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Issuing New Guidelines to Prevent Surgical InfectionsResearch Paper

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Surgical Infection

Issuing new guidelines to prevent surgical infections

Surgical site infection prevention clinical practice guidelines have become increasingly important in recent years, given the rise of Methicillin-resistant Staphylococcus aureus (MRSA)-in hospital settings. The purpose of the most recently-issued guidelines by the Surgical Care Improvement Project (SCIP) related to surgical prophylaxis is to ensure safety for the patient and to minimize the risks of the procedure. The specific stated goal of the guidelines is the "identification of evidence-based prevention measures pertaining to SSIs" to give healthcare providers "the knowledge base needed to effectively deliver high-quality, continuity of care among patients" (Smith, Dahlen, Bruemmer, Davis, & Heishman 2013). These guidelines include "nasal swabbing, preoperative skin cleansing, preoperative hair removal, perioperative antibiotic timing, and specific postoperative care measures" (Smith et al. 2013).

Stakeholder involvement

Given the seriousness of the issue, the comprehensive guideline was created using input from multiple sources. The official author of the new guidelines was the Surgical Care Improvement Project (SCIP), "a national partnership that was developed in 2003 by the Centers for Medicare and Medicaid Services, the CDC, and various organizations committed to improving the safety of surgical care through the reduction of postoperative complications by utilizing evidence-based core measures" (Smith et al. 2013). The SCIP was specifically created due to recent concerns about the rise of MRSA. To avoid biases, the SCIP consists of a variety of expert panels. "Partners include the Steering Committee of 10 national organizations who have pledged their commitment and full support for SCIP. In addition, the SCIP target areas are advised by a technical expert panel (TEP). This group meets on a quarterly basis and provides technical expertise and resources to ensure the SCIP measures are fully supported by evidence-based research" and to eliminate any biases (SCIP, 2014). Also, SCIP always seeks to align "with Centers for Medicare and Medicaid Services (CMS) with respect to the performance measures for patients undergoing surgery" (SCIP, 2014).

Rigor of development

Guidelines are based in current evidence-based practices and extant research indicating what procedures are least apt to transmit surgical infections. "The CDC guidelines for reducing the transmission of SSIs include utilizing contact precautions for patients with known or suspected infections, employing appropriate hand hygiene measures, performing effective environmental cleaning, and following the SCIP measures" (Smith et al. 2013). Clinical research and best practices observed at healthcare institutions are both consulted when issuing guidelines.

Recommendations

Plans to improve patient care entail preoperative measures as well as procedures to be implemented during the procedure and afterward. The first of this is to determine a wound classification, to target which wounds are most likely to pose an infectious risk. According to the CDC, four types of wound classifications exist, the highest risk of which are obviously contaminated, dirt-infected wounds that are clinically infected (Smith et al. 2013). Nasal swabbing may also be conducted to pre-screen for MRSA and MSSA and the indication is that initiating treatment for those patients who test positive preoperatively may decrease the SSI rate as much as 82% among patients if done 14 days prior to the surgical procedure (Smith et al. 2013). This allows for pre-treatment until the day of surgery. Preoperative hair removal can also reduce the risk of cross-contamination. Timing and duration of antibiotics and antimicrobial agents and pretreatment of all infections is essential (Smith et al. 2013).

Special patient populations may also have unique issues and risk factors. For example, diabetic patients need to have their glucose monitored and are more prone to sores and wounds that do not heal properly, such as foot lesions. The literature suggests to "consider checking hemoglobin A1C levels in patients with diabetes. Adequately control serum blood glucose levels in patients with diabetes and particularly avoid hyperglycemia during perioperative phase" (Smith et al. 2013). Of course, diabetic patients must always be monitored when undergoing a procedure in general to ensure appropriate care but infection risk in particular is of concern given that "hyperglycemia reduces the body's natural resistance to infection. Diabetes has been associated with an increased risk of surgical site infections" (Smith et al. 2013). Patients with preexisting dental problems can also be at a higher risk of infections due to the exacerbation of dental abscesses; renal failure; malnutrition; and patients on steroids and immunosuppressive medication are all at increased risk.

Of course, nurses themselves can take precautions to reduce the risk of the spread of… [END OF PREVIEW]

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