Title: Understanding and Preventing Surgical Site Infection following Surgery for Hand Trauma
Funder: Department of Health and Social Care

Abstract: BackgroundThe hand and wrist are important for social, occupational and recreational activities. Hand and wrist injuries account for 1-in-5 A&E attendances, an incidence of over 5 million injuries/year and 250,000 operations/year in the UK. Hand trauma, which includes fractures of the hand and wrist bones, nerve injuries, tendon injuries and traumatic amputations, can cause significant short and long-term morbidity. Emergency surgery to repair the damage is key in maximising the chances of restoring function, allowing people to return to work and independence. Surgical site infection (SSI) in hand trauma surgery can result in additional significant morbidity, further emergency surgery, prolonged hospital stay and even amputation. Antimicrobial sutures might reduce SSI risk according to studies in abdominal surgery, but this cannot be extrapolated to hand trauma surgery, as the patients and clinical pathway are very different. Further investigation of antimicrobial sutures is warranted. AimTo undertake high quality research into the risk of SSI in hand trauma surgery and to establish the feasibility of running interventional trials to moderate it. Objectives To estimate the risk of SSI following hand trauma surgery To assess the feasibility and acceptability of conducting a RCT of antimicrobial sutures versus standard sutures in patients undergoing hand trauma surgery.MethodsThis DRF will build onto an established DPhil research package: Workstream 0 (pre-DRF): Systematic review of SSI risk HES analysis SSI risk in secondary care Workstream 1: CPRD analysis - risk of SSI in primary care data Workstream 2: feasibility RCT of antimicrobial suturesFor Workstream 1, I will perform an analysis of routinely collected primary care data to assess the risk of SSI following hand trauma surgery. Workstreams 0 and 1 will provide a comprehensive and accurate risk of SSI following hand trauma surgery. Workstream 2 is a multi-centre randomised feasibility study of antimicrobial sutures in hand trauma surgery, to determine the practicality of conducting a definitive trial. I will include 116 participants across three hand trauma units in England. TrainingI have designed a bespoke research training programme that complements both of these workstreams and will build a specific methodological skill set. This will enable my progression to an independent researcher, specialising in clinical trials in trauma. Anticipated impact and dissemination This research package will provide reliable risk data for SSI following hand trauma surgery that clinicians can use to inform and manage NHS hand trauma patients. The feasibility study results will inform both a definitive trial of antimicrobial sutures, and other future trials in hand trauma. Outputs will be shared with the medical community, national societies and charities. I will expand the impact and dissemination of my results through my central position on key trauma research committees. I will disseminate results to the UK Trauma PPI Group and the project-specific PPI group, who will guide the presentation and sharing of results. I will disseminate results via social media, using a bespoke Twitter handle to maximise international engagement.

Lay abstract: Background Hand and wrist injuries, also known as 'hand trauma', account for 1-in-5 A&E attendances and affect five million people in the UK every year. Hand trauma can be very severe, including cuts to major nerves and blood vessels, broken bones or even amputation of a finger or hand. This has a big impact on people's lives, as hand and wrist are important in daily life and for earning a living. About 250,000 people need surgery for their injury. The risk of infection after surgery is unknown but may be as high as 1-in-5. Infection after hand surgery causes major problems, including more antibiotics, more operations and re-admission to hospital. In the worst cases, infection leads to complete loss of use of the hand - surgeons have even had to amputate infected hands to save the person's life. Specially coated stitches, known as 'antimicrobial stitches' could reduce infection risk by killing bacteria after surgery. Preventing infection would improve recovery and return to normal life. I am exploring infection risk currently during my PhD. I now need to get more detail on infection risk from GPs. I then want to test these antimicrobial stitches with a clinical trial in the NHS.Aims To work out how many people see their GP with a surgical wound infection after hand trauma surgery. To do a 'small-scale' study looking at antimicrobial stitches in hand trauma surgeryMethods I will look at data that GPs routinely collect from patients. This will tell me how many hand trauma patients see their GP for wound infection. Building on previous projects, this will enable me to work out a very accurate risk of infection, which will help us inform and treat hand trauma patients.I will then conduct a small-scale study looking at antimicrobial stitches. In this study, people with hand trauma from three hospitals in England will be allocated, completely by chance, into two groups. One group will get antimicrobial stitches during their surgery and one group will get normal stitches. I will then collect data on how well the study processes worked and how many people took part. This is crucial in running a full-scale study to test whether these stitches reduce infection risk. The study will be completely paper-less, improving sustainability and to reduce hospital visits for participants. This is important regarding future pandemics. To improve diversity, equality and inclusion, I will review those who could not take part in the study, so I can develop strategies to make sure they can be involved in the full-scale study.Patient and public involvement (PPI) The UK Trauma PPI Group helped design this work. From this group, I recruited six people for a project-specific PPI group session. Together, we made sure that this research met the expectations of NHS users. This included increasing how often we contact participants. Going forward, we will meet twice a year to review study progress, discuss research topics and to work on how to raise the importance of hand trauma in the wider public. Two PPI representatives are on my research steering group, both with experience of hand trauma. All study participants will be invited to join a Hand Trauma PPI network.Sharing results I will present results to PPI representatives, at national conferences and will publish them in medical journals. I will work with PPI representatives to develop content for wider circulation, including via social media. I will create a bespoke Twitter handle for the project to maximise online engagement. My results will also be distributed through societies and charities, including the national societies for hand and wrist surgery.

Research activity codes: 6.4 SURGERY
Health categories: INFECTION;MUSCULOSKELETAL