A1. When a patient is getting ready for surgery, one of the last things on their mind is infection. As medical personnel though, it is a thought that definitely does not leave the mind. Getting an infection after surgery not only increases a patients hospital stay and recovery time, but also increases expenses for the hospital. When thinking of ways to decrease infection, it most often starts with preparation of the surgical site and insertion of invasive catheters. When cleaning the site, many institutions continue to use beta dine though research shows that Chlorhexidine has better results.
Though Beta dine and Chlorhexidine both reduce bacterial count, Chlorhexidine is found to be more profound and longer lasting (Jarral, McCormack, Ibrahim & Shipolini, 2011). A2. a. Currently betadine is being used when preparing the surgical site at the institution being examined. When attempting to figure out who made the decision for the way skin is prepped, it is unknown. Though to change the current practice, the nursing practice council will need to show evidence supporting the change. Once that is done, it may be brought to the nurse manager in the OR and up to administration to help facilitate a change.
Once the change is approved, it is up to nursing leadership to show a good example and educate the current nursing staff on the importance. b. Using betadine in the OR for skin prep is how it has been done for many years. Though that does not mean it should not be changed, it has been thought of as being the best practice for the cleaning of the surgical site. When discussing the issue with current OR nurses, they are unaware of the exact reason why they use it, no one knew any studies that supports their current practice.
This is just “how they have always done it” and they thought this is the best way. c. When interviewing current OR employees, not many people had much to say as to “why” they currently use betadine for preparing the skin. As of right now, they have no seen enough evidence to change their technique. Currently the people involved are under the impression that this is the best way to prepare the skin for surgery. A3. Darouiche, R. O. , Wall, M. J. J. , Otterson, M. F. , Webb, A. L. , Carrick, M. M. , Miller, H. J. , Awad, S. S. , & Crosby, C. T.
(2010). Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. Retrieved from http://www. ncbi. nlm. nih. gov/pubmed/20054046 Edwards P, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No. : CD003949. DOI: 10. 1002/14651858. CD003949. pub2. Eiselt, D. (2009). Presurgical skin preparation with a novel 2% chlorhexidine gluconate cloth reduces rates of surgical site infection in orthopaedic surgical patients.
Orthopaedic nursing, 28(3), 141-145. doi: 10. 1097/NOR. 0b013e3181a469db Jarral, O. A. , McCormack, D. J. , Ibrahim, S. , & Shipolini, A. R. (2011). Should surgeons scrub with chlorhexidine or iodine prior to surgery?. Retrieved from http://icvts. oxfordjournals. org/content/12/6/1017. full. pdf html Noorani, A. , Rabey, N. , Walsh, S. , & Davies, R. (2010). Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. (11 ed. , Vol.97, pp. 1614-20).
Cambridge, UK: British Journal of Surgery Society Ltd. Retrieved from http://www. ncbi. nlm. nih. gov/pubmed/20878942 A4, A5. When thinking about patient safety, it is easy to see that Chlorhexidine is much more effective against surgical site infections then betadine. Chlorhexidine–alcohol was significantly more protective than povidone–iodine against both superficial incisional infections and deep incisional infection ( Darouiche, Wall, Otterson, Webb, Carrick, Mikkler, Awad & Crosby, 2010).
In return, especially since Obama-care has come in to effect, hospitals themselves will save money when decreasing surgical site infections. Since hospitals are required to bite the bullet for any costs of infections that have been acquired in the hospital, including surgical site infections, using Chlorhexidine will save them in many ways. For instance, lower costs related to testing for infections, antibiotics for treatment of infections, longer hospital stays and repeat admissions. Using Chlorhexidine will most likely be a smooth transition for most.
The hospital will need to be better stocked with the product. Although the hospital will be spending money on stocking more of the new product, they will not be ordering as much of the betadine. The amount of money that will be saved by reducing the amount of infections is substantially more than the cost of making the change. A6. It at times may be very difficult to implement change in a hospital, especially when people have been used to a certain way for the majority of their careers. It is vital that the key stakeholders in this situation are on board in order for things to run smooth.
Equipment needed for the change, as discussed earlier, is more chlorhexidine. This needs to be discussed with the person who is in charge of the hospital ordering and charging. When it comes to the education of the operating room nurses, their nurse educator needs to be presented with the information and all of the supporting data so that he/she can have a smooth transition with the nurses. The current physicians and all operating room staff will need to be reeducated as well. The educator on the floor may present them with the information as well so that everyone is on the same page.
The problem may very well lie within the acceptance of the change by the physicians. As long as the physicians are educated on the impact it could have on their patients, they will be more apt to make the change. As patient clinicians, it is our job to ensure patient safety and do what is possible for the best outcome. B. Doing the best practice research is only a small portion of what is needed in order to make a change in an institution. Once the topic of change is discovered, it is great to have a team of nurses who are willing to help with obtaining the evidence needed.
Many people may have difficulty understanding the literature that is out there, that is why having a team to assist each other is essential. Translating the research that has been found and making it into a best practice change may cause some difficulty along the way. Sure, from the research it may be obvious that the change needs to be made, but in order to implement the change, people need to know all of the “why’s”. The statistical data needs to be present, as well as money saving data. When thinking about barriers that may be present, the change theory comes to mind.
When attempting to implement a change, you are going to have many people that push against you and try to ignore the change around them. In order to ensure the success of a change, you need to make sure that everyone is clear on the present goals, indicators of success and formulated action plan. First and foremost, people need to go through the process of “unfreezing”, which is letting go of an old pattern. Once that is done, the thought process needs to change and then you need to go through the process of “refreezing”, developing a new habit.
If refreezing is not completed, people will end up back in their old habits. Implementing change is going to require due diligence for everyone to change their old habits. The team implementing these changes is going to have to follow a couple of strategies to help with the resistance and barriers. As a hospital, it can be made easier by having the Chlorhexidine readily available so that providers directly involved will see the change. Think of “out of site, out of mind”. Unless we make the Chlohexidine easily available for people, their habits will make them go right back for the Betadine.
It is important that we do all we can in order to assist in the “refreezing” process of the change theory. By doing that, we must establish a new habit. Another strategy to help with some of the barriers we may come in contact with is having a question and answer session for those directly involved. This will help with the thought changing process of the change theory. By allowing people to discuss their concerns with the change, it also allows you as the change maker to provide all of the evidence as support.
When it comes to saving lives, reducing hospital cost of infections, etc., people are going to be more apt to change when hearing it all. Also, it is important to have somewhat of an open door policy. As a nurse leader, if people feel as though they can trust you and discuss barriers they personally are feeling and having, they are more apt to trust the decisions and research you have implemented. In conclusion, Chlorhexidine without a doubt should be used when prepping the surgical site of a patient preoperatively. Although both techniques lower the amount of bacteria that is present, Chlorhexidine is proven to be much more dramatic.
Also, Betadine has less of a residual effect then Chlorhexidine as well( Darouiche, Wall, Otterson, Webb, Carrick, Mikkler, Awad & Crosby, 2010). In order to make the implementation of the change from betadine to chlorhexidine a smooth transition, it is so vital that all of the evidence be provided to those involved. References Current nursing. (2011, September 12). Retrieved fromhttp://currentnursing. com/nursing_theory/change_theory. html Darouiche, R. O. , Wall, M. J. J. , Otterson, M. F. , Webb, A. L. , Carrick, M. M. , Miller, H. J. , Awad, S. S. , & Crosby, C. T. (2010).
Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. Retrieved from http://www. ncbi. nlm. nih. gov/pubmed/20054046 Edwards P, Lipp A, Holmes A. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No. : CD003949. DOI: 10. 1002/14651858. CD003949. pub2. Eiselt, D. (2009). Presurgical skin preparation with a novel 2% chlorhexidine gluconate cloth reduces rates of surgical site infection in orthopaedic surgical patients.
Orthopaedic nursing, 28(3), 141-145. doi: 10. 1097/NOR.0b013e3181a469db Jarral, O. A. , McCormack, D. J. , Ibrahim, S. , & Shipolini, A. R. (2011). Should surgeons scrub with chlorhexidine or iodine prior to surgery?. Retrieved from http://icvts. oxfordjournals. org/content/12/6/1017. full. pdf html Noorani, A. , Rabey, N. , Walsh, S. , & Davies, R. (2010). Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery. (11 ed. , Vol. 97, pp. 1614-20). Cambridge, UK: British Journal of Surgery Society Ltd. Retrieved from http://www. ncbi. nlm. nih. gov/pubmed/20878942.