"Silo busting” in the fight against surgical site infections

Hygienists, microbiologists, institutions and companies have been researching and developing measures to combat postoperative wound infections (surgical site infections, SSI) for years. Despite efforts to contain SSI, they remain one of the most common forms of nosocomial infections in Europe. With the aim of slowing down this development, experts from various disciplines are now working even more closely together to break down silos.

“Silo busting” – this term originally comes from business administration. Yet this motto defined the third CEE Conference on Hospital Hygiene and Patient Safety of the Semmelweis foundation, which was held on 12 and 13 March 2019 in Vienna, Austria. Particularly in the health sector, it is crucial to break out of the silo mentality, because communication between different stakeholders, as well as thinking and acting across departments, is of such great importance.

“A company will never develop the best solution by itself, nor will a hygienist or the user develop the best solution alone. Intensive cooperation between the participants, an exchange of ideas and an unbiased approach to challenges is the best opportunity to further improve patient and user protection in the future,” summarised Dr Roland Knieler, Managing Director of Knieler & Team, following the Semmelweis conference.

This is why, only a few days later, on 15 March – the specialist for topics, consulting and innovations when it comes to disinfectants intensified the exchange with colleagues from various disciplines. Participants of the expert round initiated by L&R in Slavkov u Brno, Czech Republic, were Knieler, Professor Axel Kramer from the Institute for Hygiene and Environmental Medicine of the University Medical Centre Greifswald, Thomas Menitz, COO and Senior Executive Vice President of L&R, and Tina Leeb, Head of the division department within the R&D that focuses microbiology. Together they discussed how postoperative wound infections can be avoided.

Innovative treatment of surgical site infections

Such an interdisciplinary exchange can save lives. Surgical site infections are one of the most common types of nosocomial infections in Germany, currently at 22.4 per cent.1,2 This is not only due to the increasing resistance of pathogens to antibiotics3. Hygiene deficiencies are also responsible.2

Innovation in the realm of surface and hand disinfection helps to increase convenience and compliance at the same time, as Knieler made clear. “In surface disinfection, the biggest change is certainly the switch to ready-to-use systems. In other words, wipes that are pre-moistened and no longer need to be prepared by staff. This represents a high degree of safety.” And there are also other effective developments in hand disinfection that have resulted from the close exchange between users and manufacturers: coloured dispensers at the point of care and discontinuing the use of residual active ingredients

Creating consensus in antiseptics and establishing standards

A further aspect in the fight against SSI and antibiotic resistance was presented by the specialist for hygiene and environmental medicine, Professor Dr med. Axel Kramer, to his colleagues in the expert panel. In 2018, he chaired an international committee of experts who dealt with the advantages of modern wound antiseptics in the “Update of the Expert Consensus on Wound Antiseptics 2018”.

All steps to avoid SSI can only be effective if they are consistently implemented. “In order to improve compliance, it has proven effective to combine particularly important measures into a package of measures, to train people in using these, and to monitor compliance through self-monitoring using a checklist,” Kramer explained. “It is important that the Surgical Care Bundle measures are evidence-based, highly effective, easy to implement and easy to monitor,” he continued.

Looking at the big picture

In the spirit of “silo busting”, Kramer advocated interdisciplinary cooperation “not only between clinical and theoretical disciplines. We must also involve the manufacturers, because sometimes very small ideas can lead to a revolution in implementation.” For this reason, Thomas Menitz, COO and Senior Executive Vice President of L&R, also participated in the discussion. “Our product portfolio makes an important contribution to reducing infections. But in the long run, thinking and acting in terms of hygiene and hygiene measures must also change,” Menitz emphasised.

Tina Leeb, Head of the division department within the R&D that focuses on microbiology is working on further developing L&R’s product solution outcomes. She is trying to close the gap between research and application. “Exchange and cooperation is the buzzword. If you focus too much on one area, you lose sight of other important things. I think it’s really great to have an interdisciplinary team at your disposal to really be able to look at the big picture.”

After all, a change of perspective can have a great effect. Instead of looking at just one discipline, a silo, the system should be seen as a whole. At the centre of this system is the patient and the expert’s creative drive – this was agreed on by all of the panel participants.

Further information

  1. Deutsche Nationale Punkt-Prävalenzstudie zu nosokomialen Infektionen und Antibiotika Anwendung 2016
  2. Infektionsschutz und Umsetzung der KRINKO-Empfehlungen, Antwort der Bundesregierung
  3. Nosokomiale Infektionen und Antibiotika-Anwendung. Zweite nationale Prävalenzstudie in Deutschland. , Behnke M, Hansen S, Leistner R et al; Dtsch Arztebl, 2013
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