A survey of surgical site infection prevention practice in UK vascular surgery

Abstract

Background: Surgical site infections (SSI) have a significant impact on morbidity and mortality within vascular surgery. Despite the publication of several guidelines, there is a lack of consensus regarding the most effective perioperative practice to minimise the incidence of SSI. This study aimed to assess the current practice of SSI prevention among UK vascular surgeons. Methods: An online survey developed using the current National Institute for Health Care and Excellence (NICE), Centers for Disease Control and Prevention (CDC) and World Health Organisation (WHO) SSI prevention guidelines was piloted in a tertiary vascular centre before being distributed by email to the members of the Vascular Society of Great Britain and Ireland. The survey contained 15 question domains across preoperative, perioperative and postoperative phases to establish current SSI prevention practice. The survey was open for 1 month with reminder emails at 2 and 3 weeks. Results: A total of 109 respondents from 47 UK hospitals completed the survey, 90 of which were consultants (82.6%). The median reported SSI rate was 7.5% (IQR 5–10%). Lower limb arterial and major limb amputations were highlighted as the highest risk procedures of SSI. Empirical criteria are used by 67.2% of respondents to diagnose SSI, and over half (52.2%) of surgeons used this alone. Most respondents use alcoholic chlorhexidine gluconate (69.6%) skin preparation and basic wound dressings (67.6%). Around half (52.5%) of respondents reported that they would use negative pressure wound therapy for closed wounds. Formal wound surveillance was not undertaken by 73.7% of respondents. Conclusions: There is little agreement in current guidelines on the best practice to prevent SSI. Unsurprisingly then, clinical practice follows suit and continues to show little consensus on prevention measures used. There also appears to be a disparity in registry level, clinical perception and literature data for SSI rates. Well-designed high-quality trials are needed to provide evidence-based recommendations in this field.