Understanding and Preventing Surgical Site Infection following Surgery for Hand and Wrist Trauma.

Injuries of the hand and wrist, collectively known as hand trauma, account for 1-in-4 of all injuries that present to A&E and nearly 1-in-5 of overall A&E attendances. Over 5 million injuries occur per year in the UK with nearly 250,000 hand and wrist trauma operations occurring each year.

They occur in all ages but are most common in young working people and elderly people. These injuries require emergency assessment and treatment, sometimes including surgery, and specialist follow-up. Surgery has a risk of infection after the operation has been performed. Infection is the abnormal growth of bacteria in an area of the body that can lead to severe problems, sepsis and death. Infection following surgery at the site of an operation is a known complication after hand and wrist injury, and can happen to as many as 1 in 4 people. The impact of infection after hand and wrist surgery, including the effect on long-term hand and wrist function is not known. Infection is usually successfully treated with antibiotics and treatment at the site of the infection itself. One particular method to reduce the risk of infection is to use stitches that are coated in a substance that is toxic to bacteria - antimicrobial stitches. This could prevent bacteria growing on and around the wound stitches, reducing the likelihood of infection. There has been some research in other areas of the body that shows that these coated stitches may reduce infection, but they have not been tested in the hand and wrist. This study will characterise and describe infection rates after surgery for hand and wrist and will establish whether using antimicrobial stitches might reduce problems in terms of infection and any impact on function.

I will investigate whether it is possible and practical to perform a clinical study to find out whether antimicrobial stitches can reduce the risk of infection after surgery for hand and wrist injury. This would need to be proved in a much larger study, where people are given antimicrobial stitches or normal stitches, by chance or like the toss of a coin (randomisation), without the knowledge of the surgeons or participants, performed at multiple hospital sites. The 'randomisation' aspect means that only the stitches are different between the study participants, so any difference in infection is probably down to the different stitches. In order to plan this, I will run a small-scale version of the study at two hospital sites to investigate how feasible this study is, in particular if there are any strengths or weaknesses that can be identified before a larger study is performed.

The likely impact of this research will be a much better understanding of infection after hand and wrist trauma surgery and whether we can reduce infection with coated sutures. This will mean that people can be better informed by clinicians about infection risk before surgery is undertaken. It may also help us to reduce infection after hand and wrist trauma surgery and reduce the problems it causes for people. Lastly, understanding the use of coated stitches may help our fight against antibiotic resistance, which is an increasing problem worldwide.
Research Skills Training

I have developed a structured, bespoke research methods training programme that I will undertake during my fellowship:

Systematic Review:
I have authored 19 systematic reviews, including two Cochrane reviews to date. I have received training at the Cochrane UK Author Centre. This one of my areas of strength but I will seek to build on this by attending the Meta-analysis and Network Meta-analysis Courses at the University of Oxford.

Epidemiology:
I will also undertake training in epidemiology and big data analysis. This is a much newer area of research for me where I want to build my skills.

Clinical Trials:
I will receive training on designing and implementing clinical trials in surgery through both local practical training, and research methods training.