Infection prevention: key issues raised

Infection prevention and control experts recently gathered at Infection Prevention 2012, to discuss the latest research and innovation – aimed at reducing the burden of healthcare-associated infection in the UK. One of the main highlights of the conference, each year, is the EM Cottrell Lecture, which is given in honour of the first infection control nurse. This year, the motivational lecture was delivered by Professor Judith Tanner, professor of clinical nursing research, De Montfort University, who has carried out numerous research studies focussing on surgical site infection. Entitled Think; Plan; Do, Prof. Tanner discussed how a ‘can do’ attitude can be developed, while offering an insight into how research can be implemented into practice. Reflecting on the importance of motivating others to deliver improvements in practice, Prof. Tanner commented: “When I was asked to give this presentation, I was initially told it was a motivational session. At first I was worried – what do I know about motivation? Then, recently, I was handed some delegates’ feedback after a conference I had been speaking at. One of them said: ‘This session really motivated me to go back to my workplace and make changes,’ and then it struck me, you don’t need to be Ranulph Fiennes and climb Everest to be motivational – the work that we do everyday matters. The work that we do saves lives.” She gave an insight into how she first became involved with improvement projects at University Hospitals of Leicester NHS Trust, in 2008, when the lead tissue viability nurse highlighted the fact that her spending on vacuum dressings had significantly increased because of surgical site infection (SSI).

Surveillance

A team was formed to look into the issue and to conduct a surveillance programme to quantify the incidence of SSIs. An initial pilot was undertaken to perform high quality, post-discharge surveillance. This involved an independent surveillance nurse telephoning every single patient on day 10, day 20 and day 30. “For colorectal surgery the SSI rate was 27% and for breast surgery the rate was 10%,” said Prof. Tanner. “During the surveillance programme, we found other issues which enabled us to change practice. We found that the average cost of treating an infected colorectal wound was £10,500 and the average cost of treating a breast infection was £1,500. “Primary care was picking up the tab for these costs. When the Primary Care Trust was made aware of this fact, they established CQINN targets, which proved extremely useful as it provided a driver for change.” The chief executive was also informed of the rates and the costs, and gave his full backing to address the issue, so the infection prevention team put forward a proposal to roll out a Trust-wide surveillance programme. As a result of the initiative, the team found that smoking was the biggest risk factor for wound infections in breast surgery patients. “We therefore changed our patient information leaflet to encourage patients to stop smoking before surgery and set up a smoking cessation programme in GP surgeries,” said Prof. Tanner. “We also found that 40% of the women who had breast surgery developed seromas [i.e. fluid collection in the breast area]. “These women had an average of eight visits to the seroma clinic to have a syringe inserted into the breast to draw out the fluid. We looked into this and realised we had no guidelines on when you should drain a seroma – there are no national guidelines either. As a result, nurses worked together to come up with some guidelines which have now reduced the number of visits that women have.” The team at Leicester also discovered that for patients who incurred an SSI, discharge was delayed by one night, while they had a vacuum dressing applied, at a cost of £400. However, a quarter of patients who were discharged with vacuum dressings had their dressings removed within 24 hours because the primary care nurses did not know how the vacuum dressings worked. “As a result of this finding, we worked closely with tissue viability nurses in the community to make it a more seamless service,” said Prof. Tanner. Reflecting on the project findings, she commented: “We thought, at first, that the hospital would not allow us to publish our results, but to our surprise, it encouraged us to share our insights and to raise the profile of the work – to share the message with other hospitals that, if you undertake good surveillance, these are the realistic infection rates that you will find. This was really encouraging.” This work also provided the impetus behind a number of follow-up projects, Prof. Tanner explained: “We knew we needed to build a case to support the investment in initiatives by demonstrating the cost-effectiveness of interventions. The infection prevention team came up with a plan to ‘blitz’ patients for six months to reduce infection rates and achieve 100% compliance with all the interventions.” Drawing on the expertise of David Leaper and Martin Kiernan, nurse consultant, infection prevention Southport and Ormskirk Hospital NHS Trust, the team set to work – appointing a dedicated project nurse for a period of six months to help achieve a goal of 100% compliance. Although this was just an initial pilot study, the team were disappointed to find that the infection rates did not significantly decrease. Nevertheless, the work uncovered some interesting findings.