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Evidence

The gold standard for reporting SSI is at 30 days.

To facilitate patient reported 30-day SSI rates after colorectal resection, a standardised questionnaire was produced by the Public Health England SSI surveillance service in 2009. This is an evidence based tool designed to detect superficial wound infection based on patient assessed appearance and management of wound according to the following criteria:

  • Criterion 1 – Discharge pus AND antibiotics prescribed
  • Criterion 2 – Clinical signs* AND dehiscence
  • Criterion 3 – Clinical signs* AND antibiotics prescribed

* At least 2 of the following clinical signs must be present: pain, heat, redness or swelling.

When the questionnaire was used at North Bristol NHS Trust, 67% percent of 1527 colorectal patients presented to community services rather than in hospital, so it is very important that 30 day SSI is measured. This means that any data collection strategy such as GIRFT (which focuses on in-hospital), SSI surveillance and readmission will grossly under report SSI rates and therefore post discharge surveillance is essential.

The introduction of the PreciSSIon care bundle produced a sustained reduction in 30 day patient-reported infection rates after colorectal surgery, displaying that the four interventions when used concurrently can reduce the incidence of SSI.
Read more in this paper, published April 2020.

The SSI rates by year, at North Bristol Trust, are demonstrated below:

Read more about the evidence of PreciSSIon in part 1.3 of the toolkit.