Ordinary Wound Dressing and Surgical Site Infections - Research Paper Example

Introduction The paper aims at determine nursing practices that lead to the provision of high quality wound care through a comparison of the different wound dressing techniques. Wound care is a crucial role in the nursing profession and the need for nurses to polish on this entails but not limited to acquiring knowledge from research studies. There exists a wide range of wounds but the most common that nurses encounter in practice is the post-operative wound. In taking care of the patient wounds, nurses are equipped to deliver wound care up to wound healing by applying proper clinical judgment and use of the information available about the wound. Along with this skills, a nurse delivering wound care has to be knowledgeable on the different types of surgical wounds and the danger signs of wound infection. It is also important for the nurses to make decisions in line with the patients’ preferences and all that patients patient rights. Wound dressing is central to the management plan of wounds while the emergence of wound infections makes surgical wounds hard for the nurses to deal with. The practitioners are particularly challenged when they have to choose specific ordinary or antimicrobial dressing styles. Making the appropriate choices fastens the healing process it cuts healing costs and improves the patient’s experience. To empower nurses in this spectrum, innovation has introduced newer techniques that are fairly available in the facilities. These measures has contributed in the elimination of surgical wound infection. More attention has been paid to the psychosocial issues influencing a person's personal satisfaction, together with a superior comprehension of the patient's, wellbeing experts and lay vocation's point of view. There are more than a huge number of sorts of wound dressings accessible available today the organizations are contending to deliver many kind of dressing with various quality and cost. Additionally, we have wound care medical caretakers group are in charge of surgical injuries more progress in this training. Background Following surgeries surgical site infections (SSI), which can be shallow and affecting the outer part of the skin around the surgery areas may occur. The Surgical site infection can also occasionally be severe when the infection spreads into the tissue and body organs (Young & Khadaroo 2014). This contamination significantly undermines the lives of a large number of patients, in regards to worldwide weight of endemic for Lower Middle Income Countries (LMICs), 11.8% demonstrative with surgical site diseases post-surgical however this issue not just with the poor nations likewise United states drifted more than 10$ billion annually and prolongs patient’s stay by 400 thousands days in the facilities in light of the surgical site contaminations particular body or Infected from an outside source (World Health Organization 2016). However, the SSI can be prevented through ensuring that wound management is properly done in the postoperative stage (Maurya & Mendhe 2012). Providing appropriate wound care is through correct drug administration, advising patients on proper nutrition and consideration of age and sex factors (Buggy 2000). The course of preventing the infections must be ensuring prevention is provided (Reichman & Greenberg 2009). Generally, critical care nurses perform surgical wound care much better than surgeons because of their observance of patient’s condition broadly and the fact that they have systematic procedures based on the intensity of the infections. Additionally, nurses are mandated to work by the guidelines provided for the administration of elective wound care (Han & Choi-Kwon 2011). The dressing of surgical wounds prevents infections by controlling bleeding after surgery, covering the growing tissue, reducing the pain and by absorbing any surgery exudates. The wound care providers need to have the appropriate knowledge and skills to enable them to examine the wounds, the symptoms and from these, to accord the appropriate wound care. A large part of the knowledge has to deal with high level familiarity with wound care products alongside their uses. The providers must be well-versed in the phases of wound healing and situations on which secondary intention healing may be necessary ”(National Collaborating Centre for Women’s and Children's Health 2008) . The dressing material is absorbent so as to suck on the blood. The materials must also provide absorbing the minimal exudate from the wound as well as having the required level of adherence to the wound. These combination of characteristics facilitates fast healing and itself does not become a contamination to the wound as this will counteract with the desired functions (National Collaborating Centre for Women’s and Children’s Health 2008). Going by the published material on the subject, wound dressings are broadly classified according to nature of action; and the antimicrobial dressing. The core of wound management for a long time was to have the wounds dry and protect the sites from infection. The inert /passive dressings are applied to enhance underneath recovery by the action of covering. These include gauze and tulle wound dressings. The passive wound dressings, though have minimum impact on the healing process prevent inhibit bacterial infection by creating a substantial barrier to the wounds. Interactive or bioactive dressings classified under active dressings react with the exudate to form a gel, regulating the exudate’s movement from the wound to the dressing and providing alginates, hydrocolloids and other biological content that facilitates healing. The wound exudates could be films, hydrogels and foam dressings. Antimicrobial or Anti-infective Dressings, on the contrary may cause slow healing of the wound. Examples of the anti-microbial dressings include Povidone-iodine Dressing (Inadine/Iodoflex), Honey Dressings (Activon Tulle / Algivon), Silver (Ag) Dressings – (Aquacel Ag /Actisorb Silver) and Polyhexamethylene biguanide hydrochloride (PHMB). If a wound is infected, systemic antibiotics are usually required along with an anti-infective dressing (Layout et al. 2016). The surgical wounds are very diverse in nature. Making the best choice of antimicrobial or ordinary dressing for the wounds therefore becomes quite a task for the nurses. Use of the best form of dressing speeds up the wound recovery process significantly, it cuts costs that could arise from secondary infections and ultimately makes the healing experience and the after life better for the patient. With the goal for medical caretakers to have the capacity to decipher the outcomes and discoveries of research, they survey prove based research to help choices that are made inside their nursing practice. Clinical choices ought to be founded on the most exact most solid and forward research accessible inside the field of nursing. One strategy for on a very basic level assessing proof based research is to utilize the technique for utilizing a PICO question. The reason for this paper is to portray what a PICO question is, available one and after that utilization this strategy to assess fitting exploration to either bolster or invalidate the PICO question. For the reasons for this paper, a predetermined number of research articles will be assessed to assess the accompanying PICO question. PICO question is in postoperative patients (P), dosage antimicrobial dressing (I) contrasted with standard dressing (C) lessened surgical injury contamination (O). Clinical Question The PICO question to be addressed in the paper is the comparison between dose antimicrobial dressing and ordinary dressing in postoperative as applied on wounds to to curb the infections on surgical wounds. In line with the questions, I will examine four articles to establish the right practices regarding postoperative wound care on the levels of ordinary dressing and antimicrobial dressing. The research’s primary objective is to examine practitioner’s wound care techniques in the surgery wards. Methods The literature research about the subject topic aimed at examining the articles was not quite seamless. Some of the published articles were not easily accessible but through the use of different vocabularies, I was able to garner information relevant to the topic. In the search for peer revied articles I ascertained that nurses were incorporated in the researches and made part of the publishing process of the articles. The involvement of nurses adds credibility into these articles while giving insight to what changes the nursing practice has undergone. As part of the background research, a thorough online library research through the websites CINAHL, Medline, PubMed and Google scholar provided legions of information pertinent to the topic questions. The database research lead to the four articles to be used for analyzing nurses’ practices in providing wound surgical wound care. Keywords: Evidence based practice, wound infection, antimicrobial dressing, ordinary dressing and postoperative. Literature Review: The first article I analyzed was that of a research conducted by researchers form University Malaya Medical Centre in Malysis. The study compared the dressing materials; plain gauze and the gauze mounted with polyhexamethylene biguanide. The rate of pin tract infection for the limb lengthening procedures was also evaluated in this therapeutic study. The patients undergoing this procedure, specifically those that were involved in the study were those in the orthopedic unit of the hospital facility. The participating patients were 38 and there were 40 limbs on which limb lengthening or correction limb deformities were being performed. By using an external parameter of between the July of 2009 and June of 2010 the patients were randomly placed into two groups. For the first group consisting of 22 limbs, a polyhexamethylene biguanide dressing was applied while the rest of the participants (control group) of 18 limbs was set for observation. The infection rate of infection for the total 1932 pin site observation was x2 [1, n=1932] = 23.00 and the relative risk of infection was (0.228; 95% confidential interval, 0.118, 0.443) while for the polyhexamethylene biguanide (n=1068; 1.0%) than for the control group (n= 864; 4.5%). As per the literature available on this, there isn’t adequate information for the comparison that will qualify pin site case as being effective. The shortcoming of the study was that it focused on studying the rate of infection per the number of observation rather than per the pin sites under study. This concurs with the assumption that even the clinician can easily predict the risk the infection during the consultation regardless of the stage at which the wound recovery is. The general working assumption of the study was that the variation in the rates of risk established would be insignificant if the research was conducted at intervals of 2 weeks or 2 months. The study did not however provide tangible explanation to support the assumption. The observations were derived from the patient response to treatment which was reflective of the nature of use of the technique. The random selection of control and test group eliminated biases from the results and the double-blind design also eliminated observation biases. Given all the factors listed in the methodology, polyhexamethylene biguanide impregnated gauze’s rate of pin tract infection was 2.6% more effective than that of the plain gauze. Also most pin tract infections can be treated without the use of antibiotics. Application of fixators on the long-term takes several observations at constant intervals to ascertain the rate of pin site infection (Lee et al. 2012). The second level 1 study, also therapeutic (Epstein 2007) was based on the Winthrop University Hospital New York. The research compared between routine dressings (iodine- or alcohol-based swab and dry 4 × 4 gauze) and the silver impregnated dressing. The two limit after infections on lumbar laminectomy with instrumented fusion. The participants were 234, 128 with routine dressings while 106 participants had the silver impregnated dressings. The conditions for the study were dressing application for 2 weeks after surgery and clinical, surgical and outcomes between the two groups largely comparable. Three of the patients with routine dressings that had also undergone multilevel laminectomies with instrumented fusions contracted postoperative wound infections. The infections were adequately treated in 6 weeks using postoperative antibiotics since none of the infections necessitated a second surgery. Other 11 patients with the routine dressings also developed external skin irritations; 7 of these were prescribed to oral antibiotics only while 4 had to undergo superficial wound revision. There were no such conditions for the 106 patients with silver impregnated dressings. Although the wound infection cases for the routine dressings were not many, the silver impregnated dressing registered reduced postoperative wound infections. Numerically, 0% wound infection from silver impregnated dressing and 2.5% infection rate for the other group. The limited comparison of this statistical data due to lack of corresponding data on the same was a challenge in the verification of the results. Utilization of the double-blind design reduced possible biases in the methodology. The study’s results led to the conclusion that silver impregnated dressing on lumbar wounds laminectomies reduced significantly the cases of postoperative externals and deep wound infections (Epstein 2007). The third study was that conducted at Nanjing Stomatological Hospital by Nanjing University in Chine (Length & Paper 2008). This level 1 research done in November 2004 to Decemebr 2006 was to determine how oral prevention through the antibacterial dressing spray (JUC spray) affected the oral region on which surgery was done. The JUC spray was applied on the oral region of oral cancer patients and an antimicrobial to prevent the growth of drug resistant bacteria and prevent the chances of wound infections. This antibacterial spray is a product of the NMS Company in China and is made with the macromolecular active agent that acts against microbial on the long-term. The mechanism of action of the antimicrobial spray is by solidifying into an invisible layer upon spraying on the mucosal area. The spray is water soluble forms overlapping layers that reinforce protection against bacteria. The study’s participants were sixty patients suffering from squamous cell carcinoma, they were randomly put in two groups with 30 individuals each. The control group and the group on which the antibacterial dressing spray was used. For this later group, 30ml of the JUC spray was applied on the oral region, the oropharynx, nasal cavity and the neck areas at the prescription of thrice a day 0.1 ml per day after surgery until the wound was completely healed. The treatment used orally for the control group was the standards medical caring antiseptic that was soaked in 0.9% sodium chloride. This was also done three times a day. The healing period for the two groups was the compared and the control group patients took much longer to heal. The patients on which the JUC spray was applied healed much more quickly. With the use of the antibacterial dressing spray, the oral wounds resulting from the oral surgeries healed in 8.97 days. This was a shorter time compared to the control group where the wounds took 9.74 days to heal. In addition to this, the antibacterial dressing spray had no side effects on the oral health of the patients because upon testing no bacteria were cultured from the samples mucosal samples. For further testing to prove this, fifty samples from taken from the area beneath the the incisions were tested for the presence and amount of streptococcus, staphylococcus and Neisseria bacteria. The results revealed that the amounts of these bacterial were much lower than those in the samples of patients in the control group. Other bacteria tested in the samples were Veillonella and Actinomyces and based on these there was no significant difference in the amounts for samples from both groups. The JUC spray had no side effects, it also fastened healing of the wounds. Because of this and the applicability of the water soluble spray, the treatment can be used on patients after oral surgery procedures to catalyze the healing process (Length & Paper 2008). The fourth study significant to the research question was level 2 and therapeutic as well (Gaspard et al. 2013). The McGill University Health Centre of Quebec Montreal conducted the study with the aim of establishing if cardiac surgery related surgical site infections can be reduced by the use of antimicrobial dressing. The nature of the study was random, prospective and cohort and the patients were qualified based on the cardiac surgical procedures specifically the coronary artery bypass grafting (CABG), valve replacement, and or repair of the median sternotomy. The research was planned and executed between May 28 2005 and March 31st of 2007. Full consent of the participants was granted and the freedom to withdraw was granted. The criteria on which exclusion was granted included the occurrence of other infections, subject to any other systemic incision procedures, the occurrence of allergies to compounds chlorhexidine, biguanides, tape and any other material to be used in the study. The patients had to take preparative measures as stipulated. This included taking chlorhexidine showers, decolonization of the nasal tract with mupirocin clipping of the surgical incisions, rigorous medication to control glycaemia and the administration of antimicrobial prophylaxis in the surgery theatre. The dressings applied on the surgerized incisions were changed after two days in postoperative but the time interval could be adjusted based on the level of saturation of the dressing. Once the surgery wounds epithelized, the dressing was removed. The plain was evaluated from 28th May 2005 to 31st May 2006, while the polyhexamethylene biguanide was assessed from 28th May 2006 to 31st March 2007. The time lapse between the two tests allowed for complete replacement of the initially used dressing. The techniques used in the wound care were maintained throughout this testing period and the period of hospitalization as the patients were keenly observed for symptoms as described by the Centre of Disease Control. The patinets were observed for one year after surgery to locate any signs that amounted to surgical site infections. Chart reviews, clinic visits, readmission to hospital after a patient was discharged and laboratory surveillance and on the phone interviews were the tools used to identify the SSI. The interviews were held at 6 months after surgery and repeated at 1 year after. In the period of time between Mat 2005 to March 2007, 692 patients out of the 1399 participating patients were treated with plain dressing while 707 used the polyhexamethylene biguanide dressing. The results of the study in scheduled time as per the tools used to identify the surgical site infections revealed higher infection rates in patients treated with plain dressing than in patients treated with polyhexamethylene biguanide dressing. This meant that the polyhexamethylene biguanide dressing cut greatly reduced wound infections (OR 0.58 [0.38-0.89]). Other risk factors became part of the study. Obesity as a factor remained independent in predicting SSIs regardless of the specific surgical site. Other factors that came out independently in the study were increasing age and the left ventricular ejection fraction at 30%- 49%. The randomization of the participants was a plus for the study yet the two identical dressings on the three hospital units; the operating room. Intensive care unit and the cardiac unit would have created openings for confusion and random errors. For this reason, a no contemporaneous approach would not have been the best for use in the introduction of the two dressings. Nevertheless the results obtained from the appropriate design that was applied were not affected by the techniques used and the fact that patient mobility was limited throughout the study period. The researchers were also keen enough to adjust patient characteristics as found appropriate due to the fact that patients with plan dressings were more vulnerable to infections than those on which polyhexamethylene biguanide was used. All conditions during the first research period were upheld in the second phase and the seasonality in occurrence of infections was accounted for when computing the resulting data. Based on the findings, use of the plan dressing opens chances for wound infection while administration of the antimicrobial dressing reduced the infections arising from the cardiac incisions made during surgery. The efficiency and the multiple benefits of the antimicrobial techniques could have been boosted by the preoperative preparation, postoperative standardization and proper wound management procedures that were used for the program. (Gaspard et al., 2013). Conclusion The four articles used for used as the resources and source of information for the research provided solid information regarding ordinary wound dressing and surgical site infections. Out of the four articles, three were random controlled in design while the one was level two as it utilized the quasi-experimental research design. The participants of the studies were adult patients going through the wide range of surgical procedure such as orthopedic, oral, cardiothoracic, vascular or neuro surgery. The researchers were from different countries and so were the participants and three dressing materials were put into perspective. That is the polyhexamethylene biguanide, silver impregnated dressing and antibacterial dressing spray (JUC spray) as used post the surgeries. The literature review conducted prior to the study had provided insight that the antimicrobial dressings significantly controlled wound infections. The four clinical studies used in the study supported this evidence in a mighty way. The studies provided compelled evidence that the antibacterial dressing have multiple advantages over diverse wounds. The antibacterial dressing were easy to apply on the wounds, they inflicted minimal pain on the wounds given that they were applied shortly after surgery. This type of dressing also did not cause bleeding during removal as they do not stick on to the surgery site. In addition to this, the antibacterial dressing propagate fast healing as they do not gorge out growing tissue, with their use it is easy to pick the signs of infection and deterred healing. Based on the listed advantages of antimicrobial dressing, there is reasonable advocacy for the replacement to the use of plain dressing on surgery wounds. The two fundamental purposes of dressing that are medically stated which are promotion of healing and improved quality of life are achieved by the use of antibacterial dressing. This makes them better and more preferable to the ordinary wound dressing. The limiting factors to the use of antimicrobial dressing include the aspect of higher costs that the ordinary dressing. It also a challenge for practitioners to pick out the most effective type of antibacterial dressing for wounds. More than this, it is expected that bacteria may develop resistance, consequently the antibacterial dressing will lose their efficiency. Significance to nursing The study relates to postoperative wound care on several levels. The key one is on the provision of quality care to patients as springing from evidence based care. This also cuts across the aspect of integrating techniques that available using exquisite expertise to patients after surgery. Since providing the highest quality of care is fundamental in the nursing profession, identifying the areas for change to achieve this is tied to the replacement of the ordinary dressing with the proven antibacterial dressing on wounds. Such a research provides a reliable evaluation that promotes improved patient care (Haycock et al. 2005). The different researches are used as reference on which meaningful conclusion can be drawn about the subject topic. The researches provide views on the best practices that nurses can employ in delivering service to patients (Nieswiadomy 2012). From this, the quality of care granted at the hospital facilities is deeply affected by the practitioners’ ability to single out areas of change and implement the desirable changes. This fall back on the policies regarding the role of nurses in integrating healthcare techniques that streamline the quality of patient care practice (American Nurses Association, 2010). The American Nurses Association is one instrumental body by which nurses are obliged to use the evidence based findings of researches as guidance to develop strategies that improve the quality of patient care (2010, P.51) Besides, the incorporation of efforts from other bodies like the Quality and Safety Education for Nurses (QSEN) mainstreams measure and the introduction of practices that improve on the practitioners’ competence (Dolansky & Moore 2013). The execution of such practices helps to fill the gaps in the quality of healthcare provision. The obligatory measures also challenge the nurses to develop a broader picture in the application of the quality improvement practices. The specific complications that result from surgical wounds are as established by far the most devastating experiences that patients go through. Identification of such a space demands that the best wound care practices be employed, that nurses be very competent at this and that they are capable of using evidence based research to reduce the pain of sternal wounds. (Travis et al. 2009).   The reference researches used in this study took a step further to incorporate the use of telephone calls from time to time to inquire about the recovery of the wounds. This highlighted with a lot of importance the importance of communication in improving patient services. The communicative link between the healthcare providers creates openness that is key to ensuring that patients have a better healing experience. For instance, in the administration of wound recovery antibiotics, there may be allergies to some of the contents. A breakdown in communication between the nurses and the patients would aggravate such health conditions and even impact on the healing process. Communication is also important on the level of practitioners adhering to policies and the changes thereof within this line of service delivery. Reference: American Nurses Association, 2010. Scope and Standards of Practice - Nutrition, Buggy, D., 2000. Can anaesthetic management influence surgical-wound healing? Lancet, 356(9227), pp.355–357. Dolansky, M.A. & Moore, S.M., 2013. Quality and Safety Education for Nurses (QSEN): The Key is Systems Thinking. Online Journal of Issues in Nursing, 18(3), pp.1–12. Epstein, N.E., 2007. Do silver-impregnated dressings limit infections after lumbar laminectomy with instrumented fusion? Surgical Neurology, 68(5), pp.483–485. Gaspard, F. et al., 2013. Impact of an antimicrobial dressing in reducing surgical site infections in cardiac surgery patients. Wounds : a compendium of clinical research and practice, 25(7), pp.178–85. Han, J.Y. & Choi-Kwon, S., 2011. Adaptation of Evidence-based Surgical Wound Care Algorithm. Journal of Korean Academy of Nursing, 41(6), p.768. Haycock, C. et al., 2005. Implementing evidence-based practice findings to decrease postoperative sternal wound infections following open heart surgery. Journal of Cardiovascular Nursing, 20, pp.299–305. Layout, R.S., Author, R.J. & Malek, J., 2016. Wound care Supplementary materials. Lee, C.K., Chua, Y.P. & Saw, A., 2012. Antimicrobial gauze as a dressing reduces pin site infection: A randomized controlled trial. Clinical Orthopaedics and Related Research, 470(2), pp.610–615. Length, F. & Paper, R., 2008. Application of an antibacterial dressing spray in the prevention of post-operative infection in oral cancer patients: A phase 1 clinical trial. Journal of Biotechnology, 7(21), pp.3827–3831. Maurya, A. & Mendhe, S., 2012. Prevention of Post-Operative Wound Infection in Accordance with Evidence Based Practice. International Journal of Science and Research (IJSR) ISSN (Online Impact Factor, 3(7), pp.2319–7064. National Collaborating Centre for Women’s and Children's Health, 2008. Surgical Site Infection: Prevention and Treatment of Surgical Site Infection., Nieswiadomy, R.M.C.N.-R.. . N. 2012, 2012. Foundations of nursing research, Boston : Pearson. Reichman, D.E. & Greenberg, J.A., 2009. Reducing surgical site infections: a review. Reviews in obstetrics & gynecology, 2(4), pp.212–21. Travis, J. et al., 2009. Coronary artery bypass graft surgery: surgical site infection prevention. Journal for healthcare quality : official publication of the National Association for Healthcare Quality, 31(4), pp.16–23. World Health Organization, 2016. Global Guidelines for the Prevention of Surgical Site Infection. Global Guidelines for the prevention of Surgical site infection, pp.1–185. Young, P.Y. & Khadaroo, R.G., 2014. Surgical site infections. Surgical Clinics of North America, 94(6), pp.1245–1264. Read More