Investigating opportunities to improve surgical site infection prevention through social and technological innovation

Background Surgical site infections (SSIs) are a common cause of morbidity and mortality and pose a significant problem for patients, health systems, and society. There is a wealth of literature on SSI prevention interventions, yet SSIs remain a problem. Surveillance of SSI rates on a local and national scale has been shown to be fundamental to reducing rates and improving patient safety. The national surveillance program for SSI rates in England is focused mostly on orthopaedic SSIs and in-hospital surveillance, and data collection is done manually despite advances in automation. Aims This thesis aims to address four key research questions emerging around SSI prevention through surveillance at the interface of two concepts: social innovation and technological innovation. Four questions arising from gaps in the literature are 1) which surgery types should be targeted for SSI surveillance, 2) what are healthcare workers’ perceptions and beliefs about SSI prevention and surveillance, 3) how can technology enhance SSI surveillance, and 4) how can post-discharge SSI surveillance be improved? Study design Quantitative methods were used to synthesise data on SSI risk, burden, cost, and national reporting requirements in different surgery types in England to inform decisions on how to prioritise surveillance. To better understand perceptions and drivers of SSI prevention and surveillance practices, qualitative interviews with staff stakeholders at a large London NHS Trust were analysed thematically. A mixed-methods case study used quantitative validation of a semi-automated in-hospital surveillance algorithm and qualitative workshops with staff to explore barriers and facilitators to implementation. The final studies used a realist review and patient focus groups to assess post-discharge surveillance methods. Results Current practices for SSI surveillance do not match the medical or economic burden posed by SSIs in different surgical categories. The highest contributors of SSIs in England are large bowel surgery and caesarean section, which are under voluntary surveillance or no national surveillance respectively. Differences in the perceived responsibility for SSI prevention (whole team and patients) versus accountability for rates (consultant surgeons) create tensions in the team, but surveillance can help stimulate engagement. Electronic systems to improve SSI surveillance are a promising and obvious solution to chronic resource problems, but poor technological infrastructure and difficulties proving their cost-effectiveness prevent a universal solution. Patients are often required to contribute to post-discharge surveillance of SSIs but need to see this task as useful and easy. Conclusion Improvements in technological infrastructure in the NHS would facilitate enhanced SSI surveillance, while top-down encouragement from national bodies and hospital managers to broaden surveillance could provide the social support needed to re-prioritise surveillance. On a local level, team accountability of SSI rates could precipitate social change by facilitating stakeholder engagement.Open Acces