SURGICAL SITE INFECTIONS 12

KryshiaRose-delCastillo

Grand Canyon HLT-364

July 10, 2016

Abstract

Surgicalsite infection is a problem that requires concerted efforts andproper procedures so as to initiate a reversal of the same. This isespecially necessary, given the fact that the health of people is aparamount need as tonot be putinharm’s way. Therefore,the true need to create properstructures that may reduce such infections and adhere to themaccordingly is a must. A success of the same will have huge benefitsas it will reduce cases of hospital readmissions that arenormally associatedwith the problem. The fact that mortality cases that are usuallyrelated to this scenario will reduce from the application ofpreventive measures is a matter that also needs to betakeninto consideration.

Keyword:Surgicalsite infections

SurgicalSite Infections

SurgicalSite Infections relate to the state of patients who are under asurgical procedure contracting other health complications, as aresult of being exposed to undesirable elements. Such a situationusually brings in complications as it hampers the possibility of suchpatients healing properly of the ailment that was under treatment(Gagliardi,Eskicioglu, McKenzie, Fenech,Nathens &amp McLeod R, 2009).In much worse situations, it compounds the problem, leaving thehealth care providers with a larger problem to deal with than it wasbefore. Such a case also goes without saying the obviousinconvenience that surrounds handling a problem that wouldnot be there, in the first place,ifpersonnelconducted the procedure according to safe standards. Sitecomplication is usually a touchy issue.

Thisis mostlybecause it relates to the life of a human being, which needs to behandledwith great care and dignity. There is usually the real costimplication that touches on the treatment of the infection. While attimes, the hospital facility could take the responsibility of takingcare of a re-infection, which is not easily detectable,and the patient would need to foot the bill, him or herself. Surgicalsite infections cause a huge strain onthe society as they put the cost of treatment, unnecessarily high.

Whileit is true that it is an issuethat should not be in occurrence at this time and given themilestones madein medical research, the problem is quite real. At times, it is alsohard to prevent it with exemplary success. A realization of suchknowledge helps to initiate an innovative way of thinking amongpeople involved in medical research and practice with a highpossibility of setting procedures that are paramount in dealing withthe problem.

ProblemStatement

Casesof surgical site infections have increased considerably within thelast two months, increasing patient readmission rates on the med/surgunit. This situation occurs despite the fact that management hasengaged personnel at the unit in a bid to help salvage the situation.There is fear that if the problem isnot curtailed,it could escalate, thereby causing an obvious dwindling of thequality of services offered at the facility. The health facility willalso strain to focus on corrective treatment, instead ofconcentrating on new cases that are brought in. The increased casesof surgical site infections also bear the real problem of increasingthe cases of mortality among patients subjected to theproblem.PurposeStatement

Thestudy isaimedat establishing measures that can be put in place to preventinfections at the med/surgunit and the result of such actions in the reduction of readmissioncases at the unit. In case such an occurrence subsides,the hospital shall be able to save alot ofmoney that goes into taking care of patients who have been affected.The hospital shall also improve its quality of service delivery topatients, a factor that shall build its image, immensely.

LiteratureReview of Causes and Prevention of SurgicalSite Infections

Anthonyet al. (2011) indicate that there are several situations thatcontribute to surgical site infections. One contributing factorincludes the use of mechanical bowel preparation. This strategy ismost often preferred by medical practitioners due to its ease of useto clear the bowel of patients who areslottedfor a surgical procedure. The problem of using such a strategy isthat it predisposes patients to the real problem of infection as someof the particles from the stomach content could find their way in thearea beingoperatedon by the surgeons (Anthony,Murray, Sum-Ping, Lenkovsky, Vornik, Parker, &amp Huerta, 2011).It isoften assumedthat such cases are rare, but with the possibility of occurrence, itis quite ill informed to carry out a procedure that in itselfpossesses a huge risk on a patient. Oneof the best ways to remedy such aproblem is the integration of mechanical bowel preparation with theuse of antibiotics on the patients so that they may be able to killany substances found in the body, which have a potential of causingan infection inthe area ofoperation.

Anotherproblem that isassociatedwith these types of infections is the lack of proper warming ofpatients before, during, and after the operation procedure. It isimportant to point out that patients are usually under very differentphysiological states while undergoing an operation. Thisis mostly related to the decline intheir body temperature, breathing rate, and blood circulation(Engemann, Carmeli, Y., Cosgrove, Fowler, Bronstein, Trivette, &ampKaye, 2003). Therefore the patients require controlled conditions sotheir bodies would continue to function as it would be desirable. Incases where the temperature inside the room is not increased to suittheir situation, patients risk a likelihood of suffering from healthconditions that could bepreventedin the first place. The personnel in charge of the surgical unit needto put proper observation on the patient, especially as it relates tohis or her temperature to ensure that it does not fall below therange of what would beregardedas normal.

Also,related to this aspect, is the fact that at times patients underoperative care lack proper oxygen supply, which reduces the chancesof different organs inside their bodies to function properly (Webster&amp Osborne, 2015).The area under operation at times also lacks proper covering, anaspect that predisposes surgical sites to elements that are likely tocontaminate them. Even with the application of antiseptics on areasbefore, during, and after the operation, there is still the high needof ensuring that they are well covered to prevent any elements thatpresent a chance of causing infections. Some forms of surgery such asan orthopedic implant surgery require environments that are veryclean, including the air around the patient. Where such a case isnot observedto the letter, there is a huge chance of infection taking place. Thepersonnel involved with manning the operating room, may, therefore,need to install air monitors which could come in handy in showing thelevel of air quality inside the room and clean it, where necessary.

Theintegrity of the surgical solutes and instruments also has a big roleas it relates to surgical site infections. Even a minor contaminationof these elements has a real possibility of causing major healthproblems upon the patients that are set to undergo an operation.There are various factors that touch on the aspect of sterility ofthe instruments (Meekset al., 2011).One of them is the time lapse between the sterilization and use ofthesematerialsand equipment.When a long period, such as thirty or more minutes passes betweenthe time of sterilization and the time it isused,it creates a chance of contamination of such equipment, which in turncould cause an infection inthe patient. Another factor is the concentration of the disinfectantused on the equipment. If the concentrationis low, there is a possibility of failure of proper sterility takingplace, thereby, making the patient susceptible to infections. Thepersonnel involved with the sterilization process need to be carefulto take these factors into consideration so as to safeguard the lifeof the patients under their care.

Theintegrity of the personnel inside the operating room also needs to beenhanced. These are mere human beings with the potential of goingagainst the procedures that arewell outlinedforthe purposes of makingtheir work easier (McHugh,Corrigan, Dimitrov, Cowman, Tierney, Hill, &amp Humphreys, 2011).Thisis mostly done at the expense ofthe patients who are at the hospital and as a result, this ends uphaving dire consequences. One of the issues that the personnel needsto learn is the basics of ethics in medical practice. They need tomake sure that the activities they do arealignedwith the intention of making the health of the people on theoperating table much better than they were. As a result, people willhave a great sense of responsibility to do everything within theirpower to achieve the same. They may also be able toeasily detectthose people who are not keen to observe the standards of practiceand be quick to warn them or report them to the relevant authoritieswhere it deems necessary to do so.

Medicalpersonnel at the hospital may also need to put the patient who hasjust undergone a certain medical procedure under close observationand regular tests so as to ensure that the wound they bear doesnot risk being contaminated or having any infections. They may alsoneed to address any case of infection speedily to prevent it fromescalatingtomuch worse levels which could be quite hard to dealwith.

Hospitalsalso need to source for ways for ensuring the operating room is wellfunded. Most of the measures highlighted to help prevent siteinfections are way too expensive andas a result, some of them arenormally skipped on purpose. Forinstance,some operating rooms could lack air scanners that are crucial formonitoring the quality of air inside the room. As a result of thissituation,it brings in the real problem of the likelihoodof infection if there is a slight chance the room is contaminatedsince it will not be detected.

Discussionof Concerted efforts

Asestablished, the process of reducing surgical site infectionsrequires input from various quarters. One of them lies in the abilityof the medical personnel in-charge of the operations to undergothorough and regular training. As a result, they will be keen onensuring that they put the patients who are under their care underproper treatment (Gibson,2014).Through consistent workshops and capacity building, people willimprove their ability to dispense their duties with limited chancesof harm upon the patients that are under their care. It is also truethat people will be able to share ideas as it pertains to infectionprevention. Such a practice has positive effects in that most of thetrainees will develop their skills effectively and help to protectthe lives of people.

Practitionerswill incorporate various practices as key to sustaining the health ofpeople. One includes surgeons keeping their nails short all the timeand especially before they handle a patient. They also need toscrub their hands and forearms properlyup to the elbow level with a proper antiseptic, about 5 minutesbefore they embark on any surgical activity (Medscape, 2016). Theelbows need to beputup a distance from the body to prevent any chance of contamination ofthe washed area. Doctors will also need to cut their hair short atall times as well and properly cover their head with a non-fibrematerial during the operation period. The clothing the surgeons wearduring the operation need to be clean and sterile as much aspossible,andthey need to avoid going into the operation room with outside shoes.Rather, they may opt to put on flip flops that never leave thesurgical room.

Anotherstandard practice also involves the fact that thosepersonswho appear to have skin lesions and problems that have a chance ofcausing infections need to beexcludedfrom taking part in the operation until such a time that they areproperly healed and ascertained by a competent health professional.The same also applies to personnel who bear other forms of infectionssuch as Saureus (Meekset al., 2011).It is also important for medical personnel to be encouraged to openup when they feel they have a medical condition that could have achance of creating infections. This is achievable when medicalpersonnel understandsthe importance of their level of health to the success of a giventherapy. They are also able to understand the main objective isensuring that patients who are brought into a health facility healand arenot exposedto any other problem.

Thecase of patient safety is also a diverse and complex topic thatrequires consistent research on the part of people involved inmedical research so that they come up with proper measures that willbe key in causing a reduction inthe cases of infections (Meekset al., 2011).Therefore, they areable toreview strategies usedin different facilities with an aim of setting the standard operationprocedure as a highlikelihood of creating positive results as it pertains to sustainingthe health of all people who arebroughtunder surgical care. Researchers may also establish some practicesthat are highly risky and which bear the real danger of exposing thepatients under surgery to the real problem of having certaininfections.

Otherpeople who are important in the prevention of surgical site infectioninclude those who will take care of the patient after he or she hasbeendischargedfrom the operating room. This could include nurses or relatives ofthe patient. Such people also need to learn aboutthe measures that they could use to avoid predisposing the patient toserious health problems (CDC,2016).They may, therefore, need to learn about the procedure of handling,cleaning, and dressing of wounds. This has a big effect in that suchpeople will be on the forefront of ensuring thepatient does not contract any infectiononthe area where surgery wasconducted. They may also learn to observe keenly and quickly report any case ofinfectionthat they note on the patient.

Limitationsof the study

Whileit is the study may be able to unearth better infection preventionmeasures, onefactor for sure is that it is an ongoing process and there still moreinformation that needs to beuncoveredregarding the same. Staff may need time to adjust to the newdevelopments as well as being given the opportunity to give their ownviews regarding the same. This is mostly because these are the peoplewho will primarily need to implement most of the laid down strategiesaimed at preventing surgical site infections (MedlinePlus, 2016).Where possible, they may also be included in the designing of theinfections’ prevention module for the hospital facility. Anactivity such as this is crucial because personnel will feel thehospital has a high value for them. They will, therefore, highlylikely ensure they follow the ideals of the module to the best oftheir capability.

Conclusionand future studies

Theissue of surgical site infection is a touchy problem that could takea long time for the relevant stakeholders to have a grip overit in totality. However, with the right mind, the process ofimplementation will be much quicker. It also requiresthe complete willingness of all people involved to ensure the processis a success. This will go a long way in making the patients visitingthe hospitalfor surgical care to have faith in the procedure offered at thefacility. They will also be able to observe proper measures, evenafter being released so as to ensure they do not run the risk ofinfection and unnecessary readmission at the hospital. The generaldecline in the cost of treatment will reduce significantly,and the survival rate of the patients will also increase. This meansthe hospital shall be able to maintain its majorobjective that lies in improvingthe quality of life of the patientsvisiting the institution. There is high need to conduct studies toidentify more measures that could be essential in preventing surgicalsite infections.

References

Anthony,T., Murray, B. W., Sum-Ping, J. T., Lenkovsky, F., Vornik, V. D.,Parker, B. J., … &amp Huerta, S. (2011). Evaluatingan evidence-based bundle for preventing surgical site infection:a randomized trial.&nbspArchivesof Surgery,146(3),263-269.

CDC(2016). State-based HAI prevention retrieved fromhttp://www.cdc.gov/HAI/stateplans/state-hai-plans/nv.html

Engemann,J. J., Carmeli, Y., Cosgrove, S. E., Fowler, V. G., Bronstein, M. Z.,Trivette, S. L., …

&ampKaye, K. S. (2003). Adverseclinical and economic outcomes attributable to methicillin resistanceamong patients with Staphylococcus aureus surgical site infection.Clinicalinfectious diseases,36(5),592-598.

GagliardiA, Eskicioglu C, McKenzie M, Fenech D, Nathens A, McLeod R. (2009).Identifying opportunities for quality improvement in surgical siteinfection prevention. AmericanJournal Of Infection Control[serial online]. June 200937(5):398-402 5p. Available from: CINAHLComplete, Ipswich, MA. Accessed July 3, 2016.

Gibson,A. (2014). &quotReadmissionafter delayed diagnosis of surgical site infection: a focus onprevention using the American College of Surgeons National SurgicalQuality Improvement Program.&quot.The American journal of surgery (0002-9610), 207 (6),&nbsp 832.

MedlinePlus (2016). Surgical wound infection – treatment retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/007645.htm

Medscape(2016). Wound Infection Treatment &amp Management retrieved fromhttp://emedicine.medscape.com/article/188988-treatment

MeeksD, Lally K, Kao L, et al. (2011). Compliancewith guidelines to prevent surgical site infections: As simple as1-2-3?.AmericanJournal Of Surgery[serial online]. January 2011201(1):76-83. Available from: AcademicSearch Complete, Ipswich, MA. Accessed July 3, 2016.

McHugh,S. M., Corrigan, M. A., Dimitrov, B. D., Cowman, S., Tierney, S.,Hill, A. D.,&amp Humphreys, H. (2011). Preventinginfection in general surgery: improvements through education ofsurgeons by surgeons.&nbspJournalof Hospital Infection,&nbsp78(4),312-316.

Webster,J., &amp Osborne, S. (2015). Preoperativebathing or showering with skin antiseptics to

preventsurgical site infection.TheCochrane Library.