have to say it was good to just listen to others for a change. Among all the excellent talks, were two inspirational SSI presentations from top infection control experts from the UK (Jon Otter) and Malta (Debbie Xuereb).

Both talks placed emphasis on the need for better and broader SSI surveillance that acknowledges complexities of infection prevention and control in operating rooms and prioritise patient safety. Key attributes of such SSI surveillance programs include simplicity, flexibility, acceptability, sensitivity, timeliness and representativeness. A concept of adopting semi-automated SSI surveillance and new initiatives like the Photo At Discharge (#PAD) were also presented. These concepts and initiatives are timely given Covid-related increases in telemedicine or remote monitoring. In fact, there are new mobile apps now being evaluated, which aim to improve SSI data capture post discharge. I very much look forward to outcomes of these evaluations and hopefully widespread implementation across the healthcare sector. Improving SSI data capture post discharge will enable us to better inform & improve clinical practice when indicated.

Jon & Debbie encouraged delegates to read Professor Judith Tanner’s SSI prevention paper on patient stories to enable us all to connect with real issues presented by surgical site infections. In my experience of collecting SSI data, I have always had patient safety and experience at the heart of everything I do. I have also spoken to patients who sadly developed surgical site infections over the years and can concur with Professor Tanner’s findings when she interviewed SSI patients. In fact, not ever wanting to see another patient suffer from SSIs has continued to ignite my passion for SSI prevention. This is probably the reason I’ve stayed in one role for all these years.

The Maltese experiences of implementing the #OneTogether resources were passionately presented during the conference. SSI prevention resources and quality improvement initiatives shared during this talk are available via the OneTogether website. It is thought that more than 55% SSIs are preventable, which brings into sharp focus the importance of this patient safety initiative.

So what do we need to do now?

We all need to work together and at least start by evaluating or establishing systems for inpatient/readmission and post discharge SSI surveillance data collection, analysis, feedback/reporting. Once data collection systems are established, organisations can better quantify local SSI burden then use the data to inform potential SSI prevention interventions.

Is it easy to implement a robust SSI surveillance program?

Managing change is not always easy therefore implementing a robust SSI surveillance program from nothing is no exception. Leadership buy-in and a whole team and whole health economy approach are important considerations. From experience, I often hear people highlighting a lack of resources as a barrier to implementing robust SSI surveillance programs. However devastating cost consequences of SSIs are not always taken into consideration when making decisions about resource allocation. Even with some successes demonstrated by established systems for collecting SSI data in England, Wales, Europe and many other countries, SSI data collection is still limited. In fact, some of these established SSI surveillance programs are thought to only tell half the story. We must do better! Dr Jon Otter presented an ideal team that is required for successful SSI surveillance and prevention programs - nurses, pharmacists, doctors, auditor, surveillance & epidemiology. An SSI reduction success story from Guy’s & St Thomas’ was presented to inspire everyone and prove that it can be done! Yes, anyone can do anything if they put their mind to it 😊.

I thoroughly enjoyed listening to a presentation by another passionate SSI prevention champion Mr Giles Bond-Smith at IPS conference during a lunchtime industry sponsored session. Together with Lisa Butcher, Giles has been leading a very successful SSI surveillance program in Oxford, UK. He has on numerous occasions shared a 10-point SSI prevention bundle which they successfully implemented in their organisation with excellent patient outcomes. Post conference, I also enjoyed listening to a recent webinar presented by Lisa & Giles via LinkedIn; in which both passionately discussed SSI surveillance and prevention approaches. This was a super inspiring scintillating #SSI discussion. I certainly look forward to more of these events in future.

Did you just say someone else is more passionate about SSI prevention than me? Is my #SSIQueen title disappearing? ☹. How come Lisa, Giles, Jon and Debbie all now appear to be more passionate about #SSIPrevention than myself? Jon even did a podcast with Martin Kiernan at the IPS conference: “SSI surveillance - who cares? (I care, and we should all care very much!) #ip2021”. I thoroughly enjoyed listening to this podcast and many others. You should all listen to this and other #InfectionControlMatters podcasts that are facilitated by Martin & Brett Mitchell.

To answer Jon’s question - I care very much about improving patient safety and experience through #SSIPrevention but I care less about who leads it or who is more passionate as long as we’re all making a difference to the care we give to our valued patients. Well…, perhaps I care a little loool or should I say it really doesn’t bother me provided I remain the ‘undisputed #SSIQueen’ 😊😊. Seriously though, it’s great to see top infection control experts and surgeons now coming together to push the #SSIPrevention agenda to new heights. Not forgetting recent double Award winners of the #PreciSSIon #SSIPrevention patient initiative. This team is awesome and I can't wait to see what's coming next. Congratulations to Anne Pullyblank, Kerry Holden, Craig Bradley and teams for outstanding SSI prevention work in colorectal surgery.

What to say now?

Yes, the time is now, things are happening. I have been waiting for this moment, I am absolutely thrilled! I look forward to continuing work with others to raise the SSI prevention bar to new heights! Come join the SSI prevention 'revolution' and make positive contributions to patient safety. Let’s all do the best we can to promote this and many other important patient safety initiatives to give each patient an opportunity to receive harm free healthcare.

Jon’s slides are available here.

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