REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS1 Review of Literature on Surgical Site Infections Introduction Hospital-acquired surgical site infections (SSIs) have emerged to be issues of concern in delivery of quality healthcare services. Recent studies have found that SSIs are the major causes of prolonged stay in hospitals after surgery. Other additional adverse impacts of SSIs are financial costs and increased mortality rates in women undergoing caesarian delivery. Stanic, Bojanic, Grubor, Mijovic, and Maric (2017) define surgical site infection as an infection that occurs on the part of the body where surgery had been done. In spite of technological developments, cases of SSIs are still prevalence in many hospitals and have adverse effect on the patients. Different scholars have documented research work on SSI with the goal of determining the causes, treatment, and possible interventions that could help reduce the impact of SSI on patients. This paper reviews twelve of research published literature on SSIs to establish the current understanding on the topic. Research Design Badia et al. (2017) conducted a systematic review of literature on the impact of SSIs on quality of life and financial costs. The researchers reviewed studies on SSIs published in Spain, France, Germany, Netherlands, Italy, and the United Kingdom. Studies were obtained from online databases and screened to eliminate duplication. Twenty-six studies qualified for analysis. Evidence from the Study Evidence from the studies indicated that SSI contributed to 36% of post-surgery complications. The study also established prolonged stay in hospitals, increase in costs of medication, and increase in mortality rates in hospitals where SSIs were prevalent. The researchers concluded
REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS2 that in spite of efforts to provide sustainable and affordable healthcare, SSIs have adversely negated the efforts put in place to address the quality of care in hospitals. Limitations of the Study The study focused on articles published in English alone. The selection criteria did not include studies published in other languages, which could have affected the findings from the study. Guidelines Provided Badia et al. (2017) recommend renewed efforts in addressing SSIs in European countries. Considering the impact of SSIs on the cost of healthcare and overall quality of life, there is a need for the healthcare sector to focus on SSIs to help patients that undergo surgery. Lessons from the Study SSIs prolong the stay in hospitals, increase in costs of medication, and raise mortality rates in hospitals. SSIs negate the efforts put in place to address the quality of care in hospitals. Application to practice The study contributes to existing literature on SSIs. Since it is evident that SSIs have adverse impact on quality of life and financial costs, the study could help in addressing the issue of SSI in hospitals. Cheng, Chen, Soleas, Ferko, Cameron, and Hinoul (2017) conducted a systematic analysis of articles on SSIs published between 2005 and 2015. The researchers reviewed studies on SSIs published in English and retrieved from PubMed, CENTRAL, and CDSR. Seventy-six studies qualified for analysis. A similar method was used by Martin, Kaye, Knott, Nguyen, Santarossa, Evans, Elizabeth and Jaber (2015) where 94 studies published between 1985 and 2015 were systematically reviewed. Martin et al. (2015) found diabetes as the risk factor for SSIs.
REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS3 Evidence from the Study Evidence from the studies indicated that prolonged period of surgery contributed to high chances of SSI by 89% of post-surgery complications. The study found a linear relationship between prolonged surgery and development SSIs. Limitations of the Study The study focused on articles that are retrospective in nature. Retrospective studies emphasize accuracy and could have impacted the findings from the study. BothMartin et al. (2015) and Cheng et al. (2017) explain that the reviewed articles combined different types of SSIs in one study, leading to a generalized conclusion. Guidelines Provided BothMartin et al. (2015) andCheng et al. (2017) recommend a look into the period of surgery. Considering the impact of SSIs on the quality of life, there is a need for the healthcare sector to focus on the period spent on patients undergoing surgery in addition to looking at other risk factors. Lessons from the Study Prolonged surgeries increase the risk of SSI complications which translate to prolonged stay in hospitals, increase in costs of medication, and high mortality rates in hospitals. There are also other risk factors like diabetes which contributes to SSIs Physicians should revise the length of time spent on surgeries to minimize prevalence of SSIs. Application to practice The study contributes to existing literature on SSIs. Since it is evident that SSIs are directly linked to time spent on surgeries, physicians should take into consideration the time spent on surgeries.
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REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS4 Research Design deOliveira and Sarmento (2017) conducted an observational study on methods of surgery and how the surgery team dressed and adhered to surgery procedures. A total of 116 observations were made. SSIs were linked to non-compliance with surgery procedures and recommendations Evidence from the Study Non-compliance with surgery procedures contribute to SSIs. Limitations of the Study This was an observational study which could have suffered elements of bias. The observers were undercover researchers who could have been detected, leading to bias in findings. Guidelines Provided De Oliveira and Sarmento (2017) recommend training of surgery teams on compliance with surgery requirements to tackle SSIs. Lessons from the Study Non-compliance with surgery procedures increases prevalence of hospital-acquired SSIs. Application to practice Since it is evident that SSIs are directly linked to non-compliance with surgery procedures, further trainings could reduce the prevalence of SSIs. Research Design In Gillespie, Kang, Roberts, Lin, Morley, Finigan, and Chaboyer (2015), the researchers conducted an integrative review of research literature on methods used by physicians to address SSIs. Thirteen studies published in North America were reviewed. Team-based care reduced the time of surgery processes, hence reducing the risk of SSIs. Evidence from the Study
REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS5 Team-based surgeries reduced the chances of developing SSIs. Limitations of the Study This was on based on secondary review of literature in North America alone. Thirteen articles are not significant enough for making global conclusions. Guidelines Provided The researchers recommend team-based interventions in surgeries to reduce the prevalence of SSIs.. Lessons from the Study SSIs increase with negligence and prolonged surgeries. Application to practice Since it is evident that SSIs are directly linked to hospital environments, there is a need for physicians to collaborate for improved surgery delivery and reduce cases of SSI. Research Design Grundmeier, Xiao, Ross, Ramos, Karavite, Michel, and Coffin (2018) investigated the efficiency of EHR data on surveillance of children that had undergone surgery. 234 surgeries were monitored. Evidence from the Study EHR data helps in surveying groups that have undergone surgery. Limitations of the Study The study focused on EHR data but did not consider the causative agents in SSIs. Additionally, EHR surveillance is not sufficient on its own. There has to a follow-up to monitor the progress. Guidelines Provided
REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS6 The researchers recommend use of EHR interventions in surveillance of patients who have undergone surgeries to reduce the prevalence of SSIs. Lessons from the Study EHR monitoring could improve monitoring of patients that have undergone surgeries with the goal of reducing SSIs. Application to practice Since it is evident that SSIs EHR system improves monitoring of patients that have undergone surgery, hospitals should start using EHR records to monitor patients who have undergone surgeries. Research Design Mueck and Kao (2018) reviewed English literature to determine the causes of SSIs. The literatures reviewed were obtained from online databases. Systematic review of literature sought to establish factors responsible for SSIs. Evidence from the Study Evidence from the studies indicated that SSI was a multifaceted problem. The study found a linear relationship between SSIs and prolonged stay in hospitals. Limitations of the Study This was a generalized study that did not address a specific problem in SSI. The findings could not provide a specific solution due to generalized approach. Guidelines Provided The researchers recommend use of multifaceted interventions in identifying and addressing causes of SSIs. Lessons from the Study
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REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS7 SSI is a multifaceted problem that needs collaborative approach to address it. Application to practice There is no single acceptable method of tackling SSIs. SSIs occur as a result of multifaceted methods that have to be addressed before conducting surgery. Research Design Power, Davies, Hargest, Phillips, Torkington, and Morris (2014) identified patients with wound infections and documented them. 56 patients were identified for observation. The researchers found that chances of developing SSI increased with open surgeries. Evidence from the Study Open wound surgeries increase risk of SSIs Limitations of the Study The study only considered infections documented in hospitals and not those away from facilities. This could have undermined the impact of open surgeries. Guidelines Provided Power et al. (2014) recommend that doctors carrying out open would surgeries take maximum interventions to address SSIs. Lessons from the Study Open wound surgeries increase the risk of SSI complications which translate to prolonged stay in hospitals, increase in costs of medication, and high mortality rates in hospitals. Application to practice The study contributes to existing literature on SSIs. Since it is evident that SSIs increase with open wound surgeries, physicians should take into consideration the safety of the wound when carrying out surgeries.
REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS8 References Badia, J. M., Casey, A. L., Petrosillo, N., Hudson, P. M., Mitchell, S. A., &Crosby, C. (2017). Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries.Journal of Hospital Infection,96(1), 1-15.Retrieved fromhttps://www.ncbi.nlm.nih.gov/pubmed/28410761 Cheng, H., Chen, B. P., Soleas, I. M., Ferko, N. C., Cameron, C. G., & Hinoul, P. (2017). Prolonged operative duration increases risk of surgical site infections: a systematic review.Surgical infections,18(6), 722–735. doi:10.1089/sur.2017.089. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685201/ de Oliveira, A. C., & Sarmento, G., C. (2017). Surgical site infection prevention: An analysis of compliance with good practice in a teaching hospital.Journal of infection prevention, 18(6), 301–306. doi:10.1177/1757177417703190 Gillespie, B. M., Kang, E., Roberts, S., Lin, F., Morley, N., Finigan, T. & Chaboyer, W. (2015). Reducing the risk of surgical site infection using a multidisciplinary approach: an integrative review.Journal of Multidisciplinary Healthcare,8, 473–487. doi:10.2147/JMDH.S73565. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4610798/ Grundmeier, R. W., Xiao, R., Ross, R. K., Ramos, M. J., Karavite, D. J., Michel, J. J., & Coffin, S. E (2018). Identifying surgical site infections in electronic health data using predictive models.Journal of the American Medical Informatics Association,25(9), 1160-1166. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29982511 Martin, T., E, Kaye, K., Knott, C., Nguyen, H., Santarossa, M., Evans, R., Elizabeth B., & Jaber, L. (2015). Diabetes and risk of surgical site infection: A systematic review and
REVIEW OF LITERATURE ON SURGICAL SITE INFECTIONS9 meta-analysis.Infection Control & Hospital Epidemiology,37(1), 88-99. Retrieved from https://www.shea-online.org/index.php/journal-news/press-room/press-release-archives/ 432-diabetes-identified-as-a-risk-factor-for-surgical-site-infections Mueck, K., M., & Kao S. L. (2017). Patients at high-risk for surgical site infection.Surgical Infections,18(4), 440-446. Retrieved from https://www.liebertpub.com/doi/full/10.1089/sur.2017.058