The post operative infection rate for patients having surgeries has slowly increased over the last several years and preventing surgical site infections (SSIs) has become a priority with many surgeons. The studies reviewed for this research have stressed the importance of prophylactic antibiotic therapy (Stefansdottir, et al. 2009) and that the timing of this dose being given is becoming the utmost importance; along with the importance of appropriate antibiotic being given. There is not a large study found for the need of post operative antibiotic therapy to be given, the studies found show that there is a question of the effect of the antibiotics after 24-48 hours post procedure. Surgical Practice (2006) reported of a study done in the United Kingdom that showed that the need for preoperative screenings are now being questioned due to the fact that patients are carrying infective microorganisms into the operating room on themselves and the surgical scrub is not enough to alleviate the possibility of an infection.
The purpose of this study is to show the relationship of post operative infections in arthroscopic orthopedic surgical patients who were given antibiotic treatment pre-operatively compared to patients who did not receive any antibiotic therapy. In reviewing literature of previous research studies regarding preoperative antibiotic therapy for surgical procedures, there was a barrier in the knowledge of whether the importance of administering antibiotics was necessary or not. A campaign to prevent one hundred thousand unnecessary deaths was promoted by The Institute for Healthcare Improvement (IHI), this campaign was to help with reducing surgical infections in all areas of surgery. For this study the IHI stated “The goal of prophylactic antibiotic therapy administered before surgery is to protect the patient from infection with as little risk as possible.
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To meet this goal, clinicians must administer antibiotics when they’ll do the most good and select the most effective antibiotics to provide maximum coverage. Improving timing and choice of antibiotic to be administered is a crucial first step toward preventing SSIs.” The overall results showed that the best timing for the antibiotic to be given was just before the incision was to be made, 60 minutes was the time stated due to the need for an exact measurable time that could be recorded, the exception was with antibiotics that require a longer infusion time such as quinolones and vancomycin; they are allowed 2 hours for such antibiotics as these. (Daniels, 2007) A quantitative study was completed using a purposive sample of 302 arthroscopic surgical patients that were chosen based on “age, gender, diagnosis, type and date of the procedure, type of anesthesia, whether prophylactic antibiotics were used or not, tourniquet time, the presence and type of SSI, co-morbid conditions, treatment of the SSI, and follow-up.” (Rose, et al, 2008)
The definitions of SSI were based on the National Nosocomial Infections Surveillance System and any infections recorded were noted to have occurred within the 30 days following the surgery. Of the 302 surgeries performed only 14 patients received prophylactic antibiotics and 288 did not. The 14 patients who received the antibiotic therapy did not develop postoperative infections. From the other group that did not receive the antibiotic therapy; 5 did get postoperative infections, 4 were superficial infections and 1 was a deep infection. From this study it was determined that it may be beneficial to the patient and cost effective to the hospital for prophylactic antibiotics to be given. (Rose, et al, 2008) A second research article from the Canadian Journal of Surgery showed where new findings are happening daily.
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A new research done on patients not only receiving intravenous antibiotics preoperatively but also receiving povidone iodine irrigation during an orthopedic surgery was performed on 414 patients. For this study there were “two single-blind random case trials” (Chundamala, Wright, 2007) with 208 patients (group 1) having the surgical wounds irrigated with the povidone-iodine solution before the operative site was closed and 206 (group 2) were randomized to only have a 2000 mL saline irrigation before surgical site closure. All of the patients received preoperative antibiotic treatment along with postoperative antibiotics to also prevent infection. Of the 2 groups there was no wound infections noted to group 1; group 2 had 7 infections noted with 1 being superficial and 6 were considered deep infections. The study noted the only side effects with this possible solution for SSI’s would be sensitivity to iodine, burns, thyroid or renal disease; these cautions were placed on the study until further investigation could be performed.
Conclusion of the study showed a decrease in the infection rate of patients who not only received preoperative antibiotic but a surgical site washing of povidone-iodine irrigation, thus proving the wash would help in the battle of preventing SSI’s. Betty Neuman’s System Model will be used due to the fact that it focuses on the response of the client system to actual or potential environmental stressors and the use of primary, secondary and tertiary nursing prevention. A patient undergoing surgery should be ordered a prophylactic antibiotic to prevent infection and therefore preventing any stressors on the body. If the problems of infection can be stopped before they are started then the downward spiral will stop before it begins and thus create a better outcome for all parties involved. The methodology of the proposed study is quantitative with the concept of the need to be the decision of whether to used prophylactic antibiotics and will they prove to be beneficial for the patient and will the infections they prevent be cost effective for the hospitals.
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The purposive study will use only orthopedic arthroscopies which are elective surgeries along with patients who have no underlying infections or conditions that would cause interference in the study. The sample size would be for 100 surgeries performed in the same operating room, same equipment and staff, if possible. The sample group will be separated in to 2 groups with group A being the control group and receiving the prophylactic antibiotic therapy, where as group B will not receive the prophylactic antibiotic therapy. All patients would be cleansed with an antibacterial soap prior their arrival to the preoperative area, intravenous antibiotics would be given 60 minutes prior first incision for group A and then sterile prep would be used on all patients to cleanse the surgical area.
Postoperative surgical sites would be monitored for 30 days, watching for redness, swelling, foul smelling drainage, fever or severe pain with all data recorded daily. The results will be used to determine if preoperative antibiotics are efficient or just a waste of the patient and hospitals money. Decreasing this knowledge deficit of the physicians need to give a prophylactic antibiotic or not and giving the correct antibiotic in the appropriate time frame would benefit the patient and the hospital because hopefully it would decrease the return admission rates for postoperative infections.
Increasing the knowledge would be beneficial to all parties involved, with the patient being the most important party involved. Postoperative infections are a costly and time consuming problem for the hospital and the surgeons along with compromising the surgical outcome of a speedy recovery. In all the studies researched for this topic, it has been shown that in addition to sterile procedures, prophylactic antibiotics have assisted in reducing surgical site infections in arthroscopic orthopedic surgeries.
References
Anwar, R., Botchu, R., Viegas, M., Animashawun, Y., Shashidhara, S., & Slater, G. R. (2006).
Preoperative methicillin-resistant Staphylococcus aureus (MRSA) screening: An effective method to control MRSA infections on elective orthopaedics wards. Surgical Practice, 10(4), 135-137. doi:10.1111/j.1744-1633.2006.00314.x Stefansdottir, A., Robertsson, O., W-Dahl, A., Kiernan, S., Gustafson, P., & Lidgren, L. (2009).
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Inadequate timing of prophylactic antibiotics in orthopedic surgery. We can do better. Acta Orthopaedica, 80(6), 633-638. doi:10.3109/17453670903316868 Chundamala, Josie, and James G Wright. 2007. “The efficacy and risks of using povidone-iodine irrigation to prevent surgical site infection: an evidence-based review.” Canadian Journal Of Surgery. Journal Canadien De Chirurgie 50, no. 6: 473-481. MEDLINE with Full Text, EBSCOhost (accessed March 22, 2011).
Rose, R., Ameerally, A., Frankson, M., & Henry, H. (2009, February 13).
Knee arthroscopy: Surgical site infections and the need for prophylactic antibiotics. The Internet Journal of Orthopedic Surgery, 10(2).
Retrieved from http://www.ispub.com/journal/ the_internet_journal_of_orthopedic_surgery/volume_10_number_2_4/article/ knee_arthroscopy_surgical_site_infections_and_the_need_for_prophylactic_antibiotics.html Daniels, RN, MSN, S. M. (2007, August).
Improving hospital care for surgical patients. Nursing 2007, 36-41. Retrieved from http://www.nursing2007.com
