Practice Issue
The topic
Would post-op patients benefit more from using chlorhexidine pre-wash for 3 days prior to surgery compared to the standard cleansing technique to prevent surgical site infections?
The nursing practice issue related to the topic
The main nursing practice issue related to the topic is surgical site infections.
The scope of the practice issue
Surgical site infections are a critical problem in nursing, as they influence patient outcomes, increase length of stay, and contribute to medical costs. According to Shepard et al. (2013), healthcare-related infections, including surgical site infections, are the most common complication of hospital care in the United States. Surgical site infections are associated with longer hospital stays, higher readmission rates, and increased health risks (Shepard et al., 2013). Thus, the issue has a profound impact on nursing and the healthcare section in general.
The practice area
The practice area is clinical.
How the practice issue was identified
- Safety/risk management concerns
- Unsatisfactory patient outcomes
- Wide variations in practice
- Clinical practice issue is a concern
The issue was identified based on the incidence of surgical site infections and their impact on patients. The issue constitutes a significant risk for healthcare organizations due to its impact on patient safety. There are also wide variations in surgical site care, which could contribute to the problem. Therefore, the identified clinical practice issue is a significant concern.
Evidence that must be gathered
- Literature search
- Guidelines
First of all, it would be beneficial to assess evidence from literature on the effectiveness of different care strategies in reducing the incidence of surgical site infections. Using systematic reviews, it will be possible to outline scientific evidence in support of particular methods. Secondly, official guidelines can provide valuable information about different prevention strategies, including surgical site care. This would also contribute to the analysis.
Evidence Summary
The practice problem with reference to the identified population, setting and magnitude of the problem in measurable terms
Surgical site infections include infections of tissues that develop on the surgical site in post-op patients. The chosen populations. In the target population, the risk of developing a surgical site population is 2.7% for low-risk patients and 9.1% for high-risk patients (Webster & Osborne, 2015). The research also found that surgical site infections increase medical costs by $3,000 per patient, and thus contribute to healthcare costs in the United States (Webster & Osborne, 2015). The issue is prevalent in all medical facilities where surgeries are performed, which increases the scope of the practice issue.
Identify the objectives of the systematic review article
The objectives of the article was to evaluate the evidence and compare the proven effectiveness of preoperative bathing or showering with antiseptics in reducing the risk of surgical site infections.
The questions being addressed in the work and in relation to the practice issue
There are two separate questions that are being addressed in the systematic review article: “What is the evidence in support of preoperative bathing or showering with antiseptics for reducing the risk of surgical site infections?” and “Is there enough high-quality research evidence to recommend one method over the other?” (Webster & Osborne, 2015). Both questions relate to my practice issue because they consider different prevention methods used in clinical settings to reduce the incidence of surgical site infections. The questions also contribute to evidence-based practice by inquiring about the amount and level of evidence in favor of these methods.
The interventions the authors of the systematic review suggest to improve patient outcomes
Although the authors suggest using interventions with proven effectiveness to improve patient outcomes, they do not offer any specific examples of such interventions.
Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper. (If an optional supplemental source is also used, include a statement of relevance to it as well.)
The authors found that the relative risk of a surgical site infection in the chlorhexidine group compared to the placebo group was 0.95, with strong evidence supporting this finding (Webster & Osborne, 2015). However, the authors found level II evidence in that the relative risk of an SSI after bathing with chlorhexidine compared to no washing was 0.36 (Webster & Osborne, 2015). These outcomes are relevant to the project paper, as they show the potential effectiveness of chlorhexidine compared to no washing, but show that other antiseptics or bar soap can be used to achieve similar outcomes. The article by Shepart et al. (2013) is also relevant to the project, as it considers the medical costs of the problem and would support the discussion of its importance.
Evidence-based solutions for the project
The two evidence-based solutions that will be considered are washing with chlorhexidine and regular cleansing techniques.
Limitations to the studies
In the systematic review researchers only considered the risk of SSI, which is a major limitation. It would be important to consider the influence of chlorhexidine use on other outcomes, such as infection severity and length of stay. In addition, some studies included in the review were poorly designed, which impacts the reliability of findings.
References
Shepard, J., Ward, W., Milstone, A., Carlson, T., Frederick, J., Hadhazy, E., & Perl, T. (2013). Financial impact of surgical site infections on hospitals: The hospital management perspective. JAMA Surgery, 148(10), 907-914.
Webster, J., & Osborne, S. (2015). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systematic Reviews, 2015(2), 1-41.