The Mölnlycke O.R. blog
Would you do everything in your power to help prevent a surgical site infection?
Ulrika Kanth is a former surgery nurse who is now a clinical specialist/account manager with Mölnlycke Health Care.
I want to and do believe that everyone working in healthcare would do anything within their power to do what is best for their patients. I also know, though, that there are multiple other factors to take into account. As a nurse you are expected to do everything and be everywhere all at the same time. Your patient is right in front of you, and you are responsible for his or her care – but you also have general rules and regulations to consider. Most of the time, healthcare professionals balance these priorities, care for the patients at hand and move forward. But is it possible to consider what happens to patients after they leave care – and what you as a healthcare professional can do to ensure that best practices are employed and care is taken to reduce the risk of postoperative complications, such as surgical site infections? To be successful in preventing SSIs and other HIAs, safety procedures and routines must be put into place and practiced1.
When visiting several different operating rooms in many different hospitals, it is immediately clear that both doctors and nurses face different challenges in their immediate, daily work. Of course there are life threatening situations when all you can think about is how to save a life. But there are also procedures that run by routine. You may replace two hips the same day and quite a few during one week. You know every step of the procedure by heart and know that performing this procedure and the pre- and post-op care provided really make a difference in each patient's life.
But again, do you think about the aftermath for the patient? Do you think about how many days this particular patient will stay in the hospital, how many hours of physical therapy s/he will need, possibly in pain and getting up from the bed and starting to walk again? You probably do. These kinds of considerations may overlap with your duties.
But somewhere in the periphery of your duties and responsibilities, do you think about how many patients actually get an infection after that surgery? Have you thought about how many patients would possibly even get a deep tissue infection and lie immobile in that bed for several months? Not being able to start walking again. Putting their lives on hold for a very long time. Not earning any income. Maybe losing their jobs. And on top of their challenges and suffering, consider all the nurses and care professionals tending to the patient to treat that infection – not even taking the resource-intensive nature of treatment and extended hospital stays into consideration.
Thinking of it in these terms, it's clear that the old saying is true: prevention is cheaper and easier than cure. Framed this way, are you ready to ask yourself whether you are doing everything you can to help prevent your patients from getting a surgical site infection?
Surgical site infections can often be prevented. We may not be able to get the percentage down to 0 percent but imagine lowering the infection rate from 1.2 to 1.1 percent. Imagine that one patient who did not get an infection because of the precautions you took.
There are many ways to help prevent surgical site infections. These ways include everything from correct skin preparation, organizational buy-in, access to the right equipment and a holistic approach and knowledge about SSI rates: one study found that intensive infection control and surveillance routines resulted in a 32 percent reduction in infection rates over a five-year period1.
Another place to start is in the operating room itself by reducing the amount of airborne particles in the operating theatre2. Instead of possibly carrying bacteria into the O.R. – which travel from you into the open wound on the operating table3, you can work to lower the amount of CFUs (colony forming units), which can be as easy as making sure you wear single-use clean-air suits in the O.R.4,5,6.
What will you wear tomorrow? What are some tactics you use in the O.R. to help reduce the risk of SSIs?
- Hayley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP et al. 1985. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemio. 121:182-205.
- Lidwell OM, et al. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. BMJ1982;285:10-14.
- Lidwell OM, Lowbury EJL, Whyte W. Airborne contamination of wounds in joint replacement operations: the relationship to sepsis rates. J Hosp Infect 1983;4:111-31.
- Swedish Technical Specification SIS-TS 39:2012. Microbiological cleanliness in the operating room – Preventing airborne contamination – Guidance and fundamental requirements.
- Hoborn J. Thesis: Humans as Dispersers of Microorganisms - Dispersion Pattern and Prevention. Department of Clinical Bacteriology, Institute of Medical Microbiology, University of Göteborg, Göteborg, Sweden. 1981.
- Tammelin A, et al. Single-use surgical clothing system for reduction of airborne bacteria in the operating room. Journal of Hospital Infection, 2013.