Helping NHS trusts see the value in reducing surgical site infections

By lowering the risk of surgical site infections (1), Ethicon’s Plus Sutures may be able to help the National Health Service at a time of unprecedented pressure.

On 28 June 2021, the National Institute for Health and Care Excellence (NICE) issued new medical technologies guidance (MTG) recommending the use of Ethicon Plus Sutures in all surgeries when absorbable sutures are an appropriate option within the National Health Service (NHS) (1). By lowering the risk of SSIs1, Plus Sutures may help the NHS to manage its hospital bed capacity and cope with the significant backlog of elective surgeries postponed during the Covid-19 pandemic which has served to disrupt routine hospital services globally (2).

Surgical site infections (SSIs), which account for 37 per cent of all hospital-acquired infections in surgical patients (3,4), cause significant clinical and economic burden (2). While SSIs can lead to an additional 10 days in hospital (5), reducing the risk of SSIs can release beds, save costs (1) and allow for extra procedures to be performed. Data shows that 40-60 per cent of SSIs may be preventable (3,4) and clinical data, comprising of 31 randomised controlled trials, as well as the NICE MTG meta-analyses, showed that Plus Sutures is associated with a nearly 30 per cent reduction in the risk of surgical site infection (1).

Dimitri Pournaras, Upper Gastrointestinal, Bariatric and Metabolic Surgeon, North Bristol NHS Trust , said: “Reducing SSIs is crucial for our patients, the multidisciplinary team looking after them, hospitals, and healthcare systems. In the provision of surgical care each procedure needs to be as efficient as possible. Using the resources and technology available to reduce SSIs, we can improve patient outcomes and reduce the burden of SSI to the NHS, society and our environment.”

The use of triclosan-coated sutures in wound closure as part of SSI-prevention is recommended by a growing number of health authorities around the world (6-10) with NICE stating that Plus Sutures is cost saving compared with non-triclosan absorbable sutures by an average of £13.62 per patient (1).

NICE also acknowledged the use of Plus Sutures can result in environmental benefits by preventing SSIs (1). Environmental savings were based on the NHS England Sustainable Care Pathways Guidance and included greenhouse gas emissions, freshwater use, and waste generation (1).

1. NICE 2021. Medical Technology Guidance: Plus Sutures for Preventing Surgical Site Infection. Available from: Accessed August 2021.
2. COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. June 2020. 107:11:1440-1449.
3. World Health Organization. Safe surgery saves lifes. WHO Guidelines for Safe Surgery 2009. (162120-201208)
4. Odom-Forren, Preventing Surgical Site Infections. Nursing 2009; 36: 58-63. (162120-201208)
5. Jenks PJ, Laurent M, McQuarry S, Watkins R et al. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infec 2014; 86: 24-33.
6. Berrios-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-791. (156562-201021)
7. Ban KA, Minei JP, Laronga C, et al. American college of surgeons and surgical infection society: surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017; 224(1):59-74. (156562-201021)
8. NICE Guideline Updates Team (UK). Surgical site infection: prevention and treatment. NICE website. Accessed Nov 16, 2020. (156562-201021)
9. World Health Organization. Global guidelines for the prevention of surgical site infection. Published November 2016. Accessed Nov 16, 2020. (156562-201021)
10. Prevention of postoperative wound infections. Recommendation of the Committee for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. Bundesgesundheitsbl. 2018;61(4):448-473. (156562-201021)

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