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One of the common challenges in the health care surgical sector is the surgical site infections. However, these infections can be prevented if the errors are eliminated. A surgical site infection refers to an infected condition on a site after surgery. These site infections are caused by bacteria. These bacteria could come from the site if not properly cleaned before surgery or from the surgical tools used in the procedure. Existing guidelines direct health professionals to reduce the chances of the occurrence of these infections. Such recommendations could include sterilizing surgical equipment as well as the use of antibacterial soap, gowns, masks, and surgical gloves. In addition, there are the guidelines on how to maintain the aseptic technique throughout the whole procedure. Surgical site infections are preventable, and thus it is important to understand this clinical problem, its classification, the risk factors associated with it and the necessary protocols that can be upheld to reduce the surgical site infection (SSI) risks and its prevalence.
Summary of the Clinical Problem
Surgical infections can be prevented and efforts to prevent complications are the top priority at every healthcare facility. A surgical infection, which occurs at or near the site within the first 30 days after a surgical procedure, known as SSI, contributes to many deaths. Surgical infections develop in an approximate of four percent of Americans who undergo surgery every year (Leaper, 2010). These infections cause excess hospital stays for about 3.7 million people and an increase in the hospital costs (Hawn et al., 2011). According to Mu, Edwards, Horan, Berrios-Torres, and Fridkin (2011), patients who undergo post-operative complications are likely to stay longer in the hospitals, have an increased risk of death, and experience higher medical costs.
Classification of SSIs
According to CDC and NNIS, surgical site infections are classified into three types. The first type of SSI infection affects the superficial incision. The second type of SSI is characterized by a deep incision. This infection category affects some part of the incision site tissue. Whereas the first type of SSI affects the skin and some subcutaneous tissue, the second type affects tissues such as the muscle. Generally, the latter category affects both the deep and the superficial sites. Lastly, organ or space SSI refers to any infection other than the incision site. The study by Anthony et al., (2011) indicated that superficial incision SSI had the highest prevalence of 42 percent, followed by the deep incision with a prevalence of 40 percent and finally, the organ/space with a prevalence of 18 percent.
Clinical Implications and Complexities
Surgical procedures pose a challenge due to their undesired cause of site infections. Early treatment of SSI is essential since slight delays can prove to be fatal to the patient. The main reason behind the occurrence of the SSI is that most hospitals are not up to the mark as required to be able to control this infection (Berenguer, Ochsner, Lord, & Senkowski, 2010). As it is the case, multiple visitors are not prohibited in most hospitals, which increases the chances of SSI. In addition, the skin itself is generally occupied by various micro-organisms which if not properly eliminated before the procedure can cause a variety of infections. The verification of SSI requires undisputable signs accompanied microbial facts. SSI mostly affects the outer tissues; however, in some instances, these infections impinge on the deeper body tissues. Prophylaxis antibiotics are mostly prescribed to prevent the occurrence of this kind of infection. However, antibiotic resistance in some patients poses a great threat.
The prevalence of SSI has been increasing over the years. The WHO indicated that an average of 66 percent of the total world countries has no documented data on SSI; and yet in those countries that have documented, the information is insufficient (Mu et al., 2011). Likewise, few hospitals have recorded how they prevent the occurrence of SSI. Globally, the highest incidence rate of SSI is reported in Tanzania with a percentage of 19.4 percent, followed by Italy at 2.7 percent, United States at 2.6 percent, and lastly Belgium at 1.5 percent (Mu et al., 2011). These statistics indicate that the prevalence of surgical site infection cases is high in developing countries.
Risk Factors Related to SSI
There are a number of risk factors that predispose a patient to chances of getting a SSI. The CDC and other health index organizations, such as NNIS, have given a clear classification of the risk factors associated with SSI in patients. The multifactorial hazards include diabetes mellitus, obesity, corticosteroid use, malnutrition, the use of immunosuppressant drugs, and anemia (Berenguer et al., 2010). Similarly, other factors that predispose one to SSI include the duration of the surgery, poor glycemic control after surgery, the techniques used during surgery, the presence of drains during surgery, and the maintenance of pre-operative temperature (Leaper, 2010). Anthony et al., (2011) in his study states that the ASA score has an implication in the SSI development. In fact, the score greater than two is associated with SSI.
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Protocol to Improve Nursing Practice
To prevent surgical infections, procedures before, during, and after surgery should be done while paying attention to the aseptic technique. The first step in the implementation process is the use of clippers instead of shavers while removing patient’s hair. In the same context, patients are to be told never to shave themselves preoperatively (Anthony et al., 2011). This rule minimizes the risk of injury and the spread of infection from the surface. The second protocol to be strictly adhered to is the administration of the recommended antibiotic regimens 30 minutes prior to a surgical procedure. The latter rule should be an approved regimen recommended by the health ministry. Doctors and other health professionals such as the anesthetists will be reminded to consistently obey this recommendation and the timing. Prophylactic antibiotics are meant to act as defense mechanisms for any infection that might be acquired.
Diabetic patients are often at high risks of getting infections. Thus, glucose monitoring for each patient will reduce this risk. Nurses and other professionals in PACU should be requested to strictly monitor and control glucose levels of post-op diabetic patients (Ata, Lee, Bestle, Desemone, & Stain, 2010). The physicians and nurses are responsible for controlling that the glucose level of the post-op diabetic patients is always below 11.1 mmol/l. Another recommendation to uphold the protocol is to ensure that a patient’s temperature is kept within the normal range of 36.0 to 38.0 preoperatively, intra-operatively, and post-operatively (Hawn et al., 2011). Maintaining the normal temperature can be done through the use of warmed forced-air blankets and the administration of warm intravenous fluids. The surgical room temperature should be slightly increased during the procedure to prevent hypothermia cases. A warm blanket can also be put under the patient’s operating table. Another protocol which should be strictly adhered to is the regulation of the number of people visiting a surgical patient (Ata et al., 2010). When a patient has many visitors, he or she experiences an increased risk of acquiring SSI. Thus, limiting the number of visitors is as safer as reducing the risk of SSI.
Plan of Implementation
The first step of implementing the protocol in the hospital is to ensure that all the protocol steps are outlined clearly. The second stage is to involve the staff, health care givers, and the physicians in the training to stress the need to uphold the protocol in minimizing SSI. In fact, the care givers will be reminded of the need to maintain the aseptic technique as they deal with the patients. Anesthetists will be reminded of the need to give patients antibiotics pre-operatively. The risk factors for SSI will also be outlined. Glycemic control in the patients with diabetes will be emphasized and the importance to keep the operating room warm (Ata et al., 2010). Revising these guidelines with the staff will promote patient safety as they will ensure that the health professionals follow them strictly as they deal with patients. The guidelines will be divided into preoperative, intraoperative and, post-operative protocol guidelines for easy interpretation.
The other step to foresee protocol implementation is the formulation of the necessary disciplinary actions for those who do not abide by the protocol guidelines. This recommendation is necessary because they will be putting the patients at risk of SSI which is unethical. Disciplinary actions will ensure that the physicians and the other care givers will abide by the set protocol guidelines. Lastly, the number of people visiting the patients will be limited since they promote the spread of infections to the patient. This protocol strategy will be meant to protect the patient’s health by minimizing the risk of infection (Ata et al., 2010). Thus, the safety of the patients will be put first which is the aim of every healthcare.
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For a long time, researchers had focused on identifying the right antibiotic therapy for SSI. Afterward, studies gave a focus on the risk factors of SSI and its prevalence among patients. The recognition of the risk factors is a great step to determine the ways in which the infections can be prevented. The obligatory protocol is important in limiting the chances of occurrence of the infections. Such approach involves setting guidelines that should be adhered to by every care giver that deals with patients. Moreover, the integration of protocols with the hospital policies can decrease the SSI risk. Proper surveillance is mandatory, and it is also everyone’s obligation to follow and maintain the set rules aimed at prioritizing the patient’s safety prior, during and after surgery. Thus, adherence to the safety protocols will have a positive impact on the quality of care and the reduction in SSI cases.