Prevention And Control Measures For Surgical Site Infections In A Medical Ward

Causes and Types of Surgical Site Infections

Question:

Discuss about the Surgical Site Infections Prevention.

The current assignment focuses on the concept of surgical site infections (SSIs) and its prevention and control measures in a medical ward of a hospital. There has been a drastic increase in the number of infections which had taken place after surgery in a surgical ward of a specific hospital as reported by the nursing unit manager. The surgical site infections are one of the major causes of morbidity worldwide.

The study here takes into consideration the origin, causes and preventive measures for the control of surgical site infections. The SSIs have been seen to claim a number of lives apart from resulting in longer hospital stays. Additionally, higher amount of expenditures are generated attributed to the specialised care and services. The assignment also takes into consideration a number of steps such as the origin and the causes of the SSIs outbreak. The types of the SSIs have been grouped based on its symptoms and site of expressions. Therefore, a number of parameters such as the Who checklist needs to be established which helps in maintaining the safety requirements of the surgery.

Surgical site infections are a major source of post-operative illness and is the second most common form of health associated infections within the context of a hospital.  The surgical site infections may originate from a gaps or loopholes which may arise out of mere carelessness during the process of undertaking a surgery (Uppal et al. 2013). As mentioned by Anderson et al. (2014), the immunity and the clinical condition possessed by the patient further dictates the risk of contracting a surgical site infection by the patient. For instance, in the context of diabetes mellitus the immune system of the person is affected resulting in poor wound healing. Additionally, poor glycemic control associated with diabetes mellitus leads to increased risk of SSI (Chiang et al. 2014). The SSIs may be differentiated based upon the place of occurrence of the SSIs such as superficial incisional surgical sire infection, deep incision surgical site infection, organ-space surgical site infection etc.

Superficial incisional SSI

The incisional superficial surgical site infection may be defined as the one which occurs at the site of incision within 30 days of surgery. As mentioned by Namba et al. (2013), the superficial SSI affects the skin and/or subcutaneous tissue where an incision had taken place. The symptoms exhibited may consist of continuous drainage from the site of infection (Waits et al. 2013). The superficial SSIs are limited to the surface of the skin only and are not deep rooted. Therefore, the healing process occurs more speedily reducing the recuperation time along with the additional charges of hospitalization.

Preventive Measures for Surgical Site Infections

Deep incisional   SSI

The SSI occurring after 30 days of surgery if no implant had been left in the place, or surgical infections occurring within a year of surgery, when an implantation has been made is known as deep incisional SSI (Schweizer et al. 2015). This particularly affects the soft and deep tissues of the body and takes an incessant amount of time in healing.  The wound redressal often takes a longer amount of time along with constant monitoring by the physician in required in the process.

Organ-space SSI

The organ spaces SSI are known to occur within 30 days of surgery generally with or without an implant. The infection may originate at any other site of the specific organ other than the site of the infection. The management of the condition requires high doses of antibiotics to be provided the patient as the wound is deep rooted. The organ spaces SSI are often associated with a number of contradictions such as huge number of precautionary measures which needs to be implemented for reducing infections (Korol et al. 2013). As commented by Uckay et al.  (2013), failure in the implementation of the precautionary measures can result in the occurrences of severe disruptions within the clinical procedure. However, the risk factors of triggering of autoimmune disorders are present in the organ transplant, which calls for stricter measures to be followed (Owens et al. 2014).

The occurrence of the SSI is directly linked to the type of surgery performed and the natural micro biota of the organ where the incision has been made. Most commonly the infections are caused by gram positive coccus bacteria including Staphylococcus aureus and Staphylococcus epidermis (Chen et al. 2013). They mostly affect the skin of the patient and results in superficial infection. On the other hand, gram negative bacteria Enterococcus feacalis and Escherichia Coli affect the GI tract of the patients after surgery.

There might be a number of risk factors which further increases the chances of surgical site infections manifold time such as the present health status of the patient, the surrounding physical environment and the clinical interventions. The risk of SSI is measures as a product of contamination and virulence divided by the host resistance (Xing et al. 2013). In this context, the exact details regarding the nature and the severity of the infection were collected from the patients. A microbial analysis was done were skin surface lesions were collected from the patients of the ward. On further microbial analysis, the presence of superficial infections caused by staphylococcus aurreus was revealed. Therefore, further investigation was carried on which revealed the use of contaminated surgical instruments within the local ward. Therefore, a number of control measures could be implemented over here including sterilizing and cleaning the ward apart from isolation of the ward.

Control Measures for Surgical Site Infections

A number of preventive or control measures can be undertaken for the prevention of surgical site infections. Reports and estimates have suggested that 11% of the patients who undergo surgery get infected in the process. As per estimates in the United States alone the occurrences of the SSIs results in additional 10 billion dollars every day. In 2008, World Health Organization (WHO) initiated the ‘Safe surgery, Save lives’ initiatives to safeguard the life of the patients undergoing surgery (who, 2017). As commented by Edmiston et al.  (2013), the purpose for the launching of such as program was to spread awareness regrading safety measures to be undertaken during the conduct of serious operations. The Who guidelines are binding upon the hospitals and the emergency care wards, which helps in ensuring that risk situations are avoided(Mackenzie et al. 2013).

Some of the precautionary measures which could be taken over here are implementation of evidence based tools for the control of surgical site infections.  As commented by Jenks et al. (2014), the evidence based tools helps in accurate implementation of safety measures within acute hospitals settings. In this respect, a modified grading of recommendations, assessment, development and evaluation (GRADE) strategy could be implemented within the current hospital scenario to reduce the rates of surgical site infections due to false methods or procedures.

Some of the precautionary measures, which could be implemented over are here bathing the patient with antimicrobial or antiseptic agent before the day of surgery. The antimicrobial prophylaxis should be administered based upon clinical guidelines only. As asserted by Anderson et al.  (2014), the timing should be noted so that the concentration of the bacteria is maximum in the blood or serum when the inclusion in made. This helps in establishment of the bactericidal effects controlling the rate of growth of the population. During the surgery glycemic control needs to be implemented using blood target levels less than 200 mg/dl (Tanner et al. 2015). As mentioned by normothermy needs to be maintain in the patients along with increased fraction of inspired oxygen should be maintained in the patient during the surgery.

The recommended categories of the GRADE administrative tool could be divided into four different types such as Type 1A, 1B, 1C and II. The types could be further discussed as follows:

Type 1A- This consists of a strong recommendation supported by high to moderate clinical evidences suggesting net harm or benefits to the patients. This helps in maintaining sufficient transparency within the policy framework and the procedure guidelines.

Challenges in Implementing Safe Surgical Practices

Type 1B-This comprises of low quality evidence suggesting net harm or benefits of the clinical practise. This mainly consists of basic methods implemented for the prevention of microbial infection during and after the post –operative surgeries and consists of aseptic techniques.

Type 1C- The type c could be defined as a strong recommendation implemented by the state or federation. This mainly consists of evidence based procedures supported by data and clinical trials for the prevention of surgical site infections.

Type II- This consist of weak recommendation supported by quality based evidence suggesting trade off between clinical benefits and harms.

No recommendations- An issue with low to very low quality recommendations suggesting uncertain tradeoffs between the benefits and harms of implementation of practices.

There are a number of contradictions are faced for the implementation of the surgical practices. The contradictions mainly arise due to lack of clarity regrading the guidelines for the effective implementation of safe surgical methods. Additionally, some of the factors such as sufficient amount of support from senior administration regarding the implementation of safe surgical practices, lack of surgical buy ins can result in serious contradictions. Moreover, presence of some other forms of sicknesses such as diabetes can result in delaying the wound healing process. As commented by Schweizer et al. (2014), the presences of diabetes have often been linked with some other co-morbid conditions such as chronic Kidney disease (CKD).

The CKD could be measured by estimating the amount of creatinine present in the blood of an individual. The presence of excess amount of creatinine have been related to severe physiological implications such as development of leg amputations in individuals and reported delay in the healing of wounds, along with additional discharge.WHO has suggested the use of checklist for evaluating the safety parameters during and after the post –operative surgeries. However, as argued by Martin  et al. (2016), the implementation of each and every safety parameter in the checklist often requires a lot of time. This could further delay in the immediate redressla and time of surgery.

Conclusion

The current assignment focuses on the concept of surgical site infections and the effects of the same on the health of the patient. The surgical site infection is of three main types depending upon the severity and the types of the infection. The SSIs have been claiming more life than often and are associated with larger number of casualties within the acute hospital setting. The surgical site infections have been increasing at an alarming rate within the health care. The SSIs often results in longer duration of hospital stays along with additional costs to be mitigated in medicines.

The SSIs had been further discussed based upon its categories such as the deep incision SSI, superficial SSI and organ transplant SSI.  For the control and the mitigation of the same the WHO had provided a number of checklist and precautionary measures which needs to ne implemented strictly within the hospital set up. The checklist helps in measuring each and every underlying parameter, which helps in reducing the gaps and the errors in the services. Additional sufficient amount of support from the supervisors can help in reducing the chances of such major incidents. Some of the major steps which needs to be taken in this regrade are use of sterilized surgical instruments along with sufficiently trained professionals helps in reducing the chances of such accidents.

References

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