Reducing Risk for Postoperative SSI in the Older Adult Population

Reducing Risk for Postoperative SSI in the Older Adult Population Residing in LTC Settings
Name
Institutional Affiliate
Reducing Risk for Postoperative SSI in the Older Adult Population Residing in LTC Settings
Goal
This project aims to develop an effective interventional measure towards reducing the risk for postoperative surgical site infections (SSI) and even prevention of the same among the older adult population in LTC settings. However, this study will apply the use of patient-centered procedure as an intervention measure that engages the attention and concentration of the older adult patients to reduce the risks associated with SSI.
Overview/Abstract
The increasing number of the aging population in the United States and other developed countries around the world correlates to the equally rising cases of chronic illnesses or conditions among the older adult population. The increasing cases of chronic conditions among the aging population or individuals within the ages of 65 and above further reflect an increasing rate of surgical procedures among the older adult population and increased exposure to SSI (Gillespie et al., 2015).
The increasing rate of the aging population coupled with rising cases of chronic illnesses among the same demography correlates to the high cases of surgical site infections (SSI) among the older adult population, including those residing in long-term care (LTC) settings (İnci et al., 2016). The rising cases of SSI further make one of the healthcare-associated infections (HAI) accounting for mortalities and morbidities among the elderly in the United States. The intrinsic features or characteristics defining a patient’s health and well-being make for one of the categories of risk factors for SSI among the older adult population. The surgical procedures also expose older adult patients to SSI and constitute extrinsic risk factors. Preoperative patient preparation through the administration of antimicrobial prophylaxis (AMP) is an effective interventional measure for reducing both the risk of exposure to SSI and preventing the same during surgeries among the older adult population.
Background/Statement of the Problem
The United States is currently witnessing a surge in the aging population across the country with an almost proportionate increase in the cases of chronic diseases among the older adult population aged 65 years old and above (Gillespie et al., 2015). The said changes in the country’s demographic distribution weigh on the diverse changes witnessed across its healthcare system. The older adult population, for instance, is characteristic of weaker immune systems compared to the young population and thus more susceptible to diseases and infections (Gillespie et al., 2015). The rising cases of chronic diseases such as diabetes, cardiovascular diseases, and hypertension among the elderly or older adult population are characteristic of the weakening immune systems coupled with their less physically inactive lifestyles (Gillespie et al., 2015). Consequently, the older adult population is exposed to more surgical procedures as part of their diagnosis and treatment of chronic health problems. The surgical procedures further expose the aging population to other healthcare-associated infections, including surgical site infections (SSI) (İnci et al., 2016). SSI makes for one of the HAIs, causing morbidities and mortalities among the elderly in long-term care settings. The SSI area is characterized by intrinsic and extrinsic risk factors whose failure to mitigate pre and post surgeries may lead to postoperative SSI in an older adult patient.
According to İnci et al. (2016), surgical site infections account for significant percentage of the healthcare-associated infections (HAIs) occurring in the United States. The author and his colleagues further state that SSIs are a major cause of morbidities and mortalities among the older adult populations. The research study intimates that older adults have a high risk of SSIs due to their equally higher comorbid cases compared to the younger populations. Other factors leading to the higher rate of infections include changes in the immune system, migration of body cells, and reduced production of the antibodies (İnci et al., 2016). The author categorizes the risk factors into intrinsic and extrinsic characteristics. The former refers to the patient’s features, and the latter making for the factors associated with the surgical procedure. The proposed interventional measure from the research is the preoperative administration of antimicrobial prophylaxis, which should be carefully selected for addressing the known pathogens associated with SSI for a given surgical procedure. The study proposes the administration of antibiotic prophylaxis within one hour before making a surgical incision. The antimicrobial prophylaxis functions to increase tissue concentration before at the surgical site and thus reduce the risk of infection (İnci et al., 2016).
There are practical interventions for preventing SSI among the older adult population in acute care settings (Gillespie et al., 2015). The article brings to attention the scope of the problem in an acute care setting with statistics indicating that the rate of occurrence for SSIs is between 2% to 5% of surgical patients (Gillespie et al., 2015). The rate of occurrence translates to approximately 300,000 cases of SSIs, which further reflects negatively on the overall cost of healthcare in the United States due to the high costs of mitigating the same. The authors provide an overview of the problem across the United States’ healthcare system and propose the administration of antimicrobial prophylaxis as one of the recommendations and highly effective interventions for reducing postoperative SSI among patients. The proposed recommendation herein provides an effective platform for developing a reliable interventional measure to reduce and prevent SSI infections among the older adult population in LTC settings.
Literature Review
Title/Author

Description of Intervention

Purpose and Populations

Outcomes Achieved

Ariyo, P., Zayed, B., Riese, V., Anton, B., Latif, A., Kilpatrick, C., & Berenholtz, S. (2019). Implementation strategies to reduce surgical site infections: a systematic review. Infection Control & Hospital Epidemiology, 40(3), 287-300.

Systematic review.
The study used 125 studies searched through PubMed, Embase, CINAHL, the Cochrane Library, the WHO Regional databases, and AFROLIB.
There are multifaceted strategies such as engagement, education, execution, and evaluation strategies of adherence with evidence-based interventions alongside patient outcomes.

The study aims to implement strategies that focus on improving the level of adherence towards evidence-based interventions that reduce SSI.

The application of different implementation strategies provides an appropriate complement to the existing clinical practices that encourage efforts to reduce SSIs.

Boreland, L., Scott-Hudson, M., Hetherington, K., Frussinetty, A., & Slyer, J. T. (2015). The effectiveness of tight glycemic control on decreasing surgical site infections and readmission rates in adult patients with diabetes undergoing cardiac surgery: a systematic review. Heart & Lung, 44(5), 430-440.

A quantitative systematic review of literature.
From the database, a total of 1755 articles were selected. Further, a meta-analysis of approximately ten studies revealed that glycemic control alongside a continuous infusion of insulin helps in reducing the rates of SSI amongst diabetic patients.

The study focuses on reviewing the influence of tight glycemic control with the flow of insulin infusion for the purposes of achieving blood glucose levels lower than 200mg/dl on SSI amongst diabetic patients

The concept of maintaining blood glucose levels lower than 200 mg/dl at all stages helps in reducing SSI incidences at significant levels

Gillespie, B. M., Kang, E., Roberts, S., Lin, F., Morley, N., Finigan, T., & Chaboyer, W. (2015). Reducing the risk of surgical site infection using a multidisciplinary approach: an integrative review. Journal of multidisciplinary healthcare, 8, 473.

An integrative review of the literature.
Summary tables were applicable in extracting data. Total of 13 studies were utilized and analyzed through inductive content analysis.

The study describes the various strategies and processes applicable by healthcare practitioners’ multidisciplinary teams to reduce SSI.

Patient-centered intervention increases the level of their participation in reducing the risks to SSI.

İnci, A., Talmaç, M., Ülker, V., Akbayır, Ö., & Namoğlu, C. (2016). Risk factors in infection development of surgical site infection in patients who were operated due to endometrial cancer. Disease and Molecular Medicine, 4(2), 13-17.

Systematic Study Review.
The process involved a review of patients’ medical records who underwent surgery owing to endometrial cancer.

The article focuses on reviewing the definition as well as the surveillance of SSI, there is a description of various risk factors alongside outcomes for SSI amongst the older adults. Then the recommendation for treatment alongside prevention strategies for SSIs amongst the older adult population.
The study utilized a population of 103 patients.

Prediction of SSI risk factors is necessary, especially when dealing with the elderly patients suffering from chronic illness, and may help reduce the occurrence of SSI after surgery.
The older adult population is more vulnerable to more surgical procedures as part of their diagnosis. This includes the treatment of chronic health problems. In this case, the surgical procedures expose further the aging population to other healthcare-associated infections that including surgical site infections (SSI)

Qasem, M. N., & Hweidi, I. M. (2017). Jordanian nurses’ knowledge of preventing surgical site infections in acute care settings. Open Journal of Nursing, 7(5), 561-582.

Cross-sectional design methodology used.
The study samples 200 participants who are registered nurses by use of convenient sampling across four hospitals.

The study assesses the level of nurses’ knowledge regarding evidence-based approaches for preventing SSIs and how nurses’ knowledge relates to socio-demographics and dichotomized variables.

This provides various anticipated challenges that prevent nurses’ knowledge regarding evidence-based guidelines on the prevention of SSI within the acute care environment. The recommendations as proposed provide an effective ground that helps develop a reliable interventional measure capable of reducing and preventing SSI infections amongst the older adult population within the LTC settings.

Rundgren, J., Enocson, A., Järnbert-Pettersson, H., & Navarro, C. M. (2020). Surgical site infections after distal radius fracture surgery: a nationwide cohort study of 31,807 adult patients. BMC Musculoskeletal Disorders, 21(1), 1-10.

Nationwide observational cohort study.
The study was conducted within a period of 7 years, between 2006 and 2013. There was the inclusion of patients above 18 years of age. All the patients had the registration of a surgically treated DRF within the NPR between 2006 and 2013.

The study focuses on comparing SSI rates between plate fixations, percutaneous pinning as well as external fixation, and also studying various factors that relate to SSI

The various factors that influence SSI include a surgical method, fracture type (closed/open), age as well as sex

Stryja, J., Riha, D., & Szkatula, J. (2020). A silver-based antimicrobial dressing for the prevention of surgical site infection-a pilot study. EWMA Journal, 21(1).

A descriptive clinical study.
The study utilized 22 participants, both male and female above 18 years, and from a groups of patients who underwent planned surgery.
The total number of dressing changes was monitored until the time of stitch removal, the state of the wound was also monitored, including patient and nurse satisfaction.

The study focuses on testing the effectiveness of SSI-related services from a novel silver-based dressing material as applicable for the management of acute wounds.

Such nature of dressing provides good clinical services to patients.

Parameters of Assessment
There is a need to complete a holistic assessment of the patients to identify factors that may influence the surgical wound’s rate of healing in the pre-, intra-, and postoperative stages. The aspect of reassessment is necessary during the whole postoperative period. Notably, the preoperative stage follows a strictly guided timing that basically provides the opportunity capable of creating an environment capable of preventing complications associated with surgical wounds (Gillespie et al., 2015). The attitude is all about how a spe...