The current research will examine the relationship between strict glycemic control and the development of postoperative complications in diabetic and non-diabetic inpatients undergoing isolated Coronary Artery Bypass Surgery in a single hospital unit. The research will examine the patient outcome variables of length of stay, presence of infection, surgical site infections, renal failure, readmission to the ICU, return to theatre, bleeding, deep sternal wound infection and mortality.
The hypotheses that strict glycemic control is positively correlated with better patient outcomes and that poor glycemic control results is positively correlated with poorer patient outcomes will guide this research. Theoretical Basis The theoretical framework that guides this research is that proper management of patient in the hospital setting is an essential ingredient in ensuring positive outcomes.
Researchers examining the issue of the development of complications related to CABG surgery have therefore operated under the premise that failure to control perioperative conditions, on the part of nurses, is one of the greatest contributors to poor patient outcomes and thus, in order to effect change, a change in nursing practice would be needed. Poor patient outcomes have generally been examined under the context of hospital acquired infections and complications. Researchers estimate that between five and ten percent of admitted patients in the United States develop an HAI (Rizzo & Odle, 2006).
Additional data from the Centers for Disease Control and Prevention (CDC) suggest that yearly about just under two million hospitalized patients develop an HAI (CDC, 2007). Furthermore close to 100,000 of these patients eventually die, as a consequence of the infection (CDC, 2007). McCaughey further exemplifies the true prevalence of HAIs, estimating that one in 20 hospitalized patients develop and HAI resulting in 20 million infections yearly (as cited in Stommen, 2007).
In addition the prevalence of HAIs varies considerably depending on the nature of the infections developed and the characteristic of the patient affected. Patients admitted to the intensive care units (ICU) of hospitals are the most at risk for developing HAIs. Mohr et al. (2005) estimate that 10 percent of patients undergoing acute care are infected annually. For patients in the ICU this figure increases exponentially to as much as 30 percent (Mohr et al. , 2005). HAIs that are brought about during or as a result of surgical procedures are the second most prevalent forms of HAIs (CDC, 2007).
Patients develop infections at the site of the surgery. The CDC estimates that these account for 22 percent of HAIs. Among patients hospitalized for the purpose of surgery solely, these infections are the leading cause of HAIs among this population. Estimates suggest that just over four percent or one in every 24 patients undergoing inpatient surgery, develop an infection in their surgical wound (Hollenbeak et al. , 2006). These HAIs can have significant and deadly effects on the affected patients. The specific means of acquiring this HAI is hinged on numerous factors.
The susceptibility of the patient to infections and their level of exposure are two of the most important factors in predicting whether or not a surgical patient will develop wound infections. Susceptibility to this HAI is usually heightened for patients depending on their age, the presence and stage of diabetes mellitus, and the length of time they were in the hospital prior to the surgery (Hollenbeak et al. , 2006). In terms of exposure, risk for surgical wound infections is heightened by unhealthy practices either within the hospital itself, or on the part of the clinical personnel dealing with the patient.
The level of traffic through the operating room during surgery, the introduction of foreign bodies to the wound, lengthy surgeries and other surgical practices may affect patients’ likelihood of infection (Hollenbeak et al. , 2006). One of the major issues that have been debated in contemplating this issue is proper hygienic practices specifically in relation to washing hands between patients and the administration of antibiotics which increase the risk of infections.