It’s COVID-19 for now but we may need to step up our SSI prevention campaigns afterwards

I acknowledge that things may not get better anytime soon with this current coronavirus (COVID-19) pandemic (UK updates and Global picture). Most surgical procedures are being cancelled and hospital services / operational activities are being prioritised as organisations seek to increase critical care bed capacity. With social distancing set to become the norm at least for the next couple of weeks / months in the UK and other countries, pubs, restaurants, cinemas etc. are being shut down temporarily and public gatherings discouraged with people being instructed not to travel unless it’s absolutely necessary in order to minimise COVID-19 spread. I cannot applaud everyone enough for pulling together and encouraging one another to follow recommendations and set aside individual or political differences during this critical time in our lives. I am absolutely excited to see the emphasis being placed on people spreading kindness and not the virus. My friend, Jude Robinson shared useful tips on how to help those is self-isolation via Twitter recently. Yes, we must stay in touch, help each other out and offer to help those in need during challenging times. I am humbled to see messages like this from our Prime Minister Boris Johnson, thanking everyone, especially all NHS staff who are doing a fantastic job and all the messages of support being posted on various individuals on social networks.

With all my excitement for surgical site infection (SSI) prevention, the long term implications of COVID-19 has certainly only begun to hit home. Things will never be the same again, at least for the foreseeable future. There won’t be much SSI monitoring for most surgical specialties except for caesarean sections and emergency surgery. Nevertheless, we cannot afford to have any surgical patients developing avoidable SSIs, as this will increase length of hospital stay and may potentially lead to poor outcomes due to stresses caused by fear of COVID-19. It will not be easy but I know all healthcare professionals will aim to get it right the first time even when under pressure. I can’t help but think of the psychological impact this pandemic is having on those whose surgery is being cancelled and/or postponed.

Speaking from my own experience of having emergency surgery in September 2018, I have to admit that I was super-anxious about having surgery even before I was told I needed surgery due to the symptoms I was having. Thankfully, when the day of surgery came, I didn’t have time to worry about the emergency operation up until it was all completed when I sighed ‘I could have died!’ I can confess that even though I did not develop an SSI, it took me over 15 months to start feeling like myself again although I continued to ‘operate as normal’. I am eternally grateful to the NHS for saving my life and giving me another opportunity to ‘save/serve’ others.

Although limited evidence suggests that about 20% of patients develop post-traumatic stress disorder in the post-operative period which could possibly lead to poor overall outcomes, there is a suggestion that the percentage could be higher in patients with a psychiatry history. Other evidence points towards a possible link between depression and length of hospital stay after surgery. Furthermore, depression may increase patients’ risk of developing post-operative infections. Interestingly, according to one paper loneliness and lack of perceived social support is not thought to impact recovery from surgery, although it is acknowledged in general that loneliness and lack of social support will have a negative impact on people’s mental well-being. For example, employees from a hospital in Beijing who were involved with and quarantined during the severe acute respiratory syndrome (SARS) outbreak in 2003 were reported to experience adverse mental health consequences up to three years after the outbreak ended. Therefore, whilst everyone is focusing on dos and don’ts of the current COVID-19 pandemic, let’s also remember to fully support and manage perceptions of health care professionals and those dealing with the additional emotional impact of surgery cancellation after months of preparation and the uncertainty of when and if their operations will be done soon enough to alleviate their symptoms or deal with underlying health problems. I acknowledge that it is not easy for all of us but healthcare providers, families and friends or charities can offer the much needed emotional support to mitigate the risk of post - traumatic stress disorder after this COVID-19 pandemic. I certainly enjoyed reading a recent piece from Professor Peter Brennan and colleagues who acknowledge some of the psychological implications a crisis like COVID-19 may cause. I also read an interesting blog here which also explores some of the psychological dimensions of COVID-19 and the impact of secondary stressors.

In as much as SSI prevention will continue to be ‘my best friend’ and passion, I acknowledge that now is a time for me and all of us to be particularly mindful of wider consequences of this current COVID-19 pandemic on staff, those awaiting surgery and hospital treatments and to support each other through it. Let kindness and support systems flourish. I’m very optimistic, things will ‘get back to normal’ and it is highly likely that there will be increased pressure to perform cancelled operations and catch up with backlogs at which point we will intensify our SSI prevention campaigns again. Until then, I’m splitting my time between SSI prevention and helping out colleagues on the front line. Together, we can beat this!