HCA 375 Continuous Quality Monitoring & Accreditation
Instructor: Annajane Schnapp
October 27, 2012
I chose to do my paper on the hospital-acquired condition of surgical site infections. In this paper I will discuss what a surgical site infection is, why it is considered preventable, the legal implications related to the patient, the role disclosure plays, accreditation expectations, and analyze the cost of continuous quality monitoring as it relates to quality. Surgical site infections account for 40 % of all hospital-acquired infections ( HAIs) and are unnecessary and largely preventable. Use of antibiotics is fundamental in preventing surgical site infection and includes three core elements: 1. appropriate selection, 2. timing of the first dose, 3. and discontinuation postoperatively. It used to be the standard practice to “shave and prep” a patient prior to surgery, but a study done in 1992 revealed that surgical site infections were 50% lower in surgery patients whose hair was removed with clippers rather than a razor. One of the most common complaints from surgery patients is being cold in the holding area, operating room, and the post anesthesia care unit ( PACU) . This is uncomfortable and can increase risk of complications; such as surgical site infections. Glucose control is also important as a method for decreasing surgical site infections ( Frances, 2005). Guidelines for preventing surgical site infection are at the preoperative stage, intraoperative stage, and postoperative stage. They are as follows: 1. Preoperative stage:
* Identify and treat all infections before surgery; postpone surgery if possible until infection is resolved. * Do not remove hair by the incision site unless it interferes with the operation; use electric clippers immediately before surgery if hair must be removed. * Have patients bathe or shower with an antiseptic the day of the surgery or the night before. * Thoroughly wash and clean at and around the incision site to remove gross contamination. * Keep hospital stays as short as possible to limit the patient’s exposure to nosocomial infections. Antimicrobial prophylaxis-
* Work with the physician, pharmacist, and administer a prophylactic antibiotic only if it is indicated; antibiotic chosen should be effective against common pathogens that cause surgical site infections. * I.V. administration of the antibiotic should be timed so it is concentrated when the incision is made. * Do not use Vancomycin for antimicrobial prophylaxis routinely.
Surgical team preparation-
* Keep fingernails short, no artificial nails; bacteria and fungi can colonize on your hands if you wear artificial nails. * Surgical team members who have signs or symptoms of an infectious illness need to promptly report this to their manager and occupational health service personnel. * Surgical team members that have draining skin lesions should be relieved from duty until infection has been ruled out, they have had therapy, or the infection is gone. * It is also suggested that no hand or arm jewelry be worn, as well as nail polish. 2. Intraoperative stage:
* Maintain ventilation in the operating room and maintain a minimum of 15 air changes per hour. * Keep the operating door closed as much as possible.
* Limit the number of staff entering the operating room.
Surfaces and equipment-
* Clean surfaces or equipment with hospital disinfectant if they are soiled with blood or body fluids before the next operation.
* Do not perform special cleaning or closing of operating room after contaminated or dirty operations. * Sterilize all surgical equipment according to guidelines. * Assemble sterile equipment and solutions just before using them. Surgical attire-
* Before entering the operating room, a surgical mask and hood that covers the...