4 Reducing surgical site infections after caesarean using Leukomed Sorbact; a bacteria binding wound dressing

Abstract Aims Surgical Site Infections (SSI) are one of the most common complications after a caesarean with significant morbidity. With rising caesarean section rates internationally, the complications caused by post operative surgical site infections will increase. The Evidence suggests that by using a bacteria binding Leukomed® Sorbact® (Essity) wound dressing to reduce bacterial wound colonisation, SSI rates can be reduced post caesarean. Barking, Havering & Redbridge University Hospitals NHS Trust, London, UK (BHRUT) maternity unit sought implement National Institute for Health and Care Excellence guidelines by using Leukomed Sorbact in all women undergoing a caesarean and with the aim of reducing their SSI rate, SSI readmission rate, antibiotic usage and evaluate any associated cost savings. Methods From 1st January 2022 wound dressings used after caesarean were switched from Mepore® (Molnlycke) to Leukomed Sorbact. No changes were made to wound cleaning products, prophylactic antibiotic use or surgical technique and wound closure technique remained the choice of the individual surgeon. Retrospective and prospective audits were undertaken to compare SSI incidence pre-and-post implementation of the dressing. Results The baseline SSI rate between January–December 2021 was 6.1% and the SSI readmission rate was 1.27%. Comparative data for January–December 2022 showed an SSI rate of 3.8% (38% reduction) and a readmission rate of 0.88% (31% reduction). There was also a 38% reduction in readmission bed days, a 30% reduction in antibiotic use and a reduction in women needing a second procedure or debridement. The reduction in SSI rates was evident across all body mass index (BMI) categories and reductions were seen in women having both elective and emergency caesareans. When readmissions alone were analysed there was a saving of £49 750. Total savings due to the reduction in SSI rates over twelve months were £234 784, or £99.15 per Caesarean, which will be an ongoing saving. Conclusions Childbirth is an extremely special time but delivery, especially by caesarean is not without risks. The development of a SSI not only carries significant morbidity but can affect the mother and baby bonding experience too. Preventing SSIs is a challenge internationally that requires multiple approaches pre, intra and post operatively. The use of Leukomed Sorbact dressings after Caesarean resulted in a clinically significant reduction in surgical site infections, which is all the more impressive given the low initial SSI rate. In addition, there was a reduction in readmission rates and rates of women requiring debridement demonstrating reduced morbidity and an improved patient experience. The reduction in antibiotic usage fits with good antimicrobial stewardship and is an important finding in the current climate of increasing antibiotic resistance. In the UK there is no mandatory reporting on SSI rates after caesarean, making comparisons or benchmarking difficult and consideration should be given to making a national mandatory reporting system.