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Routine Shaving of the Surgical Site
Select a preoperative procedure (e.g., routine shaving of the surgical site) that you would commonly find on a surgical floor.
Describe the process or procedure you have chosen and why you think it needs change.
The process which I have chosen for surgical floor is routine shaving of the surgical site and I think it needs change because patients going through surgery are required to remove hair from the site of the cut. This is considered to reduce the chance of the surgical site becoming infected (National Collaborating Centre for Women's and Children's Health, 2008). Shaving, clipping the hair and using a cream which dissolves the hair are some of the different methods available to remove hair. And these are important because clinically, care plans offer a way to plan and communicate appropriate patient care.
A2. Based on your initial investigation of the situation, do the following:
Explain who determined the basis for the practice?
Major changes in American society and the health care area will offer professional extra ordinary opportunities for professional growth. Nurses can greater improve their chances of success by becoming aware of and preparing for the major changes.
2. Explain the rationale for making the decision for the procedure?
The prevention of surgical site infections encompasses careful operative techniques, different preventive measures with the purpose to neutralize the threat of bacterial, viral and fungal contamination, suitable preoperative antibiotics, environment in the operating room, and the patient's endogenous skin flora. Multiple factors such as patient variables (illness and overall health status), patient care variables (use of antibiotics), level of nursing education etc. (Collins, n.d.) Shaving the surgical site increases the rate of surgical site infection and particularly when it is done earlier than immediately prior to the operation.
3. Explain why the practice is performed this way?
Different organizations have focused on improving surgical care by reducing the complexities and difficulties. The Surgical Care Improvement Project (SCIP) a national quality partnership of organizations focused on improving surgical care by significantly reducing surgical complications has developed recommendations for hair removal methods that can help reduce the occurrence of surgical site infections, a complication that develops in 2% to 5% of operated patients each year.
Appropriate removal of hair does help prevent surgical site infections. Shaving has traditionally been the most common method used to prepare the skin before surgery. But the best method of removing hair is debatable.
Razors can rapidly remove hair from the surgical field, but may result in small cuts and abrasions. This minor skin damage can provide an area where bacteria flora can multiply and potentially infect the surgical incision site.
An alternative to using razors is powered surgical clippers. Clippers mechanically trim the hairs close to the skin, effectively removing it from the field, and avoid the skin trauma caused by the sharp blade of a razor. A study of open heart surgery patients showed a significant decrease in deep infections in individuals whose hair was removed by clippers compared to those whose hair removal was done with a razor. Reviews of other randomized controlled trials have confirmed this finding. When hair needs to be removed, it should be clipped instead of shaved.
Using depilatories creams that remove the hair from the surgical site via a chemical, rather than a mechanical, action may be even more effective in lowering infection rates. Although depilatory creams are easy to apply and avoid mechanical trauma to the skin, they are costly and may generate a sensitivity reaction at the surgical site.
A3.Conduct a review of the literature concerning the procedure you have chosen:
Surgical site infections (SSIs) are common surgical complications that can be prevented with antibiotic prophylaxis. Research shows poor adherence to guidelines for this practice. We conducted a scoping review to identify factors or interventions that influence antibiotic prophylaxis administration.
Shaving has traditionally been the most common method used to prepare the skin before surgery. Razors can rapidly remove hair from the surgical field, but may result in small cuts and abrasions. This minor skin damage can provide an area where bacteria flora can multiply and potentially infect the surgical incision site. Clippers mechanically trim the hairs close to the skin, effectively removing it from the field, and avoid the skin trauma caused by the sharp blade of a razor. Using depilatories -- creams that remove the hair from the surgical site via a chemical, rather than a mechanical, action -- may be even more effective in lowering infection rates.
Nineteen of 192 studies met the eligibility criteria. Seven studies investigated predictors of appropriate antibiotic use through descriptive or exploratory means. Twelve evaluated adherence to antibiotic prophylaxis recommendations by comparing patient cohorts before and after the introduction of quality-improvement strategies. Individual knowledge, attitudes, beliefs and practice; team communication and allocation of responsibilities; and institutional support for promoting and monitoring practice appear to influence practice.
Larger and multisite studies included in our review favor implementation of multidisciplinary pathways, individualized performance data and written or computerized order sets as quality-improvement strategies, but further research is warranted to more rigorously evaluate the effectiveness of these strategies on antibiotic prophylaxis practice.
A4.Explain (suggested length 1/2-page) what the clinical implications of this practice might be, based on your review of the literature.
Preventing the development of a surgical site infection is a goal of every member of the perioperative team. The Perioperative Nursing Data Set (PNDS) includes, "The patient is free from signs and symptoms of infection" as one of the expected perioperative patient outcomes. For the surgical patient, there are numerous factors that may increase his/her risk for the development of a surgical site infection (SSI). One area that has gained increased recognition in recent years is that of preoperative hair removal. While once accepted as the standard of practice for the majority of surgical procedures, hair removal is now being reconsidered with regard to research findings. This study guide will review the impact of surgical site infections (SSIs) and the role of preoperative hair removal as an infection prevention strategy.
Surgical site infections remain a significant source of patient morbidity and mortality, extended hospital stays, and increased healthcare costs. In the United States, of the estimated 27 million patients who undergo surgical procedures annually, approximately 500,000 will suffer an SSI; additionally, 10,000 deaths are associated with SSIs on an annual basis.2 SSIs are the third most frequently reported healthcare-associated infection (HAI), accounting for 14% to 16% of all HAIs among hospitalized patients.3 Surgical site infections may result in as many as 3.7 million extra hospital days and increased health care costs of more than $1.6 billion per year.4 An estimated 40% to 60% of SSIs are preventable. By implementing projects to reduce SSIs, hospitals could recognize a savings of $3,152 and a reduction in extended length of stay by seven days for each patient who avoids an infection.
A5. Discuss (suggested length 1/2-page) whether the procedure could be done better, more efficiently, or more cost-effectively.
Process improvements should be driven by the data outcomes. Stratification is important to enable the appropriate analysis of the data, recognize trends, and focus efforts on meaningful improvement activities.
1. Pre-op Showering and Nasal Decolonization:
If a pre-op program consisting of showering and nasal decolonization is not in place, one should be implemented to reduce SSI rates, particularly in the presence of Staphylococcus aurous as the predominant causative organisms. If these programs are in place, compliance with pre-op showering and nasal decolonization should be monitored and results should be reviewed for performance improvement opportunities.
2. Antibiotic Prophylaxis
Deficiencies in any of these areas should be noted in the analysis and the processes evaluated for improvement opportunities.
3. Hair Removal:
The hair removal methodology should be reviewed with the OR staff. The timing of the hair removal, removal with the use of clippers vs. razors, and where the removal is performed (i.e., in a pre-op location vs. The OR) are important processes that must be reviewed and changed when necessary to meet current standards.
4. Glucose Control:
Compliance with the SCIP standards for glucose control should be monitored and appropriate action taken as needed.
5. Surgical Skin Antisepsis:
The type of skin antisepsis products utilized by the surgical team and the prepping technique should be observed to assess opportunities for improvement. The proper application method is an important step in reducing the microbial count to prevent endogenous sources of wound contamination.
6. Flash Sterilization:
Instruments flashed during a surgical procedure must be avoided whenever possible, whereas the risk of contamination to the sterile field upon the delivery of the instrument to the field is high. Therefore, the use of flashed instruments, including the type of procedure and reasons for flashing, should be monitored. Containers used for flashing should be closed to prevent contamination, regardless of the proximity of the autoclave
7. Aseptic Technique:
Observing aseptic technique while cases are in progress will provide an excellent opportunity for the trained preventions to identify areas…[continue]
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