Introduction

This quality standard covers the prevention and treatment of surgical site infection for adults, children and young people undergoing surgical incisions through the skin, in all healthcare settings. For more information see the scope.

Why this quality standard is needed

Surgical site infection is a type of healthcare-associated infection in which a surgical incision site becomes infected after a surgical procedure. It can cause significant morbidity and mortality if left untreated. Other types of surgery-related infections include postoperative respiratory and urinary tract infections, infections secondary to wound sepsis or medical devices (such as intravascular cannulae), and diarrhoea related to antibiotics (particularly Clostridium difficile-associated disease). Surgical site infections have been shown to account for up to 16% of all of healthcare-associated infections. The rate of surgical site infection varies depending on the type of procedure, with rates of less than 1% for orthopaedic procedures and rates of over 10% for large bowel surgery[1]. Surgical site infections can often be prevented with appropriate care before, during and after surgery. If an infection does develop, appropriate treatment will minimise morbidity resulting from the infection.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measureable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2013/14

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare.

3 Helping people to recover from episodes of ill health or following injury

Overarching indicators

3b Emergency readmissions within 30 days of discharge from hospital*

Improvement areas

Improving outcomes from planned treatments

3.1 Total health gain as assessed by patients for elective procedures

i Hip replacement

ii Knee replacement

iii Groin hernia

iv Varicose veins

Improving recovery from injuries and trauma

3.3 Proportion of people who recover from major trauma

Improving recovery from fragility fractures

3.5 The proportion of patients recovering to their previous levels of mobility/walking ability at

3.5i 30 and

3.5ii 120 days

4 Ensuring that people have a positive experience of care

Overarching indicators

4a Patient experience of primary care

i GP services

ii GP Out of Hours services

4b Patient experience of hospital care

4c Friends and family test

5 Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicators

5a Patient safety incidents reported

5b Safety incidents involving severe harm or death

5c Hospital deaths attributable to problems in care

Improvement areas

Reducing the incidence of avoidable harm

5.2 Incidence of healthcare associated infection (HCAI)

i MRSA bacteraemia

ii Clostridium difficile

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework (PHOF)

Table 2 Public health outcomes framework for England, 2013–2016

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.3 Mortality from causes considered preventable

4.8 Mortality rate from communicable diseases

4.11 Emergency readmissions within 30 days of discharge from hospital

Coordinated services

The quality standard for surgical site infection specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole surgical pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care for the prevention and treatment of surgical site infection.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing high-quality services for the prevention and treatment of surgical site infection are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals and social care and public health practitioners involved in surgery, including surgical site infection prevention and treatment, should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting adults, children and young people having surgery. If appropriate healthcare professionals and social care and public health practitioners should ensure that families and carers are involved in the decision-making process about investigations, treatment and care.