...(1995), concept analysis allows nursing to examine the attributes or characteristics of the concept. * Concept Analysis of the Surgical Wound Infection ? I will like to identify patients conditions and other factors contribute to the development of Surgical Wound infections. * Determine the aims or purposes of analysis The purpose is to understand the effect of environment in surgical wound infections. Prevention of infection requires the application of the principles of microbiology and accept practice. Measure of this concept is based on the stages of wound healing and the Centers of Disease Control and Prevention guidelines defining surgical site infection as occurring 30 days postoperative. * Identify all uses of the concept The Merriam-Webster Dictionary was used to explore the general definition of surgical wound infection Surgical of or relating to the process of performing a medical operation: of or relating to surgery. Wound an injury that is caused when a knife, bullet, etc., cuts or breaks the skin. Infection is the act or process of infecting someone or something: the state of being infected. The Oxford English Dictionary (OED) was also used to explore the definition. Surgical relating or used in surgery. Wound is an injury to living tissue caused by a cut, blow, or other impact, typically one in which the skin is cut or broken. Infection is the process of infecting or the state of being infected History of Surgical Wound Infection Hippocrates...
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...Glenda Doctor Western Governor’s University Procedure, basis for practice, rationale and explanation The procedure for the use of povidone-iodine for surgical cite antisepsis is: skin preparation for surgery includes the use of sterile drapes to drape the patient and square off surgical area with sterile towels to absorb excess solution. The incision site is where the prep begins and proceeds outward from that point. Iodine soap or scrub, wet the skin with sterile water the iodine scrub will be added to the point of lather, the site is to be scrubbed for 5 minutes. Excess solution is to be blotted with sterile towels or sterile gauze. When iodine paint is used the iodine paint will be applied and allowed to dry before first incision. This practice of surgical skin preparation has been a standard for many years. At this facility povidone-iodine is used predominantly however a few surgeons do use chlorhexidine, it has typically been surgeon choice for skin preparation. Studies have shown that Chlorhexidine-alcohol is a superior product to povidone-iodine to reduce skin colonization and reduce surgical site infection, (Darouiche, Wall, Itani, Otterson, Webb, Carrick, & ... Berger, 2010). No specific use for either product was found in the policy and procedures for the hospital on the hospital web site. There were no available protocols involving the products that were found. It is not apparent that there has been any evidenced based practice involved. ...
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...The role of preoperative Chlorhexidine as an antiseptic solution to reduce the risk of postoperative surgical site infection C1369366-MET319 Word count: 3546 Contents: Introduction: 3 Objective: 4 Methods: 4 Table 1: Search strategy 5 Critical appraisal of the literature: 5 Discussion: 17 Conclusion: 17 References: 18 Introduction: Surgical Site Infection (SSI) is a common complication in surgical practice. The incidence depends on multiple factors including the type and location of surgical procedure ranging from 2%-4% in simple skin lesions (Rogues et al., 2007) to 36% in cases of reversal of stoma (Liang et al., 2013). Incidence of SSI can be kept low by simple measures such as rescheduling elective procedures in presence of infection; e.g.: Urinary Tract Infection, Respiratory Tract Infection which can seed Bacteria to surgical wounds (Ollivere et al., 2009). Prophylactic Antibiotics given prior to elective surgery remains debatable and of questionable value considering the risk of side effects, emergence of Multi-drug resistant Pathogens and Anaphylaxis, and therefore should be used according to guidelines like in patients with higher risk for developing SSI (Wright et al., 2008, Dixon et al., 2006). Also, procedures at certain body sites and those involving surgical reconstruction are better covered with prophylactic Antimicrobial agent (Rosengren and Dixon, 2010). Use of antiseptic scrub has been...
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...as a secondary diagnosis. Surgical site infection (SSI) is classified as a HAC and considered a preventable condition. For an eligible patient with a SSI coded as a secondary diagnosis, the hospital will only be reimbursed based on the primary diagnosis. (Medicare Learning, 2012) The hospital is left to absorb the remainder of the cost for the care of this patient. Much research has been done on ways to prevent SSI. This is a review of one quantitative study related to the effects of postoperative dressings on surgical complications, including surgical site infections. Protection of Human Participants In the study “Are Postoperative Dressings Necessary?” (Borkar & Khubalkar, 2011), 123 patients were recruited and signed informed consent. The researchers demonstrated protection of the participants from harm by way of the selection criteria. Only patients undergoing clean or clean-contaminated surgical procedures were included. Those with co-morbidity factors like diabetes or jaundice were excluded from the study, as well as those with contaminated wounds such as ruptured appendix or peritonitis. No particular benefit or risks to the participants were clearly identified by the authors; however, this reviewer could infer benefits such as closer monitoring of the surgical site during the recovery period which would also enable prompt diagnosis and treatment of infection. The inferred risks to the participants would be the increased risk of infection. The participants were free...
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...NURSING PRACTICE In the United States there are approximately 5% of sterile surgical operations that will become infected each year. The number one nosocomial infections regarding surgical patients are infections at the surgical site (Kalb, Lefevre, Dididze, & Levi, 2013). For reductions of infections on any surgical site, this skin will need to be cleaned (or prepped) and covered with a sterile towel or drape. The site of the incision is prepped so that bacteria or microbes that cause the infection are found on the skin surface. Due to these microbes, prepping a patient’s skin will be the most important step prior to any surgery. Different hospitals throughout the United States use many different products for the cleaning or prepping stage. At the hospital of my place of employment, there are three different agents that can be used. This list includes Chlorhexidine gluconate, chlorhexidine alcohol, and povidone iodine. Any type of infection involving the incision site can cause complications that could be long term for any patient to deal with and may have financial consequences to any hospital. This particular hospital is considering a change to standardize the prepping solution and needs to determine the cost factor if it were to change to a new product or to add premixed applicators of particular type of surgical prep solution. At this hospital, the current standard is using a surgical prep cleanse that the primary surgeon chooses to use. The hospital’s policy has...
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...chemotherapy and Apheresis. While CVCs can be lifesaving they also have significant risks of surgical-site infection (SSIs). Providone-iodine (Betadine) has been the primary cleanser for central line placement for the last decade, but surgical- site infections (SSI) continue to increase raising the question if betadine is a sufficient agent for surgical insertion of a CVC or is there an alternative proven through evidence- based practice to be a more effective anti-microbial. A2a. Basis for Practice Procedures and protocols are researched by the safety committee who release their findings to the clinical practice committee for review and evaluation. In a culture that use to accept betadine as the primary anti-microbial agent to cleanse the skin prior to CVC insertion has been questioned and through evidence based practice is in favor of using chlorhexidine gluconate (CHG) as the primary agent by identifying and concluding that it is superior to betadine by reducing the risk of SSIs by approximately 50% (Chaiyakunapruk, Veenstra, Saint, and Lipsky (2009). If the clinical practice committee approves the use of CHG for CVC insertion it is communicated to the department of nursing followed by the nurse managers, educators and staff nurses. A2b. Rationale CHG and betadine are anti-microbial agents that reduce the incidence of primary SSIs. Cleansing the surgical incision site of the CVC is practiced by disinfecting the skin...
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...make relative good decision compare with those users with good measurements. 2. List and explain the four major categories of quality costs. Give examples of each. Quality cost can be divided into four major categories as follows: * Prevention costs: investments made to keep nonconforming products from occurring and reaching the customer. Prevention costs could be the salaries of individuals associated with quality planning and problem solving teams, the development of new procedures, and new equipment design. Or the investment in the information system expansion to develop data requirements and measurements. * Appraisal cost: associated with efforts to ensure conformance to requirements, generally through measurement and analysis of data to detect nonconformances. It could be the cost to calibration and...
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...The quality improvement project I chose to critique focused on decreasing the occurrence of postoperative surgical site infections following a cesarean delivery. This project was initiated in August 2014 at the hospital in which I am employed. It was started in response to our elevated number of surgical site infections. The rates of surgical infections had been slowly increasing over the previous year but stayed below our benchmark of 1 out of every 100 procedures. When our infection rate rose to 3.32, it was clear that an intervention needed to occur and the quality improvement project was launched. During this quality improvement initiative, a bundle of recommendations was created to address several areas of concern in regards to infection...
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...SIGNS The symptoms of necrotizing fasciitis usually occur within the first 24 hours of infection. They often include a combination of the following: Increasing pain in the general area of a minor cut, abrasion, or other skin opening. Pain that is worse than would be expected from the appearance of the cut or abrasion. Redness and warmth around the wound, though symptoms can begin at other areas of the body. Flu-like symptoms such as diarrhea, nausea, fever, dizziness, weakness, and general malaise. Intense thirst due to dehydration. More advanced symptoms occur around the painful infection site within three to four days of infection. They include: Swelling, possibly accompanied by a purplish rash. Large, violet-colored marks that transform into blisters filled with dark, foul-smelling fluid. Discoloration, peeling, and flakiness as tissue death (gangrene) occurs. Critical symptoms, which often occur within four to five days of infection, include: severe drop in blood pressure toxic shock unconsciousness HOW IS IT DIA GNOSED ? Necrotizing fasciitis progresses very rapidly, making early diagnosis crucial.Unfortunately, that does not always occur. The early symptoms of an infection with flesh-eating bacteria are similar to other conditions like the flu or a less serious skin infection. The early symptoms are also similar to common post-surgical complaints, such as: severe pain , inflammation , fever, and nausea. Diagnosis is often...
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...nosocomial infections that occurred within the past year. In your report, categorize the different parameters (i.e. person, time, place and ethnicity and gender) used in the compilation of data into the information summative. Hypothetically, Good Health Hospital is assumed to have possessed nosocomial infections as in any real hospitals where patients seek admission for treatment. According to Center for Disease Control and prevention (CDC), and Pennsylvania Department of Health (PADOH), a healthcare associated infection (HAI) which is also known as nosocomial infection is an infection that a person gets while staying as a patient in a hospital or other health care facility (PADOH, 2008). Hence, it is clearly understood that patients always acquired nosocomial infections during the process of receiving health care services from health professionals in any hospital or healthcare setting. PADOH has also confirmed that HAIs are the primary contributors of most sicknesses and mortalities in the world. For example, in American hospitals alone, HAIs account for about 1.7 million infections causing 99,000 deaths each year. Therefore, based on the analysis of Good Health Hospital records, research had shown that a great number of recent nosocomial infections that had happened before were identified. Among the different kinds of nosocomial infections verified, few infection type have been listed as followed: 1. Surgical site infection (SSI). 2. Urinary tract infection (UTI). 3....
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...Nosocomial Infections Monica Butler Strayer University Dr. Godson Ezejiofo HSA 535 Managerial Epidemiology January 25, 2015 Introduction Good Health Hospital has proved to be among the best hospitals in the region since its inception. The medical professionals and all members of staff are always committed to ensuring delivery of quality services to patients. The hospital has had a good reputation of excellent staff, good patient relations and top quality services. In the recent past, several cases of E. coli have been reported at Good Health Hospital. E. coli exists in a variety of types but most varieties a less harmful to human health. Research by medical professionals has shown that E. coli bacteria live in the intestines, for both people and animals. Symptoms of E. coli infection include diarrhea, abdominal pain and vomiting (Bennett, Jarvis & Brachman, 2007). E. coli emanates from taking contaminated food and water. E. coli may lead to death or permanent health problems if appropriate measures are taken on time. Nosocomial diseases can be termed as an infection that a person gets while being attend to in a health institution. The goal for this task is to explore the nosocomial infections, intervention strategies and recommendations on how to control and manage the various types of nosocomial infections. Analysis of Good Health Hospital records Records of Good Health Hospital show that a number of nosocomial diseases have been reported. Among the commonest...
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...The goal of Nightingale Community Hospital is to establish a comprehensive Infection Control Program to ensure that the hospital has processes in place to minimize/eliminate the risk of Surgical Site Infections (SSI) and Healthcare Associated Infections (HAI) B. The Infection Control Program at this hospital incorporates the following on an ongoing basis: i. Surveillance/identification, prevention/control, and reporting of infections throughout the hospital not limited to patients, employees, or physicians focusing on Nosocomial Infections (Endogenous infections and cross contamination infections) 1. Nosocomial Infections: known as hospital acquired infections are infections are not presenting at the time of admission but develop over the course of stay. a. Endogenous: the patient already has the infection at the time of admission minus the signs/symptoms of such infection but resistance lowers over course of stay and infection presents b. Cross Contamination: patient becomes infected while staying in the hospital by coming in contact with infective agents subsequently developing an infection ii. Evaluate and monitor the results of changes made 2. Continually edit procedures and policies as needed iii. Select and implement best techniques to minimize negative outcomes 3. Separate the infection source from the rest of the hospital (aspetic techniques included) ...
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...Preventing Hospital Associated Infections April Shannon Walden University NURS 4000 Section 04, Research and Scholarship for Evidence-Based Practice November 18, 2012 Change in Practice: Preventing Hospital Associated Infections Benjamin Franklin was quoted as saying “an ounce of prevention is worth a pound of cure.” With the increasing costs of healthcare and the emergence of multi-drug resistant organisms this truth still resonates today. Hospital associated infections (HAIs), have been a complication in hospitals for many years. The purpose of this assignment is to address this problem in nursing practice, and discuss evidence on practices that will address this issue. The problem Hospital associated infections (HAIs) can be defined as an infection acquired in hospital by a patient who was admitted for a reason other than that infection. An infection occurring in a patient in a hospital or other healthcare facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility (central line associated bloodstream infections, catheter associated urinary tract infections, surgical site infections, ventilator associated pneumonia, etc.) (World Health Organization, 2002). HAI’s have become one of the leading caused of hospital related deaths in the United States. However, these infections have been proven to be...
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...laparotomy closure. As well as surgical closure technique, individual biological and patient dependent risk factors play a key role.1 Incisional hernia remain the most frequent long-term complications in visceral surgery after midline laparotomy, often requiring reoperation for repairing. The rate one year after laparotomy is within the range of 9 - 20 percent.2 The rate of incisional hernia increased significantly from 12.6% at one year to 22.4% at 3 years after midline laparotomy.3 The cause of incisional hernia is multifactorial and influenced by patient related and technical factors. Patient-related factors include obesity, malignancy, wound infection, diabetes mellitus, use of immunosuppressant agents, corticosteroids, smoking and previous laparotomy and cannot be influenced by the surgeon. Technical factors, however, are directly controllable and amenable to action by the surgeon. Attempts to minimize hernia rates after laparotomy have led to various surgical options ;variations of incision type, closure technique and suture material.3 There is high incidence of incisional hernia following operations for peritonitis because, as a rule , the wound becomes infected. The placing of a drainage tube through a separate stab incision as opposed to bringing such a tube through the laparotomy wound...
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...URINARY TRACT INFECTION Elizabeth Quartey Abstract According to the CDC estimates in 2002 there were 1.7 million Healthcare-Associated Infections (HAI), and 99,000 HAI- associated deaths in the hospital. The report stated that the four largest categories of HAI, responsible for more than 80% of all reported HAI, are central line-associated bloodstream infections (CLABSI, 14%), ventilator-associated pneumonia (VAP, 15%), surgical site infections (SSI, 22%), and catheter-associated urinary tract infections (CAUTI, 32%). HAI are a great financial costs to health care facilities. The Centers for disease Control and Prevention (CDC) estimates the medical cost of HAI in the U.S. hospitals as $6.65 billion in 2007, and that number has increased to almost $10 billion a year currently. Statement and Significance of the Problem One in 20 patients who are admitted to a hospital will be a victim to an infectious agent they are exposed to during their hospitalization according to the Centers for Disease Control (CDC) (Goodman, Brenda, 201, Hospital-Acquired Infections cost $10 Billion a year). The five most common infections are surgical site infections, infections associated with the use of devices like central lines, catheters, ventilators and clostridium dificile are costing the health care System in the USA almost $10 billion a year to treat. In the article Vitamin D has the potential to reduce the risk of Hospital-Acquired Infections, the writer...
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