Surgical Site Infections

Surgical Site Infections Elizabeth Griffor HCA 375 Continuous Quality Monitoring & Accreditation Instructor: Annajane Schnapp October 27, 2012 I chose to do my paper on the hospital-acquired condition of surgical site infections. In this paper I will discuss what a surgical site infection is, why it is considered preventable, the legal implications related to the patient, the role disclosure plays, accreditation expectations, and analyze the cost of continuous quality monitoring as it relates to quality.Surgical site infections account for 40 % of all hospital-acquired infections ( HAIs) and are unnecessary and largely preventable. Use of antibiotics is fundamental in preventing surgical site infection and includes three core elements: 1. appropriate selection, 2. timing of the first dose, 3. and discontinuation postoperatively. It used to be the standard practice to â€Å"shave and prep† a patient prior to surgery, but a study done in 1992 revealed that surgical site infectio ns were 50% lower in surgery patients whose hair was removed with clippers rather than a razor.One of the most common complaints from surgery patients is being cold in the holding area, operating room, and the post anesthesia care unit ( PACU) . This is uncomfortable and can increase risk of complications; such as surgical site infections. Glucose control is also important as a method for decreasing surgical site infections ( Frances, 2005). Guidelines for preventing surgical site infection are at the preoperative stage, intraoperative stage, and postoperative stage. They are as follows: 1. Preoperative stage: Patient preparation- Identify and treat all infections before surgery; postpone surgery if possible until infection is resolved. * Do not remove hair by the incision site unless it interferes with the operation; use electric clippers immediately before surgery if hair must be removed. * Have patients bathe or shower with an antiseptic the day of the surgery or the night before . * Thoroughly wash and clean at and around the incision site to remove gross contamination. * Keep hospital stays as short as possible to limit the patient’s exposure to nosocomial infections.Antimicrobial prophylaxis- * Work with the physician, pharmacist, and administer a prophylactic antibiotic only if it is indicated; antibiotic chosen should be effective against common pathogens that cause surgical site infections. * I. V. administration of the antibiotic should be timed so it is concentrated when the incision is made. * Do not use Vancomycin for antimicrobial prophylaxis routinely. Surgical team preparation- * Keep fingernails short, no artificial nails; bacteria and fungi can colonize on your hands if you wear artificial nails. Surgical team members who have signs or symptoms of an infectious illness need to promptly report this to their manager and occupational health service personnel. * Surgical team members that have draining skin lesions should be relieved from d uty until infection has been ruled out, they have had therapy, or the infection is gone. * It is also suggested that no hand or arm jewelry be worn, as well as nail polish. 2. Intraoperative stage: Ventilation- * Maintain ventilation in the operating room and maintain a minimum of 15 air changes per hour. Keep the operating door closed as much as possible. * Limit the number of staff entering the operating room. Surfaces and equipment- * Clean surfaces or equipment with hospital disinfectant if they are soiled with blood or body fluids before the next operation. * Do not perform special cleaning or closing of operating room after contaminated or dirty operations. * Sterilize all surgical equipment according to guidelines. * Assemble sterile equipment and solutions just before using them. Surgical attire- * Before entering the operating room, a surgical mask and hood that covers he hair on the face or head must be worn. * Sterile surgical gloves must be worn, putting them on after a sterile gown. * Shoe covers are not necessary for preventing surgical site infections. Vascular access- * Adhere to the rules of asepsis when placing intravascular devices and administering I. V. drugs. 3. Postoperative stage: Incision care- * Use a sterile dressing for 24-48 hours on an incision after surgery. * Wash your hands before and after any contact with the surgical site, even when changing the dressing. Use a sterile technique when changing dressings. * Teach the patient and family about incision care, signs or symptoms of surgical site infection, and when to report any symptoms (Adams, 2001). Following these guidelines can effectively reduce or prevent surgical site infections. Although nothing is 100% full proof, surgical site infections can be reduced and prevented in most situations. If an infection is not present at the time of admission and becomes evident after 48 hours of hospitalization; it is considered to be hospital acquired.Following the above mentioned guidel ines indicates quality health care practices. By using these techniques, surgical site infections will be prevented and reduced resulting in quality care; benefiting both the patient and the hospital. A legal implication related to a patient developing a surgical site infection, results in more cost to the hospital, less profit, and leaves them open to possible lawsuits. Hospital acquired infections affect 1. 7 million hospitalizations, cost $ 8. 1 billion to treat, and lead to 2. 3 million total days of hospitalization.Infections are the fourth most expense in hospitals, costing $ 252,600 per hospital on average, and each afflicted patient requires $ 24,500 more in care on average as a result. Examples of lawsuits filed due to hospital infections are as follows: July 2008, couple awarded $ 2. 58 million after the patient contracted a deadly type of staph infection ( MRSA), resulting in the loss of a kidney, and an amputated leg and foot. November 2008, jury awarded $ 13. 5 million to a woman’s family after she died of an infection aused by flesh-eating bacteria; contracted during cancer treatment. And November 2008, a woman reached a confidential settlement of $ 16 million when a hospital failed to detect a flesh-eating bacteria, before and after she gave birth, resulting in the loss of three limbs and several organs ( Gaffey, 2010). According to the AMA’s code of ethics, it is a requirement that a physician should at all times deal honestly and openly with patients concerning medical errors. Several doctors cite the risk of litigation as grounds for caution when discussing medical errors.Practicing defensive medicine such as ordering more tests or consults has become the norm to avoid malpractice suits. 94% of physicians say they would inform a patient if a mistake was made that caused an injury. Concern regarding legal liability which might result from telling the truth should not affect a physician’s honesty with a patient according to the AMA’s Code of Medical Ethics, however some skeptics maintain that it is easier to brag about virtue, than actually follow it ( Rice,2002).For the most part physicians agree that honesty is the best policy. Many doctors in a survey confessed to errors such as; prescribing the wrong medications, wrong dosage, misinterpreting x-rays, misinterpreting lab reports, etc†¦ One physician stated that being upfront about his mistakes, talking to the family, and apologizing probably avoided a lawsuit. Most doctors agree that it is better to be upfront about a mistake for several reasons, they are: 1. That it always comes out eventually, 2. Dishonesty causes more damage and loses the public’s trust, 3.Honesty decreases the chance of being sued, as well as it is the right thing to do, and 4. They want their patients or family to hear it from them first ( Rice, 2002). Communicating with the patient or family, educating them on the procedure and signs or symptoms to look for can prevent surgical site infections. Being open and honest with the patient and their family when an error occurs can possibly help to avoid a lawsuit. Honesty is always the best policy when providing quality health care.In October 2008, CMS announced that it would no longer pay for hospital-acquired conditions. It is their view that if a hospital has a good standard of practice and multidisciplinary care guidelines that these events should not happen and can easily be prevented. This is not to penalize health care, but to improve the safety of patient care and improve the quality of care by establishing standards of care and protocols. The Joint Commission has also implemented similar reporting and nonpayment initiatives to improve safety and improve the quality of care ( Lisa, 2009).The Joint Commissions new national patient safety goal to prevent surgical site infections includes a requirement to look for surgical site infections for up to 30 days after a procedure. The Center for Disease Control ( CDC) estimates that between 12% and 84% of surgical site infections are found after patients are discharged from the hospital. Joint Commission surveyors will be looking to see if the following protocols are being followed: * Hospital educates health care workers involved in surgical procedures about healthcare –associated infections, surgical site infections, and the importance of prevention. Before all surgical procedures, the hospital educates patients/family about surgical site infection prevention. * Hospital implements policies and practices aimed at reducing surgical site infections. * Hospital conducts periodic risk assessments for surgical site infections. * Measurement strategies follow evidence-based guidelines and surgical site infections are measured for the first 30 days after surgery. * Hospital supplies surgical site infection rate data and prevention outcome to leaders, practitioners, nursing staff, and other clinicians. Antimicrobial ag ents for prophylaxis used for a particular procedure or disease are administered according to standards and guidelines. * Administer I. V. antimicrobial prophylaxis within one hour before incision. * Discontinue the prophylactic antimicrobial agent within 24 hours after surgery. * When hair removal is necessary, use clippers or depilatories ( Hospital Infection Control, 2008). Localized improvement occurs when a team is developed to look at a specific problem; such as the rate of surgical site infections. Organizational learning occurs when this process is ocumented and results in the development of policies that are implemented; such as a protocol for preventing surgical site infections. Process reengineering occurs when a major investment blends internal and external resources to make changes; such as being accredited by the Joint Commission and following their guidelines for prevention of surgical site infections. Evidence-based medicine involves the selection of the best clinica l practices; implementing surgical site infection control guidelines or protocol to reduce cost and increase profit (Sollecito & Johnson, 2013).The most effective strategies for improving health care quality are: clinician-directed audit and feedback, clinical decision support systems, specialty outreach programmes, continuing professional education based on interactive small-group case discussions, and patient-mediated clinician reminders. Pay-for-performance strategies directed to clinician groups and organizational process redesign are modestly effective ( Scott, 2009). In my opinion using the organizational learning strategy would generate the best outcome and cost the least to implement.Having a team put together to gather data on surgical site infections and implementing a protocol or guidelines to follow to prevent these events would result in less cost and increased profit. In conclusion, surgical site infections are for the most part preventable. Following protocols or guid elines can greatly reduce surgical site infections. Educating staff, patients, and their families, can have a big impact on preventing surgical site infections and implementing these strategies reduces cost and increases profit. References: Adams, A. 2001). Preventing surgical site infection ( SSI): Guidelines at a glance. Nursing Management, 32 (8), 46-46. Retrieved from http://search. proquest. com/docview/231438710? accountid= 32521. Frances, A. G. ( 2005). Best-practice protocol is: Preventing surgical site infection. Nursing Management, 36 (11), 20-26. Retrieved from http://search. proquest. com/docview/ 231393974? accountid=32521. Gaffey, A. D. RN, MSN, CPHRM, FASHRM. ( 2010). Legal Implications of Healthcare- Acquired Infections. Retrieved from http://www. ahe. rg/ahe/conference/2010/content /092910/a. Lisa, M. S. ( 2009). Compliance with CMS â€Å" never events† billing requirements. Journal of Health Care Compliance, 11 (5), 33-36. Retrieved from http://search. proqu est. com/ docview/227916352? accountid=32521. Rice, B. (2002). Medical errors: Is honesty ever optional? Medical Economics, 79 ( 19), 63-72. Retrieved from http://search. proquest. com/docview/227734141? accountid=32521. Scott, I. (2009). What are the most effective strategies for improving quality and safety of healthcare?Internal Medicine Journal, 39 (6), 389-400. Doi:http://dx. doi. org/ 10. 1111/j. 1445-5994. 2008. 01798. x. Sollecito, W. A. & Johnson, J. K. (2013). Continuous quality improvement in health Care (4th ed). Sudbury, MA: Jones and Bartlett Publishers. ISBN: 9780763781545. The joint commission update for infection control: SSI goal: Look for infections a month after procedure. (2008). Hospital Infection Control, Retrieved from http://search. Proquest. com/docview/758852362? accountid=32521.

Alternative Dispute Resolution (ADR) Mediation Is a Form of Negotiation

A Learning Team Charter is a necessary element in managing a successful team. An effective team that aims to accomplish manageable results needs goals, communication, and conflict management. What the team will go through is a process in management and here is where the team charter will show its value. Without a team charter, the team process will at the end of the day falter and fail. The major components of the charter needed to ensure team success includes team goals, system of communication, and most important, a system of settling differences or conflict management. To handle disputes a clause called the â€Å"alternative dispute resolution† (ADR). ADR includes processes and techniques that act as a means for disagreeing parties to come to an agreement. Despite historic resistance to ADR, it has gained widespread acceptance among both the general public and the legal profession in recent years. The most common form of ADR is arbitration. Other forms of ADR are negotiation, mediation, conciliation, mini-trial, fact-finding, and using a judicial referee (Cheesman, 2010). The most effective method that will suit the needs of our learning team is the mediation method. If an agreement cannot be reached during the mediation process, then the arbitration method will be utilized. Mediation is a form of negotiation in which a neutral third party assists the disputing parties in reaching a settlement of their dispute. The neutral third party is called a mediator (Cheesman, 2010). Within a team environment the mediator would be the team members not involved in the dispute. If an agreement cannot be reached during the mediation process, then the arbitration method will be used. In arbitration, the parties choose an impartial third party to hear and decide the dispute. This neutral party is called the arbitrator. The arbitrator in a team charter environment would be the professor of our class. The arbitration process will only be used as a last resort and the professor’s decision cannot be disputed. In most cases there are no disputes that occur in a team environment because all members want to work together to accomplish a common goal which in a classroom situation means getting the best team grade possible. In the rare event that a dispute arises, the ADR process is fast becoming the process of choice in settling disputes.

The Netflix Financial Statement Essay Example | Topics and Well Written Essays - 1000 words

The Netflix Financial Statement - Essay Example Netflix needs to develop some new business strategies in order to survive in this rapidly changing movie industry. The firm can emerge as a reputable provider of DVDs by maintaining its brand identity and differentiating itself from its competitors present in the market. Meanwhile, the streaming service of Netflix can be considered as a complementary service to the firm’s DVDs rental business in the coming years. Although the movie watching market or the video market is mature the streaming market has not yet fully emerged. This means that Netflix cannot just rely on its strategies of the past but must try developing a hybrid strategy that will help in addressing the future market demands and customer’s expectations. An emerging market offers new companies an easy entry pass. Therefore Netflix must make sure that all of its strategies should be focused on the new and emerging market practices. The differentiation strategy is where the company concentrates all of its efforts in developing a single product and then incorporating unique and different attributes for meeting the needs and addressing the demands of its customers. When a firm adds value and uniqueness to their products for attracting customer, it is likely that the customer will be willing to pay the much higher price for such products and services. Same is the case with Netflix. The firm entered the online business and targeted the online renting of DVDs. This strategy can be achieved by Netflix by using the recently developed or the upcoming marketing technologies which have not been yet incorporated by other companies in their business. Netflix introduced an integrated search engine in its newly launched website enabling the customers to search and access the products of their choice. The management of Netflix must reflect ingenuity and talent while marketing their products by employing the already establishe d and available supply chain technology and infrastructure.

The Effectiveness of Training Care Home Staff on Management of Literature review

The Effectiveness of Training Care Home Staff on Management of Challenging Behaviour of Person with Dementia - Literature review Example As far as dementia is concerned, a recent study revealed that one of the best ways to equip nurses and other health professional with the basic skills and knowledge to carry out their duties effectively is by giving them training and education on how to give innovative and result oriented care to handle some of the most disturbing behaviors from dementia patients (Smithers et al, 2007). This section of the dissertation therefore reviews related literature that touches on some of the key innovative ways of addressing challenging behaviour through training in three major areas as reviewed below. 2.1 Non-Pharmacological Approaches to Managing Dementia 2.1.1 Psychosocial intervention for managing dementia Recent studies have actually pointed to the realisation that training in the use of psychosocial intervention for managing dementia is an effective way of handing challenging behaviour in dementia patients (Cohen-Mansfield, Libin & Marx, 2007). The singular reason for the effectiveness of the psychosocial intervention is in the fact that it is multi-active and thus makes use of several approaches that addresses multi-complexity issues about the patient. For instance as part of the psychosocial intervention, social, individual as well as environmental factors of the causes of the challenging behaviour may all be catered for in one pile (Davison, et al, 2007). In a very modern perspective, this intervention could be judged as highly viable because dementia as a cognitive problem does not associate its cause to just one risk factor. This means that the kind of interventions that are prescribed for its solutions must also well be varying in nature like psychosocial interventions. Indeed, practitioners who receive training and education in psychosocial intervention in managing dementia would come to the realisation that their patients are as much relevant in the solution as the caregivers themselves. This way, the practitioners would not see patients who put up challen ging behaviour as elements of problems that must be avoided but rather as companions for a common goal who should be aided to come to terms with how best they can play their part in the solution. 2.1.2 Individualized interventions for patients Even though most commentators have rooted for the use of standardised interventions for handling problematic patients who exhibit challenging behaviour as part of the dementia symptoms, there continues to be some modern researchers who believe interventions for catering for problematic dementia patients should be individualised (O'Connor et al, 2009). By individualised interventions, reference is being made to that kind of approach that sees each patient among the lot as a distinguishably different person who demands personalised approach to his or her problems (McCabe, Davison & George, 2007). Relating to this training and education for caregivers, it is said that the trainee should first and foremost possess an attitude that recognises the p eculiarity of each person and must have a very huge heart to accommodate all such differences. This means that the trainee ought to adapt him or herself in such a way that he or she would use a kind of communication that meets the understanding of the patient. There should also be practical management strategies that focus on the needs of the patient. Finally, it is important to recognise the need to have enough patience for patients to recover at their own rate. The later is indeed a major

Leprosy Research Paper Example | Topics and Well Written Essays - 750 words

Leprosy - Research Paper Example Various studies indicate that most patients attain nerve damage at diagnosis, which rates from 20 % in Bangladesh to 56 %in Ethiopia. These patients suffering from nerve damages have a high risk of developing disability if there lacks proper treatment (Lockwood, 1516). Doerr adds that failure of treating leprosy can lead to permanent harm of various body parts leading to overwhelming disfigurement and consequent disability (1). Mycobacterium leprae is a rod-shaped bacterium that is responsible for causing leprosy. G.A. Hansen discovered the bacterium in the year1873. Since this bacterium multiplies slowly, signs and symptoms of this disease may not develop and most people may not recognize them until much later after exposure to M. leprae. This may take place from several weeks after infection to 30 years or more. Even though humans are the chief host for infection with M. leprae, other animals such as mangabey monkeys, armadillos and chimpanzees also acts as hosts for infection. Though the precise route of transmission is still a mystery, most experts deem that transmission of leprosy occur through droplets from the nose and mouth during close protracted contact with an infected person (Doerr, 2). In about 80 nations of Africa, Latin America and Asia, prevalence of Leprosy occurs significantly. In a year, almost 600 000 new cases occur and almost 2400 million people live in nations with occurrence of leprosy of greater than 1 per10 000. In addition, between two and tree million people suffering from leprosy have physical disabilities. Within most nations, leprosy is unequally distributed. This means that some countries have a higher number of patients suffering from leprosy while others do not have even a single patient. In this case, twenty-five nations contribute to 92% while five countries contribute to 80% of the international burden (Noordeen,

Ineffective website design of the Suicide Prevention and Crisis Essay

Ineffective website design of the Suicide Prevention and Crisis Services of Yolo County - Essay Example The visitor cannot understand which sentences define the title or subtitles in the page. There are no images placed suitably with respect to the body of the text, which would leave the visitor wondering about the website’s owner as a whole. This is not only a lack of visual attractiveness but also a stark usability issue. A website designer must understand that visual aesthetics are related to usability rather than pompous presentation of the product. Websites that have good color balance, pictures and videos are more usable than â€Å"websites with unbalanced and poorly selected color schemes.†(2) Even if color schemes or quality of text are regarded as secondary issues, a modern website must be provided with useful pictures. As far as videos are concerned, community services must be based on credibility. Video links depicting the activities of the owner of the website provide increased credibility and understandability simultaneously (3). Disregard for these factors in the design of the website in question has led to serious compromise on quality as well as usability. With regard to the specific context of the website, there appears to be no significant content-related problems even after a careful scrutiny. The website has a number of links that helps the visitor to find various sorts of information to fulfill different purposes. So first of all, these basic qualities must be maintained if the website has to be redesigned as a whole. The owner of the website is socially active and it wants to make people aware of the negative effects of suicide ideation. Therefore, the community activities (e.g. a counseling session) of the organization can be photographed. Next, these photographs must be embedded in the webpage so that the visitor can understand the organization’s activities more clearly. With the help of social networking sites like Facebook, video sharing facilities can be provided to the

Management and the Cultural Industries Essay Example | Topics and Well Written Essays - 1500 words

Management and the Cultural Industries - Essay Example Music industry has as well attracted many followers and new artists are coming up every now and then hoping to make a living out of it. Features of music industry Diversity Music is one industry that has attracted people from all walks of life. No one is taken to be an alien in music since it incorporates all and inspires all regardless of gender, race, tribe or even age. It is so diverse that anyone can choose what they want to listen to (Abraham, 1974, p.292). It is not limited to only one theme but is diversified to accommodate all people so that everyone feels accommodated in this industry. Use of rhythms Any song produced is characterised by a certain way of presenting the lyrics to the audience. This way matters a lot since some musicians may sing off key and thus their music may not sell much. It is the organization of the beats and singing in a rhythmical way that makes all the difference. One can’t just present a song in any way and expect to change the audience. One rule should be: ‘present with audience in mind’. Practical Music is so applicable in our day to day lives and affects the way we lead our lives day in day out. One can identify with a certain song and be positively influenced maybe to stop a certain bad habit. Music is not a past tense event but one we live with thus assists in making our lives better if well applied where possible. Variety of compositional structures Music has several structures of composition since it could be solo or choir depending on the preference of the artist. Passages of homophonic chords could also be applied to make it livelier. This is could have a harmonic accompaniment which could be applied at the introduction, dynamic build up, and others at the climax (Dahlhaus, 1991, p.260). Reality of work in music cultural industry Music industry has grown pretty fast in this century as compared to how it was few decades ago. Much improvement has been made to ensure that this industry competes well w ith other industries. Players have been sensitised on how to ensure that their music is marketable and can reach many people and help them in various issues of life other than entertaining them. Players ought to concentrate very well to make sure that they are not carried away by fame and forget that music is self-employment and earns a living to them who take with the seriousness it deserves. Taking music as work is one character that will greatly assist the artists and make them realise that it needs to be taken seriously. It calls for one to work very hard and avoid many interruptions to concentrate with it. It could even land one to other side jobs such as master of ceremony in other events if taken seriously and accorded maximum concentration and dedication. In normal business life, working with dedication is suicidal to one’s business as well as life. It is imperative that business people learn to work hard just as music industry players do. Thus, a business person and one who works in the music industry get connected in that both have to work hard to their level best to ensure that they get maximum