Clinical update

Preventing and treating surgical site infections: what nurses need to know

Updated NICE guidance deals with antiseptic skin preparation, antibiotics and wound closure

    Updated NICE guidance deals with antiseptic skin preparation, antibiotics and wound closure


    Picture: Science Photo Library

    Essential facts

    According to the National Institute for Health and Care Excellence (NICE), surgical site infections (SSIs) comprise up to 20% of all healthcare-associated infections.

    At least 5% of patients having a surgical procedure will develop an SSI, yet most are preventable, says NICE.

    Infections range in severity from a limited wound discharge, happening within seven to ten days of an operation, to a life-threatening postoperative complication.

    SSIs can significantly affect a patient’s quality of life, causing pain and discomfort, delaying healing and recovery, and potentially extending hospital stay.

    What’s new

    In April, NICE published updated guidance on SSIs, replacing its 2008 document. It details the prevention and treatment of SSI in adults, young people and children who are having a surgical procedure that involves cutting through skin.

    The guidance is intended for healthcare professionals, commissioners and providers, those having surgery and their families and carers, and has several new or updated recommendations.

    These include nasal decolonisation before surgery, which NICE says should be considered based on factors such as procedure type, individual patient risk and the potential effect of infection.

    As patients are allowed home earlier... community staff are particularly important in monitoring for signs of infection, and educating patients on how to care for their wound

    Guidance on antiseptic skin preparation during surgery has also been updated, with a table to inform decisions. Specifically, the guidance warns of the risks of severe chemical injuries with the use of chlorhexidine in preterm babies. Other new recommendations focus on antiseptics and antibiotics before wound closure, alongside methods of closing wounds.

    In addition, NICE includes recommendations on information that should be given to patients and carers; what happens before, during and after surgery; treating SSIs; and specialist wound care services.

    The guidance makes a number of recommendations for further research. These include the clinical and cost-effectiveness of various methods of antiseptic skin preparation, and the effectiveness of nasal decolonisation.


    Use of antibiotics and antiseptics before wound closure features in the updated guidance
    Picture: iStock

    Recommendations for postoperative care remain unchanged since the 2008 guidance was issued. These include using an aseptic non-touch technique for changing or removing surgical wound dressings; using sterile saline for wound cleansing up to 48 hours after surgery; and advising patients they may shower safely 48 hours after surgery.

    Implications for nurses

    Nursing staff caring for patients before, during and after surgery have a key role in advising them about the risks associated with SSIs and how any infection will be managed.

    As patients are allowed home earlier, increased numbers of infections are now being seen in primary care.

    This means community staff are particularly important in monitoring for signs of infection and educating patients on how to care for their wound after discharge, including what to look out for and when to seek help.

    Listening to the patient is vital in assessing potential SSIs, alongside recognising local signs and symptoms, including heat, redness, pain, swelling, green or yellow pus and fever.

    Expert nurse comment

    Rose Gallagher, RCN professional lead for infection prevention and control

    ‘SSI is not just the business of specialist nurses. Nurses will have to manage surgical wounds in many different settings, especially as patients are often only in hospital for a short time.

    ‘In many cases, infection happens outside the hospital ward or clinic. As a result, all nursing staff need to be aware of the signs and symptoms and be able to respond to them at an early stage.

    ‘Clinical assessment skills to determine if an infection is present are vital. We shouldn’t immediately resort to antibiotics without this appropriate assessment. Listen to your patient and if they say their wound doesn’t feel right, take the time to assess.

    ‘But remember, unless there is pus, one lone symptom doesn’t necessarily indicate infection. For example, many wounds may become red as part of the healing process.’

     

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