Surgical Site Infection in Post-Op Patients - Research Paper Example

? SURGICAL SITE INFECTION IN POST OP PATIENTS Susan Avila-Brown Section A & B February 20, Introduction Surgical Site Infection refers to infections that occur after surgery on the body part where the surgery was done. These infections may at times be superficial infection that involves the skin only (Griffin, 2005). Other surgical site infections are exceedingly grave and may involve body tissues found under the skin, the organs or the implanted substance. It is therefore without doubt that surgical site infections represent a considerable portion of infections associated with health care. Its impact on mortality, morbidity, and cost of health care has resulted in its identification as a top nationwide priority in the healthcare sector. The majority of surgical site infections are unnecessary and preventable to a large extent. They account for forty percent of all the infections acquired in hospitals. On top of that, they contribute to a longer recovery, further threat of other complications, additional pain, and even death in extreme cases. Research conducted has also revealed that surgical patients who develop complications from the surgical site infections are twice likely to die compared to those not infected (Dellinger, Hausmann & Bratzler, 2005). Furthermore, they have sixty percent more chance to be admitted in ICU, the hospital stay becomes longer, and lastly the readmission rate increase as six times more compared to those patients without infections (Griffin, 2005). These factors have demonstrated the need for interventions to prevent surgical site infections from affecting surgical patients. Several interventions are put in place by various groups to reduce surgical site infection rates and mortality of patients. These groups comprise the National Quality Forum, the Joint Commission on Accreditation of Healthcare Organizations and the Centers for Medicare and Medicaid Services. They have collectively recommended the use of prophylactic antibiotics to prevent surgical site infections. The SSI avoidance through prophylactic antibiotic use consists of three core elements. These elements are appropriate selection, first dose timing, and discontinuation of the dose postoperatively. Selecting an appropriate antibiotic to prevent an infection is extremely beneficial. The antibiotic selected should be one that can effectively work against the microorganism likely to cause surgical site infection (Kurtz, 2011). The antibiotic selection varies depending on the kind of surgery. Physician and clinical experts from various health bodies, boards, and groups have developed guiding principles for appropriate antibiotic selection (Surgical Infection Prevention Guidelines Writers Work group 2004). From the proposed strategies, hospitals are anticipated to create inter-department protocols based on local consensus and formulary of the practitioners. The protocols are the guidelines that direct the medical staff on what to do in cases of emergencies. In this scenario, they assist in ensuring that the most appropriate antibiotic is chosen since they can be prepared beforehand and performed by the nursing and pharmacy personnel. In this situation, the need to note down a unique antibiotic order for every surgical patient is reduced. Furthermore, the unique regimen may contain an error or some portion of it may be inadvertently omitted (Griffin, 2005). The protocols are therefore developed with the assistance of local experts, the physicians, and surgeons handling the infectious disease at the hospital. The protocols contain clear guidelines to direct the staff on recommended substitutes in case allergic reactions occur, or the criterion as to when a doctor should be notified for a different antibiotic order. The antibiotic protocols should be reviewed, renewed, and updated annually basing the changes on the accessibility of medicines and amendment in guidelines nationwide. The timing of the antibiotic administration is another fundamental aspect in preventing surgical site infections. Clinical experts recommend that the initial dosage of an antibiotic for surgical site infection prophylaxis should be given prior to the commencing of surgery. This time is also recognized as the incision time (Griffin, 2005). Research has revealed that giving the first dose of antibiotics on the right time (60 minutes before incision time) plays a vital part in minimizing the risks of surgical site infections. Findings from frequently cited studies where nearly three thousand surgical patients were interviewed with different first dose timings revealed that surgical site infections rate was the lowest for those patients who had received their first antibiotic dose within a time frame of sixty minutes prior to their surgery (Griffin, 2005). Those patients who got their first dose of antibiotics either longer than sixty minutes prior to surgery or after the operation had greater chances of acquiring surgical site infection (Dellinger, Hausmann & Bratzler, 2005). The research also showed that the further the dosage time was from the surgery, the higher rate of surgical site infection. The differences in the rates of SSI are as a result of tissue perfusion and the half-life of medicine in the tissues. Early administration of the dosage may make the drugs reach their peak effect and even surpass it before the incision is made. The overall result is less protection against surgical site infections. On the other hand, if the medicines are administered during the operation or after, the time taken by the antibiotic to fully perfuse all the surrounding tissues makes it too late to offer maximum protection (Kurtz, 2011). For its effective performance and protection from SSI, the entire dose of antibiotic should be completely administered prior to the surgery but no longer than sixty minutes prior. It should also be administered via rapid infusion in order for the dose starting time to be close to the ending time. Lastly, the dose should be adjusted according to the weight of the patient sizes since large patients are known to require high doses for the required therapeutic level to be achieved. The continuation of prophylactic antibiotics after the surgery should not exceed twenty four hours except for cases of cardiac surgery. Clinical experts argue that continued use of antibiotics is unnecessary and may contribute to antibiotic resistance. Protocols have therefore been set to ensure that the antibiotics are discontinued from the patient in a timely fashion. To conclude, a surgical site infection is a serious problem in the health sector. Its common causes include complications arising from surgical hypothermia, contamination from surgical instrument, bacterial cross-contamination and contamination of the surgical site by skin parts. Its side effects which range from morbidity, mortality and increased cost of health care makes it an issue of national concern. References “ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery. (2002). American Journal of Health-System Pharmacy, 56: 1,389-1,888, Dellinger, E., Hausmann, S. & Bratzler, D. (2005). Hospitals collaborate to decrease surgical site infections. Am J Surg; 190: 10-17 Griffin, F. (2005). Best Practice Protocols: Preventing Surgical Site Infections. Nursing Management. Retrieved 19 February 2012 from www.nursingmanagement.com Kurtz, R. (2011 July 22). “14 CDC Recommendations to Prevent Surgical Site Infections.” Becker’s Clinical Quality & Infection Control. Retrieved 7 March 2012 from http://www.beckersasc.com/asc-quality-infection-control/14-cdc-recommendations-to-prevent-surgical-site-infections.html Surgical Care Improvement Project: Making Surgery Safer Project Overview. Retrieved 19 Feb 2012 from http://www.medqic.org/scip/scip_homepage.html Surgical Infection Prevention Guidelines Writers Work group. (2004). Clinical Infectious Diseases. 38(15 June):1706-1715. Read More