The development, implementation and evaluation of a cross organisational clinical guideline for the management and prevention of wound infection

Abstract

BackgroundThe Tissue Viability services in acute and primary care in Leeds had concerns about the increasing inappropriate use of topical antiseptic dressings for wound management and were aware that the use was disproportionate to the evidence supporting their prescribing. A scoping exercise of the use of topical antiseptics and systemic antibiotic usage in Leeds led to the identification of heterogeneous prescribing of systemic antibiotics and an almost £500,000 spend on topical antiseptics across Leeds community. MethodsThe project involved the following stages.1Local scoping of topical antiseptics and systemic antibiotic prescribing.2A cross organisational working group to develop and implement a clinical best practice guideline for the prevention, diagnosis and management of wound infection.3Development of a revised local dressings formulary.4The establishment of a new referral process to Tissue Viability for wounds requiring topical antiseptic treatments.5Evaluation of the new guideline through -monitoring prescribing-monitoring wound sampling-monitoring A & E admissions-collecting patient feedback through the ‘Tell Tissue Viability’ process. Results•Expenditure on topical antiseptic dressings for the period Oct 2009–Dec 2009 was £128,864 and this reduced to £65,604 for the period Nov 2011–Jan 2012. This demonstrates an overall saving of £63,260 with a projected annual saving of £237,584 within the community trust alone.•A reduction in the number of wound swabs sent to microbiology from inpatient locations by 1500/year comparing 2008/9 with 2010/11.•An increase in wound swabs sent from GPs by 100/year comparing 2008/9 with 2010/11.•A reduction in penicillin V and co-fluampicil prescriptions and an increase in flucloxacillin prescriptions in general practise suggesting greater concordance with local antibiotic prescribing recommendations. ConclusionThe implementation of a clinical guideline in association with support from the specialist team, for patients requiring topical antiseptics has resulted in a reduction in the inappropriate use of topical antiseptics in hospital and community. Wound sampling practises and prescribing practises have changed. No apparent increased risk for patients has been identified but it has not been easy to obtain details about admission to Accident and Emergency with cellulitis and optimising surveillance remains a challenge for the future.