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Improving surgical site infection prevention practices to reduce antibiotic use and antimicrobial resistance 

Judith Tanner (Health Sciences), Sarah Atkinson (Engineering), Stephen Timmons (Business School), Bryn Baxendale (Consultant Anaesthetist, Nottingham University Hospitals) and Roger Bayston (Medicine)

The issue

Currently, around 5% of the 7 million patients who have surgery annually in England develop a surgical site infection (SSI). This is a great concern as antibiotics are the primary treatment for all SSI, and antimicrobial resistance will result in deaths among patients following even minor or routine surgery.  One of the greatest risk factors for SSI is peri-operative hypothermia. Patients who are hypothermic (temperature below 36°C) are three times more likely to develop an SSI than normothermic patients. A national survey shows that only 17% of clinicians comply with NICE hypothermia prevention guidelines, and other studies also show poor compliance with warming interventions to prevent SSI. The Department of Health’s 5 Year Antimicrobial Resistance Strategy is “to get to a point where good infection prevention and control measures to help prevent infections occurring become the norm”.

The research

The aim of this study is to improve compliance with surgical site infection (SSI) prevention interventions, thus preventing infections and reducing dependence on antibiotics permanently.The study will be carried out at Nottingham University Hospitals. Researchers will follow surgical patients as they progress from hospital admission to post-surgical wards, identifying organisational boundaries, professional boundaries, risk areas for human factors and areas of risk of hypothermia. This information will be analysed and compiled into a process map. Researchers will conduct exploratory interviews with NHS staff to uncover issues which influence compliance with warming guidelines and attitudes towards SSI prevention. Data from the process map and interviews will be used to develop a whole-systems patient-warming implementation toolkit to prevent hypothermia and prevent SSI.

The impact

The researchers believe that the transfer of clinical guidelines into real practice needs an implementation strategy to be successful. Current warming interventions to prevent SSI fail to address organisational, contextual, behavioural, individual and design factors. Conventional approaches to warming focus on interventions in the operating room but patients can get cold at any stage in their hospital journey, from the pre-surgical ward to the anaesthetic room, the operating theatre, the recovery unit and the surgical ward. To prevent cooling, “keeping the patient warm” needs a coordinated, whole system approach that addresses human behavioural factors and crosses organisational and professional boundaries.This study plans to impact on antimicrobial resistance by reducing the number of SSIs, thus reducing dependence on antibiotics. High antibiotic use contributes to the increase in antimicrobial resistance in human beings and in the environment.

If you are interested in finding out more about this research or about Bridging the Gaps please be in contact with Harry Moriarty h.moriarty@nottingham.ac.uk in the first instance.