Using Prophylactic Antibiotics for Reducing Risk of SSIs in Operation Theatres

This report discusses the importance of infection control and prevention in reducing the risk of surgical site infections (SSIs) in operation theatres. The research question is whether using prophylactic antibiotics 30 minutes before the surgery can help in reducing the incidence of SSIs. The report evaluates four sources of evidence, including a meta-analysis and randomized controlled trials, and concludes that prophylactic antibiotics are effective in preventing SSIs in various surgical procedures.

STUDENT
Assessment – Written report
CHCPOL003 Research and apply evidence to practice
Research Topic 1
Infection control and prevention
(You may choose a different topic, but your educator must agree with the topic you have chosen.)
Topic 1 – Background
Read before starting your assignment
You are a new enrolled nurse working in a clinic located in a remote area. The clinic building is an older
structure and lacks the use of clinical and client information, such as posters. It has been identified that
many of the staff are efficient in their roles but have some out-of-date ideas in their nursing practice.
The clinic manager has asked you to research the most current information about a specific topic, such
as:
Infection control
Plan the research activity
1. In order to complete this assessment, you need to identify TWO (2) areas related to the
topic, where research can help support and improve your own practice as an EN.
E.g topic: Infection control and prevention (or as agreed with your educator)
Infection control and prevention to reduce the risk in surgical sites in operation theatres
Surgical site infections (SSIs) account for hospital-acquired infections with 14% to 17% and 38%
nocosomial infections in the surgical patients (Li et al. 2013). These infections contribute to substantial
amount of infection and morbidity and emergence of antibiotic-resistant microorganisms. SSI are caused
due to multiple factors comprising of patient-related and procedure-related and most importantly,
influenced by quality of operating theatres. A salubrious and safe operating theatre is required that can be
achieved by infection control and prevention. Therefore, for SSI prevention in operating theatres, infection
control and prevention is of paramount importance demanding multidisciplinary approach including
nurses and commitment for improving the quality of operating theatres.
The most common site for hospital-acquired infections include surgical operating theatres and nurses play
an important role in infection prevention. They promote the health and well-being of the patients through
infection control and prevention. Nurses can intervene and can minimize the spreading of the disease and
ensuring that their nursing practice is evidence-based research and patient education. They advocate for
the patients and are placed in unique position for improving the patients’ standards of care. Therefore,
nurses play a vital role in creating a safe environment for the patients that are cornerstone in making
operation theatres free from infection (Anderson et al. 2014).
12th January 2017 Page 1

STUDENT
Assessment – Written report
CHCPOL003 Research and apply evidence to practice
2. Identify the reason(s) for undertaking your research from the list below.
 You may select several reasons.
 Provide a brief rationale for each.
E.g reasons: Comparison / hypothesis testing / trend identification / own knowledge
extension / strengthen quality of own practice.
Nurses have the duty to reduce the risk of SSIs in operation theatres through infection control
and prevention by utilizing their knowledge and skills of nursing practice and thereby,
facilitating patient recovery and minimizing infection related complications for better patient
outcomes. Patient safety is the prime duty of nurses and infection control and prevention acts
as the main realm in it (Sievert et al. 2013). Through this research, one would be able to
understand the standards for prevention of HAIs to reduce risk of SSIs in operation theatres.
3. Write a clear statement highlighting your research question or hypothesis, e.g. “Is there a
difference between hand washing protocols and actual practice”.
It may include:
 Nursing interventions applicable to the topic
 Client perceptions of the provision of this topic
 Models of nursing care that utilise the topic
 Political issues confronting nursing practice and health care provision in relation to
the topic
An example of a question (the student can NOT use this example), would be:
Does hand washing among healthcare workers reduce hospital-acquired infections?
Question: Does antibiotics prophylaxis reduces the rates of SSIs in operation
theatres.
An example of a hypothesis (the student can NOT use this example), would be:
Hospital acquired infections are more likely to be passed on by hand washing with water
than when hands are washed with soap.
Hypothesis: Using antibiotic prophylaxis before the surgery will help in reducing
the rates of SSIs in operation theatres.
SSIs are prevalent in the healthcare systems and its prevention and control is the major
focus for the multidisciplinary team including nurses. In the recent years, many
interventions have been developed with an aim of reducing the risk of SSIs in operation
theatres through infection control and prevention. These interventions are designed to
deliver prevention at three levels: pre-intra and post-operatively. Pre-operative phase is
the time between the need for surgery and operation start time when the patient is
brought to the operation table. It is the point when the operation staffs before proceeding
with the surgery make preparation occurring in this phase. Use of intra-operative
prophylactic antibiotics are largely focused on skin decontamination using antiseptics and
soaps, prevention of micro-organisms movement into wounds barriers through barriers
12th January 2017 Page 2

STUDENT
Assessment – Written report
CHCPOL003 Research and apply evidence to practice
use and as a result, patient health outcomes are optimized promoting best recovery
(Allegranzi et al. 2016). The use of prophylactic antibiotics acts as both barrier and
decontamination methods for the operating staffs and people at the operation theatres.
Prophylactic antibiotics are the best way for preventing SSIs administered at the
appropriate time like 20 minutes before the surgery. Research has suggested that
prophylactic antibiotics administration before the surgery has provided to largely
decrease the incidence of post-operative infections like SSIs especially at the inoculums
where the bacteria count is high. Appropriate administration time of antibiotics can help
to prevent and control surgical site infections in the operation theatres.
Nursing intervention: The intervention would be using antibiotics 30 minutes the surgery
procedure or incision by nurses and operating staffs. One or two doses re-administration
is recommended depending on the duration of the surgery that greatly reduces the
chances of incidence of SSIs in the operation theatres.
Client perspective: Apart from skin antisepsis, the prophylactic antibiotic administration
adopted by operating staffs greatly reduces the chances of SSI infections promoting
patient safety. There was better recovery phase with reduced chances of hospital re-
admissions and decrease in spread of surgical site infection thereby controlling HAIs and
postoperative infections outbreak.
Political issues: Non-compliance to prophylactic antibiotic administration, lack of nursing
staff and financial constrains in antibiotic selection
4. Establish and define the general research objective.
Tips:
 A research objective summarises what is to be achieved by the study.
 Ensure your objective is S.M.A.R.T and relevant, logical, feasible, observable and
measurable.
 The objective should be clearly phrased – use verbs, e.g. to assess, to establish, to
determine, to compare, etc.
The aim of this research is to explore the effectiveness of prophylactic antibiotics administered 30
minutes before the surgery for the prevention and reducing the incidence of risk of SSIs in
operation theatres in 3 months.
Specific Measurable Achievable Realistic Timely
Reduce
incidence of
risk of SSIs
explore the
effectivenes
s of
prophylacti
c antibiotics
In
operation
theatres
setting
30 minutes
before
surgery
3 months
12th January 2017 Page 3

STUDENT
Assessment – Written report
CHCPOL003 Research and apply evidence to practice
5. Identify ONE (1) other discipline that could be connected to this research activity.
 Briefly explain your choice of discipline.
Patient safety is the chosen discipline that is associated with reduction in risk of SSIs in operation
theatres through infection prevention and control. Infection control is a vital component in every
healthcare system occupying a unique position in patient safety and in prevention of HAIs. Nurses
provide patient care that is within their professional nursing practice by performing interventions
and actions for infection prevention and control. Therefore, infection prevention and control
promote positive health outcomes and fast recovery ensuring patient safety (Zimmerman et al.
2013).
6. In order to gather information about the research topic, you will need to access credible
sources of data and evidence.
 List two (2) sources you intend to use for this assignment.
 Copy the link address of the source and paste it next to the source’s name – this will
provide the proof to your assessor that you accessed it.
o E.g. PubMed - http://www.ncbi.nlm.nih.gov/pubmed
 Source 1: PubMed- https://www.ncbi.nlm.nih.gov/pubmed/
 Source 2: Cochrane Library- http://www.cochranelibrary.com/
HINT: This is a good time to contact your educator and discuss your research topic
and verbally gain confirmation that you and your partner are still on track.
Gather information for your research
7. Evaluate and select a maximum of two (2) methods of gathering information you think
would be most appropriate to answer your research question.
 Briefly explain why you have chosen a particular method over another, e.g. more time
efficient.
Tips:
Methods of gathering include search engine using correct key words, literature reviews,
systematic reviews, interviews, surveys, seminars, and surveys.
For meeting the research objectives, authentic databases like Google Scholar was used for
searching articles regarding prophylactic antibiotic administration for preventing SSIs.
Various key search items like “infection control”, “prophylactic antibiotic administration”,
“SSI prevention”, were used for retrieving articles that are related to the objective
question. Boolean operators like AND and OR were used and articles that were published
in English were included for the study.
8. You are now to gather information for your research topic using a systematic approach.
12th January 2017 Page 4

STUDENT
Assessment – Written report
CHCPOL003 Research and apply evidence to practice
Stages for your information gathering activity
1. Statement of objective – you should have already completed that step
2. Data collection, i.e. a literature search
3. Data evaluation – critiquing articles to include or exclude them from the review.
 You may use the appraisal tools developed by JBI to help you
http://joannabriggs.org/research/critical-appraisal-tools.html
4. Analysis – comparing, contrasting, challenging & reflecting
5. Presentation of findings
At this stage, select four (4) sources
Please find the hierarchy of evidence, below:
1. Systematic reviews and meta-analysis
2. Randomised controlled trials (RCTs)
3. Cohort studies
4. Case-control studies
5. Cross-sectional surveys
6. Case reports
Statement of objective: Using prophylactic antibiotics 30 minutes before the surgery by operation
staffs helps in reducing the risk of SSIs in operation theaters.
Data collection: Peer-reviewed articles were retrieved from authentic databases that correlated
with the research aim of using prophylactic antibiotics in reducing risk of SSIs in operation
theatres as a part of infection prevention and control. The first level of evidence is meta-analysis
and another study is randomized control trials (RCTs).
Data evaluation: The first piece of evidence that was evaluated is meta-analysis that studied the
efficacy of prophylactic antibiotics in the prevention of SSI in plastic surgery procedures. This
piece of evidence provided high-quality evidence for investigating efficacy of prophylactic
antibiotics as the results of the study suggested that systemic prophylactic antibiotics
administration is highly recommended for breast surgery especially plastic surgery (Ariyan et al.
2015).
The second level of evidence is RCT for studying the efficacy of antibiotic prophylaxis for SSI
prevention after inguinal hernia repair open tension free surgery. A double blind, randomized
placebo controlled trial was performed for the study where elective open mesh-plug hernia repair
were randomized and prophylactic group, cefazolin (1.0g) was given intravenously 30 minutes
before administration. An equal volume of sterile saline was given in the placebo group and end
was SSI incidence (Mazaki et al. 2014). The results concluded that prophylactic antibiotics are
quite effective in SSI prevention after open-mesh plug hernia repair.
The third level of evidence is a retrospective cohort study where the timing of administration of
prophylactic antibiotics is associated with SSI prevention in surgical sites. The procedures like
vascular, colorectal, orthopedic and gynecological were included in the study from 2005 to 2009
where the patients underwent knee or hip arthoplasty, hysterectomy and colorectal surgeries. The
timing of antibiotic administration was studied with respect to the incision time. From the study, it
can be concluded that quinolone and cefazolin sodium in combination with an anaerobic agent
that were associated with few SSI events after surgery. From the study, it can be suggested that
although, timing of antibiotic administration is not associated with SSI prevention, adhering to its
use before the surgery helps in reducing the chances of SSIs (Hawn et al. 2013).
The fourth evidence is the efficacy of administration of prophylactic antibiotics for breast cancer
surgery through a RCT. The study was controlled, phase IV randomized and parallel-group efficacy
12th January 2017 Page 5

STUDENT
Assessment – Written report
CHCPOL003 Research and apply evidence to practice
trial. As compared to the control group, SSI significantly reduced in prophylaxis group with no
adverse reactions. Therefore, it can be concluded that SSI incidence greatly reduced with antibiotic
prophylaxis administration after breast cancer surgery in obese patients (Gulluoglu et al. 2013).
Data analysis: From the above four evidences, it can be concluded that two out of four articles
were most appropriate that gave an insight into the fact that prophylaxis antibiotic administration
is helpful in reducing risk of SSIs in operation theatres followed by surgery.
9. Distinguish between relevant and irrelevant information.
 Briefly explain why one (1) piece of your information is particularly relevant according
to your objectives and your workplace requirements.
Among all the four evidences provided, RCT conducted for studying the efficacy of antibiotic
administration in the prevention of SSIs after open-tension free inguinal hernia repair was
considered factual. Due to this fact, a randomized, double-blind and placebo-controlled trial
performed to study the administration of antibiotic prophylaxis. Cefazolin of 1.0 mg was
considered effective when administered 30 minutes before the surgery as compared to placebo
group where sterile saline was given. As a result, there is decrease in SSI infections and so this RCT
was considered useful. This information is useful for fulfilling the research objectives indicating
that nurses play vital role in patient safety through careful handling of surgical equipments and
thus reducing the chances of SSIs. Nurses are at the frontline of patient safety where they have the
opportunity to incorporate best quality practices thus reducing the morbidity and mortality due to
HAIs. Nurses work in accordance with the multi-disciplinary team in reducing the risk of SSIs
through infection control interventions like prophylactic antibiotics and skin and hand hygiene.
Therefore, RCT provided relevant and high level of evidence that can help enrolled nurses in
increasing their knowledge and skills in infection control and prevention.
10. In order to facilitate your analysis, organise the information you have found.
Tips:
 You may summarise each source of information using key words.
 You may choose to order your articles in chronological order if your focus is to show
an evolution of practices.
 You may order your articles following the rules of evidence, i.e. RCT > case report.
HINT: Contact your educator and discuss your research topic and verbally gain
confirmation that you and your partner are still on track.
Analyse the information
11. Prioritise information based on the research objectives.
 Using questions 9 and 10 to help you, select only TWO (2) articles that you will keep
for the rest of this assignment.
 The two articles are :
 A randomized trial of antibiotic prophylaxis for the prevention of surgical site
infection after open mesh-plug hernia repair
 Timing of Surgical Antibiotic Prophylaxis and the Risk of Surgical Site Infection
12. Compare and contrast your two (2) sources of information.
 Use the table provided in Appendix A.
 You must complete all the sections.
12th January 2017 Page 6

STUDENT
Assessment – Written report
CHCPOL003 Research and apply evidence to practice
 Instructions in italics are to be removed.
13. You have now thoroughly analysed the information available to you. Now draw conclusions
based on your findings.
From the research findings, it can be concluded that infection control and prevention is crucial for
reducing risk of SSIs. Infection control nurse play an important role in SSI prevention being
comprehensive in the continuum of care. They play an important role in the execution and
promotion of evidence-based practices for infection control and prevention. Pre-operative
interventions include prophylactic antibiotics administration that are implemented by infection
control nurses for promoting and implementing strategies for SSI prevention while bringing the
best evidences into clinical practice. Timing of prophylactic administration is not significant as
illustrated in few studies, however, RCT results showed that administration 30 minutes before the
surgery is considered effective. Therefore, infection control nurses implement their nursing
knowledge in infection prevention and control that ensures patient safety and thereby fostering a
safe environment in spanning the continuum of care.
14. As your findings may be used to establish evidence-based practice, identify one (1) impact
your conclusions may have, in terms of duty of care requirements.
 E.g. in order to do no harm to the clients and prevent disease transmission, all nurses
should wear gloves when touching the client.
As a duty of care, nurses should maintain standard practices that help in the prevention of
spread of pathogens like bacteria and viruses. The primary role of nursing profession is
patient advocacy where the central goal is patient safety through preoperative nursing
interventions for infection control and HAIs prevention. Nurses need to be compliant
towards infection control practices to avoid SSIs by using prophylactic antibiotics before
surgery. In healthcare settings, nurses share responsibilities for practicing good hygiene
practices, monitoring patients and implementing evidence-based practices for preventing
HAIs thereby ensuring patient safety (Olans, Olans and DeMaria Jr 2015).
HINT: Contact your educator and discuss your research topic and verbally gain
confirmation that you and your partner are still on track.
Use information in practice
15. Assess one (1) way in which different aspects of information may be used in your
workplace.
The steps and timing for using prophylactic antibiotics 30 minutes prior to surgery need to be
disseminated in the healthcare settings through conferences, flyers or posters that contain
information about its administration. This would help the hospital staffs to be aware of the
infection control and SSI prevention strategies and thereby can promote patient safety and
advocacy through prophylactic antibiotics administration before surgery.
16. Using and reflecting on what you have learnt from your research
 Identify one area for change in your workplace or current practice.
For the implementation of prophylactic antibiotic for SSI prevention in current practice, the
research findings need to be disseminated to the members of multi-disciplinary team including
operation staffs. This can be done through weekly conferences and presentations providing
information about the efficacy of prophylactic antibiotics administration for SSI prevention. The
healthcare professionals should adhere to the infection control guidelines and practices along with
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STUDENT
Assessment – Written report
CHCPOL003 Research and apply evidence to practice
continuous monitoring and evaluation of reduction of SSI infection cases.
17. Identify issues that require further research and evaluation.
Future research is recommended on determining the timing of administration of prophylactic
antibiotics before the surgical procedure that can minimize the risk of SSIs largely and thereby
prevent spread of HAIs. The timing of the administration with respect to incision time during the
surgery has less evidence and therefore, future focus should be on timely prophylactic
administration of antibiotics for better infection control and better care.
18. Using one piece of A4 paper or PowerPoint (1 slide) (portrait format), develop a poster or a
flyer to address outcomes of research, i.e. select a method to disseminate your findings.
 You will be required to scan it and upload it on Blackboard with this assignment.
 Refer to your learning activities 11 and 12 for more ideas about how to do a poster or
a flyer using PowerPoint.
Tips:
 Consider your audience, the time and resources available.
 It is recommended you adopt a flyer or poster style with a mix of text and pictures –
do not put in too much information.
HINT: Contact your educator and discuss your actions verbally gain
confirmation that you and your partner are still on track.
WORD COUNT: ___2001_____
12th January 2017 Page 8

STUDENT
Assessment – Written report
CHCPOL003 Research and apply evidence to practice
Article 1 – Mazaki, T., Mado, K.,
Masuda, H., Shiono, M., Tochikura,
N. and Kaburagi, M., 2014. A
randomized trial of antibiotic
prophylaxis for the prevention of
surgical site infection after open
mesh-plug hernia repair. The
American Journal of
Surgery, 207(4), pp.476-484.
Article 2 - Hawn, M.T., Richman, J.S., Vick,
C.C., Deierhoi, R.J., Graham, L.A.,
Henderson, W.G. and Itani, K.M., 2013.
Timing of surgical antibiotic prophylaxis
and the risk of surgical site
infection. JAMA surgery, 148(7), pp.649-
657.
Currenc
y
2014 2013
Study
findings
Significant reduction in SSIs and
infection prevention upon
administration of prophylactic
antibiotics use prior to surgery
Cefazolin sodium and quinolone
administration with anaerobic agents
resulted in less SSI infections
Strength
of study
antibiotic prophylaxis administration
is effective among randomized group
Largest retrospective cohort study, detailed
patient- and procedure-level data
Relevanc
e to
objective
s
SSI prevention through investigating
the efficacy of prophylactic antibiotics
Procedure and patient factors determine
SSI risk prevention as well as by antibiotic
properties, however no relevance with the
timing.
Reliabili
ty
RCT helped in accessing the
effectiveness of prophylactic antibiotic
administration in HAIs prevention
Although, adherence to time is important for
administration, however little evidence is
available.
Validity The results were not consistent with
the previous findings regarding open
mesh-plug hernia repair as efficacy of
prophylactic antibiotics was not
studied earlier.
Robust examination of timely
administration of prophylactic antibiotic in
SSI prevention
Benefits Prophylactic antibiotics
administration is the best way to
prevent SSIs through RCT
Prophylactic antibiotics serves as better way
in preventing risk of SSIs
Risks SSI risk might have increased through
increase in time of administration
prior to surgery
Choice of prophylactic antibiotics for
colorectal and orthopaedic procedures may
be associated with SSI risk
Feasibili
ty
Prophylactic antibiotic administration
can be implemented readily in the
Prophylactic antibiotic administration can
be implemented although timing need to be
12th January 2017 Page 9

STUDENT
Assessment – Written report
CHCPOL003 Research and apply evidence to practice
associat
ed with
informat
ion
hospitals before surgery adjusted that require future endeavours
Conclusi
ons
Prophylactic antibiotic administration act as an effective infection control practice in
preventing and minimizing the risk of SSI in healthcare settings
12th January 2017 Page 10

STUDENT
Assessment – Written report
CHCPOL003 Research and apply evidence to practice
References
Allegranzi, B., Zayed, B., Bischoff, P., Kubilay, N.Z., de Jonge, S., de Vries, F., Gomes, S.M., Gans, S.,
Wallert, E.D., Wu, X. and Abbas, M., 2016. New WHO recommendations on intraoperative and
postoperative measures for surgical site infection prevention: an evidence-based global
perspective. The Lancet Infectious Diseases, 16(12), pp.e288-e303.
Anderson, D.J., Podgorny, K., Berríos-Torres, S.I., Bratzler, D.W., Dellinger, E.P., Greene, L., Nyquist,
A.C., Saiman, L., Yokoe, D.S., Maragakis, L.L. and Kaye, K.S., 2014. Strategies to prevent surgical site
infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(S2),
pp.S66-S88.
Ariyan, S., Martin, J., Lal, A., Cheng, D., Borah, G.L., Chung, K.C., Conly, J., Havlik, R., Lee, W.A.,
McGrath, M.H. and Pribaz, J., 2015. Antibiotic prophylaxis for preventing surgical-site infection in plastic
surgery: an evidence-based consensus conference statement from the American Association of Plastic
Surgeons. Plastic and reconstructive surgery, 135(6), pp.1723-1739.
Gulluoglu, B.M., Guler, S.A., Ugurlu, M.U. and Culha, G., 2013. Efficacy of prophylactic antibiotic
administration for breast cancer surgery in overweight or obese patients: a randomized controlled
trial. Annals of surgery, 257(1), pp.37-43.
Hawn, M.T., Richman, J.S., Vick, C.C., Deierhoi, R.J., Graham, L.A., Henderson, W.G. and
Itani, K.M., 2013. Timing of surgical antibiotic prophylaxis and the risk of surgical site
infection. JAMA surgery, 148(7), pp.649-657.
Lankford, M.G., Zembower, T.R., Trick, W.E., Hacek, D.M., Noskin, G.A. and Peterson, L.R., 2003.
Influence of role models and hospital design on the hand hygiene of health-care workers. Emerging
infectious diseases, 9(2), p.217.
Li, G.Q., Guo, F.F., Ou, Y., Dong, G.W. and Zhou, W., 2013. Epidemiology and outcomes of surgical site
infections following orthopedic surgery. American journal of infection control, 41(12), pp.1268-1271.
Mazaki, T., Mado, K., Masuda, H., Shiono, M., Tochikura, N. and Kaburagi, M., 2014. A randomized trial
of antibiotic prophylaxis for the prevention of surgical site infection after open mesh-plug hernia
repair. The American Journal of Surgery, 207(4), pp.476-484.
Olans, R.N., Olans, R.D. and DeMaria Jr, A., 2015. The critical role of the staff nurse in antimicrobial
stewardship—unrecognized, but already there. Clinical Infectious Diseases, 62(1), pp.84-89.
Sievert, D.M., Ricks, P., Edwards, J.R., Schneider, A., Patel, J., Srinivasan, A., Kallen, A., Limbago, B. and
Fridkin, S., 2013. Antimicrobial-resistant pathogens associated with healthcare-associated infections
summary of data reported to the National Healthcare Safety Network at the Centers for Disease
Control and Prevention, 2009–2010. Infection Control & Hospital Epidemiology, 34(1), pp.1-14.
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STUDENT
Assessment – Written report
CHCPOL003 Research and apply evidence to practice
Zimmerman, B., Reason, P., Rykert, L., Gitterman, L., Christian, J. and Gardam, M., 2013. Front-line
ownership: generating a cure mindset for patient safety. HealthcarePapers, 13(1), pp.6-22.
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