In general, the epidemiology of HAIs and SSIs has undergone significant changes in the United States and across the world. As a result, the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) introduced the updated Guidelines dedicated to the prevention and management of infections (Solomkin et al., 2017). In the present day, they include reviewed and updated risk factors for HAIs and SSIs, especially the increased virulence and resistance of infecting organisms. Thus, risks for infection during surgical procedures for people with underlying diseases, such as diabetes mellitus or obesity, started to be considered more than before (Solomkin et al., 2017). In addition, new guidelines have provided new insights into infections’ microbial mechanisms and specific mechanisms of some disease processes that may cause increased infection rates.
At the same time, in order to promote positive changes in infection control, management, and prevention, health care providers should pay particular attention to the implementation of care bundles. Regarded as “a collection of standardized clinical practices that individually have been shown to improve patient outcome,” care bundles lead to superior health outcomes in comparison with individual measures (Solomkin et al., 2017, p. 386). In general, applicable changes should be implemented in several basic directions, including the improvement of hand hygiene and aseptic technique principles, general competency and information seeking, care documentation, and patients’ education and their involvement in care as well.
One of the most efficient implementation plans that aim to reduce HAIs and SSIs in medical facilities is “Four Es” that focuses on engagement, education, execution, and evaluation (Ariyo et al., 2019). First of all, it implies the engagement of frontline staff predominantly by forming efficient multidisciplinary teams that include perioperative nurses, surgeons, anesthesia providers, pharmacists, and specialists for infection prevention control. The main goals of the team are to review existing practices of infection prevention, identify opportunities for their improvement, develop appropriate interventions, measure progress, and provide feedback to staff. Education implies staff education dedicated to strategies and practices of infection prevention in various forms, including didactics, large-group workshops, grand rounds, peer education, briefings, role-playing webinars, debriefing sessions, online videos, and live simulations (Ariyo et al., 2019).
Execution refers to both various multifaceted strategies and the focus on “streamlining interventions by simplifying and standardizing the care delivery process and creating verification checks,” checklists, order sets, and electronic reminders (Ariyo et al., 2019, p. 4). Multifaceted strategies may include hand hygiene, aseptic techniques, the use of surgical antibiotics, proper surgical site preparation, glycemic control, hair removal techniques, preoperative bathing, preoperative cleansing, instrument sterilization, normothermia, wound care, operating room discipline, and gloving techniques (Allegranzi et al., 2016). Evaluation refers to SSI surveillance, observation of clinical performance, and providing feedback related to patients’ health outcomes in order to improve infection prevention practices.
Evidence-Based Practice in the Intervention Plan
Regardless of the fact that the United States Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) issue guidelines, emphasizing the significance of appropriate prevention measures in relation to HAIs and SSIs, evidence-based recommendations are frequently “not delivered at the bedside” (Ariyo et al., 2019, p. 1). It may be determined by limited guidance on their translation into routine practice. Nevertheless, it is highly significant to implement evidence-based practice in the development of an efficient intervention plan. It should focus on clinical and administrative stakeholders and have not only technical but cultural work to enhance the translation of evidence-based recommendations and accelerate the efforts of improvement.
Evaluation of Intervention
It goes without saying that successful intervention should result in the reduction of HAIs and SSIs in medical settings and their negative impact on patients. In general, evaluation includes giving instant feedback to medical staff after intervention in order to analyze the implementation of appropriate strategies and improve techniques for motivation and better prevention in the future. In addition, evaluation refers to long-lasting in-depth analysis of infection control and prevention in medical facilities. It implies data collection for the evaluation of infection rates within the period of several years for the following feedback and improvements if results are unacceptable.
Challenges and Barriers
The main barriers to the successful implementation of an intervention plan are connected with a lack of knowledge in relation to evidence-based practice. In other words, a considerable number of nurses “are unaware of the evidence-based recommendations to prevent SSIs,” and adherence to evidence-based guidelines may be regarded as suboptimal (Lin et al., 2018, p. 1643). In addition, other challenges connected with the reduction of HAIs and SSIs include “the increasing proportion of infections caused by antimicrobial-resistant pathogens such as MRSA” (Solomkin et al., 2017, p. 390). It may cause the increasing numbers of immunocompromised and severely ill surgical patients and impact poor antimicrobial stewardship that will lead to the spread of infection. These barriers may be overcome through intensive education for medical staff to raise their competency and awareness of the evidence-based practice. In addition, evidence-based practice is highly necessary for the conduction of scientific research dedicated to responsive measures against resistant pathogens.
Allegranzi, B., Bischoff, P., de Jonge, S., Kubilay, N. Z., Zayed, B., Gomes, S. M., Abbas, M., Atema, J. J., Gans, S., van Rijen, M., Boermeester, M. A., Egger, A., Kluytmans, J., Pittet, D., Solomkin, J. S. & the WHO Guidelines Development Group. (2016). New WHO recommendations on preoperative measures for surgical site infection prevention: An evidence-based global perspective. The Lancet Infectious Diseases, 16(12), 1-12. Web.
Ariyo, P., Zayed, B., Riese, V., Anton, B., Latif, A., Kilpatrick, C., Allegranzi, B., & Berenholtz, S. (2019). Implementation strategies to reduce surgical site infections: A systematic review. Infection Control & Hospital Epidemiology, 1-14. Web.
Lin, F., Gillespie, B. M., Chaboyer, W., Li, Y., Whitelock, K., Morley, N., Morrissey, S., O’Callaghan, F., & Marshall, A. P. (2018). Preventing surgical site infections: Facilitators and barriers to nurses’ adherence to clinical practice guidelines—A qualitative study. Journal of Clinical Nursing, 28(9-10), 1643-1652. Web.
Solomkin, J. S., Mazuski, J., Blanchard, J. C., Itani, K. M. F., Ricks, P., Dellinger, E. P., Allen, G., Kelz, R., Reinke, C. E., & Berrios-Torres, S. I. (2017). Introduction to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee guideline for the prevention of surgical site infections. Surgical Infections, 18(4), 385-393. Web.