Essay On Surgical Site Infection

 

A surgical site infection is considered to be an infection that takes place after surgery in the body part where the surgery has been done. It should be noted that sometimes surgical site infections can also be superficial infections that involve the skin (Zhou et al 2020). On the other hand, there are some other types of surgical site infections that are more serious involving tissues under the skin, organs along with implanted material (Zhou et al 2020). Surgical site infection is often caused by germs that infect the surgical wound through several forms like a touch from a contaminated caregiver or surgical instrument (Sun et al 2018). Germs can also be contaminated through germs in the air or through germs that are already present in the body and might spread into the wound.

 

 
The degree of risk of surgical site infection is often linked to the type of surgical wound. It cannot be denied that surgical site infections can have physical, mental, and emotional impacts on not only patients but also on their family members (Sun et al 2018). Apart from this, these types of infections also have a negative impact on the healthcare organization and its staff. Hence, the primary aim of the paper is to critically evaluate and analyse the impact of surgical site infection from the perspective of patients.

 

There are various reasons why surgical site infection takes place. Any type of surgical site infection causes redness, fever, pain, warmth, swelling, delayed healing, tenderness, and others (Curcio et al 2019). Though the reputation of the healthcare organization and healthcare professionals are put at stake when a surgical site infection takes place, however, it is the patients who suffer the most from such incidences (Curcio et al 2019).

 

 

It cannot be denied that healthcare-associated infection or surgical site infection is considered to be one of the most adverse events in healthcare. These types of infections can be easily prevented by healthcare staff since acute wounds which include both simple and complex surgical wounds are common wounds found in hospitals (Liu et al 2018). There has been an increasing focus on patient-reported outcome measures pertaining to wound care during the last decade. Therefore, it should be noted that efforts to understand the quality of life amongst individuals suffering from chronic wounds have received increasing attention from both healthcare providers as well as funders (Liu et al 2018).

 

 

According to Kapp et al (2017), surgical site infections have a tremendous physical impact on the health of the patient. The authors stated that some of the physical effects of chronic wounds that have been reported by patients who have suffered from surgical site infections are the physical effects of chronic wounds like wound pain, changes in the image of the body, and disruption in sleep as well as limitations in physical mobility. These physical issues emerging from surgical site infections have not only affected the patients physically but have also had a deep mental impact on them where they tend to suffer from depression as well as acute stress (Kapp et al 2017).

 

The authors have also stated in their article that patients who suffer from surgical site infections tend to suffer from further physical illnesses due to physical inactivity that can lead to weight gain, cardiovascular problems due to lack of mobility, and other issues that have been reported by several patients (Kapp et al 2017). It has also been reported by Kapp et al (2017), that after being infected by surgical site infection patients lose trust in healthcare professionals as often, they receive treatment products that are not related to their specific needs.

 

Unlike other authors who will be discussed in the paper, Kapp et al (2017), highlight an essential and significant point that is faced by patients who contract surgical site infection. The authors have found that the impact of surgical site infection is directly related to the sexual health of patients. It cannot be denied that wounds in clinical sites lead to tremendous discomfort and disheartenment, however, during this time patients have complained about their sexual health being affected and the impact it has on sexual partners which sometimes even leads to relationship problems (Kapp et al 2017).

 

Fearns et al (2017), arguments are in conjunction with the arguments that have been made by Kapp et al (2017). In other words, the authors of both articles have indicated how surgical site infection has a tremendous impact on the social life and relationship of individuals. Fearns et al (2017), have reported that social isolation is often worsened due to impaired mobility, bulky dressings, inadequate clothing as well as footwear, and due to some of the prescribed immobility like bed rest, raised sitting for a long period of time and others.

 

Unlike, Kapp et al (2017), Fearns et al (2017), have highlighted how the loss of independence and reliance on others for simple activities lead to a deep emotional and mental impact on patients. The authors also highlight that when patients are unable to make use of effective coping strategies, do not receive adequate treatment and support, and experience feelings of hopelessness and helplessness it often leads to mental health issues of depression and anxiety (Fearns et al 2017).

 

Kapp et al (2017), too, have gone to highlight a different point where he states that functional impairment, as well as pain, generated from surgical site infection, affects individuals’ ability to work. In other words, the authors have indicated that the presence of wounds hinders job attainment since individuals are unable to effectively concentrate on their work due to the mental and emotional health impact caused by surgical site infections.

 

The above argument is in congruence with the argument made by Sanger et al (2014), where the authors too, have discussed how surgical site infections affect the quality of life for patients and most importantly how these make patients disconnected from their healthcare providers during the critical time of recovery. The authors have stated how patients contracting wounds during their clinical stay tend to have a physical health impact on patients due to either pain or leakage (Sanger et al 2014). It also sometimes affects their self-esteem and causes exhaustion due to frequent trips to the hospital.

 

On the other hand, McCaughan et al (2018), in their article have stated the perspectives of patients who have suffered from surgical site infections. According to the research conducted by the authors, patients have reported frustration with the healthcare system. It has been reported by patients that they experience great frustration after a surgical infection because during interactions with healthcare professionals patients report that they and the healthcare provider were not on the same page pertaining to treatment recommendations as well as care goals (McCaughan et al 2018).

 

Unlike the above authors, McCaughan et al (2018), have also discussed in their article how suddenly being infected or becoming a victim of surgical site infection can lead to an alarm, shock as well as feelings of disbelief within patients. They have also highlighted how some of the wound-associated factors tend to have a negative impact on the everyday life of individuals, affecting their physical along with psychosocial functioning as well as well-being (McCaughan et al 2018).

 

The authors have made an attempt to highlight some of the views of patients who have reported acute pain and reduced mobility and particularly highlighted difficulties in stretching and standing because of wounds (McCaughan et al 2018). Furthermore, McCaughan et al (2018), have also gone ahead to discuss how due to increased physical, mental, and emotional stress due to surgical site infection, patients suffer from the issue of reduced appetite which leads to weakness and muscle wasting.

 

At the same time, the authors have also indicated how lack of understanding regarding the wound healing process, fear as well as anxiety related to the same were quite common in patients. Sanger et al (2014) and McCaughan et al (2018), both have agreed that patients who suffer from surgical site infection experience disappointment, frustration, and dismay due to their slow healing process during the course of which patients lose their self-confidence and esteem which eventually increases their anxiety and stress.

 

Sanger et al (2014), have highlighted an essential point where patient dissatisfaction, as well as dismay, tend to increase due to unrealistic expectations pertaining to the rate of healing in patients being at odds with the expectations of clinicians. The authors have reported that positive feedback often boosts the morale of patients and increases their hope for healing, while on the other hand, negative feedback affects the outlook of patients (Sanger et al 2014). Hence, in the opinion of the authors, conflicting information often leads to feelings of consternation as well as confusion among patients.

 

Similarly, like the other author Sanger et al (2014), have also shown how surgical site infection leads to a psychosocial impact on individuals. One of the most common psychosocial impacts that open wounds had on patients was social isolation where they have reported that the time taken for the wounds to heal had resulted in acute isolation where they had to stay within the confines of their own home making them devoid of everyday pleasure and activities that were sources of their happiness (Sanger et al 2014).

 

Both Fearns et al (2017), and Sanger et al (2014), have indicated how after suffering from surgical site infection patients reported their feelings of living in a state of limbo that was dominated by several uncertainties mostly having suffered from the uncertainty of their wound healing.

 

In addition to this, though there have been some differences in the point of view of all the authors mentioned above, everyone has highlighted one of the most common issues that are faced by every patient who suffers from surgical site infection (Sanger et al 2014). This is known as the financial issue. In other words, all the authors have highlighted that financial issue is the most common issue and concern that are faced by every patient when they suffer from clinical site infections (Fearns et al 2017). It has been reported by every patient and their family members have reported that when a surgical site infection incident takes place then it not only affects patients physically, psychologically as well as emotionally but also tremendously affects them financially (McCaughan et al 2018).

 

McCaughan et al (2018), Fearns et al (2017), Sanger et al (2014), and Kapp et al (2017), all have reported how surgical site infection aggravates and complicates the health condition of patients that often increases their length of hospital stay and sometimes they also have to undergo another surgery which has a direct impact on their financial expenses. This is because another surgery or longer stay in the hospital means that the medical billings will increase due to continued medications, room charges along with other healthcare costs which tend to financially drain patients and their family members (Kapp et al 2017). This is one of the concerns that lead to tremendous dissatisfaction among patients, makes them question healthcare service, and also causes mistrust in healthcare professionals (Kapp et al 2017).

 

In addition to this, the authors have also indicated the reasons for the financial burden on patients and their families who have experienced surgical site infections. For instance, when young male patients experienced clinical site infections who were normally the bread earners of their family members and also had young children to be taken care of and supported were hit hard by uncertainties as well as restrictions due to the identified medical condition (Fearns et al 2017). This is because they had to meet the financial expenditure of their health and hospital stay while also having to bear the expenses of their family members which is said to have increased their stress and anxiety (Fearns et al 2017).

 

Currie et al (2019), have a completely different opinion as well as argument unlike the above authors regarding patient perspectives of surgical site infections. The authors have reported that often patients who suffered from surgical site infection were under constant fear of transmitting the infection to their loved and near ones and therefore, constantly tried to protect others (Currie et al 2019). This, therefore, had a tremendous impact on the daily lives of individuals, their relationship with their family members along with implications pertaining to their future job and finances (Currie et al 2019).

 

Unlike the above authors Currie et al (2019), have gone on to state the reason behind the social isolation of patients being infected by surgical site infection where they mentioned that patients often isolate themselves not only because they fear transmission but also because fear the symptoms of unpleasant symptoms that were often perceived as socially undesirable.

 

Additionally, the authors have also highlighted the behaviour and approach of patients suffering from surgical site infection on the basis of their gender. It has been reported by them that women tend to be more proactive when it comes to taking care of their personal hygiene where it is found that they engage more in keeping their wounds clean and make use of separate bathrooms (Currie et al 2019).

 

Most importantly the authors have highlighted how patients’ responses pertaining to clinical site infections are provoked by social norms as well as expectations of individuals suffering from the issue that is often influenced by feelings of “being clean” or “being dirty” (Currie et al 2019). The authors have stated that the above socio-cultural norms are often determined by aspects of being contagious, and being a risk to others and others. It has been indicated that it is socio-cultural beliefs that act as a hindrance and barrier for patients to effectively communicate and build a strong relationship with other individuals after being infected by a surgical site infection. (Currie et al 2019)

 

Currie et al (2019), further state that often communication between patients and others is characterized by fear as well as uncertainty, where both the groups have limited understanding of risks and lack knowledge about proper risk-reducing behaviour that is often constrained because of lack of information.

 

However, one argument of Currie et al (2019), that is in congruence with the argument of McCaughan et al (2018), is that both authors have pondered and aligned the theory of symbolic interactionism with the behaviour of patients. In the opinion of the authors, symbolic interactionist theory state that human beings tend to create an understanding of their own self as well as the situation that is often based on interpretation pertaining to their interaction with others (Currie et al 2019).

 

Therefore, it can be said that the interpretation of place pertaining to self as well as others within the HAI (healthcare-associated infection) context is often shaped by the responses of patients pertaining to their experience (Currie et al 2019). Thus, in the opinion of the authors, surgical site infection needs to be treated as some kind of medical condition that not only requires treatment but is also considered to be a reality that is constructed socially and is responsible for shaping both responses and experiences of patients (Currie et al 2019)

 

In the opinion of McCaughan et al (2018), one of the most significant reasons behind surgical site infection that has been reported by patients is a lack of appropriate wound dressing. In other words, patients have complained that they contracted site infections because their wounds had not been dressed or changed frequently while they were in the care of healthcare professionals and many patients also reported their dissatisfaction with the discharge procedures of the hospital (McCaughan et al 2018).

 

The authors have reported that often they felt that they were not supported during the time of discharge as they did not receive appropriate information regarding their operation which ultimately resulted in open wounds (McCaughan et al 2018). Apart from this, it can also be said that the details that were required for follow-up care are often lacking and the information pertaining to risks, symptoms as well as management regarding deficiency in wound infection (McCaughan et al 2018).

 

Thus, it can be said that the above discussions have helped in highlighting the perspectives of patients regarding the impact of surgical site infection on their physical, mental, emotional, and social health (McCaughan et al 2018). The above arguments clearly indicate that surgical site infection leads to disappointment, dismay as well as frustration for patients (Currie et al 2019). They tend to always be under fear, and threat of contaminating their family members from their acquired infections. Apart from this, surgical site infection also drains their financial health and affects their mental ability which leads to anxiety as well as stress (Fearns et al 2017). Along with this, there are several other perspectives that have been highlighted in the above discussions which help in giving an insight into the perspectives of the patient suffering from surgical site infection (Fearns et al 2017).

 

Gould et al (2021), in their article, have indicated how the issue of surgical site infection can be mitigated. The authors have highlighted the importance of nurse satisfaction and continuous professional development in preventing medical health conditions of surgical site infection (Gould et al 2021). For instance, nurses have reported that often surgical site infection cases increase because nurses do not get adequate support from the health sectors and also do not have adequate knowledge regarding aseptic technique (Gould et al 2021).

 

Hence, in the opinion of Gould et al (2021), nurses who received good support for their continuous professional education were said to be aware of aseptic techniques that had to be included while taking care of patients in clinical care settings. In other words, the authors have indicated that sound preparation at the time of pre-registration education, strong employer support as well as rehearsing skill opportunities pertaining to asepsis during their everyday practice (Gould et al 2021). It was noticed that when the above aspects have met the nurses took greater care as well as the responsibility of patients who were under their care and were also well versed with wound management strategies and techniques (Gould et al 2021).

 

 

Gould et al (2021), have also highlighted a significant argument that there need to be standardized practices regarding aseptic technique which would help in ensuring best practice for all the patients in every circumstance versus the necessity to adapt procedures for different patients in different clinical settings. Hence, the authors have indicated that it is essential for individual health providers to effectively review local arrangements that are associated with educational institutions which will help in ensuring consistency regarding what students are taught and witness during their clinical placements (Gould et al 2021).

 

Lin et al (2018), arguments are in congruence with the arguments that are laid down by Gould et al (2021), in their article. However, unlike Gould et al (2021), Lin et al (2018), have gone on to highlight some of the required facilitators as well as barriers that are faced by nurses which either encourage or discourage them from effectively performing wound care according to the clinical practice guidelines. According to Lin et al (2018), it is the barriers that do not allow nurses to comply with clinical practice guidelines of wound management which eventually results in surgical site infections.

 

 

Lin et al (2018), have clearly indicated how aseptic techniques help in preventing surgical site infections that cause discomfort to patients, increase the length of their hospital stay, and also increase their financial burden. However, he states that the main barrier that stands between the above resolution is the lack of knowledge of the nurses pertaining to asepsis principles as well as aseptic techniques that often contributes to suboptimal adherence (Lin et al 2018). In other words, the authors have indicated that the primary reason behind surgical site infection is because often the nurses are not aware of the real meaning and definition of aseptic which does not allow them to effectively perform wound care management (Lin et al 2018).

 

 

Both Lin et al (2018) and Gould et al (2021), states that sometimes surgical site infections occur due to the issue of knowledge and information-seeking behaviour. In other words, nurses and healthcare professionals were unable to get hold of the policy and procedures that documented wound care regulations, or often these documents had become outdated or the information on wound care was scattered all over the place that could not be gathered by the nurses (Lin et al 2018). Apart from this, it was also hesitancy of subordinate nurses to seek help from senior health professionals and staff and a lack of relationship between the two which do not allow them to effectively perform wound care management and comply with aseptic guidelines (Lin et al 2018).

 

Thus, in the opinion of the authors, if nurses have a good relationship with their superiors, there are strong and updated policies and procedures regarding wound management that can be easily accessed then these can act as facilitators and thereby prevent surgical site infections (Lin et al 2018).

 

Currie et al (2019), on the other hand, have also highlighted how the inefficiency of nurses in documenting wound care can be one of the reasons behind surgical site infections. In other words, when inexperienced nurses are vested with the role of taking care of patients’ wounds then they are unable to effectively understand what, how, and when to document matters of concern which does not allow them to raise timely alarms thereby leading to the mentioned medical condition (Currie et al 2019). In addition to this, nurses have also reported how due to work overload and most importantly time constraints they have been unable to effectively take care of patients’ wounds and pay attention to their dressing thereby increasing the risks of surgical site infection (Currie et al 2019).

 

Unlike the above authors, Lin et al (2018), have recommended an effective and efficient strategy and that is to involve and educate patients in wound care. This strategy will not only help in empowering patients to participate in their health decisions but will also make them aware of when to raise concerns, do the dressings and also inform the issue of wrong and inappropriate dressing which will help in overcoming the issue of surgical site infections (Lin et al 2018). This technique will not only help patients while they are in the clinical care setting but will benefit them after being discharged from the hospital.

 

In addition to this Lin et al (2018), have also indicated some of the aseptic techniques that can be effectively applied to different clinical settings. Some of these techniques include-sterile technique that is often used in the operating room, the surgical aseptic technique that is often used in the central venous catheter insertions along with the standard aseptic technique that is often used in wound management (Lin et al 2018).

 

On the contrary, Kapp et al (2017), in their article have indicated the importance of following hand hygiene which has already been mentioned by Lin et al (2018). Both the authors have stated environmental factors like availability pertaining to hand washing, and products, and some organizational factors like leadership along with education pertaining to an educational program which helps in showing that if the above aspects are available for nurses and other healthcare staff then it will help in preventing surgical site infection (Kapp et al 2017).

 

As has been mentioned by Fearns et al (2017), environmental factors like policies as well as regulations are also key factors that tend to have a strong impact on the behaviour of the healthcare staff. The authors have stated that it is the responsibility of the healthcare organizations to effectively design as well as implement clinical practice guidelines within their health sectors that will help in ensuring consistency within service delivery and will at the same time, also minimize variations in practice (Fearns et al 2017).

 

The authors have stated that the above aspect can be effectively implemented by the wound care team which will help in ensuring that they are within the recommendations of clinical practice guidelines (Fearns et al 2017). It has also been recommended that healthcare supervisors and organizations should also pay attention and give importance to wound management training that will help in improving their information-seeking behaviour (Fearns et al 2017).

 

Wilde et al (2020), are of a completely different opinion from the arguments that have been made by the above authors. Wilde et al (2020), have indicated the importance of encouraging patients to self-manage their wounds after providing them education regarding wound care management. The authors state, that if patients are taught some of the aseptic techniques and wound management strategies then they are effectively able to cleanse themselves, apply dressings, are able to assist their own wounds, or sometimes they can also seek help from others during their self-management (Wilde et al 2020).

 

In addition to this, it should be noted that self-management also helps patients to maintain an active life since they did not have to wait for visits as well as appointments or had to attend clinics that might help in saving them from exhaustion and also a financial crisis (Wilde et al 2020). At the same time, the authors have also indicated that self-management activities also helped in relieving the burden of health services while on the other hand, timeliness was another essential aspect that encouraged and motivated healthcare officials especially nurses to self-manage their wounds (Wilde et al 2020).

 

However, Sanger et al (2014), does not agree with Wilde et al (2020), since the authors state that there are several barriers to wound care as well as management that might not allow them to effectively self-manage their wounds. For instance, some of the barriers to self-care management include hesitancy pertaining to the use of medication, pain, feeling of being overwhelmed, and also being squeamish about wound care (Wilde et al 2020). Similarly, the authors have highlighted a significant point that when patients suffer from site infections then they suffer from decreased vigilance, less information-seeking, and diminished efficacy of self-care that might hinder them from effectively managing their wounds (Wilde et al 2020).

 

Furthermore, Sanger et al (2014), are of a different opinion where the authors state that when healthcare organizations promote active surveillance programs then it helps in reducing the incidences of surgical site infections, and helps in engaging patients which thereby helps in improving clinical outcomes, emotional health as well as decreased utilization of healthcare. For this, the authors have recommended the importance of making use of the mHealth solution that will help in connecting patients as well as healthcare providers which will not only enhance patient satisfaction but will also improve outcomes (Sanger et al 2014).

 

 

In conclusion, it can be said that surgical site infections create a lot of issues for patients since it not only affects them physically and mentally but also drains them and their family financially which eventually leads to stress, anxiety, and depression. It has been reported by patients that surgical site infections tremendously affect their physical mobility, socially isolate them, affect their professional work, lead to sexual problems, and also affect them emotionally and psychologically. Apart from this, the medical condition also increases their mistrust of healthcare professionals and organizations. Thus, to overcome the issue, some of the recommendations and facilitators have been mentioned that will help nurses to prevent surgical site infections and promote healthy outcomes and patient well-being.

 

Curcio, D., Cane, A., Fernández, F. and Correa, J., 2019. Surgical site infection in elective clean and clean-contaminated surgeries in developing countries. International Journal of Infectious Diseases, 80, pp.34-45.

 

 

Currie, K., Melone, L., Stewart, S., King, C., Holopainen, A., Clark, A.M. and Reilly, J., 2018. Understanding the patient experience of health care–associated infection: A qualitative systematic review. American Journal of Infection Control, 46(8), pp.936-942.

 

 

Fearns, N., Heller-Murphy, S., Kelly, J. and Harbour, J., 2017. Placing the patient at the centre of chronic wound care: A qualitative evidence synthesis. Journal of Tissue Viability, 26(4), pp.254-259.

 

 

Gould, D., Hawker, C., Chudleigh, J., Drey, N., Gallagher, R. and Purssell, E., 2021. Survey with content analysis to explore nurses' satisfaction with opportunities to undertake continuing professional education in relation to aseptic technique. Nurse Education Today, 98, p.104749.

 

 

Kapp, S., Miller, C. and Santamaria, N., 2018. The quality of life of people who have chronic wounds and who self‐treat. Journal of Clinical Nursing, 27(1-2), pp.182-192.

 

 

Lin, F., Gillespie, B.M., Chaboyer, W., Li, Y., Whitelock, K., Morley, N., Morrissey, S., O’Callaghan, F. and Marshall, A.P., 2019. Preventing surgical site infections: Facilitators and barriers to nurses’ adherence to clinical practice guidelines—A qualitative study. Journal of clinical nursing, 28(9-10), pp.1643-1652.

 

 

Liu, Z., Dumville, J.C., Norman, G., Westby, M.J., Blazeby, J., McFarlane, E., Welton, N.J., O'Connor, L., Cawthorne, J., George, R.P. and Crosbie, E.J., 2018. Intraoperative interventions for preventing surgical site infection: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, (2).

 

 

McCaughan, D., Sheard, L., Cullum, N., Dumville, J. and Chetter, I., 2018. Patients’ perceptions and experiences of living with a surgical wound healing by secondary intention: a qualitative study. International journal of nursing studies, 77, pp.29-38.

 

 

Sanger, P.C., Hartzler, A., Han, S.M., Armstrong, C.A., Stewart, M.R., Lordon, R.J., Lober, W.B. and Evans, H.L., 2014. Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution. PloS one, 9(12), p.e114016.

 

 

Sun, Y., Wang, H., Tang, Y., Zhao, H., Qin, S., Xu, L., Xia, Z. and Zhang, F., 2018. Incidence and risk factors for surgical site infection after open reduction and internal fixation of ankle fracture: a retrospective multicenter study. Medicine, 97(7).

 

 

WILDE, K., 2020. Patients' perceptions of self-management of chronic wounds. Wounds UK, 16(3).

 

 

Zhou, J., Wang, R., Huo, X., Xiong, W., Kang, L. and Xue, Y., 2020. Incidence of surgical site infection after spine surgery: a systematic review and meta-analysis. Spine, 45(3), pp.208-216.