INFECTION CONTROL
including liaising with GP)?Was there pre-operative commencement of intravenous insulin infusion?Was appropriate referral made to diabetic nurse and/or community services? Gould (2012) points out that it is
difficult to establish factors such as poor hand hygiene compliance resulting in the development of infection but as Swenne and Alexandrén (2012) observe, if basic hand hygiene compliance is not practiced in theatres, the risk of contamination to the patient is increased. The introduction and regular audit using HHIs demonstrates the usefulness and effectiveness of the bundles in reducing the risk of infection (Marwick and Davey 2009). The audit cycle must include clinical skills education and active action planning is required when performance is poor (Slyne et al 2011).
‘If basic hand hygiene compliance is not practiced in theatres, the risk of contamination to the patient is increased.’
1999; 20: 247-8.
Conclusion SSIhas a significant impact on the patient and healthcare service and it is considered a quality indicator. The care bundle to reduce SSIis an important starting point to establishing best practice and reducing the incidence of SSI. When incidences of deep, organ or space wound infections are identified, RCA has been proved to be a useful and effective process for identifying problems and implementing solutions with the support of key stakeholders.
References • Chamberlain N. Medical Microbiology & Immunology: The Big Picture. London: McGraw-Hill Medical (2009).
• Casadevall A and Pirofski LA. Host-Pathogen Interactions: Redefining the Basic Concepts of Virulence and Pathogenicity. Infection and Immunity 1999; August 67(8): 3703-13.
• Department of Health. Clean, Safe Care: Reducing Infection and Saving Lives. HMSO: London (2008).
• Gould D. Skin flora: implications for nursing. Nursing Standard 2012; 26(33): 48-56.
• Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infection Control and Hospital Epidemiology
‘The care bundle to reduce SSI is an important starting point to establishing best practice and reducing the incidence of SSI.’
28 THE CLINICAL SERVICES JOURNAL
• Health Protection Agency. English National Point Prevalence Survey on Healthcare Associated Infections and Antimicrobial Use, 2011: Preliminary data. Health Protection Agency: London (2012).
• Huczynski A and Buchanan D. Organisational Behaviour. 4th Edn. Essex: Pearson Education Ltd (2001).
• Jakeman A. Managing the lower limb in coronary artery bypass grafting.Wounds International 2010; 1(5). Accessed 1 May 2012.
• Joint Commission Perspectives on Patient Safety. Raising the bar with bundles: Treating patients with an all or nothing standard. Joint Commission on Accreditation ofHealthcare Organizations 2006; 6(4): 5-6.
• Jordan T and Riddle S. Tackling antimicrobial resistance issues. The Clinical Services Journal June 2012: 49-51.
• Krischak GD, Augat P, Claes L, Kinzl L and Beck A. The effects of non-steroidal anti- inflammatory drug application on incisional wound healing in rats.Wound Care 2007; 16(2): 76-8.
• Martin JL, Koodie L, Krishnan AG, Charboneau R, Barke RA and Roy S. Chronic Morphine Administration Delays Wound Healing by Inhibiting Immune Cell Recruitment to theWound Site. The American Journal of Pathology 2010; 176(2): 786-99.
• Marwick C and Davey P. Care bundles: the holy grail of infectious risk management in hospital? Current Opinion in Infectious Diseases 2009; 22: 364-9.
• McHugh S and Corrigan MA. Handling Infection Control: The use of gloves in healthcare associated infection prevention. European Medical Hygiene 2012; 1: 29- 33.
• Moinuddin M, Shaikh ZH, Bamburg B and Strelczyk K. Success of an infection
control (IC)–led multidisciplinary team to encourage judicious use of surgical antimicrobial prophylaxis (SAP) to prevent surgical site infections (SSIs) and antimicrobial resistance. American Journal of Infection Control 2005; (33)5: 27-8.
• National Institute of Health and Clinical Excellence (2012). NICE Pathways: guidance at your fingertips. Accessed 5 September 2012
• Pexton C and Young D. Reducing surgical site infections through six sigma & change management. Patient Safety and Quality Healthcare July/September (2004).
• Rochon M. Chapter 7:Wound Healing and Surgical Site Infection. In: Manual of Perioperative Care. EditorsWoodhead K. and Fudge L. London: Blackwell Publishing (2012).
• Slyne H, Phillips C and Parkes J. Saving Lives audits: do they improve infection prevention and control practice? Journal of Infection Prevention 2011; 13(1): 24-7.
• Swenne CL and Alexandrén K. Surgical team members’ compliance with and knowledge of basic hand hygiene guidelines and intraoperative hygiene. Journal of Infection Prevention 2012; 4(13): 114-9.
About the author
Melissa Rochon has, for many years, worked as a clinical nurse specialist in surveillance for the Royal Brompton and Harefield NHS Foundation Trust. Current projects include developing surveillance for wound infections in implant devices (pacemakers, internal cardiac defibrillators and loop systems) and maintaining surgical site infection reporting as a quality indicator for the Trust.
NOVEMBER 2012
www.af.mil/photos
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