Establishing a Surgical Site Infections Prevention Day: A blog by Lilian Chiwera

Summary

Lilian Chiwera is an independent surgical site infection (SSI) surveillance and prevention (SSISP) expert with experience setting up and coordinating a very successful SSI surveillance service at Guys & St Thomas’ NHS Foundation Trust from 2009–2022. Lilian shares the work she and her colleagues are doing around a surgical site infections patient safety initiative and explains why she wants to establish an annual Surgical Site Infections Prevention Day.

Content

From my own experience, the profile of surgical site infections (SSIs) is low among staff. Judith Tanner and colleagues suggest that awareness of SSIs is also low among patients – for example, some patients only knew about Methicillin-resistant Staphylococcus aureus (MRSA) but had never heard of SSIs.[1] For these reasons, I feel we must change our approach and explore ways we can raise the profile of SSIs and how to prevent them.

Given my extensive experience of setting up a very successful SSI surveillance and prevention service at my previous healthcare organisation, I came up with an idea of having an annual SSI Prevention Day, similar to the annual hand hygiene days which are run by the World Health Organization (WHO). SSI Prevention Day (SSIPD) initiatives will aim to raise the profile of SSIs.

It is a huge honour and humbling experience to have lots of people supporting this call to action. We acknowledge that for an annual SSIPD to be effective, all key stakeholders must be involved and must actively participate. Key stakeholders include all healthcare professionals and those working in and accessing healthcare (consumers) covering a broad spectrum of specialisms. The initial piece of work focused on establishing what people thought of the proposals and whether they would be willing to support it. Thankfully most of the people I consulted felt that this initiative was very much needed, especially now. 

Raising the profile of SSIs

An idea that started with an initial focus on an annual SSIPD has now broadened to cover many other areas of SSI surveillance and prevention, patient safety and healthcare regulation.

We are proposing to raise the profile of SSIs through:

1. An annual SSIPD (or week)
2. Annual regulatory style SSI Prevention Inspections that will be fed back to regulatory organisations, Chief Nursing Officers (CNO), Chief Medical Officers (CMO) and responsible health ministers or politicians prior to the annual SSIPD and then fed back to the public during the annual SSIPD campaigns. We acknowledge that this notion of annual inspections may be viewed as problematic, as is standardisation in terms of scope of surveillance, as there is potential for 'box ticking'. We hope these proposals will open up dialogues between our country SSI champions and country regulatory authorities to perhaps consider mandating this.  
3. An SSI champion model that will give us an opportunity to standardise existing SSI surveillance and prevention processes in the UK and globally through our dedicated local hospital, regional, country and continent SSI champions. Proposed SSI champions will span a variety of healthcare professionals and consumers of healthcare.  See proposed SSIP champion model below with the areas we will focus on initially.

The SSIP champion model was inspired by Albert Gonzalez-Sagredo (Vascular Surgery Department, Bellvitge University Hospital, Spain) who gave us an insight into which areas we should focus on. See his paper attached below.

SSI Prevention champion model _ Albert (1).pdf

Eventually we hope to cover broader aspects of healthcare acquired infection (HCAI) surveillance too.

The benefits of the SSIP proposal

There are many benefits of adopting our patient safety proposals, including but not limited to:

• Promoting SSI prevention expertise from ward to board through compassionate local champions, experienced SSI prevention champions, patient safety and infection prevention and control experts.
• Providing a perfect opportunity for global collaboration and learning from each other for all countries involved.
• Opportunities for the CNO, CMO, politicians and journalists to champion an important patient safety initiative in the UK and globally.

Our journey so far

What started as just another tweet on the 24 April 2022 has become perhaps one of the best SSIP campaigns I have ever done on social media and other platforms. The momentum continues to build (see the tweets via #SSIPreventionDay and Twitter).

When I recognised that this initiative was generating a huge social media response, I submitted an abstract to the annual Infection Prevention Society (IPS) conference, which was accepted for a poster talk. This gave me the opportunity to share our SSIPD aspirations with many conference attendees, The conference was a huge success and I began to think this campaign could become as popular or even surpass the successes of the WHO annual hand hygiene campaign. Towards the end of 2022, with support from the CNO for England, I presented our proposals to the NHS England Head of Infection Prevention and Control. Engaging senior leadership will be central to our SSIPD initiatives campaigns.

We had our very first historical SSIPD initiatives inaugural brainstorm meeting, chaired by the wonderful Karen Wares (a very experienced Infection Prevention Champion and Clinical Director at Gama Healthcare), on the 4 January 2023.

We’re continuing with our call to action for a SSIPD, our SSIPD initiatives group continues to grow and we now have an active WhatsApp group with almost 50 people and an email distribution list with over 115 email recipients.

What’s next for us?

1. Follow up meeting in February 2023.
2. Design and send a questionnaire via our country CNOs and CMOs as a call to action and identification of SSI champions.
3. Continue building our network and formalising our SSISP group.

Conclusion

We’re proposing a novel hybrid patient safety initiative which we hope will bring tangible surgical benefits for patients. We believe our proposed SSIPD initiatives are feasible, given the level of interest this has already generated within a short timeframe. We have an ambition to embrace all healthcare workers and everyone involved in healthcare, media and science in our quest to bring about tangible patient outcomes. Thank you to our supporters and advocates who got us to where we are today… buzzing with excitement!

To find out more about the SSIP Initiative and to get involved, email ssipreventiondinitiatives@gmail.com.

Reference

1. Tanner J, Padley W, Davey S, et al. Patients’ experiences of surgical site infection, J Infect Prevent 2012; 13 (5). https://doi.org/10.1177/1757177412452677

Further resources on the hub

See our surgical site infections area of the hub.

About the Author

Lilian Chiwera is an independent surgical site infection (SSI) surveillance and prevention (SSISP) expert with experience setting up and coordinating a very successful SSI surveillance service at Guys & St Thomas’ NHS Foundation Trust from 2009–2022. Passionate about improving patient safety, she has experience of working in digital transformation where she explored how best infection prevention and SSI prevention can be aligned with current digital transformation strategies or agendas. She is currently working within Infection Prevention and Control (IPC) at Sherwood Forest NHS Foundation Trust, UK, where she hopes to explore IPC, SSI surveillance and prevention implementation challenges and opportunities in a district general hospital. This experience will consolidate previous critical care nursing/IPC/SSIP experiences from a large acute trust, digital transformation experiences from a district general hospital and prior experiences as a microbiologist in the pharmaceutical industry to put her in a strong position to effectively support all hospitals settings across the globe via the new SSISP Day group.

As a former member of the Infection Prevention Society (IPS) Scientific Programme Committee (SPC), Former IPS Education & Professional Development Committee member, Lilian gained insight into how infection prevention societies operate and is using that experience to develop and build a strong case for an SSI Prevention society in the UK, whilst collaborating and learning from established surgical infection societies globally. She is a passionate member of the IPS and Hospital Infection Society (HIS) Guidelines Development Committee.

About the SSI Prevention Day Initiative

SSI Prevention Day Initiatives is a global collaboration between various healthcare professionals and stakeholders who are keen to see tangible patient outcomes in the field of SSIP. Our mission is to raise the profile of SSIs through our dedicated SSIP local, regional and country champions who will work with clinical teams to ensure that evidence-based SSI prevention measures are implemented for every patient each time and that staff are supported with the best environments and feel psychologically safe to deliver the best possible care to all patients. We embrace all those working in and accessing healthcare (consumers), those working in the field of IPC, SSI prevention, tissue viability, antimicrobial pharmacy, patient and public involvement (PPI) groups, diagnostics, scientists, patient safety advocates, human factors specialists, psychologists, musicians (artists) and anyone else with a keen interest in patient safety and preventing avoidable harm.

Our aims:

• Make provision for kind, compassionate individuals to champion SSI prevention in their healthcare facilities.
• Promote activism around SSI prevention visibility by engaging PPI, passionate patient safety advocates, musicians and journalists to raise the profile of SSIs.
• Engage all healthcare professionals, patients and the public from all backgrounds to promote surgical patient safety, by targeting SSI risk factors, environmental and human factors aspects that may influence SSI patient outcomes.
• Introduce and sustain an SSI Prevention inspection tool that will be used to appraise surgical practice at local level, with outcomes being utilised to inform and improve clinical practice as well as being shared during annual SSIP days.