An Opportunity to Improve Postop Surgical Site Infections

Lovely Flournoy

Jacksonville University

NUR516 Nursing informatics

 An Opportunity to Improve Postop Surgical Site Infections

The Scope of the Problem

It is a known fact that using chronic proper hand washing techniques removes germs, which prevents contagions. (Center for Disease Control; Atlanta, Ga, USA)  Many contagious diseases and conditions are easily transferred through the eyes, nose, and mouth due to the unknown frequency of constant touching and rubbing. When handwashing is inaccurately done or not done at all with soap and running water, the chances of spreading infection is increased through the constant touching of the eyes, ears, and mouth. 

Animal and human feces are essential breeding sources for microorganisms’ such as Escherichia coli, Norovirus, and Salmonella. Microorganisms as such, create symptoms related to severe diarrhea. These microorganisms may migrate and affect the lungs creating life-threatening respiratory infections. 

The University of North Carolina conducted a successful handwashing pilot program in October 2013 amongst an 853-bed facility. The Clean in and clean out the program was implemented and conducted amongst all healthcare personal leaving and entering patients room such as doctors, nurses, radiology, phlebotomist, respiratory therapist, housekeeping, occupational and physical therapist, hospital unit coordinators, nursing assistants, case managers, nutritionist, etc. (http://news.unchealthcare.org/empnews/handhygiene). The main focus was the proper hand washing technique prior to entering an inpatient room, as well as proper hand washing technique prior to leaving the room.

Within the first three months of the program, the collected data of hospital-acquired infections were compared to quarterly compliance from the last adapted observations that were reported to the CDC, according to the National Healthcare Safety Network. The program demonstrated how the improvement of hand hygiene reduced hospital-acquired infections substantially hospital-wide. With an increase in compliance with hand washing, hospital-acquired infections decreased significantly during the 17-month pilot program.

Steps to Solving and Improving the Situation

 Multidrug resistance organisms (MDRO) and Clostridium difficile (C-diff) are microorganisms that are associated with hospital-acquired infections (HAI). MDRO infections may occur in a patient who may be colonized prior to admission, which means MDRO may be lying dormant prior to an invasive surgical incision, increasing the chance of being infected with their own skin flora. It may become challenging slowing the growth, preventing or eliminating microorganisms of such when this is the case. 

With each and every surgical invasive incision, a surgical post-op infection has the potential to grow. Surgical site infections (SSI) take place at the point of entry of the surgical cut. Usually, postop infections take place within 15-30 days after the original surgical procedure. SSIs may take place in three different locations, according to the Center for Disease Control; Superficial, deep or internally with an organ, muscle, or surrounding tissue. 

Early signs of surgical site infections to look for are redness, fever, unrelieved pain, tenderness, or swelling. Antibiotic therapy may help with these early signs of post-op surgical site infections. Oozing discharge or green/yellow pus-like drainage located at the surgical incision surrounded by inflammation are the late signs indicative of a postop infection. 

Cross-contamination of germs and bacteria to skin transferred to a surgical wound creates a breeding ground for Staphylococcus, Streptococcus, and Pseudomonas. There are a variety of pathways, germs may infect and contaminate a surgical wound making it difficult for a patient to thrive postoperatively. A surgical case scheduled beyond 120 minutes, on a diabetic elderly patient, with an extensive medical history, who is an overweight smoker with a compromised immune system such as cancer may meet resistance when it comes to avoiding surgical site infections (SSI).

Prior to having a scheduled elective surgery, risk factors should be minimized to promote and solve issues associated with postop surgical site infections. Emergent unscheduled cases are complicated to prevent due to unknown and unforeseen circumstances. Patients who are smokers should be advised to wear a non-smoking -derm patch to the upper arm the night before surgery. The anti-smoking patch will decrease the anxiety that comes with butterflies and jitters that’s associated with the thought of having surgery.

 A patient that exhibit noncompliance with diabetes needs to have an elite meeting with the diabetic educator prior to surgery with the patient as well as the caregiver. When diabetic patients are noncompliant prior to surgery, the surgery process becomes a waste of valuable time due to the nonfulfillment of controlled glucose reading after surgery. Hemoglobin A1C, as well as blood

glucose levels, should be controlled and monitored diligently by the patient and an endocrinologist prior to surgery. All questions should be thoroughly answered and applied to fit each patient’s specific needs.

Because of the patients normal skin flora that may contaminate or contribute to the postop surgical site infection, it is imperative to avoid irritating the skin by shaving the operative area until it’s advised by the surgeon. Since every surgical patient deserves a family visit in PACU recovery, it is encouraged for the family not to talk over or touch the fresh surgical operative site to avoid transferring germs and bacteria that may be associated with simply entering the hospital. Self cautiously, germs are easily picked up by pushing the elevator buttons in the hospital, in the cafeteria from self-serve stations; shared bathrooms amongst family in the patient’s semi-private rooms are all ways to transmit unwanted bacterial and or viral germs to a postop patient.

In summary, the population of the unscheduled surgical cases should take precaution to life endeavors. As a member of the community, life happens due to unforeseen circumstances. Being confronted with life allows acceptance to the things that cannot be changed while making changes to the things we have total control over.  

Review of Literature

The Jacksonville University Carl S. Swisher Library was searched using the following databases: AHRQ, EBSCO, CINAHL, and OVID. Peer-reviewed articles were identified using the following keyword: preventing surgical site infections, factors affect surgical infections, hand washing, center for disease control infections postop, and transmission of germs.  Peer review and library worldwide selections provided over 250 results. Selections that were chosen to limit the search were: all formats, all authors, full text, peer-reviewed journals, and published in the last three years. English was selected below the language field.

Reference

       , C. A., Bratzler, D. W., Leas, B., Stone, E. C., Kelz, R. R., ... & Dellinger, E.P. (2017). Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA surgery, 152(8), 784-791.     

Kumar, M. (2016). Multidrug-resistant Staphylococcus aureus, India, 2013–2015.

                Surgical site infection prevention—what we know and what we do not know. JAMA surgery, 152(8), 791-792.