PreciSSIon

The PreciSSIon programme focused on colorectal surgery has now closed but you may find the below resources useful. Please note the information on this webpage was correct at the time of publication. A new PreCiSSIon project, focused on reducing the incidence of surgical site infection (SSI) after caesarean birth, launched in October 2022. Read more about our work to prevent SSI.  

PreciSSIon (Preventing Surgical Site Infection across a region) is a multiple award-winning collaborative project to reduce the incidence of surgical site infection after elective colorectal surgery. The project launched in November 2019 and involved all the hospitals in the West of England region.

Surgical site infection (SSI) refers to wound infections following invasive surgical procedures. SSI constitutes a major healthcare burden accounting for 14.5% of all hospital acquired infections in the UK and an estimated 34-226% increase in associated costs. It is also a significant cause of patient morbidity including increased length of stay, readmission, wound dehiscence, hernia, need for intensive care, as well as death. SSI is more common after colorectal surgery where wounds are frequently contaminated by bowel content and rates are reported between 8-30%.

Watch our short film which introduces PreciSSIon.

Impact

PreciSSIon halved SSI after elective colorectal surgery.  Hospitals measured 30-day patient-reported SSI and implemented a 4-point evidence-based care bundle, which by March 2021, had led to approximately 115 patients saved from a SSI, with an estimated regional cost saving of £566,720. Read more about PreciSSIon’s achievements (up to March 2021).

Read our PreciSSIon case study.

In March 2022 the Journal of Hospital Infection published a study by surgeons and trainees who formed part of the PreciSSIon project team. This evidenced the value of SSI bundles to patients and the NHS. Read the journal article.

In September 2022 the Journal of Hospital Infection published PreciSSIon – a collaborative initiative to reduce surgical site infection after elective colorectal surgery. This concluded a care bundle developed in a single hospital can be adopted and spread and the reduction in SSI after elective colorectal surgery can be replicated in other hospitals and deliver results within 18 months.

The existing World Health Organisation (WHO) SSI bundle, which is part of the Surgical Safety Checklist, is routinely used throughout the NHS. It consists of four evidence-based interventions, which have been shown to independently reduce infection. These are:

• antibiotics within 1 hour of surgery
• normothermia – temperature >36 degrees in recovery
• blood glucose control in known diabetics – glucose in normal range in recovery
• appropriate hair removal from the surgical site – using clippers, not wet razors.

The PreciSSIon bundle was developed by reviewing literature for interventions that have been shown to reduce infection other than those included in the WHO bundle. It was introduced at North Bristol NHS Trust in February 2013 and consists of:

• 2% chlorhexidine isopropyl skin preparation for all cases
• use of a dual ring wound protector
• repeat dose of antibiotics after 4 hours operating time
• antibacterial suture for mass closure and skin.

The bundle elements have been further validated by inclusion in the 2016 WHO global guidelines on the prevention of surgical site infection, and more recently in the April 2019 update to NICE guidelines. These interventions are in addition to reliable implementation of the WHO bundle.

More information and resources are available on our webpages below, including the PreciSSIon Implementation Toolkit.