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Pilot study to prevent surgical site infections and tackle AMR begins at UK hospital

A pilot study examining the benefits of nasal photodisinfection for the prevention of surgical site infections is being trialled at a UK hospital.

The six-month pilot at Pontefract Hospital has begun to make use of nasal decolonisation using Ondine Biomedical’s Steriwave nasal photodisinfection for 500 elective hip and knee surgery patients, prior to their surgery in an effort to reduce the incidence of surgical site infections.

Steriwave is a broad-spectrum antimicrobial providing targeted decolonisation safely, effectively and quickly. Nasal photodisinfection uses a proprietary light-activated agent to rapidly destroy pathogens that can lead to surgical site infections. It targets the bacterial biofilm as well as viruses, yeasts and fungi, but does not lead to resistance due to the speed of the treatment. Moreover, the technique does not harm human tissue.

Dr Stuart Bond, consultant antimicrobial pharmacist and director of innovation at Mid Yorkshire Teaching NHS Trust, commented: ‘We are very pleased to be the first NHS trust in the UK to pilot this exciting, non-antibiotic method of preventing infections after surgery. Although infections after hip and knee surgeries are rare, we know that they lengthen patients’ stay in hospital, complicate the recovery process and cause significant pain and suffering. We look forward to sharing the results of the Steriwave pilot in due course.‘

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A patient with a surgical site infection will spend an average of seven to 11 days more in hospital, significantly increasing costs and lengthening patients’ recovery. Nasal mupirocin, an antibiotic, is usually used for nasal decolonisation, however, there are serious concerns about its antimicrobial resistance rates which have been reported as high as 81%.

Nasal photodisinfection for SSI prevention

The method is already in use at a number of hospitals across Canada and has demonstrated significant improvement in post-surgical outcomes including reduced patient length of stay, fewer readmissions, and lower rates of antibiotic prescribing as a result of nasal photodisinfection.

A study presented at the Prevention Society Conference 2022 examined the role of antimicrobial nasal decolonisation in combination with 2% chlorhexidine gluconate body wash cloths as standard pre-surgical practice. In this retrospective analysis, researchers compared the level of surgical site infections (SSIs), in those with and without nasal decolonisation.

The results showed that the proportion of patients who developed SSIs was approximately half among those who received the nasal decolonisation (0.8% vs 1.5%, p < 0.001). But nasal decolonisation also offered other advantages such as a significant reduction in mortality (p < 0.001) and the mean number of days in hospital (p < 0.001).

Lower rates of infection have also been demonstrated in patients undergoing high risk surgery. In one such study focusing on instrumented spine surgery, vascular, cardiothoracic and ortho-trauma, the SSI rate for spine cases decreased from 7.2% to 1.6%.