The impact of standardising intra-operative variables on the incidence of surgical site infections in colorectal surgery in Wales

Reeves, Nicola 2021. The impact of standardising intra-operative variables on the incidence of surgical site infections in colorectal surgery in Wales. MD Thesis, Cardiff University. Item availability restricted.

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Abstract

Background and Aims Surgical site infections (SSIs) are infections of the incisional wound made during the operation or an infection within the area/organ space of the operation. SSIs affect up to 40% of patients post-operatively and are a burden both for the patient and the NHS due to resource consumption and cost on average £10,523 per patient. Within Wales, the colorectal SSI rate is unknown. The aim of this thesis was to establish the rate of colorectal SSIs in Wales, to assess the impact of the implementation of an SSI bundle and to investigate the impact of the hypothermia on SSIs. Materials and Methods A national all Wales prospective observational study was conducted to establish the colorectal SSI rate. This led to the development and implementation of an SSI bundle to assess the impact on SSIs. Despite this patient hypothermia was present in over 50% of patients. The HEAT study was designed to evaluate the use of warmed, humidified laparoscopic insufflation on intra-abdominal temperatures and impact on SSI rates. Results The Welsh colorectal and emergency general surgery SSI rate was 13%, with a colorectal SSI rate of 21.1%. The implementation of the SSI bundle reduced the SSI rate in one centre from 24.3% to 10.0%. Despite the bundle, hypothermia was identified as being present in over 50% of the patients. The HEAT study demonstrated that the intra-abdominal temperatures were often lower than the recorded core temperatures, and that SSIs mainly happened in those patients who were hypothermic. Discussion Overall, this thesis has demonstrated that the colorectal SSI rate in Wales could be halved through targeting interventions including an SSI bundle, and warming and humidifying laparoscopic insufflation gas. This is the first all Wales study to define the colorectal SSI rate, but to also demonstrate an evidence-based approach to reducing SSI rates.

Item Type:	Thesis (MD)
Date Type:	Completion
Status:	Unpublished
Schools:	Medicine
Date of First Compliant Deposit:	22 September 2022
Last Modified:	22 Sep 2022 08:21
URI:	https://orca.cardiff.ac.uk/id/eprint/150617

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