Surgical site infections (SSI) are infections acquired after a patient undergoes an invasive surgical procedure. A surgical site infection is considered a hospital acquired infection, and in the United States is the leading cause of morbidity and mortality from hospital acquired infections (Korol, Johnston, Waser, Sifakis, Jafri, Lo & Kyaw 2013). These type of infections are highly devastating to a patient and cost the hospital a tremendous amount of money to treat.
The purpose of this paper is to highlight how prevention of surgical site infections is necessary to provide excellent patient care, save costs to patient and hospital and how the use of proper technique and evidence based practices can decrease infection rates. Practice Setting Problem Patients undergoing invasive surgical procedures are always at risk of developing a post- operative infections.
When surgical site infections occur the patients hospital stay in prolonged, the need for specialized wound care and medications increase as well as an increase in the possibility of a reoperation. This causes patient and family inconvenience, a decrease in patient health status, and a financial hardship on the patient and hospital.
Importance of the Clinical Problem and its Significance to Nursing Practice According to the Association of Operating Room nurses (2014), postoperative surgical site infections are a major source of illness in surgical patients, and are the most common healthcare associated infections which occur in up to five percent of surgical patients. A surgical site infection (SSI) is an infection that develops within 30 days after surgery or occurs within one year of an implant such as a total joint. Surgical site infections are caused when bacteria is present within a wound causing a decreased patient health status.
Bacteria is easily spread, contact with surgeon, nurses or scrub techs’ hands, the bacteria could potentially become airborne during surgical procedures, or after surgery the patient has multiple opportunities to introduce bacteria into the wound. Streptococcus pyogenes, and staphylococcus aureus are the most common forms of bacteria that cause post-surgical wound infections (Chen, Wessel & Rao 2013). Surgical nurses must take extra steps in recognizing correct aseptic and sterile technique in order to provide the best possible patient care and reduce the rate of infections in surgical patients.
Research has been conducted over many years and evidenced based practices created in order to educate and provide patient care that decrease the spread of bacteria and thus the rates of poste operative infections. Bachelorette degree nurses are educated upon evidenced based practices and from research are shown to provide better patient outcomes.
Utilizing evidenced based practices such as decreased traffic in the operating room, preoperative patient skin antisepsis, prophylactic antibiotics, patient warming interventions, hand hygiene and proper isolation technique prior to closure of the surgical wound (AORN 2014) help in preventing surgical site infections. BS nurses continue to lead in healthcare and evidenced based practice routines.
Impact on Patients and/or a Community In the United States, between 500,000 and 750,000 SSIs occur annually (AORN 2014). If a patient acquires an SSI, the patient has increased hospital stay time, creating stress on the patient, the patients family, hospital costs, and inevitably creates financial distress between both the patient and the hospital.
In 2008, Medicaid and Medicare made a decree stating it would not reimburse the hospital for infections acquired during hospitalization, thus leaving costs for the hospital to cover, and increasing hospital care costs (AORN 2014). Also, with a surgical site infection the patient is at increased risk of having an additional operation, placing stress on the patient thus decreasing health status, also stressing the patient’s family and causing tension between the patient, their family and the hospital organization. Preventing SSI’s would create better patient outcomes, as well as create better patient and hospital relations.
Patient variables continue to affect the rate of surgical site infections, increased age also increases the chance of a bacterial infection growth. SSI’s increase the change of morbidity and increases the need for hospital care and longer hospital stays which increase healthcare costs to the community. According to AORN (2014) in a case study patients with methicillin-resistant Staphylococcus aureus (MRSA) post-operative infections had a median hospital charges of $92,363, which was $62,908 more than the median charge for the control group of uninfected surgical patients. Surgical site infection mean costs added up $25,546 (AORN 2014).
These increased costs only cause stress on both patient and hospital economical resources. Differences in Care Based on Evidence The Association of Operating Room nurses continually invests in research in order to analyze evidenced based practices that can decrease surgical site infections. According to research through AORN, in the operating room a large indication to reduce surgical wound infections is room air flow and staff traffic within the operating room.
Having an operating room equipped with a special air handler that creates a tunnel of air that flows down to the patient bed and carries the air along with the microbes to outer parts of the room, which is away from the patient and thus away from the open wound and decreases the chance of infection. Also, as AORN states, the least amount of traffic within an operating room decreases the risk of patient infection. Creating an operating room with staff aware of these indications would create a solid team effort in having only one team in the room during the procedure from beginning to end.
This practice would decrease the introduction of new individual’s and germs into the surgical environment. Another researched regime is the administration of prophylactic antibiotics. This practice is shown to decrease the growth of microbes during a procedure, and kills germs present on the patient before they arrive in the operating room environment (AORN 2014). Different patients require different antibiotics, according to guidelines depending on the scheduled procedure antibiotics are prescribed accordingly.
For example patients undergoing a procedure in which an implant (screws, joints, plates) are recommended to receive cefazolin based on their age and weight, other patients who arrive in the operating room with prior diagnosis of MRSA will receive vancomycin (Korol, Johnston, Waser, Sifakis, Jafri, Lo & Kyaw 2013). Prophylactic antibiotics have already shown a decrease in patient surgical site infections and the practice is continuing in order to assure infection rates remain lower.
Summary In summary, surgical site infections negatively impact patient health, economic resources and hospital and patient income means. Prevention is necessary and key in helping treat patients and continue to execute financial frugalness within the healthcare system.
Continued research can only help in creating new evidenced based practices in order to excel patient care. Also, following AORN standards when it comes to perioperative nursing, operating room sterile technique and post-operative wound care will continue to decrease surgical site infections and create optimal patient outcome.
References Association of Operating Room Nurses. (2014). Preventing surgical site infections–guiding practice with evidence. Association of Operating Room Nurses. AORN Journal, 72(2), 305-7. Retrieved from http://www. aornjournal. org/article/S0001-2092(07)00287- 6/abstract Chen, Antonia F,M. D. , M. B. A. , Wessel, C. B. , M. L. S. , & Rao, N. , M. D. (2013).
Staphylococcus aureus screening and decolonization in orthopaedic surgery and reduction of surgical site infections. Clinical Orthopaedics and Related Research, 471(7), 2383-99. doi:http://dx. doi. org/10. 1007/s11999-013-2875-0. Retrieved from Walden Library. Korol, E. , Johnston, K. , Waser, N. , Sifakis, F. , Jafri, H. S. , Lo, M. , & Kyaw, M. H. (2013). A systematic review of risk factors associated with surgical site infections among surgical patients. PLoS One, 8(12), e83743. doi:http://dx. doi. org/10. 1371/journal. pone. 0083743. Retrieved from Walden Library.