Reducing Surgical Site Infections

Problem 

One of the most common healthcare-associated infections is surgical site infections (SSIs).  These are infections that occur near or at surgical incisions within 30 days after surgical procedures. According to Anderson et al. (2014), SSIs occur in between 2% to 5% of all patients who undergo inpatient surgery in the US. SSIs are the most common form of healthcare-associated infections (Anderson et al., 2014). Some of the impacts of SSIs include longer hospital stay for patients, increased readmission rates, escalated expenses for patients, and adverse health outcomes such as increased mortality rates. Since SSIs are the most common form of healthcare-associated infections, preventing them will enhance patient outcomes in line with my area of practice. It will also improve performance and productivity within my healthcare organization. 

Investigation of the Problem.

According to Anderson et al. (2014), between 160,000 and 300,000 cases of SSIs are reported in the US annually. Moreover, SSIs are the most common source of healthcare-associated infections, which makes it a priority for healthcare organizations, including the Hialeah Hospital Labor and Delivery Unit. My facility performs several labor-associated surgical procedures and according to my nurse manager, this is one of the major challenges we face. Many mothers develop postpartum SSIs especially if they delivered through caesarean section, and it is vital that we implement a solution that will not only enhance outcomes for pregnant mothers, but one that will enable our organization to attain its goals of reducing patient risks through providing quality care to patients.

State of the Situation Using Current Data.

Current research by Kawakita and Landy (2017) has revealed that the risk factors for postpartum SSIs include maternal factors such as obesity, limited prenatal care, and tobacco use. Conroy et al. (2012) explains that other risk factors include operative and intrapartum factors such as premature rapture of membrane, emergency labor, prolonged labor, large incision lengths, and chorioamniotis, as well as obstetrical care provided, among others. Discussions with my nurse manager have revealed that in our facility, most SSIs are related to maternal factors whose major causality is poor lifestyle choices by pregnant women. For instance, obesity and tobacco use have been linked to many SSIs in the delivery unit. It is imperative that pregnant women receive education on the potential impacts of their lifestyles on the pregnancy and the potential risks they face through engaging in poor lifestyle choices during pregnancy. 

Solution for the Problem.

Since feedback from the nurse manager has revealed that most SSIs in our facility are caused by maternal-related factors such as substance use and obesity, the best solution to prevent SSIs is to develop a program that educates pregnant women on the impacts that their lifestyle choices have on the pregnancy. If women receive education and knowledge on the risks factors for SSIs during the early stages of pregnancy, they are likely to implement effective lifestyle decisions and embrace supportive behaviors that will lower their risks of developing postpartum SSIs. It is important to implement the program at a community level so that many pregnant mothers, including those who do not use our healthcare services, can gain knowledge that will enhance the health outcomes of themselves and that of the baby. 

Resources to Implement the Proposed Solution and a Cost-Benefit Analysis

To implement the educational awareness program, we will require educational materials such as books, pamphlets, videos and others that contain information on the risk factors of postpartum SSIs, lifestyle habits that enhance postpartum SSI risk, lifestyle changes that pregnant women should adopt to reduce risk of postpartum SSIs, and information on healthcare facilities where pregnant women can access more information or assistance linked to pregnancy-related issues. We will also require healthcare practitioners including our nursing manager and other practitioners to give talks and answer questions by participants on the lifestyle risks of postpartum SSIs. 

The benefits of the program will include dissemination of information and knowledge on SSIs and lifestyle-related risks. Through empowering pregnant women with such information, they will likely embrace positive lifestyle changes that will improve their health outcomes by reducing the risk of postpartum SSIs.  Additionally, the community will benefit from lower mortality rates and healthcare costs associated with postpartum SSIs, and if the program is successful, it may be rolled out state-wide or even nationally. The main cost of the program will be the financial resources needed to create the educational materials, promote the campaign and cater for the costs of the venue of the meetings. However, the healthcare costs and potential lives saved from the program will mitigate any costs associated with it. 

Timeline for implementation.

The program will be implemented within three months and it will target pregnant women at any stage of the pregnancy process. Moreover, women who are not pregnant and who wish to attend will be allowed to do so. There will be weekly meetings lasting an hour each in which the educational materials will be given out and a healthcare practitioner will hold discussions with the participants. The practitioner will answer any questions that they have. 

7. Why Each Key Stakeholder is Important for the Implementation of the Solution 

The main stakeholders in the program are pregnant women, healthcare practitioners and the government and non-governmental agencies that will partner with us. It is important for every stakeholder to be involved in implementing the solution so that they feel that they own it and can therefore support it (Ekirapa-Kiracho et al., 2017). The pregnant women are important since they are the beneficiaries of the program and empowering them with information on postpartum SSIs will improve their health outcomes and that of their babies. The healthcare practitioners are also vital since they will develop the educational materials and implement the program through holding discussions with the women and answering their health-related questions. All the practitioners I talked to supported the program and they vowed to dedicate their time to participate in creating the educational materials and talking to the women. The government and non-governmental partners will be instrumental in promoting the campaign and providing financial resources needed for the success of the program. Most of the partners I talked to offered monetary support and use of their social media sites and company websites to promote the campaign. They requested a formal notification of what was needed of them, and how they can participate in the program. 

How the Proposed Solution could be Implemented and Evaluated for Success.

The program can be implemented through involving all the stakeholders who will provide financial and time resources, create educational materials and hold discussions with women. We can meet with these stakeholders and formulate a strategy for implementing the campaign. The strategy will encompass aspects such as promoting the program on the internet, print and electronic media, booking the meeting venue based on the willing number of participants, organizing the healthcare practitioners who will give the talks, and setting the timetable for the program. To evaluate its success, we will issue questionnaires to participants at the end of the program to evaluate what they have learned about postpartum SSIs and the strategies they intend to use to implement positive lifestyle changes. Based on their feedback, we will evaluate the program’s success and address any criticism or weaknesses given, in subsequent programs. 

References 

Anderson, D. J., Podgorny, K., Berríos-Torres, S. I., Bratzler, D. W., Dellinger, E. P., Greene, 

L., Nyquist, A. C., Saiman, L., Yokoe. D. S., Maragakis, L. L., & Kaye, K. S. (2014). Strategies to prevent surgical site infections in acute care hospitals. Infection Control & Hospital Epidemiology. 35(6):605-27. doi: 10.1086/676022. 

Conroy, K. Koenig, A. F., Yu, Y. H., Courtney, A., Lee, H. J., & Norwitz, E. R. (2012). 

Infectious morbidity after cesarean delivery: 10 strategies to reduce risk. Reviews in Obstetrics & Gynecology 5(2):69-77. 

Ekirapa-Kiracho, E., Ghosh, U., Brahmachari, R. & Paina, L. (2017). Engaging stakeholders: 

lessons from the use of participatory tools for improving maternal and child care health services. Health Research Policy and Systems. 15:106. doi: 10.1186/s12961-017-0271-z. PubMed PMID: 29297336; PubMed Central PMCID: PMC5751791.

Kawakita, T., & Landy, H. J. (2017). Surgical site infections after cesarean delivery: 

epidemiology, prevention and treatment. Maternal Health, Neonatology and Perinatology. 3:12. doi: 10.1186/s40748-017-0051-3. 

Reichman, D. E., & Greenberg, J. A. (2009). Reducing surgical site infections: a review. 

Reviews in Obstetrics & Gynecology 2(4):212-21.