Table of Contents
Introduction
In the last few decades, medical sector has received a significant increase in the number patient losing their lives as a result of Surgical Site Infection (SSIs). With the increase in complexity of diseases, doctors are being forced to conduct a huge number of operations which is one of the most effective ways of treating internal health issues. According to the Center for Disease Surveillance and Prevention (CDC), Surgical Site Infection is an infection which occurs as after an operation and it may take place 30 days if where no implant is left in place. In other cases, it occurs one year after the operation if there is an implant left in place but the infection need to be related to the operation. According to the 2006 report, more than 30 million operations were conductedworldwide, and out of these surgical procedures which were conducted in the United States, about 2.6% of the operations resulted into Surgical Site Infection. Additionally, according to the report by the United States Surgical Association, Surgical Site Infection is the leading cause of mortality in the United States (Bulechek, 2013). The purpose of this research paper is to describe Surgical Site Infection, the causes, measures which can be used to prevent the infections and types of wounds which result from these infections. An article by Donald Fry indicated that even though Surgical Site Infection is considered to be the main cause of the declared deaths, the statistics can be underestimatedbecause the largest number of infections as a result of surgical operations is discovered after the patients have been discharged. There is a need to come up with aneffective measure to prevent surgical infections at the site and after the patients have been discharged.
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Background information
Surgical Site Infection is one of the most common and severe nonsocial infection among the surgical patients, and the patient’s microbial flora highly causes it. Understanding Surgical Site Infection is a major aspect of the modern medical sector due to the increasing morbidity and mortality as a result of these infections. Additionally, patients are forced to be hospitalized for more days as a result of these infections hence resulting in increasing in medical cost. Post-Operative treatments are believed to cost the government more than one billion per year and major suffering to patients (Bulechek, 2013). There are different factors which determine chances of patients getting infected during or after the surgery has been conducted. Some of these factors include firstly, inherent potential of Surgical Site Infection which is not common in the UnitedStates according to report. Secondly, the duration of operation playsa major role in the Surgical Site Infection because the more the wound is exposed, the higher the chances of being infected. Thirdly, patient’s specialty is a major factor in the increasing Surgical Site Infection.
Preventive measures which can prevent the Surgical Site Infection are one of the most effective techniques which can be used to reduce cases of these infections (CDC, 2016). Additionally, lack of health literacy among the patients and their caretakers regarding the Surgical Site Infection is a huge issue. With the largest number of these infections taking place after discharge, it is clear that if the patients and their caretakers are aware of these infections, it means that they would take the precautions which will help reduce these cases.
Anatomic location of Surgical Site Infection
The Surgical Site Infection occurs in different locations as categorized anatomically. Some of these categories include: firstly, the superficial infections are the most common type of infections. Superficial infections cater for about 47% of the total infections. This kind of infections tendsto affect the subcutaneous tissues and skin in incision highly. Secondly, deep infections are less common compared to artificial infection. Deep infections compose of about 27% of the total number of Surgical Site Infection in the United States. Some of the locations that are most preferred by deep infection include muscle and fascia layers of the patients’ body (CDC, 2016). Lastly, organ space infection involves 30% of the total number of Surgical Site Infection. This kind of infection occurs in any part of human anatomy other that the part which was involved in the incision and which might have been manipulated and opened during the operations.
The severity of Surgical Site Infection depends onwithsome pathogens which penetrate the opening and the duration taken before treatment activities are started. In most cases, Surgical Site Infection may be so severe causing the patients to remain in the intensive care unit for a long period (Gruendemann, 2011). According to a report by CDC, about 60% of the patients who have Surgical Site Infection will spend more than three months in the ICU, and they are twice more likely to die compared to patients without the Surgical Site Infection. If hospitals can be able to curb the issue of Surgical Site Infection, they can be able to reduce the number of days patients stay in the hospital after surgery operations in more than seven days and they may save more than $3, 000 per patient.
RISK FACTORS
There are multiple factors which cause SSIs. Some of these risk factors include: firstly, preoperative factors which are factors as a result of preoperative hospitalization, prophylactic antibiotic administration, and preoperative skin cleansing (Gruendemann, 2011). Secondly, intraoperative factors are major risk factors (Gruendemann, 2011). Some of the intraoperative factors include length operation, contamination of wound as a result of effective care, tissue damage which is as a result of poor medical skill and wound homeostasis. Thirdly, postoperative factor creates a major risk in surgical patients. Some of the factors which result to Surgical Site Infection include incision care, nature of wound surveillance and blood glucose control. Lastly, patient factors that may contribute to Surgical Site Infection include diabetes, preexisting infections, patients with malnutrition issues, smoking and chronic steroid use.
One of ways surgical procedures can be categorized is by degree of contamination of the wound. The incidences of diabetes, preexisting infections, patients with malnutrition issues, smoking and chronic steroid use tend to increase with the degree of contamination. There are other factors which can be used to predict the risks which are related to Surgical Site Infection (Gruendemann, 2011). Some of the most common factors include: firstly, abdominal operation, operations which duration is more than 2 hours, operations which are using contaminated or dirty equipment and the presence of more than two diagnoses. Factors such as blood transfusion and inappropriate timing of the antibiotic prophylaxis was identified as one of the risk factors for Surgical Site Infection, but most hospitals have managed to come up with factors which will help curb these issues.
Classification of Operative Wounds and Risk of Infection
Operative wounds can be classified in different risk of infection. Some of the classifications include:
| Wound | risks | Risk percentage |
| clean | This is a wound which is primarily closed, no traumatic, nonemergency, elective, which lack break in techniques, respiratory, and other none entered. | <2 |
| Clean-contaminated | This is a type of wound which has an emergency and urgent case which may be otherwise clean. It may be as a result of elective gastrointestinal, respiratory and genital urine tract which has minimal spillage but not encountering bile or urine, and with a minor break in technique. | <10 |
| Contaminated | Is a wound which may be encountering gross spillage from the gastrointestinal tract or entry into genitourinary or biliary mostly in the presence of infected urine or bile. It may have penetrating trauma <4 years ole and chronic open wound which are over covered or grafted. | ~20 |
| Dirty | Has purulent inflation for example abscess maybe as a result of preoperative perforation of respiratory, gastrointestinal, biliary, genitourinary tract, and penetrating trauma > 4 years | ~40 |
Preventive measures
Intraoperative, preoperative and postoperative management can be effective in modifying the risk for developing a Surgical Site Infection. Surgical Site Infection preventive measures are expected to target a certain population, and this is as a result of different in nature of infections (HR&ET, 2016). However, based on the general principles which exist in these measures, they should be applied to all patients. Some of the preventive measures which are taken in Surgical Site Infection include:
Antibiotic Prophylaxis
In Surgical operations, antibiotic prophylaxes are administered when there are risks of infection. Whenever the risk of bacterial contamination is high in preoperative bacterial prophylactic antibiotics is recommended or whenever the infection may result in serious mortality or morbidity. However, the indication for antibiotic prophylaxis vary with the wound categorization (HR&ET, 2016). Additionally, it is supposed to be applied in a clean-contaminated case because contained and dirty wounds as a result of surgical procedure are already infected, and thus they do not require prophylaxis but therapeutic antibiotics.
Antibiotic administration
With proper administration of plastic antibiotics, 40% to 60% of the Surgical Site Infection can be prevented. Effective of the drug level highly depend on the timing of administration. Late administration and early administration f antibiotics in Surgical Site Infection cases will result into increase in rates of infection. Administration guidelines of prophylactic antibiotics recommend that the antibiotics should be administered 60 minutes after the incision takes place (HR&ET, 2016). According to research by Center for Diseases Surveillance and Prevention, administration of prophylactic antibiotics should be done in the operating room where results indicated that they would be more effective because they will be timelier for all antibiotic types and procedures.
Antibiotic selection
The antibiotics which are selected for prophylaxis are supposed to be cost effective, safe and active against the pathogens which are commonly encountered as a result of the surgical procedure. Additionally, local resistance patterns need to be a guiding factor in the selection of the antibiotics. Some of the most recommended and appropriate prophylaxis includes first and second generation cephalosporin (Pear, 2007). The antibiotics can be used for various procedures, but in cases of colon procedures, anaerobes are applied or a gynecologic surgery. Additionally, for patients who are allergic to Beta-lactam, Vancomycin is highly recommended. In addition, fluoroquinolones and clindamycinis also accepted as an alternative for cephalosporin.
Antibiotic discontinuation
There are no benefits documented which are as a result of prolonged uses of antibiotics. There is a need to ensure all the prophylaxis which are administered during operations are discontinues after 24 hours However, there are some special cases for example, for cardiac surgery, antibiotics are supposed to be continued for about 48 hours after the operation as a result of invasive drains and lines (HR&ET, 2016). Additionally, prolonged use of prophylactic is associated with the development of infection and bacteria’s such as Clostridium difficult. Some of the effects of prolonged use of antibiotics to prevent Surgical Site Infection include: firstly, there are chances of masking signs of established infections (Pear, 2007). For physicians to identify infections after procedures are taken, human body need to have time and generate the conditions of infections which are most likely to fails to appear in cases where there is prolonged use of antibiotics. Secondly, it may result in difficulties in diagnosis of identified infection because; there are some treatments which may not be effective if the patient’s body has a huge amount of antibiotics. Lastly, prolonged antibiotics may hinder patients from receiving well-timed and enough treatment because, the signs of infection will not be seen early and if seen; antibiotics may make it impossible to understand the severity of the infection.
Measures appropriate in Preventing Surgical Site Infection in patients
There are different preventive measures which can be used for surgical patients. Some of these procedures include: firstly, normothermia where preoperative hypothermia is linked with the process of impaired healing of wound, alternative drug metabolism, adverse cardiac events, and coagulopathies (Smith, 2013). As a result of operating room environment which entails impaired thermoregulation and others, inadvertent hypothermia occurs.
Anesthesia is a compulsory component in most operations. However, it has it is known for having some effects to the patient’s body which may result into sweating, shivering and vasoconstriction. Unless warming measures are used, this case results into hypothermic. However, the hypothermic condition is prevented by enacting warming measures (Smith, 2013). Additionally, impaired vasoconstriction ensures there is a redistribution of blood flow from core to the association and this is associated with the heat loss. Through the use of hypothermia, immunes occurs which directly impair the infections hence resistance of infection and also reducing the coetaneous. However, its performance might not be adequate because impaired by hypothermia and protein wasting will decrease the capacity of healing the wound.
Guideline to Preventing Surgical Site Infection
Preoperative management
Firstly, all infections which are remote to surgical sites are supposed to be treated before the elective operation is carried out. Additionally, the operations for these patients with isolated site infections ought to be post phoned until the infection is resolute first (Smith, 2013). Secondly, a night before the patient undergoes the operation, it is important to ensure they bathe with an antiseptic agent. Thirdly, smoking patients are supposed to stop smoking before the procedure is taken. Patients are supposed to abstain from smoking of tobacco, cigar, pipe, and others at least 30 days before the elective operation. Lastly, the colon is supposed to be prepared mechanically using cathartic and enemas agents before the elective colorectal operations. Additionally, unobservable oral antimicrobial agents are supposed to be administered in divided doses few days before the operation is conducted.
Operative management
Firstly, hair should not be removed from the patients unless the hair is interfering with the operation or the hair is around the incision area. If it is necessary to remove hair from the patients’ before the operation, it is important to ensure the hair removal is done completely before the operation starts. Secondly, for skin preparation, adequate antiseptic agents are supposed to apply. Thirdly, physicians are supposed to have short nails, and for those who wear artificial nails, they should ensure they are removed before the operation. Lastly, the operating room doors are supposed to be closed and only a space to pass the equipment and personnel into the operating rooms (Smith, 2013). Additionally, for areas where there is a need for drainage, it should be closed suction drainage.
Postoperative management
For incision which has been closed primarily, there is a need to ensure the sterile dressing is used 24 to 48 hours. Additionally, hands are supposed to be washed after any contact with the surgical site (Stephen H. Gray, 2007). Proper disposal of all the materials and equipment used during the operations are supposed to be done in the recommended way.
Conclusion
The development of Surgical Site Infection is the multifunctional and same case to the prevention of Surgical Site Infection. Surgical Site Infection Prevention will provide an evidence-based measure that if well utilized; it might reduce the cases of Surgical Site Infections. Measures are directed to a certain category of patients. However, through the use of the certain procedures, there is a need to utilize some principles and this will ensure the procedures are applied to all the patients. Surgical Site Infection Prevention requires effective line of communication between the physicians and the patients or patients caregivers. 25
- Stephen H. Gray, Mary T. Hawn. (2007). Prevention of Surgical Site Infections. Retrieved fromhttp://turner-white.com/pdf/hp_nov07_surgical.pdf on 11/02/2017
- Health Research & Educational Trust. (2016). Surgical Site Infections Change Package: 2016 Update. Chicago, IL: Health Research & Educational Trust. Retrieved from www.hret-hen.org on 11/02/2016
- Suzanne M. Pear. (2007). Patient Risk Factors and Best Practices for Surgical Site Infection Prevention. Retrieved fromhttp://www.halyardhealth.com/media/1515/patient_risk_factors_best_practices_ssi.pdfon 11/02/2017
- Center for Disease Surveillance and Prevention. (2013). Surgical Site Infection. Retrieved from https://www.cdc.gov/HAI/ssi/faq_ssi.html 11/02/2017
- Smith, M. A., Dahlen, N. R., & National Association of Orthopaedic Nurses (U.S.),. (2013). Clinical practice guideline.
- Gruendemann, B. J., & Mangum, S. S. (2011). Infection prevention in surgical settings. Philadelphia, Penns: W.B. Saunders Co.
- Bulechek, G. M., Butcher, H. K., McCloskey, D. J. M., & Wagner, C. (2013). Nursing Interventions Classification (NIC). London: Elsevier Health Sciences.