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Perioperative nursing is an integral field in nursing, for it ensures that patients who have undergone surgical operations do not get surgical site infections (SSI). The recovery of patients who have undergone surgical process considerably depends on perioperative care they receive from nurses; hence, perioperative nursing is essential in enhancing patients’ recovery.
Belton and Berter (2004) explain that perioperative nurses deliver safe patient care by developing a nursing care plan, coordinating operational activities, and assessing the recovery process of patients (p. 27). Even though surgeons may perform successful surgical operations, SSI threatens to heal wounds and thus affects the recovery of patients.
The United States’ statistics indicate that SSI accounts for about 17% of all infections acquired in hospitals and causes complications of 2.6% of over 30 million operations annually (Welsh, 2008, p.2). Thus, SSI is not only an issue that faces the healthcare system but also perioperative nursing care in various hospitals. In this light, this essay examines SSI as an issue in perioperative nursing and further explores the implications of literature recommendations to perioperative nursing and perioperative environment.
Surgical Site Infections
SSI is a group of infections that usually affects patients who have undergone a surgical operation. During early times before the introduction of antiseptic principles of sterilizing surgical apparatus, many surgical patients used to suffer from SSI, which prolonged their recovery period and at times led to death. Currently, the introduction of antiseptic principles of sterilization has led to a massive advancement in surgery and perioperative nursing (Greene & Mills, 2010, p.79).
However, in spite of enormous advancement in the operating room practices, sterilization of apparatus improved surgical techniques and prevention of infections, SSI is still a severe challenge of hospital-acquired diseases. Moreover, hospitals that have limited resources to perform safe surgical procedures and offer effective perioperative care register high rates of SSI, which contribute to mortality rates, yet they are preventable.
Belton and Berter (2004) argue that since SSI is posing a severe threat to the efficiency of surgical procedures and recovery of patients, the healthcare system needs to equip perioperative nurses with appropriate technical interventions (p.27). Hence, it is the responsibility of perioperative nurses to ensure that surgical patients receive proper perioperative care to prevent SSI.
SSI consists of both endogenous and exogenous pathogens that infect site of surgery since wounds provide a section of entry into the body. Although surgeons may perform their surgical procedure in a sterile perioperative environment with sanitary equipment, SSI emanates during recovery of a patient.
Portugal and Kneedler (2011) assert that most SSI originates from endogenous flora that resides in patient’s viscera, mucous membranes, and skin, hence challenging to sterilize during the surgical procedure and recovery (p.7). Even though endogenous pathogens are resident, they do not cause any infection unless an incision exposes tissues for them to enter into the body.
Thus, surgical operations provide a route through which endogenous pathogens gain entry into the tissues and subsequently cause infections. The endogenous flora is mainly gram-negative and gram-positive aerobes.
Comparatively, the exogenous pathogens originate from surgical apparatus and perioperative environment. The extent of SSI depends on the virulence of contaminating pathogens and state of the wound after a surgical procedure. Therefore, it means that perioperative nurses have a role to play in reducing incidences of SSI among surgical patients.
Poor perioperative nursing care has contributed to increasing cases of SSI, particularly among developing countries or hospitals with limited health resources to procure essential surgical apparatus, chemicals, and perioperative nurses. Given the susceptibility of surgical patients to SSI, many hospitals experience the formidable challenge of preventing their occurrence in the perioperative environment.
Even though the healthcare system provides all essential resources, many hospitals are still grappling with increasing incidences of SSI, which has cost many lives, in addition to medical supplies. Portugal and Kneedler (2011) argue that, out of over 30 million surgeries done annually in the United States, about half a million procedures experience further complications due to SSI (p.7).
High rates of complications associated with SSI mean that about half a million surgical patients are in danger of losing their lives if appropriate interventions are not in place to reverse the trends.
If about a half a million of surgical patients are susceptible to SSI in the United States with an advanced healthcare system, what are the trends in developing countries and poorly equipped hospitals across the world? High incidences of SSI despite advancement in surgical procedures imply that perioperative nurses are facing a significant challenge in the delivery of perioperative care.
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SSI does not only result in complications that hamper recovery of surgical patients but also increases medical costs to both families and the healthcare system. Due to slowed healing, surgical patients usually endure pain, psychological, and physical suffering as well as increased risk of death.
A significant number of surgical patients has succumbed to death due to SSI, although appropriate interventions can prevent their occurrence among patients. Moreover, SSI has increased medical bills of surgical patients, hence growing financial burden to the family and healthcare system.
Burton (2007) argues that, according to National Health Service report, SSI increases medical costs of a patient by over $1800 and prolongs stay in hospital by about seven days (p. 124). Additionally, surgical patients took longer to recover fully after discharge because they are dependent on drugs, which take a toll on their medical costs. Thus, perioperative nursing is critical in alleviating the suffering of surgical patients, reducing death risk, and saving a terrific deal of resources, which cost both families and the healthcare system.
Recommendations for Preventing SSI
Given that SSI poses a formidable challenge to the healthcare system and perioperative nursing, literature review offers a broad deal of recommendations of preventing SSI in hospitals. Firstly, one of the recommendations of preventing SSI is by use of antimicrobial prophylaxis to control both endogenous and exogenous pathogens.
Perioperative nurses should look for potent antibiotics and administer during or before surgery to prevent the entry of pathogens into tissues through excised wounds. Burton (2007) recommends that perioperative nurses should choose antibiotics that target specified pathogens and administer them at an appropriate time to enhance their efficacy and prevent SSI (p.124).
Surgical procedures that take more than five hours require additional doses of antibiotics to boost the efficacy of treatment throughout the operation. Hence, perioperative nurses have to ensure that they prescribe and administer appropriate medicine and dosage to surgical patients to prevent them from getting SSI.
Secondly, it is recommendable that perioperative nurses prepare surgical patients well before letting them undergo any surgical procedure. Portugal and Kneedler (2011) advise that it is necessary to let patients shower with antiseptic before surgery to reduce endogenous pathogens that reside in the skin and visceral surfaces (p. 8).
Antiseptic sterilizes skin, and reduces pathogens load on the surface and subsequently minimizes SSI. Moreover, patients need screening for hyperglycemia, so that in case a patient has a high blood glucose level, perioperative nurses can keep a blood glucose level below 11.1mm/L during 48 hours before the operation.
Blood glucose level should be below 11.1mm/L because hypoglycemic surgical patients are prone to SSI. After preparing a patient for the surgical procedure by showering them with antiseptic and maintaining blood glucose level, it is imperative that they should not spend a lot of time waiting to undergo an operation because endogenous pathogens increase with time while blood glucose levels fluctuate.
Additionally, it is recommendable that perioperative nurses need to prepare an operation site by clearing obstructing hair in case of any and carrying out disinfection of exogenous pathogens. Recommendations for making patients imply that perioperative nurses should be extra critical in preparing patients for surgery.
Thirdly, to prevent SSI among surgical patients, it is recommendable that perioperative nurses should ventilate operating theatre accordingly. Ventilation of theatre ensures a pleasant perioperative environment that does not encourage multiplication and contamination by exogenous and endogenous pathogens.
Hong and Tam (2009) recommend that a theatre room should have a minimum ventilation rate of 15 air changes every hour, with alerting feature that shows pressure changes (p.10). Laminar flow form of ventilation systems, coupled with ultraviolet radiations, is essential in disinfecting air before allowing it into the theatre.
Moreover, the temperature of 20-230C and humidity of 36-60% is essential in creating and maintaining a pathogen-free environment, hence reducing SSI. This implies that theatre needs stringent regulation of ventilation and pressure, and thus demands new technical skills on the part of perioperative nurses.
The fourth recommendation is that surgeons and perioperative nurses need to wear appropriate surgical attire and drapes to prevent causing SSI during operation. Surgical masks are necessary to cover mouth and nose, while caps are essential to cover head and hair. Breath and falling hair contain pathogens that can potentially cause SSI, and thus, masks and caps prevent them from causing SSI during the process of carrying out surgical operation.
Hong and Tam (2009) further recommend that the surgical team need to wear gowns and drapes that are liquid resistant and sterile to prevent pathogens in sweats from causing SSI (p.11). Other surgical teams also need to wear masks, gloves, caps, and gowns that are sterile to prevent them from contaminating air, surgical apparatus, and sterile instruments of operation.
Thus, the recommendation to wear appropriate surgical attire during a surgical procedureimplies that perioperative nurses have a responsibility to ensure that all surgical team members have the proper attire to prevent contamination of the perioperative environment and ease perioperative care of patients.
The fifth recommendation involves sterilization of surgical instrument as a means of preventing SSI. The surgical instrument needs thorough cleaning, disinfection, and ultimately sterilization before any surgical procedure to guarantee the safety of patients during the operation. Perioperative nurses should not assume that disinfection alone could assure the safety of surgical instruments because some exogenous pathogens are resistant disinfectants.
King and Sapnas (2007) explain that surgical instruments that are heat resistant require steam sterilization, while those that are heat sensitive need sterilization techniques that use low temperature and chemicals such as ethylene oxide, hydrogen peroxide and peracetic acid (p.77). Such sterilization methods are central in the prevention of SSI that arises from exogenous pathogens present in surgical instruments.
In case of emergency, flash sterilization is appropriate but not always recommended as it is prone to cause SSI. Thus, perioperative nursing needs to develop standard procedures and enhance the proficiency of nurses in carrying out the sterilization process. It, therefore, implies that perioperative nurses need to be proficient in performing conventional methods of sterilization to prevent the occurrence of SSI.
The sixth recommendation is that the application of appropriate operative techniques and surveillance of SSI during the period of recovery. During operation, the surgical team needs to adhere to aseptic techniques when administering drugs, placing catheters, and inserting other intravascular devices.
Hong and Tam (2009) assert that, acceptable operative techniques such as minimal use of instruments, shallow incision to minimize trauma, excision of dead tissue and removal of foreign bodies significantly reduce the occurrence of SSI (p.12). Such operative techniques considerably lessen incidences of SSI among surgical patients.
Moreover, constant surveillance of SSI requires perioperative nurses to make a follow up to ensure that surgical wounds are clean and dressed well under the sterilizing condition to prevent multiplication of pathogens that cause SSI. SSI surveillance is also notable, for it provides feedback to surgeons regarding their surgical operations and recovery of patients.
Thus, perioperative nurses have a significant responsibility of ensuring that hospital conducts proper operative techniques and postoperative surveillance of SSI as a means of saving lives and enhancing the recovery of patients.
Perioperative nursing is particularly beneficial in preventing the occurrence of SSI among surgical patients. In spite of advancement in medical technology, incidences of SSI seem to increase as about half a million of surgical patients experience complications associated with SSI annually.
Half million patients are not only at risk of dying but also increases medical costs since patients take longer to recover while demanding additional medications necessary in treating SSI. Hence, due to the challenge of SSI, literature review offers numerous recommendations, which include use of antibiotics, preparation of patients for operation, adequate ventilation of theatre, wearing proper surgical attire, sterilization of surgical instruments, goods operative techniques and surveillance of SSI.
Belton, L., & Berter, B. (2004). Perioperative Nursing. National Student Nurses Association, 6, 27-28.
Burton, F. (2007). Preventing Surgical Site Infections. Wound Essentials, 2, 124-131.
Greene, L., & Mills, R. (2010). Guideline to the Elimination of Orthopedic Surgical Site Infections. Association for Professionals in Infection Control and Epidemiology, 1-80.
Hong, S., & Tam, C. (2009). Recommendations on Prevention of Surgical Site Infection. Center for Health Protection, 1-26.
King, C., & Sapnas, K. (2007). Building a Business Case for the Advanced Practice Registered Nurse. Preparative Nursing Clinics, 2, 75-79.
Portugal, L., & Kneedler, J. (2011). Reduction of Surgical Site Infections. Pfiedler Enterprises, 1-21.
Welsh, A. (2008). Surgical Site Infection: Prevention and Treatment of Surgical Site Infection. National Collaborating Center for Women’s and Children’s Health, 1-32.