CURRENT PLEDGES: 216883
Shared Learning 2025 – Infection Prevention and Control
Organisation
Gloucestershire Royal Hospital
Project title: Single Dose vs Extended Antibiotic Prophylaxis after Non-instrumented Lumbar Spine Disc and Degenerative Decompression Surgery
Project Overview
Introduction: Antibiotic prophylaxis in spinal surgery is crucial for preventing post-operative infections, which can lead to significant morbidity and mortality(1). However, we must balance this with antibiotic stewardship and cost control(2). The North American Spine Society (NASS) recommends a single dose at induction (3), but the UK lacks standard guidelines, leading to variations in practice (4). This study compares surgical site infection (SSI) rates in patients receiving a single preoperative dose versus extended postoperative antibiotics.
Method: We retrospectively reviewed patients undergoing lumbar decompression and/or discectomy between 01/11/2022 and 30/06/2024 in our unit. Exclusion criteria included instrumentation, non-degenerative or disc causes, and intraoperative complications. SSI rates, length of stay (LOS), and demographics were compared using Chi-squared and Student’s T tests.
Results: Of 71 patients, 24 received one preoperative dose, while 47 also received three doses of postoperative antibiotics. There was no significant difference in SSI rates (X²=0.15, p=0.70). The single-dose group had one superficial infection, and the extended group had three infections, with one deep infection requiring a washout. There was a non-significant difference in LOS (t=1.55, p=0.13) with the single-dose group staying in for a shorter period (1.21 days vs. 3.00 days). Of note the extended group was significantly older (p=0.017, 50.85 years vs. 42 years) but had no significant difference in rates of cardiovascular disease or diabetes mellitus.
Impact on tackling AMR
- We demonstrated a single-dose antibiotic regimen is non-inferior to extended prophylaxis in preventing SSIs for uncomplicated lumbar spine surgery and results in an insignificantly shorter LOS. Induction-only antibiotics are appropriate for such procedures in patients without significant risk factors.
- This finding will impact our local antibiotic protocol where we will provide a patient risk stratification protocol to guide our spinal surgeons on when to prescribe extended post operative Antibiotic.
- Our hope is that this will help influence Spinal Surgeons nationally and potentially lead to a national guideline regarding Antibiotic protocols.
Future Development
We aim to re-evaluate our SSI rate for these procedures once we have changed our Antibiotic protocol within our trust. As mentioned, we hope to take this project to the British Association of Spinal Surgeons to try and encourage a change nationally regarding Antibiotic prophylaxis in uncomplicated and uninstrumented spinal surgery.
Organisation
Nakaseke General Hospital
Project title: Improving Infection Prevention and Control in Nakaseke Through Engagement of the Under Looked Categories of People.
Project Overview
Nakaseke General Hospital (NGH) is one of hub facilities supported by the project “Center of Excellence for Antimicrobial Stewardship in Central Uganda” under the Commonwealth Partnership for Antimicrobial Stewardship (CwPAMS) phase 2 in Uganda. Following an extensive 2-year capacity building program on Antimicrobial Stewardship (AMS), the AMS committee of NGH resolved to address issues pertaining to infection prevention and control during the commemoration of the World Antimicrobial Awareness Week (WAAW) in 2024. These activities focused on increasing awareness amongst under looked categories of people in Nakaseke town council, namely; the hospital cleaners and the food vendors. The committee members started by performing workplace inspections of these various categories of people to identify the various gaps the may contribute to antimicrobial resistance within the community.
Some of the gaps identified amongst cleaners included; over dilution of the cleaning detergents, use of the same squeezer for the patient wards and the lavatories, irregular cleaning of wards on weekends, not changing the cleaning aprons after work, improper medical waste segregation and irregular orientation of new cleaners on cleaning procedures. Amongst the hospital food vendors, it was observed that proper waste management was missing, inconsistent use of aprons and scarfs, absence of enough handwashing requirements, use of polythene bags to cook local plantain (matooke), poor cleaning procedures for utensils and sourcing for beef from unauthorized butchers.
Following these inspections, engagement meetings were held between the AMS committee, health educator, inspectors and the two groups to share the findings. The findings of the inspection were used as teaching points to educate the participants about AMR and how they can become stewards in fighting it hence protecting the patients and caregivers who utilize the hospital facilities. The cleaners and food vendors were also informed that they too benefit from working in an infection free environment.
Impact on tackling AMR
The 25 cleaners appreciated the importance of waste segregation and management and pledged to always follow the stipulated Standard Operating Procedures for mixing detergents and cleaning of the patient wards and lavatories. The health workers too shall be reminded of the need to do proper waste segregation on the wards. They raised issue of being undermined by the patients with statements such as; “if we don’t make the environment, where will you work and earn a living?” A resolution was adopted to make internal MEMO posters to acknowledge the contribution that cleaners have in the fight against infections within the hospital. A comprehensive orientation and mentorship program shall be given to new cleaners especially for the highly sensitive units like the kitchen, main operating theatre and patient wards. It was made mandatory the no cleaner shall return to their homes dressed in the aprons used for hospital cleaning. The contractor for the cleaning service shall provide at least two squeezers for each cleaner.
The 15 food vendors at the hospital entrance vowed to see to it that they source for beef from authorized butchers, adhere onto proper hand washing and cleaning of utensils. The head of the food vendors promised to follow up on the dressing code (apron and scarf). The use and re-use of polythene bags/ papers to cook plantain was abolished amongst the vendors.
The health educator and inspector of Nakaseke town council pledged to do more frequent visits to follow up on the progress of the resolutions made, they also promised to follow up with the town clerk for more frequent collection of garbage from the hospital kiosks in order to minimize on the spread on infections.
Future Development
Come the year 2025, the AMS committee of Nakaseke General Hospital intends to;
1. Bimonthly inspection of the cleaners and food vendors to monitor improvement in infection prevention and control. This will be done in collaboration with the health educators and inspectors of the town council.
2. Expand the coverage and include the boda boda (motorcycle) riders and student leaders in the two nearby senior secondary schools (Nakaseke International College and Mazzolid). The leaders of these groups will be trained to become AMS champions such that they can spread the message of infection prevention to their colleagues. Reflector jackets, posters and flyers bearing various AMS messages will be given to these participants.
3. Air out IPC sensitization messages on the local public address systems within Nakaseke town council to target the traders and the general community.
4. Collaborate with leadership of Semuto and Ngoma Health Centre IV’s to plan similar sensitization meetings in their respective town councils to further spread the message of “prevention is better than cure.”
5. Conduct AMS/IPC workshops for the newly recruited community health extension workers in Nakaseke district.
As the AMS subcommittee of Nakaseke General Hospital, we believe that blocking the chances of infection spread amongst the under looked categories of people like the cleaners and food vendors can yield great freedom against AMR in our communities.
Organisation
SBUHB
Project title: Digital Wound Management and AMS
Project Overview
The Health IO minuteful Wound Management App was piloted in our district nursing services initially to ensure the wound management was interventions were at a consistent standard that met best practice. The Digital platform provides improved governance and assurances that the user accesses the most up to date dressing formally as it is linked to NICE guidelines, allows senior nurses or TVN to view images remotely and also with microbiology receiving good quality imaging reduce and treat infections appropriately. There has been a strong move towards treating topically and not needing systemic antibiotics in patients and also improved collaborative and education in AMS in the DN teams.
Throughout the process patients were made aware and involved in discussions around the development of digital and collaborative working taking place. Patients are routinely advised when/how images would be used and when collaboration takes place. Empowering the patient to be involved in all aspects of care decisions to provide quality outcomes under the remote guidance of expert clinicians within Microbiology.
Within the SBUHB efforts were made through teaching sessions to improve staff knowledge and skill around:
- Wound infection: identify and differentiate the signs, symptoms of both localised and systemic infection.
- Knowledge around dressing selection: how/when for appropriate prescribing of antimicrobial dressings.
- Wound Culture collection: All SBUHB Community microbiology forms have a sticker applied for easy identification by Microbiology staff
Impact on tackling AMR
Closer collaboration of departments, together with the ability of near real-time viewing of wound images, and access to current nursing records, allows microbiology to construct more informed reports, offering further guidance to the wound management. With the aim of reducing unnecessary wound swabbing, and more importantly, the appropriate use of antibiotics.
This new collaborative working approach integrates stewardship protocols into existing daily workflow, promoting standardisation within SBUHB Community Services. With the aim of ensuring that no matter where your care is delivered a wound will be assessed the same way, sampled the same way, and antibiotics will be prescribed appropriately.
Initially a Swansea Bay collaborative improvement, this has now been agreed as a nationwide service improvement being supported by the Welsh Wound Innovation Centre, the All-Wales Tissue Viability Nurses Forum and Public Health Wales.
Through this work, we are achieving a standardisation of swabbing technique, wound infection assessment.
Future Development
The wound app will be rolled out to other professionals delivering wound care in the Health board to deliver consistency and equity to patients across the Health Board.
With Cluster support are currently piloting the app in Primary care with general practice nurses with the app being used for simple wounds as well as complex we aim to support a reduction in the number of wounds that needing referral on and improved patient education early on in their journey
The team continue to work with the platform provider and microbiology lead support and developing the data extracted from the app to support evaluation. Current data has already evidenced a significant improvement in wound healing time and the ongoing risk of complex infections associated with soft tissue injuries and wounds and support our AMS reduction targets.
The patient management tool for virtual support and education to patients is integral in future development to support AMS.
