Mr Justin Wormald
BMRF Research Fellow for 2019/20
Research is entitled: “Infection after hand and wrist injury”.
What changes has it made to you personally?
The BMRF grant was critical in allowing me to commence my DPhil at the University of Oxford in October 2020. It was a very difficult period to secure funding for surgical research as so much money had been re-directed to COVID19 research projects. Despite being successful at interview, the NIHR were unable to fund my research at that time for this very reason. Without the BMRF grant, I would have been in considerable difficulty.
What has your research done for patient care/numbers?
Now 18 months into my DPhil I have generated new data that accurately determines the risk of wound infection after surgery for upper limb trauma. We can use this data to inform patients of their infection risk, which is especially important when there is a non-surgical option for their injury. We can also use this data to plan future research into wound infection in trauma and hand surgery. Most recently, I have opened the first ever randomised clinical trial of antimicrobial sutures in upper limb trauma - testing this potentially beneficial intervention in a new trauma population to determine effectiveness.
What is the impact of your research?
Already, the data that I have generated during my DPhil has been used to inform two national guidelines:
1. Development of the NICE Guideline: Plus Sutures for preventing surgical site infection [MTG59] 28 June 2021 – invited expert panel member through my work on a Cochrane review of antimicrobial sutures
2. Development of a National Guideline for Hand Surgery: the results of my systematic review have directly informed a new national guideline, co-badged by the British Society for Surgery of the Hand (BSSH) and the Getting it Right First Time (GIRFT) initiative
Has the award enabled you to obtain further funding or opened other doors professionally?
By funding the first year of my research, I was able to produce some data that could feed into a reinvigorated application to the NIHR. I was successful in securing £326,766.00 to complete my DPhil research and to undertake an in depth research training programme in surgical trials and allied methodologies.
What are the project outcomes?
The results of my first two work streams – a systematic review of the literature and ‘big data’ analysis – have been presented at the primary national hand surgery meeting in 2021. This data can be used today to better inform patients of their risk of infection following surgery for hand and wrist injury. This is really important because many injuries can be managed without an operation. Discussion of risk versus benefit of surgery is therefore hugely important in shared decision making. The risk of infection after hand trauma surgery was previously unknown, but was thought to be lower than in other types of surgery. However, my research has shown that actually the risk of infection is just as high, if not higher, than in other types of surgery. The risk of infection after hand trauma surgery can be as high as 1 in 10 (10%), where the national estimate is around 3-5% for all surgery. My data also show which types of hand surgery are at more or less risk of infection, which can be used to help inform patients and manage their risk.
My third work stream is a ‘feasibility’ clinical trial of antimicrobial sutures in hand trauma surgery. Antimicrobial sutures are surgical stitches that are coated in a chemical that kills bacteria, thus potentially reducing the risk of wound infection after surgery. These new sutures are expensive and have never been tested in hand surgery or in trauma surgery. I am just about to start the first ever ‘feasibility’ clinical trial of antimicrobial sutures in hand trauma patients. This will then lead on to a full-scale, definitive clinical trial to determine if they are actually effective in reducing infection risk In hand trauma.
Has it enabled you to attend any key/prominent events/meetings?
Even with the pandemic, I have been able to present all of my data at relevant meetings. My systematic review and big data analyses have been presented at the British Society for Surgery of the Hand (BSSH) Autumn Scientific meeting in October 2021. I have two accepted presentations at the IFSSH, IFSHT & FESSH Combined Congress London 2022 (the biggest global hand surgery conference that exists). I intend to continue to present outputs over the next 18 months of my DPhil and beyond.
Will papers be published?
Yes. I have had one paper accepted for publication already and one in submission. I currently have eight further planned manuscripts that I intend to publish over the next 12 months