...AVBRH Sawangi, Wardha, Maharashtra, India. drnitinborkar25@gmail.com Abstract OBJECTIVE: To determine whether or not the routine use of postoperative dressings prevents surgical site infection and wound dehiscence. MATERIAL AND METHODS: Patients with clean or clean-contaminated (e.g. hernia, orchidectomy cystolithotomy, ureterolithotomy, appendectomy) sutured surgical wounds were randomised into two groups: those who did not receive postoperative dressings (the study group) and those who did (the control group). Variables like adequate haemostasis, sterile techniques, obliteration of all wound cavities, and approximation of divided structures were not controlled for. Wounds were assessed after 6 and 24 hours, and on the third and fifth postoperative days for clinical signs of infection and dehiscence. RESULTS: A total of 123 patients with 124 clean surgical wounds were recruited into the study. The mean age and ratio of men and women in each group were comparable. There was no significant difference in the rate of wound complications between the two groups: 4.76% for the study group and 4.92% for control. CONCLUSION: Based on these preliminary data, surgical wounds left open do not have an increased incidence of surgical site infection and wound dehiscence, compared with similar types of wounds dressed postoperatively. In a large teaching hospital, the extrapolated cost savings of dressing materials alone can be significant. Larger studies are needed to confirm these...
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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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...DVT is a condition in which a thrombus is developed that blocks the deep veins of the leg or pelvis causing inflammation. Assessment of postoperative DVT and its risk factors is very important in preventing and managing DVT and thromboembolism. (Knott, 2013) Postoperative patients should be assessed for DVT, if they have risk factors, which can lead to thromboembolism, typically to a pulmonary embolism (PE). Risk factors for developing DVT can be surgery related, patient related or both. Surgery related risk factors include infections, immobilization, dehydration and type of surgery whereas patient related risk factors include cancer, previous DVTs, advancing age, varicose veins and estrogen use. (Zurawska, et al., 2007) According to the NICE recommendations, if the client is presenting with signs and symptoms of DVT, an assessment of the general medical history and a physical examination should be done. Assess for signs and symptoms of DVT including edema or swelling of the calf, pain and tenderness along the line of deep veins in calf or thigh, distension of superficial veins, increase in skin temperature around the swelling, redden skin, hard thick palpable vein and a low grade fever. (Tidy, 2012) Look for signs and symptoms of PE including dyspnea, chest pain, cough...
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...Surgical Site Infection Last Name, First Name HCA 375 April 14, 2013 Instructor Surgical Site Infection Surgical site infection (SSI) is a continuous representation of a large part of health care related infections. The impact on mortality, cost of care, and morbidity has resulted in surgical site infections being recognized as a high priority in the US Department of Health and Human Services Action Plan to Prevent Healthcare-Associated Infections. “The majority of SSIs are largely preventable and evidence-based strategies have been available for over ten years and implemented in many hospitals, as nationally recognized by SCIP and SHEA in the US” (Institute for Healthcare Improvement, 2014). Surgical site infections may range from as little as redness around an incision to treacherous sepsis. Surgical site infections add an average of an additional seven days to the hospital stay of a patient which is also very costly. By following seemingly undemanding steps that are supported by scientific evidence, surgical site infections can be prevented. However, the culture of the workplace as well as the multifaceted systems of health care services, habitually make it a practical challenge to adhere to several of the steps. In this paper I will discuss the hospital acquired condition surgical site infection and why it is considered preventable; explain the legal implications related to a patient developing the condition and the role that disclosure plays; describe accreditation...
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...practice settings (Beyea S 2004:97). In this essay exploration of research evidence around skin care preparation will be discussed. Based on the findings from the research material, conclusion will be drawn. Surgical site infections are reported to be the third most frequently occurring nosocomial infection among hospitals patients. It can increase the length of stay up to 7.3 days, and increase the cost by prolonged postoperative stay as well as increase morbidity & mortality ( The impact of Preoperative 2003:1). SSIs can occur both peri and postoperatively, and skin is a potential source of microbial contamination. Therefore, it is important to prepare peri operative skin preparation. Skin preparation is a pre-operative procedure, which is performed to reduce the risk of postoperative wound infection and to prepare patient for surgery by removing soil and transient microorganisms from the skin. Peri operative skin preparation involves two processes- the first is physical cleansing, the physical removal of bacteria and dirt by washing with soap, detergent and water. Second process involves disinfection of the skin by bacterial agent (I. Mackenzie 1988:27). The surgical site should be assessed before skin preparation, and presence of any rashes, warts or other surgical site condition should be documented. The length of time patient is in hospital preoperatively is directly related to the risk of SSI. Since many of the micro-organisms...
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...Antibiotic in Surgical Patients Gretchen Smith Antibiotic in Surgical Patients Prevention of surgical infections is a highly significant issue to pre-op nursing care, as surgeons entrust nurses to carry out the procedure, of administration antibiotic prophylactic, which have a positive impact on patient outcome. When a surgeon determined that an antibiotic is going to be required for a particular case, giving the antibiotic at the correct time is “very important” (“Case example,” 2010, p. 27). Research has found that antibiotics that are administered (“to early or after surgery begins are not effective” (“Case example,” 2010, p. 27). It is important for nurse to be aware of the timetable and take steps to implement this in to their practice. It has been debated as to whether or not antibiotic prophylaxis is appropriate in preventing infections in surgical patients. (Easter, 2010). Zaidi, Tariq and Breslin (2009), addressed the topic of timing an antibiotic prophylaxis, the researches study 525 elective surgeries and the timing of antibiotic administration. Zaidi, Tariq and Breslin stated that the “antibiotic should be administered as near to the incision time as possible,” as the study found that “pre-incisional prophylaxis administration of antibiotics is more beneficial than post-incisional administration” (Zaidi, Tariq, & Breslin, 2009, p. 226) The most significant risk factor for delivery by cesarean section is post partum infection. As antibiotics...
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...Sutures versus Staples for Cesarean Sections Victoria Fath Kent State University Absorbable Sutures versus Staples for Cesarean Sections Introduction The Merriam-Webster Dictionary (n.d.) defines a Cesarean section as, "A surgical operation for giving birth in which a cut is made in the mother's body so that the baby can be removed through the opening." "Cesarean delivery is the most common major surgical procedure performed in the United States and elsewhere. Currently, approximately a third of pregnant women in the US and 15% worldwide deliver by cesarean, and this prevalence is on the rise" (Dana Figueroa et al., 2013, p. 33). Since Cesarean sections are incredibly common and are only increasing, the risks for complications, such as infections, increase with it. To try and decrease the risks as much as possible, this study aims to look at the differences between two types of closing material used in Cesarean sections; absorbent sutures and staples. Are absorbable sutures more effective and safer than staples for Cesarean sections? The purpose of this study is to compare absorbent sutures and staples for clients undergoing a Cesarean section and to see which material has a lesser risk for infection and wound complications, which is more cost effective for the hospital, and patient satisfaction. This paper will help shed light on this subject by compiling multiple research articles and journals to create a better understanding on which material is best...
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...compared to gauze in managing surgical wounds healing by secondary intention in the U.S. and the U.K. Most sutured wounds will heal within the time they’re supposed to and without ever having a problem. However, for a wound to heal properly depends on internal and external factors that can result in complications. For example, a wound will heal much slower if there is sign of an infection, or wound dehiscence (the bursting open of a surgically closed wound) or the presence of foreign material. If this happens, the wounds become hollow and would need to heal by secondary intention (wound left open to heal from the inside out). Other surgical wounds that are not as serious and don’t need stitches such as abscesses, are left to heal by secondary intention. And wounds healing by secondary intention need to be “filled with new tissue via granulation, epithelialization (consisting of cells joined by small amounts of cementing substances), and maturation” (to produce or discharge pus, as a wound). (Guest & Ruiz, 2005) Wounds healing by secondary intention are thought to heal more slowly than wounds healing by primary intention (wounds mechanically held closed either through staples, tape sutures glue, etc) especially if infection is present, or healing is compromised by the factors I have listed above. Also, wounds healing by secondary intention must have dressing that not only is the same size, depth and shape, but will also be able to protect the wound...
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...risk factors. * To be acquainted with the different drugs for tetanus and their actions. * Plan for a suitable nursing care. * To know the purposes and specific nursing responsibilities before, during, and after some procedure done with the client. * To institute bond between the student nurse and the patient. II. INTRODUCTION Tetanus comes from the Greek word “teiteim” which means to stretch. It is also called lockjaw. It is a serious infectious disease of the nervous system in which toxin causes severe muscle spasm. It is a medical condition characterized by a prolonged contraction of skeletal muscle fibers. It is caused by a bacterium Clostridium tetani. Infection generally occurs through wound contamination and often involves a cut or deep punctured wound. Tetanus is often associated with rust, but this concept is somewhat misleading. The C.Tetani is an Anaerobic bacteria which survives in an environment that lacks oxygen, thus with or without rust a person may have a tetanus once C. Tetani...
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...of areas in nursing practice which has improved care outcomes after employing evidence-based practices are prevention of surgical site infection programs and utilization of a surgical checklist to prevent wrong site surgeries. Infection control program to prevent surgical wound infection Surgical site infections (SSI) are serious complications occurring in procedural areas. At best, unplanned antibiotic therapy...
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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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...facilitate this process? Give a specific example. Use an example that is different than the postings of other students. There are six links in the Chain of Infection. Those areas include: 1. The infectious agent itself- 2. The reservoir where the infectious agent can live and multiply or lie dormant until the organism can find the opportunity to cause disease 3. The susceptible host 4. A means of Transmission 5. A portal of exit 6. A portal of re-entry Each link in this chain must be intact for a disease to be transmitted and infect another person. There is the potential to defeat a communicable disease process by disrupting the link in this chain at any point along the way thus preventing infection in another person. An example of the simplest chain of infection is an infected patient cared for by a health care worker who doesn't wash their hands before caring for another patient. Human sources of microorganisms are healthcare workers, patients themselves and visitors, any of whom may be individuals who are in some stage of an incubation period of a disease process, may already have a disease, or may be a chronic carrier of an infectious agent. The patient may be their own source of infection. (Baldwin, 2008) The bacteria must be able to find a susceptible host. Some individuals are immune to infection or are able to resist colonization by an infectious agent while others will develop a full blown clinical disease process. Then there are those who are able...
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...Edlich states that NF is caused by bacteria and usually not just one, but a combination of different bacteria working together. Both aerobic and anaerobic as well as fungal infections work symbiotically and grow and spread through a person who is usually already dealing with a “chronic systemic illness.” The CDC states that people who are immunocompromised, have DM, cancer, liver or kidney disease, open/broken skin, such as surgical wounds, insect bites, nicks, etc. are at a higher risk for infection of NF. Also, if a person has recently had chicken pox or other viral infections, use of subcutaneous injected drug use (“Type III caused by clostridial myonecrosis- Dr.Edlich”) and steroid use can increase the risk for infection. Clinical presentation of NF varies and that is why NF is harder to diagnose. The CDC states that some of the most common bacteria that cause NF are group A Streptococcus(Type II NF- Dr.Edlich), Klebsiella, Clostridium, E. coli, Staph Aureus, and Aeromonas hydrophila as well as others. The NNFF lists general symptoms from early to advanced as NF progresses as follows: • Trauma as insignificant as a paper cut or insect bite, cuts, bruise, scratch, to surgical wounds. • Annoying discomfort in general region of the trauma. • Pain described gets worse, area more tender. This is one of the major things to keep in mind. The pain one feels is out of proportion...
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...Section 1 A surgical wound as defined by Dempsey, French, Hillege & Wilson, 2009, “is the result of planned invasive therapy or treatment.” Surgical wounds comprise of not only incisions made in surgery, but intravenous therapys and lumbar punctures (Dempsey et al., 2009). Each wound varies in size, depending on the procedure required (Lynn, 2010). Surgical wounds heal by primary intention (Schilling McCann, 2006). A primary intention wound consists of minimal tissue loss, and are typically held together by sutures, staples or clips, therefore resulting in a faint scar, as stated by Carville, 2003. Mrs Baxter’s wound will heal by secondary/tertiary intention. Tertiary intention is also known as ‘Delayed Primary Intention” (Carville, 2003). As seen in the case study, Mrs. Baxter’s wound is quiet large (5x7x3cm) and secondary intention healing is needed as the wound extends from the epidermis to the dermis and the subcutaneous tissue (Schilling McCann, 2006). Schilling McCann, 2006, classifies this as a full thickness wound. Secondary intention healing is characteristically used when the wound edges are unable to be...
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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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