Surgical Site Infections and How to Prevent Them

Quantitative Research Critique and Ethical Considerations Part II

My PICOT question focuses on hospitalized patients suffering from surgical site infections and generating a comparison of different interventions (including training and reducing stressors upon staff) to reduce the likelihood of such infections occurring post-surgery. This paper reviews the previous literature on attempts to better understand why such preventable infections occur and how to address their root causes.

Background of Study

The study of Teshager, Engada, & Worku (2015) focuses on human-related factors associated with increased risks of surgical infection in Amhara, Ethiopia. The study focused on nursing personnel specifically. Associated demographic factors with lower risk included greater knowledge of preventative factors, increased age of the nurse, increased practice experience, male gender, past training, and higher education level. The study encompassed 423 nurses, and more experienced male nurses with higher levels of training and education had the greatest knowledge of infection preventative practices. Male nurses may have been more aware of preventative factors may have to do with access to education.

The study’s findings support the idea that proactive approaches could reduce infection rates by increasing providers’ knowledge. This includes supporting nurses’ continuing education, support for obtaining graduate degrees, as well as providing on-the-job training. Results made a strong case for educational interventions, given that nurses that had taken preventative coursework were two times as likely to be knowledgeable of best practices in infection prevention versus those nurses who did not. It should be noted, however, that the study merely surveyed the level of nurse knowledge versus actual infection rates at the hospitals where the nurses were in practice.

While this particular study focused upon nurse knowledge, as measured by researchers, in another study of Ethiopian hospitals by Awoke, Arba, & Girma (2019), the focus was on the prevalence of such infections and how to prevent their occurrence from an institutional perspective. Surgical site infections were found to be a significant risk in the hospitals studied, meriting aggressive preventative interventions. Shortening preoperative stays, pre-surgical intravenous antimicrobial prophylaxis, and ensuring wound care was immediately given as orders were all suggested as ways to reduce infection, based upon a random sampling of 261 patient charts in a study of a 268-bed hospital, with a focus on medical, pediatrics, surgical, gynecology, and obstetrics wards.

How Do These Two Studies Support the PICOT Question

These two studies support an answer to the PICOT question because they focus on two different dynamics that simultaneously affect the likelihood of infection. In the case of the Teshager (et al., 2015) study, the focus is upon the education level of nurses and the actual knowledge they possess, enabling the nurses, at least in theory, to execute best practices. It did not study the actual best practices in the performance of these nurses, but the researchers suggested that without adequate knowledge, the correct execution of best practices cannot be achieved in the first place. However, in another study by Nessim (et al., 2012), elements such as teamwork were found to be very helpful in reducing infection risk. Individual knowledge of nurses alone might not be adequate, suggesting a significant limitation of this study.

The Awoke (et al., 2019) study focused upon studying patient charts and factors associated with infections. Older, less literate patients were more apt to have postsurgical infections, as were patients with longer hospital stays. In contrast to nurses, demographic factors of patients have a limited ability to be altered, so the focus of the study was instead upon how to limit controllable factors, such as the duration of the stay itself, and if preoperative antibiotics were administered to patients.

Methods of Studies

The Teshager (et al., 2015) involved a survey of nurses, based upon responses to questionnaires which surveyed their demographic data and knowledge of best practices. This required honest, careful, reflective responses by nurses. The Awoke (et al., 2019) study analyzed data based upon patients who did and did not experience infections, based upon a randomized sampling of complete patient charts. A great advantage of this is the data is likely to be accurate, given there is no subjective aspect to the reporting. Also, the different types of factors studied in the Awoke (et al., 2019) study are easier able to control in an immediate fashion, like administering antibiotics and reducing duration of hospital stay to the shortest period possible. Given the focus of the PICOT is on actionable results, this makes both useful, but the latter study even more so.

Methods of Study

Both studies focused upon data derived from Ethiopian studies, but the Teshager (et al., 2015) study focuses on self-reporting from patients. In the Awoke (et al., 2019) study, patient charts determining length of stay, antibiotics administered, and other factors enabled the researchers to analyze what risk factors were associated with the subsequent infections. The Teshager (et al., 2015) study randomly selected two of the major referral hospitals in Ethiopia as the source of the personnel within the study. Variables included knowledge, best practices, demographic factors, and how certain institutional factors such as on-site training resulted in improved outcomes. The Awoke (et al., 2019) study likewise relied upon random selection, but in this instance, random selection of complete patient charts.

Results of Study

Both studies reinforced the importance of addressing this issue from a practice standpoint, given that such infections were found to be pervasive, and highly varied practices and levels of knowledge of how to prevent surgical site infections were manifest in the Teshager (et al., 2015) study. However, both studies did offer some hope in the sense that it was possible to reduce risk, both on an individual level in terms of improving levels of provider education in the case of Teshager (et al., 2015), and addressing institutional practices such as reducing the length of patient stays in the hospital and being more diligent in the use of prophylactic on-site antibiotic treatment (Awoke et al., 2019).

Ethical Considerations