Practical Guide to Reducing Surgical Site Infections

The conference gave a valuable opportunity to discuss the NICE guidance and best practice in measures to reduce the risk of contracting a surgical site infection.  The role of monitoring and surveillance in managing surgical site infection was important and Jennie Wilson gave a presentation outlining the work of the Health Protection Agency in supporting surveillance through the Surgical Site Surveillance Programme.


In financial terms the monetary costs associated with contracting a surgical site infection varied ranging from £3,168 - £6,103 per patient.  Deep organ space infections had a significantly higher mortality rate when compared to patients who did not contract an infection with vascular surgery patients showing an odds ratio of between 3.0 - 15.4 when assessing the statistics. 


Real time reporting will be available on the Health Protection Agency web-based system and Trusts will be able to flag up early warning systems if rates appear to be showing an increasing trend, which may be used to conduct route cause analyses and review practice.


Surgical Site Infections account for 14% of healthcare infections and are an important cause of morbidity and increased cost of care.  The Surgical Site Infection Surveillance System (SSISS) provides a mechanism of benchmarking rates of surgical site infections in 14 categories of procedure.  Benchmarking needs to be enhanced by developing a standard approach to surveillance, so hospitals can compare their rates over time, and with others to inform clinical practice.  Between 2002 and 2007 SSISS collected data on more than 260,000 operations.  There is considerable variation in rates of Surgical Site Infections between hospitals.  Reductions in rates have been observed in hospitals participating in SSISS.  There is evidence for key interventions that minimise the risk of Surgical Site Infections, including surveillance and feedback of rates, and the NICE guideline on preventing Surgical Site Infections has been published this year.


Derek Butler gave a presentation outlining the importance of the NICE guideline and the Saving Lives care bundle for reducing surgical site infection.  The presentation followed a case study of a patient who had acquired a surgical site infection and the impact this had on the patient and her family.


The presentation highlighted how communicating with teams in the Primary and Acute setting, and with the patient is essential if we are to reduce the risks of contracting an infection when undergoing surgery.  The case study outlined just how critical communication is.  The presentation also highlighted how training and observation in aseptic non-touch technique play a pivotal role in reducing Surgical Site Infection.  Having the systems in place to support this through peer review can help teams achieve optimum performance and reduce risks.  Screening and surveillance play a significant role in helping to mitigate the risks from Surgical Site Infection, publishing results can help in performance management and provide an open approach to patients and the public too.



Conference participants were asked their top three tips for avoiding Surgical Site Infection.  MRSA Action UK's top three tips for reducing the risks of contracting Surgical Site Infection:


1.  Clinical staff must be skilled at aseptic non-touch technique and apply it assiduously every time.  Aseptic Non-Touch Techniques are paramount in reducing the risk of surgical site infection.  Not all pathogenic organisms are removed by hand washing.  Non touch of key components directly or indirectly is the single most important part of achieving asepsis.  This forms part of a systematic approach needed in infection prevention and can significantly reduce the incidence of surgical site infections and bacteraemia - particularly in the handling of indwelling devices.  Aseptic non-touch technique only works if:

  • All staff are trained well in it
  • Staff monitor the procedure - tell your colleagues if they are not following the principles of aseptic non-touch technique, use observation to look at how other clinical teams perform using peer review


2.  Information for Patients.  Patients and carers should receive clear and consistent messages about the risks and management of surgical site infections and what measures are being undertaken to reduce them throughout their patient journey.  Patients and carers should be given information to help them recognise a surgical site infection and who to contact if they are concerned.


Integrated Care Pathways for healthcare infections should be used to help to communicate this information to patients and all those involved in their care post-discharge.  We recommend the approach adopted by the Lincolnshire Care Pathway Project for passing information on before admission and post-discharge.  The MRSA Pictorial Care Pathway gives clear information for patients.


3.  Using data for performance management.  Each clinical team should record incidence of Surgical Site Infections, with the aim of reducing to zero - using route cause analysis to identify ways of learning and prevention.  Publish and discuss the results with the team and make information accessible for patients.


The debate and conference consensus:


Top tip priority by percentage overall


Staff education and training


Early detection and intervention


Cleanliness and hand hygiene (staff and patients)


Staffing levels and resources


Antibiotic prescribing and use




Other - including relationship with higher bed occupancy rates, no greater than 82% being a recognised standard; pre-operative screening; leadership and governance also featured



If you or someone you care about has been affected by a healthcare infection and you wish to discuss this with us, please contact us at