Surgical site infections — where we are at and where to now?

Leading international infection control practitioner and Founder of the new  Surgical Site Infection Prevention Society, a global surgical site infection (SSI) prevention group, Lilian Chiwera* is passionately working towards raising the profile of SSI globally and improving patient safety. Here, she reflects on the progress so far and the path forward.

A lot has changed for the better since Lilian Chiwera, founder of the Surgical Site Infection (SSI) Prevention Society, began her career in infection prevention and control (IPC) in 2009.

Back then, Chiwera watched IPC practitioners work in back-office silos and felt recommendations handed down to frontline staff were sometimes unrealistic.

“I remember being told to isolate infected patients at any cost, but sometimes this was just not practical. Also, research tells us that isolated patients are often tended to less than regular patients, so there were concerns about their wellbeing,” she said.

Since then, Chiwera has seen IPC culture improve and rates of infection plummet, thanks to greater collaboration, mandates and SSI guidelines from the World Health Organisation (WHO), introduced in 2016.

But despite the progress she has witnessed, Chiwera says she will not relent on her tireless mission to eradicate SSIs, not just from her own workplace, but in hospitals around the world.

“In the UK, mandates meant anyone who exceeded certain targets was ‘penalised’. But really, who wants to see any SSIs? I’d rather see them disappear altogether,” she said.

This zero tolerance approach was her motivation for founding the SSI Prevention Society — a group dedicated to driving down SSIs, globally.

Her inspiration was the memories of infected patients she saw forced back into surgery for the second time around and burned out colleagues who should have been scaling back, not ramping up, their workloads. There is also a more personal flavour to Chiwera’s mission. “I feel great empathy towards postpartum mothers who ought to be cherishing the time with their newborns, not healing from the trauma of a post-caesarean SSI,” she said.

Starting from scratch

To garner support for her initiative, Chiwera initially took to social media. She campaigned extensively, highlighting how impactful the WHO’s annual hand hygiene day had been.

“I wanted to demonstrate that if we could see such radical improvements in hand hygiene, just from an awareness raising campaign, then we could achieve similar results with our own work,” she said.

After several months, Chiwera amassed substantial interest and blew her initial expectations.

“I was amazed by how many practitioners seemed to want this as much as I did. There is this myth that surgeons aren’t interested in surveillance, but that couldn’t be further from the truth,” she said.

Soliciting advice from her professional network, Chiwera then created an abstract, which she presented at the UK Infection Prevention Society conference last year. Delegates loved her proposal and from there the project picked up momentum.

With international interest behind her, she then got in touch with key people from the NHS’s senior leadership. In January this year, she organised the inaugural SSI prevention group meeting. “You said you wanted this, how can we make it work?” she told attendees.

“Even though we already had guidelines and data around IPC, things aren’t being translated fully on the ground. I wanted to get to the heart of why that was and find better solutions,” she said.

Global mission

Among the ideas put forward was an SSI prevention inspection tool that could be used by clinicians all over the world, to ensure IPC best practice.

Additionally, some international project champions that could help drive outcomes in their respective countries and surgical domains.

“Project champions — ie, people on the ground at specific locations or sites — can help us raise awareness on SSI prevention, in ways we have not seen before. This approach was critical to my success in previous endeavours,” Chiwera said.

In pursuit of these project champions, Chiwera and team have been contacting societies from around the globe. They now have an established network of supporters, including the Surgical Infection Society Europe and the Infection Control African Network. “Essentially, every infection control society around the world is now on board with our mission,” she said.

This support, said Chiwera, has been a “game changer”.

“It means we will see difference, not just here in the UK, but in many other countries. It’s a real opportunity for us to raise the profile of SSI prevention and make those tangible changes for patients, everywhere. We already have many SSI guidelines and data, so it’s now time for practical action on the ground,” she said.

Too big to handle

With a year of campaigning now under her belt, Chiwera is still amazed by the level of engagement. In fact, with more than 200 people registering their interest, she has had to pause new intakes, with demand for the project exceeding her current capabilities.

“I’m at the point of having to slow things down and garner additional resources, as my targets have been blown out of the water. It’s fantastic to see so many people passionate about changing the status quo when it comes to SSIs. I now just need a formal, measured approach to taking on the next stage,” she said.

Aside from her tireless campaign work, Chiwera believes the key to amassing this level of support has been her passion and determination.

“I never forget my ‘why’,” she said. “For me, SSI prevention has never been about box ticking, it’s about bringing on the changes our patients and staff need for their wellbeing. I won’t stop until I have achieved the very best outcomes for each and every person that uses the healthcare system.”

Lilian Chiwera* played a key role in setting up and coordinating a successful SSI surveillance service at Guy’s & St Thomas’ NHS Foundation Trust (GSTT) (UK) from 2009–2022. Lilian, a holder of an MSc in Infection Prevention and Control, Diploma of Higher Education in Nursing studies, BSc, has held various roles for the Infection Prevention Society (IPS) society and is a member of Hospital Infection Society (HIS) Guidelines Development Committee.

She is presenting at the upcoming ACIPC (Australian Conference for Infection Prevention and Control) International Conference 2023 — ‘Driving Forward: Embracing Fundamentals and Charting A Path For The Future’ — to be held at the Adelaide Convention Centre and online from 12–15 November 2023.

Image credit: iStockphoto.com/bymuratdeniz