Continuous Quality Care: Surgical Site Infection - Research Paper Example

? Continuous Quality Care: Surgical Site Infection Continuous Quality Care: Surgical Site Infection Introduction According to reports, Medicare has already stopped reimbursing hospitals. The Centers for Medicare and Medicaid Services (CMS) have selected a number of high-cost, high-frequency events to include in the changed policy of reimbursement; and CMS term them as ‘never events’ (Brown, Doloresco III & Mylotte, 2009, p. 743). According to CMS, “a never event must be unambiguous, preventable, serious, and either adverse, indicate of a problem in the facility, or important for public credibility and accountability”; and the eight conditions CMS initially addressed are “catheter-associated urinary tract infections, vascular catheter-associated infections, and surgical site infections after coronary artery bypass grafting, certain orthopedic surgeries, and bariatric surgery” (as cited in Brown et al, 2009). ‘The Never Events’ are Preventable According to a press release dated 31 July 2008 from the CMS Office of Public Affairs (2008), the ‘never events’ are preventable medical errors that result in serious consequences for the patient. As a result, such events cause serious injury or death to the beneficiaries and unnecessary costs to the Medicare and Medicaid systems. According to CMS (2008), hospital-acquired conditions (HACs) are the conditions which were absent before admission and developed during the hospital stay. The benefit is that this step will make hospitals improve the reliability of care they provide to patients. What is Surgical Site Infection (SSI)? A surgical site infection (SSI) can be defined as the infection that occurs after surgery in the place where the surgery was conducted. It is estimated that nearly 1-3 patients out of every 100 patients who had surgery develop SSI. Surgical Site Infection takes place because during surgery, one of the body’s most important protective covering-the skin- is opened. As a result, pathogens from the patient’s body, environment, or surgical instruments easily enter the body through the incision made during the surgery and cause infection. Surgical Site Infections can be minor or serious. Sometimes, the infections go superficial covering only the skin, and sometimes, such infections become serious affecting organs and even implanted material, leading to serious illness and even death. The symptoms of surgical site infections include redness, pain, drainage of cloudy fluid, fever, and so on. In fact, the chances for surgical site infections increase if the patient has an existing health problem and if the surgical site is not properly cleaned. Thirdly, the longer the surgical procedure is, the higher the infection chances will be. Various Studies According to the information provided by COLLATAMPG (n. d.), nearly 40-60% of the present surgical site infections are preventable. Brown et al (2009) point out that not all surgical site infections are preventable. To illustrate, based on a study, the scholars prove that only 40-60% of the surgical site infections are preventable. Also, it is noted that timely prophylaxis is not linked to surgical site infection rates in orthopedic surgeries. In addition, providing antibiotics in time is not associated with the rate of surgical site infection. However, there is the observation that using the available techniques, it is not possible to reduce the incidence of surgical site infections to zero. To illustrate, Brown et al (2009) point out that 40-60% of the surgical site infections are preventable. Based on studies, the scholars point out that timely prophylaxis is not linked to reduced rates of surgical site infections in orthopedic surgeries. Similarly, timely antibiotics intake is not connected with surgical site infection rate. However, it was possible to reduce the vascular catheter-associated infections in adult patients by 56% when the ‘best available prevention techniques’ were used (Brown et al 2009). Similarly, Nichols and Florman (2001) look into the issue of SSI and point out the issue of pathogens’ developing resistance; it is found by the scholars from the National Nosocomial Infections Surveillance System that the pathogens show antimicrobial resistance and methicillin resistance. That means, with the new regulations in place, hospitals will eagerly use the various antibiotics to prevent such events, and the result will be the creation of antibiotic-resistant organisms. Admittedly, preventing this condition will help improve the quality of healthcare if the aims are achievable. First of all, the patients who are admitted will be closely monitored for the presence of such pre-existing health conditions. Also, after surgeries, the patients will be closely observed for the occurrence of such issues. Thirdly, during surgeries, adequate attention will be given to safety and cleanliness. As already seen from data, nearly two-thirds of the usually reported Surgical Site Infections are preventable if there is proper precaution. If this target is met, there will be significant improvement in the healthcare provided. Some Effective Measures With the present regulations in force, the healthcare team is in need to communicate openly with the patient and his or her family members. This is so because many people including the patient himself, the healthcare team members, or the relatives of the patient can be the transmitters of pathogens. For example, a touch with an unwashed hand, or even coughing and sneezing, are powerful enough to develop infection in the Surgical Site. National Institute for Health and Clinical Excellence (2008) points out in its release named Surgical site infection-prevention and treatment of surgical site infection that good communication between healthcare professionals and patients is very important in this matter. Also, such communication should be supported by written information, and when possible, families and careers of the patient should be allowed to take part in decision making (p.3). The communication include giving the patient and his family a clear picture of the risks of surgical site infections and what steps are being taken to prevent the same. In addition, it is possible that the patient and his family carelessly handle the wound after discharge. So, they should be provided adequate information and advice on how to care for the wound and the consequence associated with not adhering to the same. Another point is that the patient and the people who care him should be taught how to identify a surgical site infection. Also, the people should be taught whom to contact and what to do if infection is noticed later on. The white paper from the Infection Prevention Leadership Summit prepared by Dellinger, Richard, Gordon, Guglielmi, Huber & Kohut (2011) declares that Educate, Empower and Engage (E3) are the very basis of SSI prevention. A healthcare provider might be reluctant to discuss the development of this condition with a patient for a number of reasons. First of all, it is possible that as a ‘never event’ leads to unavailability of payment from Medicaid and Medicare, the leadership of a hospital might want to keep the issue unreported. Secondly, a patient who comes to know about the development of SSI might resort to legal action against the hospital for lack of care. However, not discussing or disclosing the same to the patient and his family will have even worse consequences. First of all, the patient and his family will fail to take the necessary precautions to control the infection. Secondly, the hospital becomes guilty of violating rules and regulations by not disclosing necessary health factors to the patient or the people concerned. The Joint Commission & Accreditation The joint commission worked with the Centers for Medicare and Medicaid Services on AMI and HF and developed a common set of measure specifications documentation which is known as the Specifications Manual for National Hospital Inpatient Quality Measures (The Joint Commission, Core Measure Sets). According to the Joint Commission, hospitals are supposed to implement evidence-based practices to prevent surgical site infections. It includes educating staff and practitioners, at the time of hiring and annually during employment. Secondly, hospitals should educate the patients and their families as required before a surgical procedure about surgical site infection and its prevention (The Joint Commission, Accreditation Program: Hospital). Thirdly, hospitals should implement such policies and practices which are aimed at reducing surgical site infections. The adopted policies and practices should be well in accordance with the evidence-based guidelines as provided by the Centers for Disease Control and Prevention and other professional organizations. Also, in order to reduce surgical site infections, hospitals should conduct regular risk assessments and adopt such measures which are considered as the best practices according to various guidelines. In addition, hospitals should monitoring and evaluating systems to ensure strict adherence to the regime Moreover, hospitals are required to measure surgical site infection rates for 30 days in the case of such medical procedures with no implantable device insertion, and for one year in the case of implantable device insertion. Such measure results should be made public and provided to key stakeholders. The on-site survey is very important in the accreditation process. In the onsite survey, the survey team will adopt tracer methodology and various other survey techniques to look for areas of noncompliance with the Joint Commission standards. At the end of the survey, a survey finding report will be provided to the hospital, but this does not mean accreditation decision. The Agency for Healthcare Research and Quality of the U.S Department of Health & Human Services (2007) conducted a study to determine the effects of various quality improvement strategies on the prevention of surgical site infections, and healthcare associated infections and hospital-acquired illness; the strategies adopted in the case of Surgical Site Infections ranged from antibiotic prophylaxis, educational interventions, audit and feedback, and clinician reminders. Decision Making and Strategies Evidently, the first continuous quality improvement strategy is educational intervention which involves initial and regular education for the staff and practitioners. Also, they should be made familiar with the steps to be adopted. Secondly, printed and computer-based reminders are used to improve timely use of surgical antibiotic prophylaxis. The third strategy will be the use of a checklist to ensure strict adherence to the guidelines. Localized decision making is helpful in addressing and acknowledging local cultures, customers, preferences. As evidenced from the study by Diefenbach, Dorsey, Uzzo, Hanks, Greenberg, Horwitz, Newton &Engstrom (2002), it is necessary to take into account the treatment-related beliefs and affects during the treatment counseling process. In this particular case, it means keeping the patient and family well aware about the possibility of surgical site infections, and when possible, allowing them to take part in the decision-making process. Organizational learning can be termed as the effective processing, analysis, and response to, data both inside and outside an organization. It is possible that when there is collaboration and teamwork, information will be passed among the staff. Also, there are the chances of observing and imitating skilled and knowledgeable people. Process reengineering involves observing a particular situation, identifying the key issues, and taking necessary steps to overcome the same. In the case of preventing surgical site infection, process reengineering takes place when necessary steps are taken to overcome the existing problems. An example of evidence-based medicine in this case is a decision-making regarding treatment, which takes into account the history of the patient, his family, and the community and culture the patient lives in. In other words, the preferences, values and rights of the patient are given adequate attention while applying the best medical practices. Education has an important role in making the staff and practitioners aware about the importance of surgical site infection prevention. Similarly, research will help find out better and better intervention strategies which can make hundred percent prevention of surgical site infection prevention a reality. Thirdly, collaboration is very important in the case of surgical site infection prevention because it requires the combined effort of practitioners, staff, family members and the patient. Collaboration ensures proper exchange of information. Information technology helps in storing, analyzing and distributing information as and when required. Leadership is required to offer strong support and guidance to the staff, to set rules and regulations, and to monitor and evaluate performance. Teamwork ensures that all people remain aware about their roles and do them properly. Conclusion Out of the strategies discussed, it seems that the best and cheapest is the educational intervention. The mere fact is that without adequate knowledge and motivation, staff will not be able to perform their duties well. There can be lack of knowledge, lack of commitment, lack of clarity regarding the attitude of the leadership, inability to collaborate, lack of communication, and various other issues which affect staffs’ ability to engage in effective surgical site infection prevention activities. Here, regular educational sessions will be of immense help in keeping the employees informed and motivated. References Agency for Healthcare Research and Quality. (2007). Healthcare-associated infections, quality improvement. U.S Department of Health & Human Services. Retrieved from http://www.ahrq.gov/clinic/tp/hainfgaptp.htm Brown, J., Doloresco, F & Mylotte, J. M. (2009). Never Events: not every hospital-acquired infection is preventable. Oxford Journals, Clinical Infectious Diseases, 49, (5): 743. Centers for Medicare & Medicaid Services. (2008). ‘Medicare and Medicaid move aggressively to encourage greater patient safety in hospitals and reduce never events’. Press releases, CMS.gov: Centers for Medicare and Medicaid services. Retrieved from http://www.cms.gov/apps/media/press/release.asp?Counter=3219&intNumPerPage=10&checkDate=&checkKey=2&srchType=2&numDays=0&srchOpt=0&srchData=never+events&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=1&pYear=&year=0&desc=&cboOrder=date COLLATAMPG.About Surgical Site Infections. Retrieved from http://collatampg.ca/surgeons/about-surgical-site-infections/ Dellinger, Richard P. Gordon, D. S. Guglielmi, C. L. Huber, L. S & Kohut, K. (2011). Educate, Empower, Engage: A Collaborative Interdisciplinary Call to Action for Reducing Surgical Site Infection; Proceedings and Recommendations from the 2011 Infection Prevention Leadership Summit. Retrieved from http://multimedia.3m.com/mws/mediawebserver?mwsId=VVVVVx8BN2ivo_wXr9pcP_Cchy8th28BKyWVhyWVhVVVVVV--  Diefenbach M. A, Dorsey, J., Uzzo, R. G., Hanks, G. E, Greenberg, R. E., Horwitz, E., Newton, F &Engstrom, P. F. (2002). Decision-making strategies for patients with localized prostate cancer. Seminars in Urologic Oncology, 20(1), 55-62. The Joint Commission, Core Measure Sets. Retrieved from http://www.jointcommission.org/core_measure_sets.aspx The Joint Commission. Accreditation Program: Hospital. Retrieved from http://www.jointcommission.org/assets/1/6/2011_NPSGs_HAP.pdf The Joint Commission. (2011). From Survey Report to Accreditation Decision. Retrieved from http://www.jointcommission.org/What_Happens_After_Your_Joint_Commission_Survey/ Nichols, R. L & and Florman, S. (2001). Clinical presentations of soft-tissue infections and surgical site infections, Oxford Journals, Clinical Infectious Diseases, 33 (2): S84-S93. National Institute for Health and Clinical Excellence. (2008). Surgical site infection-prevention and treatment of surgical site infection. Retrieved from http://www.nice.org.uk/nicemedia/pdf/CG74NICEGuideline.pdf Read More