A surgical site infection (SSI) is one of the most common healthcare-related illnesses that people get while receiving treatment in a hospital. Preoperative antiseptic soap bathing is used in various hospital settings to avoid SSI. Yet, inconsistent study results show that a review is still needed in the United States of America. " "Each year, an estimated 1,700,000 patients in the United States (U.S.) suffer from healthcare-acquired illnesses (HAIs), with 99 thousand of those resulting in mortality." "2011 (Institute for Healthcare Improvement [IHI]) (McNeil, 2017).
The topic is whether preoperative bathing has a negative or favorable effect on SSI prevention. A unit that admits patients awaiting organ transplant has the responsibility to eradicate SSI since a huge number of the patients who visit such Unit have to be put on medication to ensure their body systems do not reject the organ. Patients who develop a surgical site infection will face prolonged hospital stay, increased hospital costs and increased risk of losing the donated organ. Addressing the above practice issue in such a healthcare unit will not only improve patient outcomes but also aid in reducing hospital costs. The infection is an inadvertent but preventable complication that results from surgery through improving the quality of an operating theater in any health care unit.
Change Model Overview
The ACE Star model is utilized in different evidence-based processes as a tool for articulating a potential solution to a practice issue. Dr. Kathleen Steven developed the model in as a tool for evidence-based practice process in nursing. Hence, nurses utilize the model to identify solutions to such nursing issues as managing information, conflict of interest, informed consent and healthcare-acquired infections. The model portrays different stages regarding knowledge acquisition and transformation. Knowledge transformation includes the adaptation of findings from research contained in the primary research outcomes achieved through evidence-based practice process. Different stages of the model illustrate the procedure utilized in knowledge transformation in any evidence-based process.
The first stage of the model represents the knowledge discovery regarding the healthcare-acquired infection. The knowledge concerning a practice issue comes to light through the empirical research. The qualitative and quantitative research can be utilized in discovering the knowledge about a specific practice issue. The second stage of the model represents the evidence summary. The synthesis of the research regarding a particular practice issue emerges at this point in the model. The third stage of the model involves practice recommendation. After synthesis of evidence, the holistic evidence follows at this point for the population which feels the effect of the practice issue. Moreover, the fourth stage of the model involves an integration of the evidence-based into practice and coming up with a change design. The practice will be implemented into the organization. Lastly, the fifth stage includes the evaluation process.
The Scope of the Surgical Site Infection
A surgical site infection (SSI) is among the healthcare-related infections that patients acquire while they are undergoing some treatment service in a healthcare setting. The infection is an inadvertent but preventable complication that results from surgery. According to Webster and Osborne (2015), SSIs are most common among hospitalized patients, and they result in high costs, lengthy stay in hospitals, high readmission rates, and patient mortality. While many stakeholders believe that the process of preoperative bathing prevented SSI, the yearly direct cost linked with HAIs to the United States of America's health care systems are estimated at $45 billion.
The efforts to prevent SSIs are a priority to all the stakeholders in the healthcare systems. Moreover, bacteria have become resistant to antiseptics and antibiotics, resulting in a scenario where prevention of SSI becomes more important in the modern world of the healthcare industry (Sherwood & Jane, 2012). Entire-body showering or bathing with antiseptic soap keep surgical site infection from occurring is a practice that takes place before a patient goes through surgery. The reason for the practice is to clean the skin by eliminating transient flora. Preoperative bathing with antiseptic soap an accepted process for decreasing the skin microflora, yet it is less obvious whether the same process results in a reduced SSI incidence. However, an estimated number of 1,700,000 patients contract healthcare-associated infections, with 99 thousands of those leading to deaths annually (Webster & Osborne, 2015).
Stakeholders
While working to achieve quality care improvement towards containment of surgical site infection, various stakeholders are necessary to achieve the best outcome. These stakeholders fall under the categories of hospital's multidisciplinary and administrative team. Hence, under these categories, the stakeholders involved in improving the nursing issue of surgical site infection include Patients, caregivers, nurses, infection control experts, patient care technicians, lab staff, and surgical site infection Committee members. Furthermore, transporters and physicians are also regarded as the stakeholders in improving the nursing issue of surgical site infection.
The technical or clinical experts are some of the major stakeholders in improving the issue of surgical site infection. They are process experts or the subject matter. Furthermore, they constitute stakeholders who offer direct care in the healthcare process either in health unit or at home. The team members of this kind of stakeholders might include pharmacist, nurse, unit secretary, patient transporter or a physician.
Determine Responsibility of Team Members
Patients
As a stakeholder in improving the nursing issue of surgical site infection, patients should be admitted into healthcare setting that has no device associated infections. Patients admitted into an unsafe environment where there is surgical device associated infections are susceptible to contracting surgical site infection. The primary role as stakeholder includes the fact that patients should agree to receive the appropriate preoperational bath and post-operational care in the event of hospitalization. Furthermore, educating patients on quality of operating theater as well as the importance of preoperational bath and post-operational care improves the nursing issue of surgical site infection by reducing cases of infection. Therefore, patients play a huge role as stakeholders in enhancing the nursing issue of surgical site infection.
Nurses
Bedside nurses also form part of stakeholders of improving the nursing issue of surgical site infection. They have the highest impact on the appropriate preoperational bath, post-operational care and quality of an operating theater. Nurses should offer feedback on contemporary practice for surgical site infection and care to improve quality of the health care services that a patient receives. Furthermore, the nurses should address patients willingly for the appropriate preoperational bath and post-operational care necessities. Therefore, nurses have full accountability for improving the nursing issue of surgical site infection.
Patient Care Technicians
Patient care technicians are vital stakeholders in improving the nursing issue of surgical site infection since they offer services of surgical instrument maintenance. To improve the nursing problem, patient care technicians should adhere to the present surgical instrument and operating theater care policy. Patient care technicians are vital stakeholders in improving the nursing issue of surgical site infection since they offer services of surgical instrument maintenance. To improve the nursing problem, patient care technicians should adhere to the present surgical instrument and operating theater care policy.
Infection control team
Infection control team also forms a vital group of stakeholders in improving the nursing issue of surgical site infection. Infection control team confirms and reports all cases of surgical site infection. Also, these stakeholders offer details and procedures utilized in reporting surgical site infection. Quality reports show the right picture of the situation regarding cases of surgical site infection and directions that should be taken per the data. Infection Control team provides useful information to the public and other consumers regarding surgical site infection. Furthermore, the team also offers recommendations for reporting of surgical site infection. Some of these recommendations include reporting surgical site infections from Pediatric and adult Intensive Care Units to National Healthcare Safety Network (NHSN).
Physicians and Surgeons
As a stakeholder in improving the nursing issue of surgical site infection, a doctor has a multifaceted role in a healthcare team. A medical practitioner focuses on treatment plans as well as management of surgical site infection. Doctors also take patient's medical histories and carry out a physical examination to examine the patient for determination of a possible diagnosis of any surgical site infection (Vijay, 2014). Therefore, physician plays an important role as a stakeholder in improving the nursing issue of Catheter-Associated Urinary Tract Infections. Moreover, a surgeon carries out appropriate surgical procedures that help in reducing surgical site infection among patients.
Evidence
Literature search formed the largest part of this evidence-based practice process. The evidence present in this literature search includes preoperational bathing utilized in preventing surgical site infections. However, direct cost linked with HAIs to the United States of America's health care systems is estimated at $45 billion annually. Moreover, the preoperational bath with antiseptic soap shows minimal positive results among patients preparing for an operation. Therefore some steps must be taken to reduce surgical site infection.
Summary of the Evidence
According to Webster and Osborne (2015), SSIs are most common among hospitalized patients, and they result in high costs, lengthy stay in hospitals, high readmission rates, and patient mortality. While many stakeholders believe that the process of preoperative bathing prevented SSI, the yearly direct cost linked with HAIs to the United States of America's health care systems are estimated $45 billion. Moreover, bacteria have become resistant to antiseptics and antibiotics, resulting in a scenario where prevention of SSI becomes more important in the modern world of the healthcare industry. Entire-body showering or bathing with antiseptic soap keep surgical site infection from occurring is a practice that takes place before a patient goes through surgery.
The reason for the practice is to clean the skin by eliminating transient flora. Preoperative bathing with antiseptic soap an accepted process for decreasing the skin microflora, yet it is less obvious whether the same process results in a reduced SSI incidence. The authors also find no difference between the rate of SSI between patients who used antiseptic soap during their preoperative bashing and those who did not preoperatively wash while waiting for surgery. Hence, preoperative bathing indicated no noticeable benefit. The authors used heterogeneous participants in their study, making their findings reliable (Webster & Osborne, 2015). Recommendations for Change Based on Evidence
Preoperative bathing indicated no noticeable benefit. The authors used heterogeneous participants in their study, making their findings reliable (Webster & Osborne, 2015). Therefore, combining the preoperational bathing with the theater quality enhancement can improve the practice issue. Healthcare units should maintain the quality of their operating theater besides preoperational bathing.
Translation
Action Plan
The project will be implemented through involving all the stakeholders named above. The steps involved in this project include sensitizing all the stakeholders about the practice issue through seminars and workshops that will last for two months. Members of the public and nurses will the guided on the best preoperational bathing practices and the quality of operating theater. Moreover, the nurses will also receive guidance on how to report the cases of surgical site infections with the help of infection control team. Furthermore, the patient care technician will guide on means of managing the quality of an operating theater. Henceforth, the evaluation process will commence with the organization.
Process, Outcomes Evaluation and Reporting
The process of the assessment takes place within the healthcare unit. The records of the cases of surgical site infection must be gathered from the report prepared by various nurses in the unit. The cases of surgical site infection are expected to reduce within the healthcare unit. Therefore, a comparison between the previous data regarding cases of surgical site infection and the ones obtained after the implantation of the project must occur. The results must then be presented in seminars, workshops and some on the notice boards within the healthcare unit stakeholders
Next Steps
Implementing the plan on a large scale will involve partnering with the government agencies in the health care sector as well as private healthcare settings. This will ensure that the plan involves a larger geographical area. Involving the government agencies and asking them to ensure that the plan becomes a policy in the health care sector will ensure that the plan becomes permanent.
Findings
The findings of the project will be communicated with the organization through staff meetings and on the placards placed at strategic positions with the organization. The move will ensure that the information reaches as many staff member as possible.
Conclusion
Surgical site infection is one of the healthcare-acquired infection that is manageable. Currently, surgical site infection is a burden to the entire healthcare systems of the United States of America since it causes, death, morbidity and longer stay in healthcare units during hospitalization. However, applying ACE Star model in the evidence-based practice process will ensure the positive outcome. Therefore, future research should focus on the working with ACE Star model to improve surgical site infection issue. References
McNeill, L. (2017). Back to Basics: How Evidence-Based Nursing Practice Can Prevent Catheter-Associated Urinary Tract Infections. Urologic Nursing, 37(4), 204-206.
Webster, J., & Osborne, S. (2015). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004985.
Sherwood, G., & Jane, B. (2012). Quality and Safety in Nursing: A Competency Approach to Improving Outcomes, 1st Edition; Wiley-Blackwell.
Vijay, S. A. (2014). Reducing and optimizing the cycle time of patients discharge process in a hospital using SIX SIGMA DMAIC approach. International Journal for Quality Research, 8(2).
