Postoperative Surgical Site Infections - Essay in Medicine

Picot Question: Among the obese surgical patients, how does the infection rate in laparoscopic compared to open surgery affect patient healing and discharge

The problem, issue, suggestion, initiative, or educational need that will be the focus of the project

One of the most problematic cases is the issue postoperative surgical site in factions. There have been debates among healthcare professionals on the infection rate among the laparoscopic colorectal surgery and open colorectal surgery. According to the study done by Kokudo, Uldry, Demartines, & Halkic, (2015), a total of 7755 LAP and 16184 open colorectal surgery cases were identified. However, the found that the laparoscopic groups had higher rates of post-operative surgical site infections was 9.4% versus 15.73 % among the open surgery group (p<0.0001). The researchers found that there were no significant statistical differences in the type of surgical site infections because both LAP and open surgery patient has superficial incisional SSI, deep incisional SSI, and organ/space SSI (Kokudo et al., 2015). Even though LAP decreases the risk of infections, there were higher chances that diabetic patient might have similar infection rate due to compromised immune system

The setting or context in which the problem, issue, suggestion, initiative, or educational need can be observed.

Working in Medical-Surgical Nursing, I interact with many patients before and post-operation, and most of these patients have present cases of post-surgical infections. Most of the colorectal surgery patient indicated that after surgery, superficial and deep infections were common making the infection rate a worrying trend (Nanashima et al., 2014). This capstone will compare the rate of infection among the surgical patient and determine if the diabetic patient is at more risk of infection after laparoscopic surgical and open surgery. The result of the study would help in identifying the kind of intervention to implement (Uchino, Ikeuchi, Bando, Chohno, Sasaki, & Horio, et al., 2017).

Impact of the problem, issue, suggestion, initiative, or educational need in the work environment.The most common impact of the post-operative surgical infection includes an increased stay in the hospital as dressing the infection delays the discharge by days or weeks. Secondly, post-operative surgical infection is likely to increase the economic and emotional burden on the patient and the family members while also affecting the utilization of the hospital resources. The prolonged hospital stays and bed utilization affects the ability of the hospital to provide care to other prospective patents (Sawai, Yoshioka, Matsuo, Suyama, & Mukae, 2017). The prolonged stay may also affect the patient satisfaction with the hospitals quality of care as well as affect patient outcomes. Therefore, post-surgical infections should be investigated to determine the most common type of surgical procedures that have a high rate of post-surgical infections rate should be targeted for maximum care (Dimovska-Gavrilovska, Chaparoski, Gavrilovski, Milenkovikj, 2017).

The significance of the problem, issue, suggestion, initiative, or educational need and its implications for nursing.Among the surgical patients, the rate of postoperative surgical site infections (SSIs) is currently estimated at 30% of all colorectal surgery patients. This is a statistically significant number that needs early interventions, the hospital should, therefore, initiate corrective measures aimed at reducing the rate of infection.

A proposed solution to the identified project topic

Based on the high rate of postoperative surgical site infections (SSIs), it is essential to determine the common pathogens in most infection but the surgical procedures, identify the right post-operative surgical site infection care, the patient-specific risk factors. This paper proposes the use of duct tubes to prevent bile leakage and arrest subsequent organ/space SSI (Nanashima et al., 2014).

References

Kokudo, T., Uldry, E., Demartines, N., & Halkic, N. (2015). Risk Factors for Incisional and Organ Space Surgical Site Infections After Liver Resection are Different. World Journal Of Surgery, 39(5), 1185-1192. http://dx.doi.org/10.1007/s00268-014-2922-3

Sawai, T., Yoshioka, S., Matsuo, N., Suyama, N., & Mukae, H. (2017). Intraabdominal abscess caused by Stenotrophomonas maltophilia : A case report. International Journal Of Surgery Case Reports, 41, 212-214. http://dx.doi.org/10.1016/j.ijscr.2017.10.027

Uchino, M., Ikeuchi, H., Bando, T., Chohno, T., Sasaki, H., & Horio, Y. et al. (2017). Efficacy of Preoperative Oral Antibiotic Prophylaxis for the Prevention of Surgical Site Infections in Patients with Crohn Disease. Annals Of Surgery, 1. http://dx.doi.org/10.1097/sla.0000000000002567

Dimovska-Gavrilovska A, Chaparoski A, Gavrilovski A, Milenkovikj Z. (2017). The Importance of Perioperative Prophylaxis with Cefuroxime or Ceftriaxone in the Surgical Site Infections Prevention after Cranial and Spinal Neurosurgical Procedures. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 1;38(2):85-97. doi: 10.1515/prilozi-2017-0026.

Sadamori H., Yagi T., Shinoura S., Umeda Y., Yoshida R., Satoh D., Nobuoka D., Utsumi M, Yoshida K., &, Fujiwara T. (2013). Risk factors for organ/space surgical site infection after hepatectomy for hepatocellular carcinoma in 359 recent cases. J Hepatobiliary Pancreat Sci. 20(2):186-96. doi: 10.1007/s00534-011-0503-5.

Liu X, Duan X, Xu J, Jin Q, Chen F, Wang P, Yang Y, &, Tang X. (2015). Impact of

intra-operative intraperitoneal chemotherapy on organ/space surgical site infection in patients with gastric cancer. J Hosp Infect. ; 91(3):237-43.

doi: 10.1016/j.jhin.2015.05.017.

Cheng, H., Chen, B., Soleas, M., Ferko. C., Cameron, G., Hinoul P. (2018). Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review. Surg Infect (Larchmt); 18(6):722-735. doi:10.1089/sur.2017.089

Nanashima, A., Arai, J., Oyama, S., Ishii, M., Abo, T., & Wada, H. et al. (2014). Associated factors with surgical site infections after hepatectomy: Predictions and countermeasures by a retrospective cohort study. International Journal of Surgery, 12(4), 310-314. http://dx.doi.org/10.1016/j.ijsu.2014.01.018