Clinical Practice Guideline: Analysis and Application


Surgical site infections are among the most critical issues in the contemporary health care setting. They can occur prior, post, and during the actual surgery or intervention, and they can frequently lead to severe health complications (Kim et al., 2015). This problem is actual for the majority of healthcare institutions as well as for my practice setting, which is a nursing hospital. Clinical practice guidelines or CPGs are a set of materials that support health care organizations in maintaining the sufficient level of care regarding the safety measures and practices in terms of a specific pertinent healthcare issue. They rely on evidence-based materials, researches, and documents to provide such recommendations and approaches that are up-to-date, feasible and ensure positive outcomes for both patients and specialists. The purpose of this paper is to review and analyze the clinical practice guideline in terms of surgical site infection prevention.

Scope and Purpose

The purpose of the document is to facilitate healthier, safer and more feasible measures to avoid or eliminate the possibilities of infections that occur during, before or after a surgery of the musculoskeletal system. The aim is to provide the guidelines to healthcare specialists including orthopedic nurses that ensure the best of care for the patients (Atkinson Smith, Dahlen, Bruemmer, Davis, & Heishman, 2013). However, the guideline focuses intensely on the prevention measures. In terms of scope, the document identifies the recommendations relying on a compilation of evidence-based literature and scientific research. The guidance is standardized to foster the application of preoperative, intraoperative and postoperative care interventions in all the patients. The aim of the CPG is to provide the nursing staff with practices to ensure patient safety through the appropriate measures to avoid, eliminate or reduce the possibility of infection emergence.

Stakeholder Involvement

The CPG is aimed at all the parties involved in the surgery either directly or indirectly. It is applicable for the performance conducted by registered nurses orthopedic nurses, in particular), the surgical specialists, clinicians, and any allied hospital personnel. In addition, all the nurse practitioners, patients and their families, pharmacists are included in the stakeholder group. Overall, the health providers can be considered the main associates in that matter. Importantly, patients and their families or assistants are included in this category. Apart from that, the target population for this guideline is RNs, clinicians, patients undergoing surgeries on the musculoskeletal system and surgical staff (Atkinson Smith et al., 2013). Despite the fact that patients did not engage directly in the development of the document, the audience of the guideline has been defined particularly.

Rigor of Development

The rigor of the CPG is rather distinct. The guideline of surgical site infection prevention was presented and reviewed by the qualified experts in the area. However, the target population was not an active developer of the recommendations, but it was considered throughout the process of establishment. Nevertheless, the authors of the document obtained both external and internal evaluation and critique from the experts in the field prior to the final compilation of the writing. Importantly, the CPG was revised before it was disseminated for peer reviewing (Atkinson Smith et al., 2013). As per the level of evidence, the data and information used and provided in the document were gathered from the evidence of high quality. The authors stated that it was reasonable to rely on the high-standard practices rather than on the ones that were of low strength. Thus, it can be assumed that Level I evidence was used to compile this CPG (Peterson et al., 2014). The document provides a discussion of health benefits and risks for the target group; however, no details on the further updating of the document were mentioned.

Clarity and Presentation

In general, the clarity is sufficient. The provided recommendations are of explicit character. The writing does not give room to debates over the different possible options. In addition, the recommendations proposed by the authors provide no ambiguity, and they can be easily determined from the document’s body (Peterson et al., 2014). More importantly, the guideline has a summary that is comprehensive and contains the main points to be considered in preoperative, intraoperative, and postoperative care settings (Atkinson Smith et al., 2013). In particular, the guideline discusses the necessity of skin cleansing and hair removal prior to the operation. Further, it advises on appropriate blood transfusion risks and antibiotic timing. The recommendations include details on antibiotic prophylaxis and the importance of maintaining normothermia to avoid hypothermia. Notably, the authors emphasized the obligatoriness of noncritical items disinfection. Apart from that, the text has specific educational materials for the patients and their families in terms of necessary measures after surgery (wound care, medication, general practices such as hand washing and so on).

Applicability

The main barrier stressed out in the paper is the insufficiency or lack of competence of the health care staff when furnishing a surgical intervention to the patient. The main cause of unsafety for the patients is the improper application of procedures. As many members of the hospital staff are engaged in surgery processes, it is essential that every member of the team is knowledgeable of the necessary measures to prevent infections (Peterson et al., 2014). If any of the members does not comply with these measures, it is likely that the patient develops infections prior, during or after the surgery. Needless to say, infections can cause severe health complications to the patient. Moreover, the cost of clinical non-compliance will be reflected in the increased financial expenditures to the health institution, the patient, and insurance company (Kim et al., 2015).

Editorial Independence

According to the authors, the guideline has no conflict of interest with the funding body as well as with any profit or non-profit organization. To be more precise, the authors claimed, “they have no ļ¬nancial interests to any commercial company related to this educational activity” (Atkinson Smith et al., 2013, p. 242). Thus, the editorial independence is evident.

Summary

The reviewed CPG in terms of surgical site infection prevention addresses the main clinical issues presented in the CPG in an effective way and in an understandable manner. It reviews the key practices regarding medical inaccuracies that can undermine the patient’s health status and lead to the increased costs for the hospital if the medical staff is negligent in any of the three stages of surgery (Atkinson Smith et al., 2013). The compiled document relies on the evidence of high quality solely and, thus, it can be considered reliable and applicable to the health care setting (Peterson et al., 2014). The advanced practice nurse could employ the CPG in multiple ways. It will additionally instruct and remind the nurse of the essential measures to ensure patient safety. The clinical guideline has the potential to create an environment in which the patient will receive the best of care, and the medical staff will be accurate, mindful, and knowledgeable of the most effective measures to facilitate patient security.

References

Atkinson Smith, M., Dahlen, N., Bruemmer, A., Davis, S., & Heishman, C. (2013). Clinical practice guideline surgical site infection prevention. Orthopaedic nursing / National Association of Orthopaedic Nurses, 32(5), 242-248.

Kim, F. J., da Silva, R. D., Gustafson, D., Nogueira, L., Harlin, T., & Paul, D. L. (2015). Current issues in patient safety in surgery: A review. Patient Safety In Surgery, 9(1), 1-9.

Peterson, M. H., Barnason, S., Donnelly, B., Hill, K., Miley, H., Riggs, L., & Whiteman, K. (2014). Choosing the best evidence to guide clinical practice: Application of AACN levels of evidence. Critical Care Nurse, 34(2), 58-68.