Design Proposal
The practical issue of this project is a high rate of surgical site infections (SSIs) that are caused by the flow of air from adjacent enclosures to operating rooms (ORs) with positive pressure and by unclean items that can be found in ORs. Ideally, an OR should always have a positive pressure when compared to adjacent areas to prevent airborne bacteria from causing SSIs. When airflow in an OR is disrupted by the movement of personnel during a surgical procedure, patient safety is compromised; therefore, the issue can be considered a safety/risk management concern (Panahi, Stroh, Casper, Parvizi, & Austin, 2012).
The potential solution to the identified problem is to limit excessive foot traffic in ORs, thereby decreasing the SSIs rate. Thus, by limiting OR traffic, it is possible to decrease the rate of the deep chest and leg harvest site infections by 1 percent and 4.1 percent, respectively (Pokrywka & Byers, 2013). Additionally, there is ample evidence suggesting that by improving inventory stocking of OR supplies, it is possible to reduce a level of foot traffic (Panahi et al., 2012).
The article plans to review factors influencing surgical wound contamination. It also aims to assess the relationship between a microbial count within an (OR) and an amount of foot traffic during a surgical procedure (Akhter, Khawar, Hamid, & Ali, 2016).
Change Model Overview
The ACE Star Model describes different forms of knowledge in a definite sequence, as study evidence moves through several cycles, combines with other knowledge, and integrates into practice. This model is a framework for methodically putting processes of evidence-based practice into operation. The model demonstrates five main steps of knowledge transformation: research identification, evidence, translation, implementation, and process, outcomes evaluation, and reporting. Nurses are recommended to use this model as a guide to facilitate change because it contains crucial information in a concise form, evaluates consistencies and inconsistencies of findings, reduces bias, improves time efficiency, and provides a basis for regular updates (Berríos-Torres et al., 2017).
The Scope of the EBP
SSIs are often caused by an increased rate of OR foot traffic, which disrupts normal ventilation patterns in proximity to a patient. SSI is a widespread hospital-acquired condition (HAC) that results in negative health outcomes, additional costs, increased length of stay, and high readmission rates among others. According to the statistics, although the percentage of people who suffer from SSI is approximately 5%, SSI is the most widespread infection associated with healthcare accounting for nearly 30% of all HAIs in hospitalized patients. On a broader scale, this problem affects healthcare in a way that there is no guarantee for patients that they will not catch an infection after an operation (Berríos-Torres et al., 2017).
Stakeholders
I will be the leader of the team, as it is my project. There will also be a surgeon, a charge nurse, a physician, and scrub nurses.
Responsibility of Team Members
The chosen members are important for my project because their role is important in the process of intervention regarding the identified practical issue. Namely, a surgeon conducts an operation, a physician prescribes medicines and administers treatment, a charge nurse’s task is to provide comprehensive healthcare, and scrub nurses are responsible for cleaning and sterilizing a surgery and surgical equipment (Berríos-Torres et al., 2017).
Evidence
SSI is a common infection associated with healthcare and complicates up to 20% of all operations with significant strain on healthcare resources. The evidence shows that the widely used methods of antibiotic prophylaxis, perioperative glycaemic control, hair removal, and avoidance of hypothermia are not very efficient in reducing SSIs (Ban et al., 2016).
The Evidence Summary
The article addresses the question of whether excessive foot traffic in an OR contributes to the increased rate of SSIs. The question is relevant to the practice issue because excessive foot traffic is known to disrupt a positive pressure, thereby increasing the chances of area contamination. By establishing a link between the amount of foot traffic and the length of time needed for normalization of air pressure in an OR, it is possible to understand the extent to which door opening during surgical procedures causes SSIs (Panahi et al., 2012). As part of the intervention process, I plan to use all the mentioned above evidence-based interventions to achieve maximum results.
However, the main finding of the study is that airborne contamination can be reduced by preserving positive pressure in an OR. Also, Pokrywka and Byers (2013) conclude that the total microbial count increases with excessive foot traffic in an OR. The authors base their findings on the review of sources the quality of which is indicative of the strength of the evidence that is being used to support their claims. The results of the study will help to advance the project.
Recommendations for Change Based on Evidence
Taking into account the analyzed evidence on the identified practical issue, the following intervention would be recommended: the reduction of foot traffic, acceleration of decompression doors’ mechanism, the use of 2% chlorhexidine before preparing skin with alcohol, antiseptic surgical coat, and postoperative wound therapy (Ban et al., 2016).
Translation
Action Plan
Overall, the intervention process will consist of three main stages. The first stage is a preoperative intervention which includes MRSA screening, glucose control, smoking cessation, and preoperative bathing. The second stage is hospital intervention which includes hair removal, antiseptic surgical attire, skin preparation, antibiotic prophylaxis, clean instruments, and so on. The third stage is post-discharge interventions which include postoperative wound care and surveillance of SSIs (Akhter et al., 2016).
Process, Outcomes Evaluation, and Reporting
The desired outcomes are those when the percentage of patients suffering from SSIs comes to a minimum or equals zero. The measurements will be conducted with the help of various kinds of surveys. The stakeholders involved in the process of intervention will know the results of the intervention immediately after they are calculated. The results can be simply sent to them via e-mail (Akhter et al., 2016).
Next Steps
This plan can also be implemented on a larger scale using involving more medical institutions in the process of intervention. This will apply to both other units and entire facilities. Additionally, to ensure that the implementation becomes permanent, I will regularly check the work of all its aspects for some time (Ban et al., 2016).
Findings Dissemination
Within my organization, I will use different kinds of printed and oral announcements to communicate the findings. Outside of my organization, I will address mass media, specialized journals, and Internet websites to report the findings (Berríos-Torres et al., 2017).
Conclusion
The change mode consists of five main steps of knowledge transformation: research identification, evidence, translation, implementation, and process, outcomes evaluation, and reporting.
Thus, the practical issue of this project concerns itself with SSIs that are caused by the airflow from neighboring enclosures to ORs with positive pressure and by unclean items in ORs. The solution to the problem is the reduction of foot traffic, the use of 2% chlorhexidine before preparing skin with alcohol, acceleration of decompression doors’ mechanism, antiseptic surgical coat, and comprehensive postoperative wound therapy. The intervention process will consist of three main stages: preoperative, hospital, and post-discharge interventions. The results of the intervention will be sent to the key stakeholders and mass media to increase public awareness of the problem and its solution.
References
Akhter, F., Khawar, M., Hamid, T., & Ali, M. (2016). Surgical site infections (SSI). Professional Medical Journal, 23(11), 1328-1333.
Ban, K. A., Minei, J. P., Laronga, C., Harbrecht, B. G., Jensen, E. H., Fry, D. E.,… & Duane, T. M. (2016). American College of Surgeons and Surgical Infection Society: Surgical site infection guidelines, 2016 update. Journal of the American College of Surgeons, 224(1), 59-74.
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, Published online. Web.
Panahi, P., Stroh, M., Casper, D., Parvizi, J., & Austin, M. (2012). Operating room traffic is a major concern during total joint arthroplasty. Clinical Orthopedics and Related Research, 470(10), 2690-2694.
Pokrywka, M., & Byers, K. (2013). Traffic in the operating room: A review of factors influencing airflow and surgical wound contamination. Infectious Disorders-Drug Targets, 13(1), 156-161.