Infection control- Surgical Site Infections

A spike in post operative complications would definitely be a concern. Post operative complications such as surgical site infections can lead to delayed wound healing and even mortality in extreme cases. A rise in post operative complications may indicate concerns will surgical procedures, operative techniques, hygiene protocols or post operative care protocols. Addressing these issues are critical in maintaining high standards. An increase in post operative complications can also have an impact on the reputation of the veterinary practice and have financial implication for the caregiver and the practice if additional treatment and follow up visits are required. 

To address this, implementation measures such as clinical audits, surgical checklists and continuous staff training to improve surgical outcomes and reduce the risk of complications. 

Clinical audits are a useful tool to check the effectiveness of and adherence to infection control guidelines. The audit can be as simple as a post-operative surgical wound audit. An audit can be invaluable for assessing the frequency of post-operative sepsis and will quickly identify infection outbreaks. It will also enable the practice to localise the problem to a specific routine or member of staff, so appropriate measures can be implemented without blame.

I would be interested to hear your experiences with clinical audits or surgical safety checklists?

If clinical auditing seems overwhelming then I would recommend visiting RCVS Knowledge. There are some fantastic resources to get you started with quality improvement including case examples and a template to plan your audits. 

https://knowledge.rcvs.org.uk/quality-improvement/tools-and-resources/clinical-audit/?&&type=rfst&set=true#cookie-widget

There are many possible reasons for an increase in surgical site infections. This could include a break in surgical asepsis, instrument processing and sterilisation failure, inconsistencies in surgical skin preparation, communication breakdown and owner compliance in post operative care and gaps in staff training and compliance. 

Implications and how to address them

Compromised Surgical Outcomes: Surgical site infections can lead to poor patient outcomes, prolonged recovery, and potential legal and financial ramifications for the clinic. While it is unrealistic and impossible to prevent all SSIs entirely, there are many preventative measures that can be implemented to reduce the risks associated with them. To mitigate these risks:

• surgical staff must ensure strict adherence to aseptic techniques at all times during surgery.
• A surgical safety checklist should be introduced to ensure that key steps in infection control are consistently followed.

Patient and Staff Safety: Both patients and veterinary staff are at risk of cross-contamination if proper hygiene and infection control practices are not followed. Addressing this includes:

• Strict enforcement of PPE use for all surgical staff, including sterile gloves, gowns, and masks.
• Regular hand hygiene protocols before and after patient interactions, especially in the surgical setting.

Equipment Reliability: failures in instrument and equipment reprocessing and  surgical instrument sterilisation can be a direct cause of infection.

• develop and implement clear instrument reprocessing and sterilisation standard operating procedures. 
• routine maintenance and calibration schedules for the autoclave and other sterilisation equipment should be implemented.

Client Confidence and Communication: SSIs can erode client trust in the clinic’s ability to care for their pets safely. To maintain client confidence:

• the practice should maintain transparent communication with clients regarding infection risks, explaining the steps taken to prevent infections. Client information leaflets can be designed and shared.
• be proactive in following up with clients after surgery to monitor healing and provide support to reassure clients and catch infections early.
• implement surveillance strategies such as routine and non routine surgical procedure post operative audits and hand hygiene audits. VetAUDIT is a centralised safe space to access free audit and benchmarking tools. You can share data with the overall aim of generating profession-wide improvements. More information can be found here: https://knowledge.rcvs.org.uk/quality-improvement/tools-and-resources/vetaudit/

Training and Compliance: Staff complacency or lack of up-to-date training contributes to infection risks. To address this:

• implement regular training refreshers, especially for aseptic techniques, hand hygiene and surgical procedures. 
• encourage a culture of accountability, where staff are empowered to report potential lapses in protocol without fear of blame.
• someone with a interest in infection control is vital in driving compliance and implementing training and reviewing programmes.