Surgical site infections are considered preventable. Because such infections are considered preventable, there are legal consequences directly connected to such a condition. In this paper, I will discuss what an SSI is and the reasons on why it is considered to be preventable. I will also discuss the role of disclosure and legal implications that are related to SSIs, accreditation expectations, and continuous quality monitoring as it relates to SSIs. A surgical site infection, or SSI, is an infection of a wound that was made due to surgery.
Such infections can be superficial (infection of skin only) and other infections can be more serious (deep tissue infection). A superficial infection at the surgical site is defined as “an infection that developed within 30 days of surgery and involved only the skin and subcutaneous tissue” (Kuzu, M. A. , Hazinedaroglu, S. , Dolalan, S. , Ozkan, N. , Yalcin, S. , Erkek, A. B. , . . . Ercumet Kuterdem. , 2005). Deep tissue SSI is a bit more complex as it may take a little longer for the infection to be detected.
Deep tissue SSI is defined as “an infection that developed within 1 year post-surgery and involved the fascial layer and muscle layers” ((Kuzu, M. A. , Hazinedaroglu, S. , Dolalan, S. , Ozkan, N. , Yalcin, S. , Erkek, A. B. , . . . Ercumet Kuterdem. , 2005). It is important for patients to know the difference between superficial and deep tissue SSI and be aware of complications that can develop due to SSI so that they can be more careful of their role in SSI prevention. SSI is, for the most part, preventable.
A patient can contract an infection in many ways; one way is as a hospital acquired condition, also known as healthcare associated infection, nosocomial infection or HAI. “Postoperative surgical site infections (SSI) are the third most common health care associated infection. ” (Jakobsson, J. , Perlkvist, A. , & Wann-Hansson, C) An HAI is an infection that is not present at the time the patient is admitted to a healthcare facility. An infection takes time before it begins to show, so hospitals will only consider an infection to be an HAI if the infection shows after the 48th hour after admission.
An infection that showing prior to the 48th hour after the patient has been admitted is considered a community acquired condition. As I have stated, SSIs are mostly preventable. The ways in which an SSI can be prevented include proper surgical timing and procedure. Surgeries lasting for 3 hours or longer also increase your risk. (Drugs. com. , 2012), proper cleansing of wound after surgery and proper patient education of how to keep wound clean and dry after hospital discharge. Providing the proper care before, during and after surgery is pivotal to the success of patient care.
Hospitals should practice prevention of SSI daily. Quality healthcare practice is important to the success of any hospital, therefore, a healthcare facility should take part in daily activities/duties that promote practices such as asepsis hand washing and the use of hand sanitizers, proper handling of dressings and proper disposal of biohazard materials to reduce the chances of infection. Although there are procedures in place that should prevent most occurrences, SSI is not completely preventable.
“Even when all of the proper procedures known to prevent SSIs are followed — from administering preoperative antibiotics to using the correct antiseptic to prepare the skin during surgery — some patients appear to be much more susceptible than others to contracting an infection”(MedicalXpress. com, 2012) Some patents will be presented for surgery with a condition that increases their chances of infection. When this is the case, proper procedures should be followed, maybe including antibiotics before surgery as well to increase the chance that infection will not occur.
Preventing SSI occurrences in a hospital will show great quality of care practices. More patients will prefer to receive their healthcare from that facility above all others because of the quality of the hospital’s health care practices. Patients want to know and feel comfortable with the healthcare facility they have chosen; especially if they are in need of a surgical procedure. Because SSI rates for healthcare facilities are made public, patients are able to gain knowledge of how well their facility SSI prevention practices work.
“It is moving fast and furiously because consumers are pleased with the progress that has been made in reducing central line infections,” says Linda Greene, MPS, RN, CIC, director, infection prevention, Rochester General Health System, Rochester, New York. The public now expects the same transparency for SSIs” (Patterson, P. , 2011) . Facilities that participate in Medicare must report their SSI for certain procedures; the list of procedures to report continues to grow as patients’ demand for listed procedures grow.
” SSI data will be reported through the National Healthcare Safety Network (NHSN) managed by the Centers for Disease Control and Prevention (CDC), a secure, web-based surveillance system for reporting data on infections and other events. The data can then be used for analysis, facility comparisons, and quality improvement. ” (Patterson, P. , 2011) Hospitals will, and should, continuously search for new ways to increase their quality of care. Having a great overall rating for a low number of incidences of SSIs can only boost their ratings.
Along with the unfortunate incidences of SSIs come legal implications. Of course, involving the legal system in cases of SSIs are desired to be avoided but in the case that they do arise, communication is key in its resolution. To begin with, the first on the list in preventing SSIs is proper procedure. Next on the list is communication. Firstly, communication to the patient and their family/caregiver must be established. Proper care of the surgical site at home is important for proper healing.
When patients, family members or caregivers are confident in knowing what to do to help the healing process, healing becomes easier on the surgical site. A representative or someone from the surgical team should be active in making sure that the proper information and instructions are given to the patient and or their caregiver. As stated, SSIs aren’t 100% preventable. Some individuals are more susceptible to developing an SSI. In the event that an SSI does occur, the hospital staff, preferably one who had a hand in the procedure should be present to explain the condition that has developed.
This presents a challenge for the healthcare provider because most are reluctant to discuss such a condition. This is partly due to the patient’s reaction to the acquired condition. The blaming game may take place where the patient and/or family members may place the blame on the surgical team or nursing staff who cared for the surgical site postoperative. There can be legal implications that occur and a host of other issues that can develop with an SSI incident.
Another reason why a healthcare provider may be reluctant to discuss a developed SSI is that it will almost certainly hurt their SSI ratings; especially if their ratings were great to begin with minimal SSI occurrences to begin with. Although discussing the newly developed SSI with the patient may cause some damage to the ratings of the hospital, not discussing such condition may worsen things. Patients may begin to feel disrespected and take legal actions die to the healthcare provider not affording the information to the patient, especially if the SSI worsened the patient’s condition in the opposite directions of healing.
To present this information about the patient’s new found SSI, the healthcare provider may need to meet with the patient in office. After diagnostic testing, the healthcare provider should begin to inform the patient of their infection as well as present more than one plan to the patient as to what treatments are available. In this discussion, the patient should also be informed of whether this condition has hindered or worsened their post surgery healing and what would be the best plan from the list of plans presented to the patient.
For some patients, their insurance company will not cover the patient for re-admittance for an SSI, so the healthcare provider will need to make a decision of whether the facility will cover the cost or charge the patient (of course charging the patient would not be in the facility’s best interest). Disclosure is important in healthcare. So healthcare providers should make every fact about the health of their patients know to their patients. Sometimes, patients need a bit of time to make their decisions, especially about and SSI and especially if it is life threatening.
Omitting information about a patient from a patient can cause legal issues that any healthcare facility would want to avoid. In the end, it is up to the patient to decide what the best care for them would be. An informed decision cannot be made about one’s healthcare if all the information is not a given. If a patient becomes permanently harmed due to an SSI, the healthcare facility can, and in all likelihood will, enter into litigation and most likely will lose resulting in the facility losing millions of dollars as well as gaining public distrust.
Public distrust and SSI ratings are not the only reasons connecting to preventing SSIs; Accreditation plays a vital role also. “The joint commission accredits 82% of the hospitals in the United States. (Sollecito & Johnson, 2013) if the hospital is accredited by the Joint Commission, the hospital should be sure the proper procedures are in place and practiced on a daily basis in order to continue their accreditation status. “The Joint Commission has issued new requirements for hospitals in an effort to prevent infections from multidrug-resistant organisms, central line-associated bloodstream infections, and surgical site infections.
” (Schneiderv, M, 2008) These requirements are in sync with the 2009 National Patient Safety Goals. This is outstanding due to the fact that the overall goal is centered on the patient and not only the health care facility. “Starting in January 2010, hospitals will need to conduct periodic risk assessments for acquisition and transmission of multidrug-resistant organisms, and educate staff and independent providers about prevention strategies and their roles.
Hospitals also will be required to provide education about infection control strategies to patients and families who are infected or colonized with multidrug-resistant organisms” (Schneiderv, M, 2008) This, again, is great for the patients. The more patient know about SSIs such as how to detect them and how avoid them, the less of a chance there will be for and occurrences. Another requirement from the Joint Commission is that “Hospitals will be required to have a surveillance program up and running by Jan. 1, 2010, that is based on the hospital’s risk assessment.
” Such requirements from the Joint Commission is necessary in order to continuously monitor the rate at which SSI develop including how they develop so as to aid in prevention. Methods of contracting a SSI are constantly changing and so must the methods of prevention. Having a continuous quality improvement strategy in place at all times will greatly benefit the hospital. A great strategy I would use would be the collaborative through the IHI method. Through this method, “participants are expected to submit reports, collect data, attend learning sessions, and share information about their experiences.
” This is the best way because it allows for needed changes to occur almost immediately. Monthly meetings regarding current practices would allow for information gathering from the healthcare team which would then allow for re-evaluation of current practices. We would then be able to change for improvement purposes as long as it is legal for accreditation purposes. After the monthly meetings, my team and I would work together to look into what is needed in order for the organization to improve.
We would first need to do research about the SSI incidences state wide as well as country wide. Learning about SSI is other facilities (such as what prevention practices were in place as well as what the outcomes were) may help in implementing our own prevention practices so as to further aid in the prevention of SSIs. “what’s more important is how you communicate the data to empower everyone who has a stake in safe patient care,” (Schneiderv, M, 2008) After locating out findings, we would need to educate our healthcare teams in such prevention practices.
New developments in terms of new bacteria and methods of contraction are always surfacing; so the latest developments would need to be known. Teamwork is important in preventing SSIs also. It is important that everyone plays their team role and provide support for team members who need it is also important in providing continuous quality care. Surgical site infections can be most costly to a hospital, especially when a hospital’s communication skills fail. Although the strategy I have listed seems to be one that will work the best in opinion, it is not the best cost wise.
I choose a rout that would be costly due to education and research but, an ‘individual consumer’ approach would be least costly. At the most, direct mailing, website dissemination, or case management through direct contact would cost a fraction of the cost for my choice yet results would remain favorable. In the end, education would still be the key to the success of preventing surgical site infections. From that point it is up to the facility as a team as well as the patient regarding the outcome.