Risk of Infection Minimization in the Operating Department - Coursework Example

Risk of infection minimization in the operating department Lecturer’s Introduction Infection prevention is an essential effort in the operating department to minimize or prevent the risk of infections transmission to the patients or the healthcare providers. Evidence has indicated that healthcare personnel, as well as patients, may acquire infections in the operating department if appropriate care is not taken. However, the prevention of infection necessitates the appropriate understanding of protocols, policies as well as the knowledge and skills of adapting to the perioperative environment. A surgical procedure on a patient requires breaking the skin integrity, the insertion of operating instruments and other materials that are foreign thus, exposing the patient to a potential of acquiring an infection. Infection prevention entails breaking the disease transmission chain to prevent against any infection occurrence. The chain of infection includes the infectious agent, its reservoir, the portal of entry of the infectious agent, its mode of transmission, the portal of exit and the host that is susceptible to the microorganism. It is important to break this chain of infection through risk identification, encouraging good practices in the operating department and designing the operating theatre appropriately. As recipients of perioperative care, patients are entitled to privacy, confidentiality, quality health services and personal dignity during surgical operations. It is the responsibility of the healthcare practitioners working in the operation department to prevent infections to the patients or themselves during surgical operations. Patient’s autonomy should be respected through obtaining adequately informed consent. To benefit the patient and reduce the likelihood of complications resulting from infections, health care practitioners must be knowledgeable and competent. Surgical site infection from the operating department is a major public health concern that needs to be handled accordingly. Surgical site infection Surgical site infection is the third most common healthcare associated source of morbidity, and it contributes to 14 to 17 percent of nosocomial infections. Nosocomial infections are hospital-acquired infections that result from inappropriate healthcare practices causing infection to the uninfected patients and healthcare professionals (NICE 2011, 5). Infection resulting from surgery results to increase in the severity of the disease, increases the rate of the patients mortality as well as cost and prolongs the rate of hospital stay of the patient (Allo & Tedesco 2005, 1292). Preventive practice from infection includes appropriate skin preparation, good control of the operating environment, among the high-risk patient’s surgical antibiotic prophylaxis and improvements in the surgical techniques to prevent any infections from occurring (Wilson 2012, 185). The risk of infection varies depending on the surgery conducted with certain type of surgeries having the highest probability of infection while others have low chances of surgical site infection depending on the complexity and site of surgery (Richmond 2009, 146). According to the infection rates statistics, bowel type of surgery has the highest probability of infection due to the nature of surgery that is involved with large bowel surgery having an infection rate of 10.1 percent while small bowel surgery having an infection rate of 6.8 percent. Limb amputation surgery has an infection rate of 5 percent while liver, bile duct and pancreas surgery have an infection rate of 8.1 percent (Elgohari & S. Thelwall, T. Lamagni 2011, 29). Prosthesis Surgical intervention has the least infection rate as hip prosthesis surgery has an infection rate of 0.8 percent and knee prosthesis infection rate is 0.6 percent. The rate of infection rate of abdominal hysterectomy is 1.5 percent (Agency 2009, 2008). The primary purpose of infection control and prevention in the operating department as well as in the care setting is to minimize infections resulting due to microorganisms resulting wound infections, inflammation, abscesses formation and tetanus as well as prevent the transmission of serious life-threatening morbidities such as hepatitis B and HIV/ AIDS disease. These results to nosocomial infections or hospital acquired infections (Humphreys et al. 2002, 88). In the United Kingdom, more than 300, 000 people every year are affected by such infections. At any moment, about 8.2 percent of patients acquire nosocomial infections from the hospitals. As a result, a patient with a nosocomial infection will spend 2.5 times longer in the hospital as compared to a normal patient and the resulting infection will cost 3,000 more for treatment (Choices 2013, 12). Nosocomial infections increase the rate of morbidity with 5,000 deaths per year resulting and it contributes to 15,000 further deaths among the susceptible patients. This results to an increase in the cost involved in the treatment process costing a total cost of 1 billion euros according to the National Health Service statistics (Koltchinskii 2006, 2597). With appropriate healthcare practices being taken, the infection rates are reducing. The statistics from 2004 to 2011 indicate that inpatient surgical site infections for some surgical categories are on the decline (Elgohari & S. Thelwall, T. Lamagni 2011, 29). These reductions resulted from a decrease in the hospital stay time. However, the rate of annual incidence of the surgical site infection rates varies depending on the surgical specialty and contamination class from 0.6 to 8.8 percent (Bai & Zhang 2008, 831). The risk of surgical site infection occurrence has been associated with the characteristics of the patient, age of the patient, comorbidities such as diabetes, the surgical intervention involved, duration of the operation, healthcare control as well as environmental care. Most of the infection occurring in surgery mainly occurs at the time of the surgical procedure leading to infection. Entry routes of infection causing surgical site infection are from the skin of the patient, infection from the healthcare team, through airborne microorganisms or by the instruments that are used during the surgical procedure (Centre 2013, 23). Environmental control during surgery is, therefore, essential but despite such measures, surgical site infections still induce a substantial burden in public health (Koltchinskii 2006, 2654). Legal, ethical professional concept in the operating department A recipient’s of care in the operating department, patients need to be entitled to confidentiality, privacy, quality health services, as well as personal dignity. This delivery of care is guided by ethical and moral principles that protect the patient from any harm. Certain perioperative standards are paramount to reduce any chances of patient infection during surgery that serve as a foundation of perioperative practice (Masnadi-Shirazi & Vasconcelos 2010, 209). It is the perioperative staff responsibility to meet these standards by providing the appropriate environment for practice for the care. Care needs to be individualized to meet the needs of the patients and need to be provided in the context of disease prevention, health restoration, health maintenance and promotion or palliative care. Patient’s goals and preferences need to be respected in developing and implementing patient’s plan of action (Fioratou et al. 2011, 253). Patient’s autonomy should be respected through obtaining adequately informed consent. To benefit the patient and reduce the likelihood of complications resulting from infections, health care practitioners must be knowledgeable and competent act in their best capabilities for the benefit of the patient. Perioperative healthcare providers such as the perioperative nurse and the surgeon is responsible for a safe and a competent performance in surgery by protecting and minimizing the operations risks such as infection through providing maximal opportunity for a satisfactory outcome to the patient (Wilson 2012, 188). This is achieved by good collaboration among the perioperative healthcare team. In the hospital and particularly under anesthesia, the patients rely on policies and systems of health care institutions to minimize the risk of harm. These policies include getting the correct patient for the operation, protecting the patient from any harm, as well as identification of allergies and medical problems, prior to surgery. Patients have a right to adequate standards of surgical care therefore; practitioners should not put the patients to any undue risks such as risk of infection. The patient is entitled to legal remedy and compensation in an event of negligent surgical complications such as surgical site infection (Humphreys et al. 2002, 86). Chain of Infection The chain of infection is a cycle involving the infectious agent, its reservoir, the portal of entry, the mode of transmission, portal of exit and susceptible host to the infectious agents. Infectious agents include pathogens that are disease-causing organisms such as protozoa, viruses, fungi and bacteria. Examples of such infectious agents include HIV and hepatitis, B virus that can be easily transmitted in surgical operations is appropriate care, is not taken. Types of infections that can be acquired during surgery include skin and soft tissue infections. Any patients undergoing surgery in the operating department as well as the healthcare workers are susceptible to infection upon exposure to a pathogen (Ash 1998, 434). Among patients who are at a risk of developing surgical site infection, include patients suffering from co-existing morbidities, immunosuppressed patient, through contaminated surgical instruments and patients in contact with infected health care personnel. To prevent infection occurring during surgery, it is important to break the chain of infection and preventing entry of the pathogen into the body system. This is achieved through the principles of perioperative infection prevention in the operating department. It is important to break this chain of infection through risk identification, encouraging good practices in the operating department and designing the operating theatre appropriately to reduce the risk of infection. The recommended operation department inflectional prevention measures are based on certain important principles. This entails considering every patient or staff to be potentially infectious, practicing hand washing as the most practical procedure for preventing cross infections, wearing of protecting equipment such as gloves before touching anything wet places, broken skin, secretions or excretions in the operating department (Wong et al. 2010, 920). It is also important to practice safe work practices such as avoiding recapping or needle bending, proper instrument processing and disposal practices. These precautions are essential in breaking the chain of infection and are designed to protect health workers and patients from infection from pathogens. Hand washing is important in the operational department as it causes a significant reduction of potential pathogens that are carried by the hands before any surgical procedure is done. 99 percent of transient pathogens are easily removed through good hand washing before conducting any surgical procedure. This is important in reducing chances of infection during surgery. Personal protective equipment is also essential in reducing chances of infection transmission such as gloves, eye and hair protection equipment, aprons and surgical gowns. Sterilization and Decontamination of instruments for surgery are important before surgery to prevent any instances of infection transmission to the patient during surgery (Weaving et al. 2008, 201). Design of operating theatre practice in infection reduction An operating theatre requires intelligent planning to help in reducing any infection risks and ensure smooth operating during surgery. An operating theater needs to be designed in close proximity to relevant areas such as the emergency department and acute wards to reduce chances of infection spread while transporting the patient. Out of the operating theatre, there should be a number of lifts available of carrying these critically ill patients to the different areas. Good ventilation is essential to allow a smooth flow of the air to reduce any instances of airborne infections especially on contagious diseases (Chow & Yang 2004, 87). Windows and ventilations should be positioned on the top to allow the warm air out as cool air enters the room. The room should be maintained warm with the appropriate humidity level and adequate lighting should be provided. Windows and arts, that provide natural views, are important as the hasten recovery and provide a conducive environment for surgery. The theatre should provide a good measure of personal control and privacy through adjustable curtains and blinds and accessible bed controls. Noise reduction is essential that is achieved through computerized pagers and silent alarms (Allo & Tedesco 2005, 1291). The operating theatre design depends on the workload and it should be adequate for good infection prevention control measures. The floor should be always maintained clean, it should not be slippery and it should not be made of absorbable material for easy cleaning. Floor needs to be covered with materials without seams to facilitate cleanliness. It is essential to control traffic in order to decrease air contamination and wound colonization during surgery. There should be no through traffic to other departments in the operating theatre to minimize infection transmission and the supply and professional traffic needs to be separated from public or visitor traffic (Richmond 2009, 145). An operating theatre should have a reception area to control the traffic. Personnel entering the operating theatre should be on theatre artier for infection control as humans naturally produce particles that could convey microorganisms. This entails wearing the cap, mask and scrubs. Other infection control measures include limiting door opening, using one-way system traffic as well as restricting the movements and number of persons in the operating theater. Sliding glass doors and partitions are preferred as they are easy to clean and to permit monitoring of the patient (Guerriero & Guido 2011, 93). Proper waste management in the operating theatre is essential to prevent infection transmissions. Coded bins should be provided for disposal of the waste products and the different types of waste needs to be separated and disposed of accordingly. Storage areas and work services need to be adequate to maintain all the necessary supplies and permit performance of desired procedures without health care personnel leaving the room (Guinet & Chaabane 2003, 70). Clean and dirty utility rooms need to separate rooms near the operating room and should not be connected. Temperature needs to be adequately controlled and the air that is supplied from the dirty utility rooms needs to be exhausted for infection control. The clean utility room is utilized for storage of all clean and sterile supplies and can be used for the cabinets for storage. The dirty utility room needs to contain a clinical sink. Covered containers must be provided for soiled linen and waste material with a sharps container available. Containers with disinfectants should be available for clean the dirty instruments before sterilization. There should be a good access of clean and sterile water in the operating department (Roebuck & Harrison 2014, 112). Conclusion Infection prevention is essential in the operating department to minimize or prevent the risk of infections transmission to the patients or the healthcare providers. The prevention of infection necessitates the appropriate understanding of protocols, policies as well as the knowledge and skills of adapting to the perioperative environment. A surgical procedure on a patient requires breaking the skin integrity, the insertion of operating instruments and other materials that are foreign thus, exposing the patient to a potential of acquiring an infection. Infection prevention entails breaking the disease transmission chain to prevent infection occurrence. This is achieved through risk identification, encouraging good practices in the operating department and designing the operating theatre appropriately to reduce the risk of infection. An operating theatre requires intelligent planning to reduce the risk of infection such as appropriate zones, ventilation, floor and space. A recipient’s of care in the operating department, patients need to be entitled to confidentiality, privacy, beneficence, justice, autonomy, non-maleficence, quality health services as well as personal dignity. Patients have a right to adequate standards of surgical care therefore; practitioners should not put the patients to any undue risks such as risk of infection. The patient is entitled to legal remedy and compensation in an event of negligent surgical complications such as surgical site infection. Bibliography Agency, H.P., 2009. Healthcare-Associated Infections in England: 2008-2009 Report. Network, pp.2008–2009. Allo, M.D. & Tedesco, M., 2005. 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