Wound Infection

Outline and discuss a clinical audit that you have undertook into one aspect of care delivery and reflect upon the experience using Driscoll’s model of structured reflection. Word Count (2197)

Dale Gordon has been a patient in the ICU for 6 days after developing complications after open heart surgery. He is an 82-year-old African American who is disoriented to place and time. He lives with his daughter Claudia in her home. Claudia and her two brothers visit Mr. Gordon daily since he has been hospitalized. Mr. Gordon has not been eating well since the surgery and has lost 3 pounds. Mr. Gordon has type 2 diabetes and is on oral antihyperglycemic medication. Before he came to the hospital, Mr. Gordon was able to only ambulate for short distances. He has orders to get up in a chair twice a day. Joan, a student nurse, is caring for Mr. Gordon this morning. She has reviewed his medical record and is now ready to start caring for him.

Preventable infections regardless of the causative agent, have become major triggers of unintended patient outcome, increased morbidity, and mortality (Arias, 2010). Methicillin Sensitive Staphylococcus Aureus (MSSA) and Methicillin Resistant Staphylococcus Aureus (MRSA) are the most common causes of healthcare associated infections (HAI) and outbreaks in acute care hospitals and community settings (CADTH, 2010). The widespread infection with the MRSA pathogen is believed to have increased from 2.4 percent in 1975 to 29 percent in 1991 and 2003 in hospitals across the United States (U S) (CADTH, 2010). The prevalence is even greater among Intensive Care Unit (ICU) patients at 53 percent (CADTH, 2010) and continues to rise due to the widespread

Researchers will decide to select wound infections that occur after open heart surgery as a topic for their study, because it is significant for staff nurses to know the effect of wound infections that occurs with the adult patients. Researchers will obtain permission from the cardiac surgery center so that they could collect information from adult patients. They will also contact and meet with staff nurses in cardiac surgery center. Nurse educators will provide the form to all staff nurses working in the operating room. The form includes the title of the study, the purpose of the study, place of the work, duration of the study, potential benefits, potential risks, participant signature, and date. The reader can follow that consent

Staphylococcus aureus, or golden staph, “is a common bacterium that lives on the skin or

Necrotizing fasciitis Staphylococcus auerus can occur in many forms, one being methicillin-resistant Staphylococcus auerus (MRSA). This specific strand of bacterium that has evolved to become antibiotic resistant. This makes MRSA necrotizing fasciitis almost impossible to treat with antibiotics alone, and often requires extensive surgical procedures. In The New England Journal of Medicine, researchers highlighted MRSA as a root cause of numerous cases of monomicrobial necrotizing fasciitis reported in Los Angeles in 2003 (7).

The International Wound Infection Institute declares that because of increasing mortality rates due to SSI, it is imperative to identify patients at risk, as well as follow preventive measures to try and contain these infections. Further, groups like the National Institute for Health and Care Excellence in the U.K. and the Surgical Care Improvement Program in the U.S. along with the National Health and Medical Council of Australia, agree that health care workers should be educated and have the information to prevent the spread of SSI 's. (Clinical Practice). In order to reduce the number of surgical site infections (SSIs) a number of procedures and practices can be bundled for the optimal prevention of the spread of these infections. There are procedures that can be done pre-op, during the surgical procedure, as well as post-op to ensure that a patient does not contract an infection at the surgical site. These procedures include patient safety practices, patient assessment, healthcare worker safety practices, operating room safety procedures, along with basic education of the health care workers, patient and caregivers once the patient is discharged.

Methicillin Resistant Staphylococcus Aureus (MRSA) is a strain of staph bacteria which has developed resistance to the antibiotics designed to treat common staph infections (Winterstein, 2009, p.189). Originally viewed as a hospital pathogen, MRSA has now begun to appear in the community. Hence, the infection is now distinguished by its origin, defined as hospital-associated MRSA (HA-MRSA), or community-associated MRSA (CA-MRSA). The close proximity of athletes, who often share soap, towels, and other items commonly used in the dressing room, as well as the vigorous physical contact involved in sporting activity (both practice and competition), have led to MRSA becoming a concern in athletics. MRSA is a concern because it can lead to severe infection and even morbidity (Indeed, athletes have become a target population for MRSA. A recent study of 377 varsity college athletes at Vanderbilt University confirms that those involved in contact sports were more than twice as likely to carry MRSA (Jiminez-Truque, 2014). It is believed that the higher prevalence of MRSA in contact sports is a result of the increased skin-to-skin contact which can lead to abrasions and cuts, which permit the superbug to enter the body and colonize it (Jiminez-Truque, 2014). Treatment of MRSA involves draining of abscesses, combined with administration of powerful antibiotics, usually intravenously (Winterstein, 2009, p.187). Since MRSA is resistant to the antibiotics developed to treat it

As outlined in Crow et al (8) following the standard precautions in wound management is essential to protecting the patient and health care provider from contamination of microbes. Microbes are essentially everywhere, on the body and in the environment (8). They are often found on equipment in the hospitals, long term care facilities, clinical care settings and are easily carried on the hands of health care providers (8). Health care providers are known to be great reservoirs for resistant microbes such as methicillin-resistance S.aureus (MRSA) (8). Lack of understanding and adherence of the standard precautions, i.e. proper hand washing, pose risk for microbes to be transferred from patient to patient and to be introduced into a patient`s wound (11). The susceptibility to infection is also much higher in certain patient populations (immunosuppressed, elderly, nutritional impaired) despite the strength or pathogenicity of the microbes

The first civilization dealt with disorders and provided detailed information about wound management were ancient Egyptians. Wound infections evidently appeared in times of World War I that accounted a significant mortality and morbidity rate among injured soldiers. Currently, around 11 million people worldwide require medical treatment for wound infections, 300,000 die every year. Scientists highlighted the concept of introduction micro-organisms into wounds resulting in an infection. The infected wound was successfully treated with a wide-spectrum antibiotics that can eradicate the pathogenic micro-organisms. Due to extensive use of antimicrobial drugs such as β-lactam, methicillin, vancomycin, etc, new strains with high resistance have

Post-surgical infections and complications are a major problem for patients and hospitals. Post-surgical complications can reach as high as 66% for high risk patients. Surgical site infections and other complications delay recovery of the patient resulting in longer hospital stays and increased healthcare costs. Does the use of closed-incision negative-pressure therapy dressings on post-surgical patients reduce wound infections and other complications verses traditional dressings?

The article by Fernandez and Griffiths (2013), compares the use of tap water to other cleaning solutions when cleaning wounds. The current practice found in the article was using normal saline because of its isotonic properties and its ability to not affect the healing process of the wounds. Current literature states that clinicians should caution when using on wounds that have exposed tendons or bone and that normal saline should be used in this case. So with that in mind, the authors conducted a study based on tap water effects in wound care.

This study will include several quasi- randomized and randomized studies. The studies that consists random participants, large sample size and test measures that assesses the infection rates will be shortlisted for this study to make it reliable. Trevillion (2008) in his study claimed that the varying degrees of wound cases that came in the emergency department were cleaned better using tap water than normal saline or other cleaning solutions. He concluded that tap water effectively reduces the infection rates, is cheaper, and can be easily used by the patients to clean their wounds at home. Moscati et al. (2007), in their study chose random population with wound in the emergency rooms and divided the population in two groups of which few were subjected to cleansing by sterile saline (200ml) with splash shield and the others by irrigating their wounds under normal tap water for 2 min. After 5- 14 days, they found a difference of 0.7% of infection rates in both groups, which was not significant concluding that tap water and sterile saline were both safe for treating wound. Bee et al. (2009) evaluated the effectiveness of the cleansing solutions by reviewing 7 out of 9 selected articles including both randomized and quasi-randomized experimental studies based on their reliability. They found no significant difference in the infection rates when used either of the solutions (tap water vs. sterile saline) for treating wounds. However, after assessing 4 randomized study, they concluded that saline enables effective wound healing while the tap water was effective for irrigation and debridement if used appropriately. Salami et al (2006) conducted wound healing experiments on rats with 2x2 cm full thickness wound on their dorso-ventral flanks, which were treated with chlorhexidine, tap water or saline. They

Infections are a significant problem in many medical and environmental situations. These infections are caused by an array of different microorganisms including bacteria, protozoa, fungi, yeasts, and viruses. The prevention of infections, and reduction or elimination of an infection once it is established is of importance,6 particularly in the area of skin and wound care. Environments that increase a patient's risk to infection include the surfaces of objects (internally and externally), fluids and fluid conduits. In healthcare, infections lead to longer hospital stays for patients and increased hospital costs. Even worse, a large number of patient deaths are attributed to infections.

According to Walker and Avant (1995), concept analysis allows nursing to examine the attributes or