Authors (including presenting author) :
Pang SY(1), To SH(1), Leung YP(1), Sezto SMR(1), Ng ML(1), Chan MKC(1), Kwong PS(2), Ng LK(1) (2), Hui SKE(1)
Affiliation :
(1)Department of Surgery, (2)Department of Anesthetist & Operating Theater, Ruttonjee & Tang Siu King Hospitals (RTSKH).
Introduction :
Elective colon surgery continues to have the highest SSI rate among all elective surgical procedures. SSI has proven to be very costly in addition to the attendant patient morbidity. In RTSKH, SSI rate (10–12%) of colectomy from 2014-2017 was found slightly higher in comparing with Hospital Authority overall result of 9%. The WCT, in collaboration with colorectal surgeons, has initiated an EBN program by the use of silver dressings on abdominal incisions for colectomy in the period of 2018-2019. The program is used to validate the effectiveness of anti-microbial silver-containing dressings in the prevention of SSI.
Objectives :
1. Analysis & weigh the assembled evidences on silver dressings for SSI prevention by a systematic search; 2. By using the avaliable evidences, develop & implement an effective EBN program to lower the SSI rate for patients undergone colectomy; 3. Advocate advanced wound management in surgical department of RTSKH.
Methodology :
Methodology:
Phase I (Integrative Review of evidences by PICO model & CAT method):
-One meta analysis included 4 RCT demonstrated the effect of silver dressings in inhibiting the growth of bacteria and decreasing SSI occurrence among patients with colectomy done.
Phase II (Interventions):
-Get approval from senior management of the EBN program.
-Apply the silver foam dressing protocol for all elective colectomy immediate post-op.
-Initiate the change in practice by WCT include nurses & doctors briefings on application of dressing & related cares.
-Monitor SSI rate by hospital Infection Control Team (ICT) as usual. -Follow Up patients in wound clinic & report for any suspected SSI to colorectal surgeon.
-Review SSI rate by WCT in every 3 months through patient records & ICT database retrospectively.
-Sharing the progress & findings in every 3 months in routine meetings. Evaluation:
-Compare the SSI rate with the rate of previous 18 months.
-Results is presented in 2 x 2 table.
Result & Outcome :
From 1 January 2018 to 30 June 2019 (18 months), total 93 nos. of post-colectomy patients used silver dressing. There were 6 incidence of SSI recorded (6.45%). On the other hands, there were 10 incidence of SSI among 98 nos. of patients without the use of silver dressing in the previous 18 months (10.2%). (RR 0.64, ARR 0.0375, NNT 26.67, 95% CI 0.2-1.6). Those patient with silver dressing used have 0.64 times the risk of SSI compared to those do not use silver dressing. SSI rate reduced from 10.2% to 6.45% & the ARR is 0.0375. It reflected the low probability of getting SSI when using silver dressing after colectomy. NNT is 26.67 which represented the 27th patient will get SSI when using silver dressing.95%CI is 0.2-1.6 which indicated the study is not precise enough as small sample size. In conclusion, an evidence-based team approach toward advanced wound management created a comprehensive guide to anchor the change of nursing practice. Finally, this modification of practice has been consolidated in Department of Surgery of RTSKH. Application of this standardized approach across our organization may improve consistency and better patient outcomes.
