A feasibility study to explore the safety, acceptability and potential cost-effectiveness of self-swabbing at home to obtain usable surgical wound culture swabs (TREASURE)

RESEARCH QUESTION Can home-based patient self-swabbing of surgical wounds provide a safe, acceptable and potentially cost-effective method of obtaining usable wound culture swabs to detect clinically significant organisms in surgical wounds? BACKGROUND Around one million (20%) of the five million patients that have surgery each year develop a complication with their wound such as a breakdown or an infection. These complications can delay wound healing, require treatment or readmissions, increase mortality rates and cost the NHS around £1 billion annually. Most complications develop at home and usual care is to advise patients who are concerned about their wound to contact their GP. The GP may swab the wound to identify any bacteria present as part of the assessment to inform the prescribed treatment. Poor access to surgical wound swabbing in the community results in patients receiving delayed or incorrect antibiotic treatment for their surgical wounds. This delay can exacerbate wound complications, extend healing times, and contribute to the growing problem of antibiotic resistance. Implementing patient self-swabbing at home could enhance access to diagnostic testing, yet its feasibility and impact remain unexplored. AIM To assess the safety and acceptability of self-swabbing surgical wounds in the home environment, plus the usability of swabs and explore whether there is the potential for self-swabbing to be cost-effectively incorporated into existing clinical pathways. METHOD There are two stages to this feasibility study. In the first stage a coproduction group comprising patient or public members with support from clinical and industry experts will convene five times to develop a set of instructions for patients to use for self-swabbing surgical wounds at home and design a self-swabbing surgical wound kit. The instructions and the kit will be used in the second stage of the study, the clinical feasibility evaluation. In stage two, 40 cardiac surgery patient participants from a city hospital and a county hospital will use the instructions and kit at home to self-swab. Participants will be observed self-swabbing at home by a nurse researcher via Teams to determine if participants are able to comply with each step of the instructions. Participants are subsequently interviewed to explore the acceptability of self-swabbing using a Likert scale plus qualitative questions. Completed swabs will be sent to laboratories where they will be processed to measure transport times and usability. Ten stakeholders will be interviewed to inform an appropriate and cost-effective pathway for self-swabbing at home. Outcomes are the feasibility, safety and acceptability of self-swabbing plus economic modelling and potential for adoption into the NHS. TIMELINES Project duration 14 months. Site set up months 1-6, coproduction months 3-6, study recruitment months 7-11, follow-up and close-down months 12-14 IMPACT AND DISSEMINATION This novel study will provide evidence on the feasibility of patients self-swabbing their surgical wounds at home which will inform a substantive trial. Self-swabbing at home has the potential to improve clinical outcomes for patients and increase cost effectiveness for the NHS through better antibiotic prescribing, shorter wound healing times, improved patient satisfaction, and easier access to NHS resources.