The Prevention of Perioperative Infection in Elderly Patients - Essay Example

The Prevention of Perioperative Infection in Elderly Patients The importance of infection control in the hospitals and clinics is uncontested. Theselargely preventable infections occur too often and cause unnecessary death to victims who have entrusted health care professionals with their lives. Because of this, in 2006, the World Health Organisation launched a campaign to minimise hospital acquired infections (Hall). Unsurprisingly, incidence of surgical infection differs greatly by the health practises of a given country. But despite the standardisation of Western medical practices, surgical infection occurs at comparably high rates. Italian hospitals report a post-surgery infection rate at 3-10% (de Werra, 2005, p. 27). The United States reports perioperative infection caused deaths at 97,000 per year (Schneider, 2006). The Institute of Medicine qualified those results further, estimating that between 44,000 and 98,000 of those reported deaths occurred as a direct result of medical errors (Watson, 2006, p. 22). Even in England, amidst our own medical facilities where our own health care professionals practise stringent infection control, these preventable infections occur far too often. Recently, Britain's most senior doctor, Sir Liam Donaldson, reported death risk due to medical error at 1 in 300 (Hall). This includes patients having contracted infections within the hospital settings. "Between 5% and 10% of patients admitted to modern hospitals in the developed world acquire one or more infections, with at least 5,000 deaths directly attributed to healthcare-acquired infections in England each year" (Hall, 2006). Older people are a specific demographic at risk for perioperative infections due to their higher incidence of diabetes and hypertension, and their immunological systems particularly susceptible to the adverse affects of prolonged smoking and obesity. While caring for elderly patients and assessing their likelihood at incurring surgery-related infections, there are a number of risk factors that should be assessed. Infection control entails hospital procedures both prior to surgery and utilisation of infection control programmes throughout surgery. There are also specific practises for complex procedures maintained in orthopaedics and cardiothoracic surgeries by Multi Disciplinary Teams. All hospital personnel must take care to follow infection control procedures and be aware of avenues and risk factors for infections, in order that older patients are cared for effectively and their infections prevented. Risk factors in older people Older people are more at risk from infection during hospitalisation due to their oftentimes immunological compromised status. Immunological debility in elderly patients arises in a variety of settings for multiple reasons. It has been shown that arriving to surgery from elderly health-care facilities is a significant indicator of perioperative and postoperative infection (Lee, 2006). This is logical due to the very fact that health-care facilities house the most compromised patients in the older persons demographic. To explain this further, it is certain that patients with diabetes, overweight patients, and obese patients have an increased risk of infection (Preventing, 2006). Likewise, poor nutrition and lack of activity cause patients to be immunocompromised. But it is not only older patients in health care facilities that warrant attention from the health industry. Studies show than anyone above 60 year of age may be at a higher risk of perioperative infection (Pugliese, 2005). The National Confidential Enquiry into Perioperative Deaths (NCEPOD) maintains a practise of reviewing data reported on specific demographic groups each year. The NCEPOD's work is the collection of information on patients who die within 30 days of a surgical procedure (Kmietowicz, 1999, p. 1324). Due to the seemingly unnecessary incidence of death among the aging demographic, the 1999 report specified more care for the elderly. This prudent step seems recommended by all fields, orthopaedics, cardiac, and general surgery, as risks for general morbidity and mortality are significantly higher for patients 60 years of age and older (Jahoda, 2006; Pugliese, 2005). Therefore, this review, or any review, of infection control is advantageous in that it enhances concentration on a subject integral to the health maintenance of a large patient population. Key principles of infection control Key principles of infection control for operative procedures in hospitals are centred on prevention, namely antibiotic treatment. Other importance aspects are maintenance of body temperature throughout procedures, maintenance of blood sugar throughout procedures, hygiene and safety practises within health care facilities, and wound cleanliness (Watson, 2006). Unanimously, researchers and hospital staff state that prophylactic antibiotic treatment for infection prevention is mandatory (Jahoda et al, 2006; de Werra, 2005) Likewise, the importance of standardisation of operative procedures is crucial. In review of the literature about infection control, it seems, however, that the most important criterion in prevention of infection is hospital procedures and programmes that standardise behaviours of personnel involved in surgeries. For example, that all possible modes for infection are evaluated and tools sanitised, that health care workers are double-gloved, and that all instruments be routinely accounted for. These issues will be discussed in more detail throughout this assignment. Hospital Acquired Infections Of the hospital acquired infections, the overwhelming majority are due to the Staphylococcus aureus virus. In a study of 169 patients that had developed surgical site infections following orthopaedic surgery, the most common infection (56%) was Staphylococcus aureus. Other infections, nosocomial infections, are those occurring surgical sites, respiratory infections, genitor-urinary infections, and gastrointestinal infections (EHA, 2006). Here again, the importance for safety and infection control is clear, as "These infections are often caused by breaches of infection control practices and procedures, unclean and non-sterile environmental surfaces, and/or ill employees. Infection control: psychological and sociological impacts Psychological and sociological importance of infection control can be assessed concerning patient trust in health care professionals and health care facilities. Also, it can be assessed through health care workers' willingness or unwillingness to report incidents in which they believe an infection may occur. The Institute of Medicine conducted research on the best practise approaches to post-management of perioperative and postoperative acquired infections (2004). The study included OR members in Canadian hospitals; its response pool consisted of general surgeons, nurses, anaesthesiologists and patients. Questioning proposed the ethical and systematic reactions to scenarios, like "a sponge is retained after an abdominal operation" and "a surgical breast specimen that is about to be oriented with marking sutures is dropped and the orientation is incorrectly marked. Interestingly, patients and nurses differed significantly in whether incidences should be reported: Although 93% of patients wanted reports made for the events that they perceived to be errors, nurses opted for documentation in a significantly lower number of events that they perceived to be errors (ie, 50% for events overall) [] In addition, nurses were willing to report only events within their disciplinary scope of practice. Patients more frequently advocated for full disclosure. (Allen, 2004, p. 493). These results are concerning. They elucidate the psychological and social fears nurses have in reporting errors. Errors need to be documented for early detection of infections. Sociological components for better infection control include higher reporting of incidents. Nursing processes with regard to infection control Within the hospital setting Nurses carry multiple roles in the prevention of infection. In regard to perioperative infections, there are many opportunities to prevent infection while preparing the patient in the weeks up to surgery as well as the day of surgery. In an October article published by London's The Guardian, D. Macqueen, the clinical nurse and director of infection prevention at Great Ormond Street reminded the public of general hygiene, insisting that patients are aware of germs even in hospital settings, that patients feel comfortable asking nurses to wash their hands once again, and are protected from their own ill visitors. Interestingly, some of the nursing processes done in regard to infection control don't seem as purposeful as they once had. Surprisingly, two research studies done reported little difference in risk of infection with preoperative shaving vs. no preoperative shaving (Segal, 2006; Consumer Reports, 2006). Similarly, in a study conducted at the University of Worchester, it was found that washing with skin antiseptics did not prevent surgical site infections (Fernell, 2006). Prior to surgery, it is most importance to maintain the patient's blood sugar, as high blood sugar increases infection risk (Prevention, 2006). Of course, the patient should not be fighting infections or viruses at the time of surgery. In elective procedures, surgeries should be postponed until the patient is at their healthiest. Surgical processes Concerning the operation ward and Multi Disciplinary Teams involved in infection control, there are simple procedures proven by research scientists that are worthy of being followed. Some methods are basic, concerning both the medical team's health as well as the patients', including double-gloving to heed the incidence of perforation (Tanner & Parkinson, 2002) and routinely counting surgical tools (Watson, 2006). Multi Disciplinary Teams & infection control Orthopaedics Multi Disciplinary Teams have become the focus of much infection control due to the complexity of specific surgical procedures and the ensuing multiplicity of hazards those surgeries relate to. Therefore, rigorous research has been done on procedure specific infection control, namely in cardiothoracic surgeries and orthopaedic surgeries. One of the major concerns with orthopaedic implants is the incidence of deep tissue infection. Approximately 1%-8% of orthopaedic surgical procedures are complicated by infection (Lee, 2006). According to Jahoda (2005) and his team, prevention of orthopaedic infections is threefold: the patient must have immunological ability to resist infection, wound/surgical technique utilised, and reduced levels of bacterium able to penetrate the wound (i.e. bandaging). Prevention of infections for elderly patients of orthopaedic surgery should focus on preoperative care in health-care facilities prior to surgery (Lee, 2006). The study published by Lee, Singletary, Schmader, Anderson, Bolognesi, and Kaye by the Journal of Bone and Joint Surgery, is unique in that it defines variables significantly associated with surgical site infections in the elderly (p. 1707). The highest risk factor they defined was admission from a health-care facility, followed by chronic obstructive pulmonary disease, the inability to bathe independently and the ability to dress independently (1707-1708). Cardiothoracic In a study conducted by Pugliese and Favero (2001) perioperative predictors of morbidity were analysed in cardiac patients 75 years and older. The study was conducted over a period of thirty months with a pool of over eight thousand patients. Those analysts compiled a list of predictors of mortality, including requirement for mechanical circulatory support, hypoalbuminemia, intraoperative blood loss, surgical reexploration, long ischemic times, and anemia. Concluding the study, the team recommended, once more, preoperative criterion, including the identification of those with likely ability to succeed after surgery (p. 731). In a study conducted at Henry Dunant Hospital in Athens, Greece, evaluations were made on methods of coronary artery bypass procedures and risks of infection. Much of their work was identification of risk factors. They cited hypertension with the development of postoperative infection. Their recommendations were on the increased observation and early diagnosis of previously identified patients. One issue particularly concerning is the prevention on surgical site infections in the area of cardiopulmonary procedures. Infections within this surgery group are a major cause of morbidity (Segers, 2006) but one that is largely preventable. After a review of postoperative mortality conducted by the University of Amsterdam, (2006) the occurrence of infections in cardiothoracic surgery declined from 8.9% to 3.9%. In cases like this, the motivations are obvious for the huge amount of literature devoted to the regularity and utilisation of hospital programmes and regimes concerning hospital procedure and infection control. The nurse's role in infection control and practises The importance of the aforementioned study, in terms of nursing is that this study reinforces the susceptibility of nursing home patients to infection. It is an indicator of an immunologically compromised patient. Nurses play an integral role in the maintenance of their patients' overall health. Nurses often are a communication link about concerns shared by the surgical team and the patient, and visa versa. It is important that nurses identify patients who may be immunocompromised and at risk of infection, by thorough interviewing and monitoring pre and post operation. Another avenue where nurse processes help to prevent infection is in patient education. Nurses are the primary communicators with patients. Patients should be informed about the importance of all aspects concerning the immune system, namely nutrition, activity, infections, obesity, and smoking factors. Hypertension and smoking were cited in 2006 by the Journal of Registered Nurses to be two of the most important and preventable indicators when assessing patients at risk of perioperative infections (Preventative). A 2004 study published by the British Geriatric Society, also reported higher risk of infection for patients with hypertension or smoking habits, 35% and 38%, respectively (Lam, p. 307). High blood sugar increases the risk of infection. Nurses and dietary aides must be cautious of patients' blood sugar and record levels often, especially with diabetic patients. Infection control practices must be utilised throughout all stages of surgical procedures. Particularly with immunocompromised older patients, attention should be given to the intense research done on specific indicators for infection in orthopaedic, cardiothoracic, and other surgeries. All hospital staff, including nurses, should practice careful attention toward strategic infection control guidelines. Bibliography Allen, G. (2004) 'Reorganizing surgical workflow; perceptions of surgical errors; patient safety; post discharge unplanned admissions', Association of Operating Room Nurses, AORN Journal, 84 (3): 493-500. (Anonymous). (2000) 'Surgery for colorectal cancer in elderly patients: A systematic review', The Lancet, 356 (9234): 968-974. (Anonymous). 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