Challenges in Perioperative Nursing Care

Perioperative nursing can be defined as a nursing practice that involves catering to patients who have undergone a surgery or some other kind of minimal invasive procedure. Nursing professionals who are involved in perioperative nursing techniques work in close association with anaesthesiologist, surgeons, nurse practitioners and surgical technologists (Blomberg, Bisholt, Nilsson, & Lindwall, 2015,p. 365). Perioperative nursing professionals deal with a wide range of functions that concern preoperative, intraoperative and post-operative care within the operation theatre (Blomberg, Bisholt, Nilsson, & Lindwall, 2015,p. 367,368). There are many vital components of pre-operative nursing which are stringently managed by the nursing professionals. This essay would focus on strategies undertaken by perioperative nursing professionals to control infections that might result due to mismanagement of operative strategies. This essay would delve deeper into exploring relevant scientific literatures and evaluate effective control strategies that can be undertaken. Further the essay would formulate an effective summary from the literatures reviewed and develop improvised interventions to monitor stringent infective control policies.

Peri-operative nursing care has been categorised as an important aspect in rendering safe healthcare services to individuals. It should be noted that patients who visit the hospital, do so with a certain level of expectations. The expectation level is to receive the best healthcare facilities without any possibility of developing an infection and also attain complete cure. Research studies have revealed that on an average there are 2 billion people who do not have access to proper health care facilities (Barnes, Spencer, Graham & Johnson, 2014,p. 525). Studies have further stated that on an average, a million deaths occur every year due to the observance inadequate and insufficient infection control strategies in the hospital settings. Studies have also stated that the time period for the possible development of infection due to casualty or negligence observed in the procedure of surgery can last from a period of 2 weeks to almost a month (Barnes, Spencer, Graham & Johnson, 2014,p. 528) . 

Major incidences of infection have been categorised as formation of blood clots in different organs of the body, development of infection in the lungs, kidney and liver. Probable incidences of developing post operative fever and ‘strokes’ have also been reported in research studies (Berend et al., 2013, p. 515). It has been found that most of the infection cases have resulted on account of critical complications arising after a difficult operation. Mortality rates have been reported to be roughly three times higher in developing countries than in developed countries primarily because of a major lacuna in managing risk factors and infection control strategies in a proper manner (Berrios-Torres et al., 2017,p.790).

Prevalence of Infections in the Perioperative Setting

Mortality rates have been reported to be higher in procedures involving surgical intervention. Moreover it has been found that mortality rate is lower in terms of developing infections due to improper anaesthetic management (Berrios-Torres et al., 2017,p.790). However, there have been several reports that have predicted the prevalence of mortality rates arising due to improper administration of anaesthesia, causing an overdose. The overdose of anaesthesia has led to the development of several complications such as pulmonary infection and development of infection in the respiratory tract (Kwon et al., 2013, p. 8). Deaths have been reported on account of blockage in the respiratory pathway. It has been reported that catheter associated infection is the most common form of infection that affects patients undergoing surgery in an ICU setting (Kwon et al.,2013, p.8,9) . Typically, it has been found that catheter related infection development around the urinary tract develops on account of manhandling or problems associated with the correct placement of the catheter in patients. Research studies have also suggested that catheter infections can also arise on account of infections caused by hospital pathogens (Poultsides et al., 2013,p. 387).

As stated by Carol and Sanjay (2013), hospitals must effectively imply stringent rules that would help in monitoring the infection standards at a typical hospital setting. In this regard, it has further been said that, effective hospital leadership, development of collaborative and dispensing effective interventions can help in minimising the development rate of infections. Evidences provided by statistical data reveals that approximately every year, 40% of peri-operative infections are primarily linked to the urinary tract infections across hospitals globally. Approximately, 23% infection cases reported at the Intensive Care Unit have also been reported in context of infection in the urinary tract (Lowbury et al., 2013, p. 111). Risk factors associated with development of infection on account of improper hygiene has also been reported in hospitals of developing countries. There have also been numerous instances when rapid infections have spread and caused major illness in infants due to improper sanitisation and maintenance of hand hygiene. Infection related to the development of sepsis-shock has also been reported in patients worldwide. In addition it should further be stated that there have been instances where drug over dose and improper handling of surgical instruments has led to fatal consequences in patients. 

Fatal consequences such as deaths have also been recorded in scientific literatures. Therefore, it is important to note here that, a number of death cases have taken place across the world primarily due to negligence in observing proper risk management procedures to control infection at a peri-operative setting (Rosenthal et al., 2014, p. 945). It is important to evaluate that patients dealing with major health complications visit the health care organizations and expect to be treated in a safe manner. It is primarily the duty of nursing professionals involved in peri-operative care to make sure that patients are being subjected to a medically safe treatment procedure that is free from the presence of any infection. Inability to dispense safe medical treatment can give rise to fatal consequences that might even take away the life of a patient. Numerous health care strategies that involve cheap and effective strategies to combat issues related to peri-operative care must be undertaken by healthcare organizations all over the world to ensure that patients can receive quality in terms of facilities and recover without the development of fatal infections. It is extremely important for the peri-operative nurses to be spontaneous, alert and at the same time efficient in order to reduce any risks or possibilities of medical error that could prove to be detrimental for the patients.

Training and Coordination among Perioperative Nursing Professionals

Peri-operative nursing professionals assisting in operation theatres can either be a scrub nurse or a circulating nurse. The prime responsibility of a scrub- nurse is to handover and passes the surgical instruments that surgeons would be using during an operation procedure the duty of the circulating nurse is to maintain a safe and hygienic environment inside the operation theatre based at a hospital setting (Talbot et al., 2013, p.632). It can hence be said in this regard that the nursing professionals working for the peri-operative department work in close association with the surgeons and other medical experts who are required during an operation in a hospital unit. It is extremely important that the duties are performed with accurate precision because a minor error such as a slight overdose of anaesthesia could lead to the manifestation of severe infections in the respiratory tract and could even prove to be fatal in some cases.

On thoroughly evaluating the evidences furnished by the research studies, it can be said that a major role of conducting a safe operation procedure depends upon the peri-operative nursing professionals. In order to avoid the occurrence of medical errors it is essential that the nursing staffs are adequately trained and are aware of the infection control guidelines as per the medical standards. 

Researchers have suggested that in order to ensure a safe surgical procedure it is extremely important to ensure that the nursing professionals involved in the peri-operative care are able to coordinate with the entire surgical team (Wood et al.,2014, p. 140). Effective team-work and maintenance of coordination plays a key role in observing a safe surgery that reduces the possibility of any risks related to infection disorder. It is important to employ a multidisciplinary team that would appropriately comprise of professionals belonging from diverse medical specialization to proceed with the surgery in a smooth manner and avoid the prevalence of any discrepancy or haphazardness. At the same time it is important for medical organizations to have a proper action plan ready in order to address all the risk factors associated with infection in an effective manner.

Further, research studies have revealed that it is important to undertake steps and ensure that a proper flow of communication operatives between the team undertaking the extensive procedure of surgery. At every step it is important to intimidate the information to the surgeons in case any abnormality is observed. Moreover, it is also important to be alert and convey the minimal changes that are hallmarks of risk developments and might lead to an infection in patients. It is also the prime responsibility of the nursing professionals to maintain a calm atmosphere within the hospital operation theatre (Wood et al., 2014,p. 138). Unnecessary crowding in the hospital or immediate family members of other patients who come and visit the hospital often talk loudly or grieve loudly in case of the demise of a family member. Evidences have also reported instances where visitors are careless with the eatables that they consume and often end up littering unnecessary that leads to contamination and transmission of infectious agents. It has been suggested that healthcare organizations must have stringent measures in order to control and eradicate these risk factors. Infectious agents have also been reported to enter operation rooms through the constant entry of stretchers that might comprise of patients who have open cuts and contaminated wounds. A secure method could possibly include immediate dressing of the wound or stringent monitoring through an intercom system that would effectively predict the safe time to bring in stretchers inside the operation room. It is also important for the nurses to ensure a quality check on the equipments being used in the surgery procedure so as to ensure that there are no possibilities of risk associated with the use of equipments. Infection control strategies also involve double assurance and cross checking of all steps undertaken during the ongoing surgery.

Effective Infection Control Strategies

The nursing professionals also need to maintain a balance between the safety of the patients and the surgeons. Many instances have been reported where the family members of the patients often indulge in violent actions if the patient is deprived of appropriate medical care or could not be saved despite a successful operation. In order to tackle these situations it is important to incorporate effective means of conveying the treatment or surgical procedure to the family members of the patient and make them clearly aware about the expected outcomes. Infection control strategies primarily comprise of efficiently preparing the patient about to undergo the surgery for the process (Wood et al., 2014, p. 139). It is crucial to note here that in most of the cases infections arise from the endogenous contamination, therefore it is important to effectively reduce the microbial load prior to the surgical procedure in order to proceed with a safe surgery. Interventions such as showering the patient with an antiseptic and administering efficient antimicrobial prophylaxis can help in the reduction of the microbiological load from the genital tract, respiratory tract or the patient’s skin. Exogenous infections are extremely common in cases that proceed with the placement of implants such as total hip prostheses. Increasing possibility of air-borne bacterial contamination has been reported in scientific literatures. In order to prevent the risk, effective strategies such as undertaking a safe and clean surgical procedure is recommended. 

Transmission of infectious agents through the skin and individuals of professionals working inside the operation theatre is common. In order to prevent the same, precautionary measures such as wearing of surgical gloves, gowns, caps and masks is highly recommended. In addition, stringent compliance with the infection control standard is maintained and the quality of environment inside the operation theatre with respect to the rate of air exchange and cleaning process is thoroughly supervised (Rosenthal et al., 2014, p. 945). Regular cleaning and sterilization of the equipments, ensuring laminar air flow, ultraviolet lighting, using surgical gowning to treat exposed wounds, maintaining positive pressure and ensuring non-turbulent germ free air envelope has been reported to be effective strategies to control infection that spread through air (Rosenthal et al.,2014, p. 947).

Conclusion:

Therefore, to conclude it should be stated that maintenance of stringent infection control norms in peri-operative setting by nursing professionals can help in reducing the morbidity and mortality rate tightly linked to post-surgical infections. Healthcare organizations across the world must ensure stringent measures to comply with the infection control strategies and incorporate effective training to professionals in order to avoid medical errors and patient deaths. Improvement in infrastructure and inclusion of effective contamination control strategies can help in providing safe surgical interventions and ultimately yield positive patient outcomes 

References:

Barnes, S., Spencer, M., Graham, D., & Johnson, H. B. (2014). Surgical wound irrigation: a call for evidence-based standardization of practice. American journal of infection control, 42(5), 525-529.

Berend, K. R., Lombardi, A. V., Morris, M. J., Bergeson, A. G., Adams, J. B., & Sneller, M. A. (2013). Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clinical Orthopaedics and Related Research®, 471(2), 510-518.

Berríos-Torres, S. I., Umscheid, C. A., Bratzler, D. W., Leas, B., Stone, E. C., Kelz, R. R., … & Dellinger, E. P. (2017). Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA surgery, 152(8), 784-791.

Blomberg, A. C., Bisholt, B., Nilsson, J., & Lindwall, L. (2015). Making the invisible visible–operating theatre nurses’ perceptions of caring in perioperative practice. Scandinavian journal of caring sciences, 29(2), 361-368.

Kwon, S., Thompson, R., Dellinger, P., Yanez, D., Farrohki, E., & Flum, D. (2013). Importance of perioperative glycemic control in general surgery: a report from the Surgical Care and Outcomes Assessment Program. Annals of surgery, 257(1), 8.

Lówbúrý, É. J. L., Ayliffe, G. A. J., Geddes, A. M., & Williams, J. D. (2013). Control of hospital infection: a practical handbook. Springer, pp. 111.

Poultsides, L. A., Ma, Y., Della Valle, A. G., Chiu, Y. L., Sculco, T. P., & Memtsoudis, S. G. (2013). In-hospital surgical site infections after primary hip and knee arthroplasty—incidence and risk factors. The Journal of arthroplasty, 28(3), 385-389.

Rosenthal, V. D., Maki, D. G., Mehta, Y., Leblebicioglu, H., Memish, Z. A., Al-Mousa, H. H., … & Apisarnthanarak, A. (2014). International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module. American journal of infection control, 42(9), 942-956.

Talbot, T. R., Bratzler, D. W., Carrico, R. M., Diekema, D. J., Hayden, M. K., Huang, S. S., … & Fishman, N. O. (2013). Public reporting of health care–associated surveillance data: recommendations from the Healthcare Infection Control Practices Advisory Committee. Annals of internal medicine, 159(9), 631-635.

Wood, A. M., Moss, C., Keenan, A., Reed, M. R., & Leaper, D. J. (2014). Infection control hazards associated with the use of forced-air warming in operating theatres. Journal of Hospital Infection, 88(3), 132-140.