A closed-loop audit to assess and improve surgical site infection rates across all surgical specialties

To assess surgical specialty performance against established national data and to assess the impact of a seven-point surgical site infection (SSI) reduction checklist on elective general surgery SSI rates; specifically, SSI rates of <1% following clean procedures and <10% following clean-contaminated surgery.

Retrospective data were collected on selected patients undergoing surgery between July-August 2022. Patient demographics, comorbidities, procedure, indication, SSI management, presence of additional complication and type of SSI were recorded. Follow-up telephone calls (with patient consent) were made to capture any additional SSIs. The reaudit period analysed elective general surgical procedures between May-June 2023, with the same data parameters. A perioperative seven-point checklist was implemented during the reaudit period in elective surgical theatres.

Overall, 955 patients were included in the retrospective review of data. Of these, 138 patients had developed a SSI, yielding a 14.5% SSI rate, and 249 patients were included in general surgery with 45 (18.1%) developing SSIs. A total of 38 additional SSIs were identified after telephone follow-up across all specialties, representing 3.97% of the total number of patients and 22.46% of total SSIs. The completion rate of the seven-point checklist during the reaudit period was 47% (n=100). The SSI rate was 1%, with the one reported case not having a completed checklist.

The results of this audit showed there was scope for improvement to reduce SSIs across specialties. A significant proportion of SSIs required admission to hospital and were only identified after telephone follow-up. The seven-point SSI reduction checklist significantly reduced the SSI rate for elective general surgical procedures.