The Incidence Of Aki Between Two Perioperative Antibiotic Prophylaxis Of Elective Hip And Knee Replacements

My practical competencies have been obtained through working with a general and orthopaedic surgeon. Whilst working with my clinical supervisor, (a consultant orthopaedic surgeon) we decided it would be beneficial to review orthopaedic wound infections. I chose to concentrate on wound infections during a Total Hip Replacement (THR). Wound infections is a massive subject so I have selected specific areas to look at, which are:

In recent years, surgical site infections are verified as one of the most errors that are common in the healthcare; however, they are also preventable. These research papers will synthesis information about surgical infections, patient experience, hospital-acquired conditions and achievement of expected treatment for specific clinical diagnoses. A surgical site infection is an infected condition in the body after surgery has occurred. Surgical site infections are caused by germs, called bacteria. Different types of bacteria from the environment may cause a delay in healing. The infection may come from surgical tools or bacteria on the skin if it is not clean correctly. Healthcare professionals use certain guidelines and

1. Write a client outcome to help Mrs. Ross resolve the symptoms (i.e., defining characteristics). Refer to Section III (beginning on p. 119) of the Ackley and Ladwig text.

A total knee replacement (TKA) is the most common joint surgery performed in the United States (Turner, 2011, pp. 27-32). Each year, over 650,000 Americans undergo this surgery (Wittig-Wells, 2015, pp. 45-49). It is an invasive surgery that involves an incision on top of the knee and replacing damaged parts of the knee with artificial parts that are either metal, ceramic or plastic. Someone would get a total knee replacement for damage of the joint, osteoarthritic, posttraumatic, or inflammatory arthritis. The cartilage is damaged, wears away and then you develop bony deformity and contracture of ligaments but it starts out with specific defects or wear of cartilage. The top nursing priorities for a total knee arthroplasty is to “prevent complications, promote optimal mobility, alleviate pain, and provide information about diagnosis, prognosis, and treatment needs” (Doenges, 2014, pg. 627). A possible nursing diagnosis from the patient who is undergoing a TKA might be ‘impaired physical mobility related to pain and discomfort as evidenced by reluctance to attempt movement.’ Another one could be ‘acute pain related to chronic joint disease as evidenced by reports of pain’ (Vera, 2014).

5. Poulin,P., et al.(2014) Preoperative Skin Antiseptics for preventing surgical site infections: What to do?

Catheter-Associated Urinary Tract Infection (UTI) 8.Vascular Catheter-Associated Infection 9. Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures 10. Certain Surgical Site Infections, including Mediastinitis after Coronary Artery Bypass Graft (CABG), following certain orthopedic procedures, and following bariatric surgery for obesity.

Conduct a literature search to locate research articles focused on a practice problem of interest. This literature search should include both quantitative and qualitative peer research articles to support your practice problem or issue of interest in 350-750 words.

The unit utilizes an evidence-based testing and pre-surgical evaluation processes, thereby making it ideal to do the required assessment, testing, and treatment effectively. Although, there continues to be resistance from some surgeons, majority are taking notice of the major impacts of inadequate pre-operative patient preparation. The JC risk assessment recommendations dictate institutions are responsible to reduce infections caused by Multi Drug Resistant Organisms (MDRO) and the initial occurrence of an epidemiologically significant organism (2016).

Pain…fever…oozing pus. Who would want to experience that? The answer is no one. Yet, out of the sixty to seventy of women who undergo a cesarean section, twelve percent will experience these symptoms due to a surgical site infection (SSI) ("Adjunctive Azithromycin Prophylaxis for Cesarean Delivery", 2017). SSI are the primary cause of mortality and morbidity amongst cesarean section women. SSI are linked to increased length of stay, hospitalization rate, and healthcare costs. Many cases of SSIs are preventable with appropriate preoperative preparation and surgical technique (McKibben et. al, 2015). One specific prophylactic method is the use of antibiotics preoperatively. Using an EBP model, PICO,

During this talk, Dr. Shah discussed his experience identifying and diagnosing prosthetic infections. Then he starts pointing out the current challenges he has been able to identify and presented a thoughtful literature review about common practices during the identification of join infections. The overall conclusion was that there is no test that allow to accurate identify join infection and this also affects treating the patient. Patients that undergo join surgery and get back with swelling, change in color in join area, and pain are part of the group easy to diagnose yet with a significant infection difficult to treat. However, when patients get back to the doctor early on during the infection when the signs are not that obvious, all comes down to clinical judgement.

The agents chosen by most hospitals are chlorhexidine gluconate (CHG) 2% and isopropyl alcohol (IPA). “The use of a 2% chlorhexidine-based preparation for cutaneous antisepsis is classified as a Category 1A recommendation—the highest level of recommendation the CDC bestows” (ChloraPrep FAQs, 2015). Alcohol is contraindicated in some instances “…including procedures in which the preparatory agent may pool or not dry, for example, procedures involving hai due to fire risk. Alcohol may also be contraindicated for procedures involving mucosa, cornea, or ear” (Anderson, et. al. 2014) Skin should be allowed to dry after the prepping of the skin. Chlorahexadine washes are encouraged the night before and the day of surgery.

Osteomyelitis is a broad and debilitating disease typically triggered by a variety of conditions. Osteomyelitis starts off as inflammation seen within bone and bone marrow that can quickly progress into a large, subclassified infection. The length of time the infection has been present in the body and whether or not there is a pus formation or increased density among the infected bone is commonly used to classify severity. Pyrogenic bacteria or mycobacteria systematically attack the route and anatomic location of the infection evolving acute conditions into chronic ones. “Staphylococcus Aureus is a gram-positive, round shaped, non-mobile cocci typically found in clusters inside these wounds. Staphylococcus Aureus is one of the most common causes of infections after injury or surgery and affects nearly 500,000 patients in hospitals each year. Staphylococcus Aureus belongs to the family Staphylcoccaceae and survives by affecting all known mammalian species including humans” (www.news-medical.net). Osteomyelitis can start in one area of the body while spreading through the blood stream into other bone regions. Typical treatment options for Osteomyelitis includes antibiotics, removal of

Throughout DN’s hospital stay he was prescribed medicine to alleviate the pain caused from the total knee arthroplasty, help prevent any infection that had potential to be a problem, and prevent any complications. DN’s current medications while in the hospital were as follows:

Ethical challenges are the most profound when dealing with patient safety; compliance with the prophylaxis antibiotic administration guidelines is paramount to a surgical patient in order to decrease the possibility of a post operative surgical site infection. Antibiotic timing requires

Postoperative surgical site infections according to Nichol (2001) remain a major source of illness in surgical patients. Beaver, (2008) point out that surgical infection is one of the side effects that occur after a patient has gone for surgery.