The Peri and Post-Operative Nursing Intervention - Term Paper Example

Table of Contents I. Introduction ………………………………………………………… 3 II. Rationale and Peri- and Post-operative Nursing Intervention in Minimizing the Risk of Nosocomial Infection ……. 3 a. Hair Removal vs. No Hair Removal ……………………… 3 b. Proper Management of Intravascular Devices …………... 4 c. Proper Management of Antibiotic-Resistant Bacteria …... 8 III. Conclusion …………………………………………………………. 9 References ………………………………………………………………… 10 - 12 Introduction Nurses are the front liners in every medical team in terms of providing a direct care for the patients. For the purpose of developing the skills and performance of each nursing student, clinical problems are usually provided by the nursing school(s) in order to train the students in the proper caring for hospitalized patients. The most frequent causes of nosocomial infection among the hospitalized patients are the surgical site infection. In line with minimizing the risk of nosocomial infections among the hospitalized patients, this study will discuss the rationale behind some of the peri- and post-operative nursing intervention particularly hair removal vs. no hair removal prior to a surgical operation, the proper management of intravascular devices and the spread of antibiotic-resistant bacteria. Rationale and Peri- and Post-operative Nursing Intervention in Minimizing the Risk of Nosocomial Infection Nursing intervention done to reduce the risk of nosocomial infection is necessary in decreasing the patients’ long staying at the hospital by up to 7.3 days as well as minimizing the rate of morbidity and mortality. (JBI, 2003a) The common causes of nosocomial infections are associated with traumatized or irritated skin caused by razor blades or depilatory agents including the improper management of intravascular devices and hospital environment. Hair Removal vs. No Hair Removal Based on an evidenced-based practice by Joanna Briggs Institute (2003), hair removal should be avoided when performing a surgical operation in order to minimize the risk of infection. It is best to avoid hair removal prior to performing a surgical operation since an evidence-based test result shows that there is a relationship between shaving and surgical site infection. (JBI, 2003a) In case hair removal is necessary prior to a surgical operation, hair removal using electric clippers is preferred than the use of depilatory creams or razor blades; while using depilatory agents is preferred more than razor blades. Studies show that the use of electric clippers is better than depilatory agents or razor blades since depilatory agents could result to adverse effects such as skin irritation and allergies (JBI, 2003a) while razor blades could cause small nicks in the skin that enables the microorganisms to colonize the wound. Thus, increasing the rate of postoperative surgical site infections. There is no significant difference between conducting the preoperational hair removal the night before the surgery or on the day of the surgery. (JBI, 2003a) Therefore, health practitioners could perform the preoperational hair removal 2 hours before the surgical incision. Proper Management of Intravascular Devices Particularly the use of prosthetic and indwelling catheter devices could lead to bloodstream infections commonly caused by coagulase negative Staphylococci (CNS), Staphylococcus aureus, Entercocci and Candida albicans. (JBI, 1998) To avoid contaminating the catheter devices, it is necessary for the healthcare practitioners to adopt personal hygiene such as handwashing before and aseptic techniques such as wearing of sterile latex or non-latex gloves, sterile gown, a mask, a cap, and a large sterile drape during the period of preparation for the insertion of the catheter devices. (McGee and Gould, 2003; Dunn et al., 2000; JBI, 1998) Handwashing is proven to be effective in removing and preventing the spread of microorganisms from one individual to another while the application of aseptic techniques are best in keeping sterile objects free from contamination. (CDC, 2002) It is important to clean the injection ports with a 70% alcohol, 10% povidone-iodine, or 2% tincture of iodine which should be removed with alcohol afterwards, before inserting the catheter devices to the preferred body parts. (JBI, 1998) Cleaning the injection ports with a 70% alcohol or 10% povidone-iodine for 3 – 5 minutes before inserting the catheter devices to the preferred body parts prevents the contaminating the catheter devices that come from the pathogens present at the injection ports. (JBI, 2003b) Healthcare professionals should be know that administering some prophylactic antimicrobials could only increase the rate of either catheter colonization or bloodstream infections. (JBI, 1998) Therefore, administering some anitmicrobials before and during the use of intravascular catheter devices should be totally avoided. The rationale behind avoiding the use of antimicrobials or antibiotics is that it could encourage the emergence of antibiotic-resistant organisms. (HICPAC, 1995) According to Dunn et al. (2000), there is no clear evidence to prove that catheters that have been impregnated with silver could reduce the incidence of catheter-related bacteriuria. On the contrary, McGee and Gould (2003) reported that specifically catheters impregnated with either chlorhexidine and silver sulfadiazine or minocycline and rifampin could lower the rate of catheter-related bloodstream infections by 2%. Particularly the application of an antibiotic ointment like bacitracin, mupirocin, neomycin, and polymyxin on the catheter-insertion site should also be avoided since a study shows that it could only increase the fungi colonization (Flowers et al., 1989) as well as it promotes the existence of antibiotic-resistant bacteria (Zakrzew ska-Bode et al., 1995). No study has been conduction to prove that the use of antibiotic ointment or anitmicrobial solution could decrease the chances of catheter-related bloodstream infections. (Dunn et al., 2000; Maki and Band, 1981) As soon as the healthcare professionals have successfully inserted the catheter devices, it is critical to cover and sealed the catheter site with sterile gauze or a transparent dressing in order to prevent bacterial colonization. (Dunn et al., 2000; JBI, 1998) In case the dressing becomes damp, loosened, or soiled, the gauze should be replaced with a sterile one. When replacing the dressing, the healthcare professional should avoid touching the catheter insertion site. A study was also conducted proving that patients with catheter in insitu between 72 – 144 hours are at higher risks of bacterial colonization than those patients that use the catheter devices for a shorter period of time (between 48 – 72 hours). (Collin, 1999; JBI, 1998; Raad et al., 1997, Maki et al., 1997) In order to prevent the growth and development of phlebitis, it is necessary for the healthcare professionals to schedule the replacement of the intravascular catheters and remove the catheter immediately from the patients as soon as it is no longer clinically recommended. (Dunn et al., 2000) As soon as the first sign of phlebitis becomes visible, catheters should be removed as soon as possible to prevent causing nosocomial infection to the patients. For patients with a prolonged catheterization, specifically the catheter hubs are the most common source of contamination. (Salzman et al., 1993) Therefore, it is necessary to disinfect the catheter hubs or frequently change the hub in order to prevent increasing the rate of catheter-related bloodstream infections. Blood products and lipid solutions are more susceptible in supporting the growth of microbacteria. (JBI, 1998) For this reason, a more frequent changing of the administration set and a closed needle sampling systems is highly recommended during blood transfusion or when injecting some medications for IV infusion. To prevent and minimize urinary tract infection (UTI) caused by urinary catheters, healthcare practitioners should encourage the use of bedpan or urinal instead. (Dunn et al., 2000) Prior to the insertion of the catheter devices, healthcare professionals should be aware of the importance of choosing the best catheter insertion site as well as the limitation of using a steel needle. A study shows that inserting the catheters at the lower limbs could result to a higher risk of phlebitis rather than inserting the devices on the upper limbs. Inserting the catheter devices in the hand shows a lesser risk of phlebitis than inserting the tube in the upper arm or wrist. (JBI, 1998) The use of steel needle should be avoided when administering some fluids or medication to the patients because it could only lead to tissue necrosis in case an extravasation occurs. (JBI, 1998) When it comes to the type of catheter materials, catheter made of Teflon or polyurethane is highly preferred more than catheter made of polyvinyl chloride or polyethylene. (JBI, 1998) On the other hand, the use of longer midline catheters shows a lower rate of phlebitis than using shorter midline catheters when providing the patients with IV therapy for more than 6 days. Proper Management of Antibiotic-Resistant Bacteria The Department of Health highly recommends isolation of patients infected with antibiotic-resistant bacteria such as Methicillin Resistant Staphylococcus aureus (MRSA). (Ayliffe et al., 1998) On the contrary, Joanna Briggs Institute stated that there is not much evidence that isolating infected patients could prevent nosocomial transmission of the MRSA. (JBIEBNM, 2002) Pittet et al. (2000) reported that the best control in the spread of MRSA is proper handwashing instead of isolation. Dancer (1999) suggests that healthcare professionals should give importance in controlling the spread of MRSA within the hospital environment by keeping the hospital clean and following the standard of infection control precaution measure (Rampling et al., 2001). When the hospital environment is free from infectious pathogens and other disease causing bacteria, the chances of patients being infected will be lesser. Conclusion Health professionals should always practice infection control and protect the patients from disease causing microorganisms. Avoiding hair removal prior to a surgical operation could lessen the chances of nosocomial infection. When necessary, using electric clippers should be used instead of depilatory agents and razor blades. Nurses should be extra careful when dealing with intravenous catheter devices. Proper guidelines such as proper handwashing and aseptic techniques should be strictly followed to lessen the risks of nosocomial infection. *** End *** References: Ayliffe GAJ et al. (1998) ‘Revised Guidelines for the Control of Methicillin-Resistant Staphylococcus aureus Infection in Hospitals’ Journal of Hospital Infection. 1998;39:253 – 290. CDC (2002) ‘Guidelines for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force’ MMWR – Morbidity and Mortality Weekly Report. 2002;15(RR-16):1 – 56. Collin, GR (1999) ‘Decreasing Catheter Colonization Through the Use of an Antiseptic-Impregnated Catheter: A Continuous Quality Improvement Project’ Chest. 1999;115:1632 – 1640. Dancer, SJ (1999) ‘Mopping Up Hospital Infection’ Journal of Hospital Infection. 1999;43:85 – 100. Dunn S, Pretty L, Reid H and Evans D. (2000) ‘Management of Short Term Indwelling Urethral Catheters to Prevent Urinary Tract Infections’ JBI for Evidence Based Nursing and Midwifery. A Systematic Review No. 6. pp. 1 – 3. Flowers RH III, Schwenzer KJ, Kopel RF, Fisch MJ, Tucker SI, Farr BM (1989) ‘Efficacy of an Attachable Subcutaneous Cuff for the Prevention of Intravascular Catheter-Related Infection: A Randomized Controlled Trial’ JAMA. 1989;261:878 – 883. HICPAC (1995) ‘Recommendations for Preventing the Spread of Vancomycin Resistance: Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC)’ MMWR Morbidity Mortality Weekly Report. 1995;44 (RR-12):1 – 13. JBI (2003a) ‘The Impact of Preoperative Hair Removal on Surgical Site Infection’ Blackwell Publishing Asia, Australia. Best Practice. 2003. 7;(2):1 – 6. JBI (2003b) ‘Solutions, Techniques and Pressure for Wound Cleansing’ Blackwell Publishing Asia, Australia. Best Practice. 2003; 7 (1). Last Revised: April 26, 2007. JBI (1998) ‘Management of Peripheral Intravascular Devices’ Blackwell Publishing Asia, Australia. Best Practice. 1998. 2(1):1 – 6. JBIEBNM (2002) Maki DG, Stolz SM, Wheeler S, Mermel LA (1997) ‘Prevention of Central Venous Catheter-Related Bloodstream Infection by Use of an Antiseptic-Impregnated Catheter: A Randomized, Controlled Trial’ Ann Intern Medicine. 1997;127:257 – 266. Maki DG and Band JD (1981) ‘A Comparative Study of Polyantibiotic and Iodophor Ointments in Prevention of Vascular Catheter-Related Infection’ in McGee, D.C. and Gould, M.K. (Eds) ‘Preventing Complications of Central Venous Catheterization’ The New England Journal of Medicine. 2003;348:1123 – 1133. McGee, D.C. and Gould, M.K. (2003) ‘Preventing Complications of Central Venous Catheterization’ The New England Journal of Medicine. 2003;348:1123 – 1133. Pittet D, Hugonnet S, Harbarth S, Hourouga P, Sauvan V, Touveneau S, Pernerger TV (2000) ‘Effectiveness of a Hospital Wide Programme to Improve Compliance with Hand Hygiene Infection Control Programme’ Lancet. 2000;356(9238):130712. Raad I, Darouiche R, Dupuis J, et al. (1997) ‘Central Venous Catheters Coated with Minocycline and Rifampin for the Prevention of Catheter-Related Colonization and Bloodstream Infections: A Randomized, Double-Blind Trial. Ann Intern Medicine. 1997;127:267 – 274. Rampling A, Wiseman S, Davis L, Heyatt AP, Walbridge AN, Payne GC, Cornaby AJ (2001) ‘Evidence That Hospital Hygiene is Important in the Control of Methicillin Resistant Staphylococcus aureus’ Journal of Hospital Infection. 2001;49:109 – 116. Salzman MB, Isenberg HD, Shapiro JF, Lipsitz PJ, Rubin LG (1993) ‘A Prospective Study of the Catheter Hub as the Portal Entry for Micro organisms Causing Catheter-Related Sepsis in Neonates’ Journal of Infectious Diseases. 1993;167:487 – 490. Zakrzew ska-Bode A, Muytjens HL, Liem KD, Hoogkamp-Korstanje JA (1995) ‘Mupirocin Resistance in Coagulase-Negative Staphylococci, After Topical Prophylaxis for the Reduction of Colonization of Central Venous Catheters’ Journal of Hosp Infection. 1995;31:189 – 193. Read More