HNB3219 Perioperative Nursing

Answer:

Introduction

Deaths out of surgical site infections (SSIs) during the perioperative process still remain to be a major source of co morbidity and mortality rates in the world, (Allegranzi et al 2016). According to the World Health Organization, up to 100 000 people die each year due to surgical site related infections, (Nygren et al 2013). Infections can either be caused by endogenous substances on the skin of the patient or they can be caused by exogenous factors such as improperly sterilized surgical tools. Infection control in the perioperative setting involves the procedural setting up of surgical instruments and the actions and methods that will ensure a proper assessment of possible risks and the proper evaluation of the infection risks throughout the perioperative process (Lassen et al 2013). The purpose of this study is to investigate patient infections in the perioperative care and the nursing interventions in reducing the infections. Avoidance of carefully related contaminations can be acknowledged by various ways, which incorporate entirely following the perioperative evaluation conventions, legitimate administration of the task room and adherence to the universally perceived nursing mediations in the perioperative setting. A legitimate nursing administration program, combined with a powerful administration of the activity room strategies, can help to effectively bring down patient contaminations that are gained in the healing center particularly amid the perioperative procedure.

Risk factors in the perioperative setting

Patient infection risks in the perioperative processes are majorly associated with contamination of the surgical site, which leads to surgical site infections (SSIs). The infection risk factor may vary depending on the number of harmful flora in the surgical site or the surgical technique used. A study that has been done recently indicates that most surgical related infections are of a patient related nature rather than treatment related nature (Gustafsson et al 2013). Risk factors can be classified into two: patient related factors and procedure related factors. The patient related risk factors that play a role in surgical site infections majorly include co morbidities such as diabetes, coronary diseases, cancer and smoking addiction. Pre-existing infections and deficiencies in the body immunity may also increase patient related risk factors. Risk factors that are procedure-related in nature include the duration of the surgery, poor sterilization of the surgical tools, improper skin preparation, and tissue trauma (Jammer et al 2015).

Prevention and Control Measures

The role of perioperative assessment in reducing patient infection

The major objective of perioperative assessment is to assess the infection risk factors that are associated with surgical procedures and which may lead to perioperative complications. However, due to improved novel surgical techniques and effective safety procedures, the past 30 years have witnessed a general reduction of surgical complications. (Anderson et al 2014). However, complications resulting from surgical procedures are still common. A study carried out recently demonstrates that risk of patients dying from patient infection in cardiac surgery can be reduced up to 0.8 % down from 1.5% by adopting the use of surgical safety checklists, (Tillman, Wehbe-Janek, Hodges, Smythe & Papaconstantinou, 2013). Surgical safety checklists are meant to instill a culture that promotes effectiveness in managing patient risks.

Perioperative Nursing interventions that enhance infection control

Nursing interventions involves all the actions that are carried out by nurses in order to help reduce patient infection cases, (Go et al 2014. The processes involved during the perioperative process are numerous, and each process requires critical attention.  The role of the nurse in perioperative care of patients is to identify the needs of the patient and analyze any risk factors that may arise out of the surgical procedure. In the recent years, the perioperative environment has become complicated, and it requires more effective measures in the operation room to reduce the risk of infection, (Keenan et al 2014).

In the process of operational rooms, nurses are tasked with the mandate of ensuring the safety of the patients and work to minimize damage to patients in the process of carrying out an invasive procedure. Furthermore, nurses have a responsibility to ensure that the surgical team work together in an efficient manner, and that coordination amongst them is good, (Garrett 2016). These interventions have been evidenced to reduce postoperative complications and lower mortality and morbidity rates that come as a result of infections, and improve the quality and efficiency of surgery processes, (Schweizer et al 2013).

Nurses also play a very important role in offering educative services to patients during the pre-perioperative phase. For example, nurses provide counselling services to patients in their initial visit to hospital, prior to their scheduled surgical operation. They also encourage patients to report any strange reactions with the progress of their health. For example, AORN (Association of perioperative Registered Nurses) recommends that patients should shower with antiseptics before undergoing any surgery, so as to reduce the risk of infection.

Interventions for infection control before, during and after Surgery

The perioperative process involves the preoperative, intraoperative and postoperative phases. To reduce the risk of surgical side infections require intensive care is needed in each of these phases. Following are the infection control interventions that can reduce risk of infection transmission to patients during the perioperative process.

i. Preoperative interventions

The nurses have to validate and ensure that the patients are in the required state. The role of the nurse is to ensure that the patient maintains a constant body temperature, since a low body temperature tends to encourage risk of an infection through vasoconstriction. AORN ((Association of perioperative Registered Nurses) recommends that patients should go through warming (hypothermia) for 15 minutes before they are subjected to anesthesia.

ii. Intraoperative interventions

The operating room (OR) nurse is tasked to ensure that all hairs are removed before surgery process begins and to ensure that the skin antisepsis factors are met. A recent study has shown that the highest risk in surgical site infections is when a patient’s hair is shaved using razors (Illingworth et al 2013). The study further indicates that the risk is low when the hair is shaved immediately before an operation begins.  Increasing oxygen delivery has also been found to condition an infection in the wound simply by augmenting the supply of oxygen to it.

Before incision, prophylaxis antibiotic has to be administered together with anesthesia before a surgical process begins. Additionally, the operating room nurse has to ensure that guidelines that are related to prophylaxis and are recorded in the safety checklist. Furthermore, the doors of the operating room must be closed and human traffic should be minimized completely.

iii. Postoperative interventions

Conduct in the operational room

The operating room environment (OR) is a special facility within a hospital where surgical operations are carried out in an environment that has been sterilized, (Vetter et al 2013). This facility is one of the health care facilities that is most commonly associated with patient infections. A number of deaths are reported each year from uncontrolled infections in the operation room, (Matatov, Reddy, Doucet, Zhao & Zhang 2013). The procedures required amid the perioperative procedure are various, and each procedure requires basic consideration. The job of the medical attendant in perioperative consideration of patients is to distinguish the requirements of the patient and break down any hazard factors that may emerge out of the surgery. In the ongoing years, the perioperative condition has turned out to be muddled, and it requires more successful measures in the activity space to lessen the danger of contamination.

In order to reduce the possible risks of infection, the members of the theatre are required to conduct a safety check before starting a surgical procedure. The operational process involves several teams that work together which includes: anesthetists, nurses and surgeons. Each one of these teams have their specific roles which they do in order for the operational procedure to run in a seamless manner, and above all, to reduce the risk of patient infection.

In order for the operation procedure to be successful and free of infection risk, the members have a shared responsibility to ensure that rules and safety protocols pertaining to the operational room are followed. For example, human traffic should be reduced around the operating table, and each of the members should have their surgical suits on. This is to ensure that person to person infections are prevented, either from the surgical personnel to the patient or vice versa, (Martindale& Deveney 2013).  Furthermore, the windows of the operation room must be kept safely operation to allow for free circulation of air, and to discourage air-borne infections.

The operational room, being a critical perioperative environment, requires intensive care and well-ordered management plans in order to ensure the safety of patients, (Matatov, Reddy, Doucet, Zhao & Zhang 2013). There has been an increasing concern on the safety of patients during the perioperative process and after. Clinicians are highly concerned and focused on improving the safety of patients in this critical setting. A successful surgery process means a successful recovery process, (Eichhorn 2013).

Conclusion

Patient infections often occur in surgical incision sites in the postoperative phase. Surgical site related infection cases do not only to the loss of loved ones, but they also increase the cost of clinical care. Hence, operation room care management is key for a successful management of risks that come about during the perioperative process. Prevention of surgically related infections can be realized by a number of ways, which include strictly following the perioperative assessment protocols, proper management of the operation room and adherence to the internationally recognized nursing interventions in the perioperative setting. A proper nursing management program, coupled with an effective management of the operation room procedures, can help to successfully lower patient infections that are acquired in the hospital especially during the perioperative process.

References

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