Quality statement 6: Treatment of surgical site infection

Quality statement

People with a surgical site infection are offered treatment with an antibiotic that covers the likely causative organisms and is selected based on local resistance patterns and the results of microbiological tests.

Rationale

People who develop an infection need to receive the treatment that is most likely to be effective in order to minimise associated morbidity. It is also important that they are not given more treatment than they need, because antibiotic therapy carries risks of adverse reactions, the development of resistant bacteria and Clostridium difficile-associated disease. Taking into account local resistance patterns and the results of microbiological tests will help to ensure that people receive the most appropriate treatment.

Quality measures

Structure

Evidence of local arrangements to ensure that people with a surgical site infection are offered treatment with an antibiotic that covers the likely causative organisms and is selected based on local resistance patterns and the results of microbiological tests.

Data source: Local data collection.

Process

Proportion of surgical site infections for which the person with the infection receives treatment with an antibiotic that covers the likely causative organisms and is selected based on local resistance patterns and the results of microbiological tests.

Numerator – the number in the denominator for which the person with the infection receives treatment with an antibiotic that covers the likely causative organisms and is selected based on local resistance patterns and the results of microbiological tests.

Denominator – the number of surgical site infections.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers ensure that systems are in place (including development of, or access to, a local antibiotic formulary) to offer people with a surgical site infection treatment with an antibiotic that covers the likely causative organisms and is selected based on local resistance patterns and the results of microbiological tests.

Healthcare professionals offer people with a surgical site infection treatment with an antibiotic that covers the likely causative organisms and is selected in accordance with the local antibiotic formulary and based on local resistance patterns and the results of microbiological tests.

Commissioners ensure development of, or access to, a local antibiotic formulary and that they commission services from service providers that can demonstrate that systems are in place to offer people with a surgical site infection treatment with an antibiotic that covers the likely causative organisms and is selected based on local resistance patterns and the results of microbiological tests.

What the quality statement means for patients, service users and carers

People with a surgical site infection are given an antibiotic that has been chosen because it is effective for the microorganisms most likely to have caused the infection. The healthcare team should look at the results of tests carried out on samples from the wound and they should also consider which antibiotics are most likely to work in the area local to the hospital, because the effectiveness of antibiotics can vary from place to place.

Source guidance

  • Surgical site infection (NICE clinical guideline 74), recommendation 1.4.9.

Definitions of terms used in this quality statement

Surgical site infection

The presence of a surgical site infection can be determined using the Surgical Site Infection Surveillance Service (SSISS) definitions in Protocol for the surveillance of surgical site infection: surgical site infection surveillance service, which are modified from those used by the US Centers for Disease Control (CDC). Other measures that are also based on clinical signs and symptoms are available. The term does not include colonisation.

Antibiotics

Antibiotics should be prescribed in accordance with the local antibiotic formulary. An antibiotic formulary is a local policy document produced by a multi-professional team, usually in a hospital trust or commissioning group, combining best evidence and clinical judgement [adapted from NICE clinical guideline 74 – full guideline]. See also the Department of Health's UK five year antimicrobial resistance strategy 2013 to 2018 and Antimicrobial stewardship 'Start smart – then focus': guidance for antimicrobial stewardship in hospitals (England) published by the Department of Health Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI).