PreciSSIon (Preventing Surgical Site Infection across a region) is a collaborative project to reduce the incidence of surgical site infection after elective colorectal surgery. The project started in November 2019 and involves all the hospitals in the West of England region.
Surgical site infection (SSI) refers to wound infections following invasive surgical procedures. SSI constitutes a major healthcare burden accounting for 14.5% of all hospital acquired infections in the UK and an estimated 34-226% increase in associated costs. It is also a significant cause of patient morbidity including increased length of stay, readmission, wound dehiscence, hernia, need for intensive care, as well as death. SSI is more common after colorectal surgery where wounds are frequently contaminated by bowel content and rates are reported between 8-30%.
The aim of the PreciSSIon project is to reduce surgical site infection after colorectal surgery by 50% by March 2021.
In order to do this, we aim to measure 30 day SSI rates and compliance with each element of the bundle.
To achieve this, the project will spread the use of a SSI bundle to reduce the incidence of SSI after elective colorectal surgery. The intervention is evidence based and could be applied to most surgical procedures where there is a risk of surgical site infection.
The existing World Health Organisation (WHO) SSI bundle, which is part of the Surgical Safety Checklist, is routinely used throughout the NHS. It consists of four evidence-based interventions, which have been shown to independently reduce infection. These are:
- antibiotics within 1 hour of surgery
- normothermia – temperature >36 degrees in recovery
- blood glucose control in known diabetics – glucose in normal range in recovery
- appropriate hair removal from the surgical site – using clippers, not wet razors.
The PreciSSIon bundle was developed by reviewing literature for interventions that have been shown to reduce infection other than those included in the WHO bundle. It was introduced at North Bristol NHS Trust in February 2013 and consists of:
- 2% chlorhexidine isopropyl skin preparation for all cases
- use of a dual ring wound protector
- repeat dose of antibiotics after 4 hours operating time
- antibacterial suture for mass closure and skin.
The bundle elements have been further validated by inclusion in the 2016 WHO global guidelines on the prevention of surgical site infection, and more recently in the April 2019 update to NICE guidelines. These interventions are in addition to reliable implementation of the WHO bundle.
More information and resources are available on our webpages below, including the PreciSSIon Implementation Toolkit which includes references for the figures listed above.