WTP8.4 Head and Neck Surgical Site Infections: A Quality Improvement Project

Abstract

Abstract Aim Audit incidence of Surgical Site Infection (SSI) and early post-operative infection in open head and neck surgery in a tertiary centre and identify opportunities for improvement. Method We performed two 6-month audit cycles of rates of post-operative infection in elective open head and neck surgery against national rates. Cycle 1 was from August 2021-January 2022, and Cycle 2 from March-September 2022. Between cycles we introduced a flow-chart antibiotics prophylaxis protocol as an improvement measure and presented findings at a local meeting. Results 172 open head and neck operations were performed in Cycle 1. 7 patients developed SSIs. 169 open head and neck operations were performed in Cycle 2. 6 patients developed SSIs. Cycle 1 included 14 diabetic patients, of whom 7 received prophylactic antibiotics. Cycle 2 included 19 diabetic patients, of whom 16 received prophylactic antibiotics. In Cycle 1, 2 diabetic patients developed early post-operative infections, one of which was an SSI, compared with 0 in Cycle 2. SSI was more likely in patients who had surgical drains placed (8 out of 94 patients with drains, p = 0.008498*) and prophylactic antibiotic practice in this group was inconsistent in both cycles. Conclusion Our tertiary centre had comparable rates of SSI to national standards. We identified low rates of prophylactic antibiotic prescription for patients with diabetes and introduced a prophylaxis protocol which, despite not reaching statistical significance, appears to have improved rates of infection in diabetic patients. Additional changes should be introduced to reduce rates of infection in patients with surgical drains.