Surgical site infection accounts for between 10 to 20% of Healthcare Associated infections and increases the length of hospital stay and utilization of healthcare resources. Surgical site infection (SSI) is a post operative complication occurring within 30 days following a surgical procedure and up to 12 months if a prosthetic device has been implanted.
The incidence of infected surgical wounds may be influenced by factors such as pre-operative care, the theatre environment, post operative care and type of surgery.
The first use of an antiseptic skin agent in surgery is credited to the English surgeon Joseph Lister (1827-1912). Prior to the mid-19th century, limb amputation was associated with an alarming 50% postoperative mortality from sepsis. Following Louis Pasteur’s discovery that tissue decay was caused by microscopic organisms, Lister theorized that the spread of these microbes through surgical wounds was responsible for death in the postoperative period. Lister began treating wounds with carbolic acid (phenol) in an effort to prevent tissue decay and the resultant infectious complications. As a result, the incidence of surgical sepsis fell dramatically, catalyzing the adoption of modern antiseptic techniques, including instrument sterilization, the use of surgical scrub and rubber gloves, and sterile patient preparation. (Micah L Hemani, MD and Herbert Lepor, MD, 2009)
Background:
Postoperative surgical site infections (SSIs) are a common complication of joint surgery. Prevention depends on adequate preoperative skin antisepsis. In previous studies, use of a 2% chlorhexidine gluconate (CHG) no-rinse cloth reduced SSI rates in general surgery patients (2009 National Association of Orthopedic Nurses)
Significance:
Foot surgery has an increased risk of postoperative infection when compared with surgery of other anatomical regions. A pre-surgical foot bath in a bactericidal solution is thought to reduce the incidence of postoperative wound infection. We will compare the incidence of post-operative wound infection in two groups; one will undergo a pre-surgical footbath and one group that will not.
Need for the study:
Wound infection is an important cause of morbidity and occasional mortality after coronary artery bypass graft surgery (CABG). The aim of this study is to assess the influence of using preoperative antiseptic solution on postoperative wound infection.
Hypothesis/research question:
Postoperative infection rate is lower among orthopedic patient who had skin preparation with antiseptic solution preoperatively than patient who did not have skin preparation.
Independent variable: preoperative skin preparation with antiseptic solution.
Dependent variable: post operative infection rate
Type of hypothesis: simple-directional
Population: orthopedic patient
Question: is there a correlation between postoperative infection and preoperative skin preparation with antiseptic solution in orthopedic patient who undergo surgery?
2.what is the effect of pre operative skin preparation with antiseptic solution on post operative infection rate?
Definition of terms/variables:
Operational definition:
Postoperative wound infection is an infection in the tissues of the incision and operative area. It can occur from 1 day to many years after an operation but commonly occurs between the fifth and tenth days after surgery. Infection is measured by:
A temperature of more than 38°C, Hot Incision, Swelling/Hardening of the Incision, Redness, Drainage from the Incision, Pain more than 5 on pain scale. Presence of one or more of previous symptom.
An antiseptic is a substance which inhibits the growth and development of microorganisms. For practical purposes, antiseptics are routinely thought of as topical agents, for application to skin, mucous membranes, and inanimate objects, although a formal definition includes agents which are used internally, such as the urinary tract antiseptics. It should be Capable of preventing infection by inhibiting the growth of microorganisms.
Purpose:
The purpose of this research is to evaluate and find out the usefulness of using antiseptic solution in preparing skin preoperatively.
Objective:
The aim of the research is to synthesize the significance of betadine bath preoperatively and infection rate postoperatively .the following specific objectives will be addressed:
To determine whether preoperative skin antisepsis prevents post-operative surgical wound infection.
To review the evidence for preoperative bathing or showering with antiseptics for preventing postoperative infection.
To demonstrate whether preoperative bathing with antisepsis solutions will decrease infection in postoperative major surgery patients.
Literature review:
1. in research concerning these issues. In 2008 a meta analyze study were conducted by Brian R. Swenson, MD, MS;raci L. Hedrick, MD;Rosemarie Metzger, MD; Hugo Bonatti, Sawyer, MD to examine the Effects of Preoperative Skin Preparation on Postoperative Wound Infection. A total of 3,209 pre operative cases were tested for 6 months period. All were divided into three groups prior to surgery with variety of skin Preparation. The finding of the study found that Skin preparation solution plays a major role in prevention of surgical site infections.
2. 0);”David J Keblish, 0);”David Zurakowski, 0);”Michael G Wilson, 0);”Christopher P Chiodo. Journal of Bone and Joint Surgery. (American volume). Boston: 3″May 2005. Vol. 87, Iss. 5; pg. 986, 7 pgs.This study was done in Boston hospital to twenty-five volunteers and the goal of the study was to determine the effect of antiseptic on the eradication of bacteria from the nails and skin of the normal foot and ankle. The result was the use of isopropyl alcohol and the use of a bristled brush both have beneficial effects on the skin-preparation process before foot and ankle surgery. In the current investigation, the most effective technique was the use of isopropyl alcohol in conjunction with scrubbing with a bristled brush. Merely washing the foot with alcohol-soaked sponges provided limited benefit to the web spaces only.
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Methodology:
Design: non experimental design/corelational studies
Sampling: we will select 40 patients from orthopedic ward in simple random sampling
Criteria for inclusion of sample: orthopedic patients who undergo major surgeries e.g, total knee replacement, hip replacement and knee scopy. Age group from 30 years and above.20 patient will be in control group and will not receive preoperative betadine bath.
Setting: this study will be conducted in the hospital. In orthopedic ward.
Type of collecting data/instrument: we will use structure observation method and checklist will be initiated as a tool for data collection for post operative sign and symptoms of infection.
Pilot study:
A pilot study of 10 patients undergoing major orthopedic surgery will be conducted .10 patients will receive betadine bath 4% one day prior to surgery, then betadine scrub in day of surgery. The checklist that was initiated by our team will be distributed among staff nurses and will be explained how to use it adequately to chart postoperative signs and symptoms of infection during patient hospitalization. We designed a random trial to test our instrument validity prior conducting the study.
Procedure:
We will write a letter to SMC administration that we are going to conduct a research about the effect of antiseptic solution in orthopedics ward after getting the approval letter. Then we will meet the ward supervisor to explain about what we need for the research to help us in choosing our sample. Ten patients will be chosen randomly for the pilot study to approve the validity of our instrument.
We will proceed in our research, so forty patients going under major orthopedic surgery will be chosen randomly by computer system. Twenty Patients will be chosen from the sample randomly as a control group. The rest will receive skin preparation with antiseptic available in the unit (example betadine bath 4%) one day prior to surgery and betadine scrub day of surgery. Our checklist will be explained to all staff nurses and any doubt about it they can refer to us any time. So post operatively patients will be observed by nurses using the checklist for the presence of sign and symptoms of infection.
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