Surgical site infection (SSI) frustrates me. When we undertake elective procedures, we have much more control over processes and patient flows than in most other aspects of hospital life. We have a range of evidence-based interventions, and we know that if we get them right, the risk of SSI is reduced hugely. And yet, preventable SSIs continue to occur because we don’t always get the bundle of interventions implemented. And so patients suffer harm, our theatres and precious beds have to do subsequent procedures related to SSI, costs ramp up, and we have to use more and more antibiotics. I gave a webinar last week providing an overview of the bundle of interventions at our disposal to reduce the risk of SSI.

So why do we so consistently get it wrong in implementing an effective SSI prevention bundle? This is a complicated question and the answer is mutlifaceted. One fundamental issue is the lack of SSI surveillance. Whilst SSIs are identified and treated effectively most of the time (at least I hope they are in most places), it is common to lack systematic and effective systems for SSI surveillance. This means that overall SSIs rates by surgical category are not known to anybody in the organisation, which allows for higher-than-is-ok rates of SSI to continue effectively under the radar.

Another issue is the quality of the evidence underpinning each element of the bundle. Or rather, the perception (reality?) of the quality of the evidence. NICE, WHO, and others have lovely SSI prevention bundle guidelines, underpinned by detailed evidence reviews. And yet some aspects of SSI remain under-researched. And others that are adequately researched remain contentious.

There’s huge variability of practice even within the same surgical specialty in the same organisation due to preferences within the surgical team. Some of this is warranted, due to subtle differences in case mix, or due to genuine uncertainties in the evidence base. But some is absolutely unwarranted, and is based on dogma and ritual, and needs calling out. (Enter the excellent and recent Healthcare Infection Society “Rituals and behaviours in the operating theatre guidelines“).

So, I’m convinced that with a bit of leadership, a bit of funding, and a bit of effort, we can make huge strides forwards in reducing the risk of SSI.