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Implementing enhanced patient education for surgical site infection prevention in cardiac surgery

24 September 2020
Volume 29 · Issue 17



Photo at Discharge (PaD) is a nurse-led discharge strategy for enhanced wound care information for patients and healthcare providers. The purpose of this study is to describe implementation of PaD in three English cardiac centres.


A prospective, cross-sectional design was used to evaluate implementation fidelity and sustainability of PaD on various geographical settings.


Three out of four hospitals (75%) approached agreed to complete surveys on implementation fidelity. Implementing the IT component took an average of 16 months (range 11–21 months). Across the three sites, 474 nursing staff have received training on PaD. Since implementing, a combined total of 9007 patients have received PaD. A 1-month compliance snapshot indicated mean of 96% (range 92–100%).


PaD requires collaborative working, a change in behaviour and a change to the service. Despite these challenges, fidelity and sustainability scores across the sites were high. The findings from this study may help to increase implementation quality and dissemination of PaD.

Worldwide, it is estimated that for every 16 surgical patients one will experience a surgical site infection (SSI), a healthcare-associated infection that carries an increased risk of morbidity, mortality and contributes to antimicrobial resistance (World Health Organization, 2016). In the UK, the likely cost of managing SSI exceeds £1 billion per annum (updated to 2020 costs) (Frampton, 2010) and institutions are not paid for readmissions of SSI above an agreed threshold of 30 days (NHS Improvement, 2019). Patients with SSI are six times more likely to be readmitted to hospital impacting on all aspects of safety, quality, cost and productivity in health care (Sanger et al, 2014; Shah et al, 2017; Getting It Right First Time, 2019). That the majority of SSI present after discharge (Woelber et al, 2016a; Public Health England, 2019), but patients and carers perceive information for surgical wound care and SSI as of low value (Sanger et al, 2014; Zellmer et al, 2015; Tartari et al, 2017) warrants particular attention. Indeed, across surgical specialities including cardiothoracic surgery there is a clear programme directed by the National Wound Care Strategy Programme's surgical stream to improve the information provided at discharge to patients and carers, as well as for referral pathways if wound concerns arise.

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