Prevention of Post-operative Infections
Post-operation surgical site infections cause a significant economic burden on the patient and health system and are associated with poor patient outcomes (Bathish, McLaughlin & Talsma, 2015). Therefore, there is a need to institute measures to reduce incidences of post-operation adverse events, improve patient outcomes and reduce the financial burden among orthopedic surgical patients.
Operating Room Nursing Staff Expertise and Patient Outcome
Bathish et al. (2015) conducted a cross-sectional cohort study to evaluate the association between the level of nurses’ expertise and patient outcomes in operation rooms (Bathish, McLaughlin & Talsma, 2015). For that purpose, data were collected from the general surgical procedure at a university-based medical center and included random samples of preoperative comorbidity and preoperative outcome (Bathish, McLaughlin & Talsma, 2015). The study found that surgical case complexity increased the odds of developing Surgical Site Infection (SSI) by 3.4 %( Bathish, McLaughlin & Talsma, 2015). Furthermore, the increase in the level of scrub nurse expertise decreased the odds of the patient developing SSI during postoperative care (Bathish, McLaughlin & Talsma, 2015). Therefore, employing expert scrub nurses reduces incidences of surgical site infections in operation rooms.
Orthopedic Snafus: When Adverse Events Happen In Orthopedics
Smith et al. (2017) conducted a systemic review of the literature to evaluate the effectiveness of topical chlorhexidine and intranasal mupirocin as a strategy for reducing surgical site infections. The primary sub-objectives of the study included assessing the efficacy of the preoperative nasal and skin decolonization on SSI and Staphylococcus aureus infection rates and comparison between universal and targeted decolonization protocols (Smith, Walsh, Levin, Eten & Yager, 2017). Most of the studies analyzed were in the United States, and patients were between 16years and 65 years. One observation study found a high level of nasal Staphylococcus aureus colonization among orthopedic patients (Smith, Walsh, Levin, Eten & Yager, 2017). Therefore, the use of intranasal mupirocin was found to be an effective preoperative strategy for reducing staphylococcus-related surgical site infections (Smith, Walsh, Levin, Eten & Yager, 2017). Due to its effectiveness, the Center for Disease Control (CDC) has recommended its use in nasal decolonization before orthopedic, cardiac, and neurosurgical procedures. Moreover, the CDC recommends the use of chlorhexidine as an appropriate antiseptic as pre-operative prophylaxis in the prevention of S aureus-related SSIs(Smith, Walsh, Levin, Eten & Yager, 2017).
Decolonization with Chlorhexidine and Mupricin in Reducing Surgical Sites Infections
George et al. (2016) described some of the frequent orthopedic surgery-related adverse events, risk factors, and evidence-based intervention strategies to reduce their occurrence. The authors identified SSI as one of the risk factors that potentially reduce patient quality of life and are detrimental to the patient outcome (George, Leasure & Horstmanshof, 2016). The study noted that the presence of SSI results in prolonged hospital stay, and costs the United States more than 5 billion dollars annually (George, Leasure & Horstmanshof, 2016). Furthermore, the article notes that SSIs are either related to emergency surgeries or contaminations during surgical procedures (George, Leasure & Horstmanshof, 2016). Some of the risk factors that lead to SSI include poor postoperative wound care, septic surgical systems, and patient-specific factors for example advanced age and poor nutrition (George, Leasure & Horstmanshof, 2016). Last, prevention strategies include active surveillance, adherence to surgical infection prevention protocols and guidelines, and continuous monitoring of patients (George, Leasure & Horstmanshof, 2016).
The Economics of Prevention of Orthopedic Surgical Site Infections
Many studies have focused on the risk factors associated with the occurrence of Surgical Site infections and possible prevention strategies (Smith, Walsh, Levin, Eten & Yager, 2017). Some of the risk factors are modifiable for instance institutional and procedural specific factors for instance employment of surgical expert scrub nurses, adherence to infection prevention protocols, and use of preoperative prophylactic antiseptics (Smith, Walsh, Levin, Eten & Yager, 2017). Due to its enormous economic impact, there is a need to assess direct costs associated with surgical infections, including indirect costs such as infection prevention programs. Therefore, the study estimates the total cost of treatment of post-operative orthopedic surgical Site infections and the cost of prevention strategies at a public orthopedic hospital.
The traditional cost-analysis of surgical site infections has underestimated the economic burden to the family, patient, and healthcare systems. Several researchers have used direct-cost analysis in calculating the cost associated with prolonged hospitalization. However, they ignore other additional expenditures associated with SSI in the surgical unit and is more than $ 3,000 per patient. Therefore, health providers should strictly adhere to prevention strategies to reduce the financial implications associated with SSI. Furthermore, hospitals should come up with a comprehensive cost-analysis method that includes indirect costs and expenditures related to post-operation infections.
Bathish, M., McLaughlin, M., & Talsma, A. (2015). Relationship Between Operating Room Nursing Staff Expertise and Patient Outcomes. Journal Of Nursing Care Quality, 30(2), 167-174. doi: 10.1097/ncq.0000000000000092
George, S., Leasure, A., & Horstmanshof, D. (2016). Effectiveness of Decolonization with Chlorhexidine and Mupirocin in Reducing Surgical Site Infections. Dimensions Of Critical Care Nursing, 35(4), 204-222. doi: 10.1097/dcc.0000000000000192
Smith, M., Walsh, C., Levin, B., Eten, K., & Yager, M. (2017). Orthopaedic Snafus—When Adverse Events Happen in Orthopaedics. Orthopaedic Nursing, 36(3), 236. doi: 10.1097/nor.0000000000000361