Sorbact Film Dressing Improves Patient Experience

A surgical site infection (SSI) is one of the most common complications of caesarean section (CS) surgery, with an average UK incidence rate of 9.6% and 0.6% recurrence rate ¹ .

It is associated with significant morbidity, increased use of antibiotics, prolonged hospital visits, wound dehiscence (the partial or total separation of previously approximated wound edges due to a failure of wound healing), sepsis (a life-threatening reaction of the body to infection) and occasionally maternal death.

As CS rates continue to increase globally, particularly with growing antimicrobial resistance, the risk posed by SSI will also increase.

In 2021, Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) underwent an internal audit, which showed an overall CS infection rate of 5.1% (the trust acknowledged that this figure could be higher when considering infections, not leading to readmission, that are managed in the community and could not be accounted for).

In response to this, the Maternity Department sought to change their clinical practices to improve outcomes for CS patients. In January 2022 the trust began a 12 month trial of the Leukomed Sorbact dressing.

The rise in caesarean section rates internationally has further increased the importance of preventing surgical site infections (SSI). By switching to Leukomed Sorbact bacteria binding dressings, for all patients undergoing a caesarean section, SSI reduced by 38%, resulting in fewer readmissions to hospital and improving the postnatal experience for patients.

Michael Magro, Consultant Obstetrician and Gynaecologist and Labour Ward Lead,
Barking, Havering and Redbridge University Hospitals NHS Trust

To identify if the use of the Leukomed Sorbact bacteria binding dressings could achieve reductions in the following:

• SSI rate
• SSI related re-admissions (rate/day)
• Antibiotic usage
• Associated system-wide costs.

Leukomed Sorbact is a sterile, single use surgical post-operative film dressing, with bacteria-binding properties, that is applied in the operating theatre at the end of a caesarean section procedure.

The DACC (dialkylcarbamoyl chloride) coating is hydrophobic and allows the dressing to physically bind, inhibit and remove microorganisms commonly responsible for SSIs. Bacteria, fungi, and endotoxins are bound irreversibly and physically removed from the wound upon dressing removal, helping to reduce the bioburden of the wound and promote healing.

A Case for Change was developed specifically for BHRUT, outlining the clinical and financial benefits of switching to the Leukomed Sorbact (LS) dressing.

In January 2022 the Maternity Department replaced non-woven island dressing with Leukomed Sorbact, for all surgical wounds post-caesarean section, regardless of BMI, smoking status, age or any co-morbidities that increase infection risk. The Leukomed Sorbact dressing stayed in place for five days, unless extenuating circumstances required earlier removal. In contrast, the non-woven island dressing would remain in place for 24 hours. No other changes in practice were made other than the new dressing.

A Caesarean Dressing Pathway was developed and signed off ahead of implementation. Essity, the supplier of Leukomed Sorbact, created and implemented a two week training plan to facilitate consistency across all clinical teams in both acute and community. The Quality Improvement (QI) Project was registered with the trust’s Clinical Audit Department and approval was obtained before any data collection took place.

A retrospective audit was conducted for all caesarean sections performed between 1 January 2021 and 12 December 2021, which established the baseline SSI rate to compare the Leukomed Sorbact to. The Clinical Auditors pulled patient reports from the electronic systems and manually filled any gaps in information from patient records. In total 2,436 patients were audited for the pre-implementation period.

SSIs were identified by any clinical notation stating an SSI, or wound infection, had occurred (or was treated for) up to six weeks post-operation. Patients who developed SSIs were identified through readmission episodes, wound swabs, antibiotics use and additional notation on community complications from the final midwife discharge call. This was advantageous for the project as it meant infections managed entirely within the community could also be accounted for, building a more accurate picture of infection rates following caesarean section.

The Leukomed Sorbact dressing was implemented on 12 December 2021, with a three week adjustment period allowing for the trust to become accustomed to the new dressing. A prospective audit was then conducted for CS surgeries performed between 1 January and 12 December 2022. The same methodology employed for the retrospective audit was applied here and in total 2,368 patients were audited for the post-implementation period.

A visual of the clinical care pathway before and after the implementation of Leukomed Sorbact:

• 37.7% SSI reduction rate
• SSI related re-admissions reduced by 29.4% (rate) and 38.8% (days when admitted)
• 30.4% reduction in antibiotic usage.
• £49,750 trust saving (using PLICS data)
• £234,784 saving in associated system-wide costs.

See our Downloads ▼ section for full details of the figures and how they were calculated. 

*Please note that the SSI system figure, referenced from the Jenks et al 2014 study ², has been adjusted to account for the rate of inflation.

As stated in the NICE MTG-55 ³, evidence supports the case for adopting Leukomed Sorbact for closed surgical wounds after Vascular Surgery.

The guidance also states that comments from clinical experts about the benefits of Leukomed Sorbact were positive, noting that it seemed to reduce SSI and was easy to use.

The clinical experts were broadly optimistic that Leukomed Sorbact could be useful for other types of surgery and that more clinical evidence in these areas was encouraged.   

To discuss this case study, and opportunities for your trust to explore using this product, please contact:

References

¹ Magro M: Reducing Surgical Site Infections Post-Caesarean Section – Reducing Surgical Site Infections Post-Caesarean Section | IJWH (dovepress.com)

² PJ Jenks, M. Laurent, S. McQuarry, R. Watkins. (2014) – Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital

³ NICE Guidance: Leukomed Sorbact for Preventing Surgical Site Infections –  Committee discussion | Leukomed Sorbact for preventing surgical site infection | Guidance | NICE