Question 1.1 Define Surgical Site Infection

Answer

Surgical site infection (SSI) is a serious condition that occurs when bacteria enter the surgical field. This intervention interferes with the healing process, causing symptoms ranging from mild pain and discomfort to serious problems that require advanced treatment. These diseases can be classified according to their depth, from superficial (only the skin and subcutaneous tissue) to deep (affecting the muscles and the space between the body) (Smyth & Emmerson, 2000). Criteria for diagnosing SSI usually include the presence of discharge, isolation of the organism from fluid or tissue culture, signs of infection (such as pain, tenderness, local soreness, redness, or warmth), and the surgeon opens the wound. Early recognition of these symptoms is important for the management and treatment of SSI (Young & Khadaroo, 2014).

Question 1.2 Identify & Assess risks of developing a Surgical Site Infection

Answer

An individual’s risk of developing SSI is multifactorial and these are both internal and external functions (van Walraven & Musselman, 2013). Internal factors; (Extrinsic factors include characteristics) patient-specific variables such as general health status, diseases such as diabetes (which affects blood flow and immunity, leading to wound healing), smoking history (affecting oxygen delivery to tissues), and obesity Duration of surgical procedures, duration of surgery and sterility of the surgical site. It is associated with a higher risk of infection (Stanic et al., 2017). Preoperative evaluation focusing on these risk factors is important to reduce the likelihood of SSI

Question 1.3 Identify factors which affect surgical wound healing.

Answer

It is important to thoroughly investigate the factors affecting the patient’s surgical wound healing, protein, vitamin C and zinc deficiency slows healing (Berger et al., 2013). Poor blood sugar control in diabetic patients can lead to decreased neutrophil function, decreased tissue oxygenation, and impaired perfusion, all of which contribute to the body’s immune system, disease, and tissue regeneration. The specific location of the wound in an area affects treatment; Wounds in areas with good blood flow heal better due to better oxygenation and nutrients. Just as the presence of a foreign body can become a factor in infection, the type of tissue involved (such as muscle and fatty tissue) also plays a role (Amri et al., 2017).

Question 1.4 Explain the pathogenesis of the infection.

Answer

Bacterial colonization at the surgical site is a hallmark of surgical site infections (SSIs), which develop when the epidermis, the body’s first line of defense, becomes compromised (Tuomanen et al., 1995). Rapid viral replication is possible after the virus has entered the body, particularly in immunocompromised individuals or after blood transfusions. Symptoms of inflammation, redness, heat, swelling, and pain are brought on by the increased blood flow to the region, which the immune system uses to combat infection. An infection might worsen, develop an abscess, or spread to deeper tissues if the immune system is unable to manage the virus (Burrell et al., 2017). The health of patients must be prioritized. This involves doing things like changing one’s diet, stopping smoking, and managing chronic conditions. During surgery, it is crucial to avoid the movement of microbes by using clean tools, practicing good hand hygiene, and erecting barriers. One possible strategy to lower the SSI incidence is to follow evidence-based recommendations for the prophylactic use of antibiotics before surgery. Important measures for wound care following surgery include keeping the wound clean and protected, keeping a close eye out for symptoms of infection, and teaching the patient how to properly care for their wound. Reducing the incidence of SSI may be achieved by an integrated strategy that uses various evidence-based therapies concurrently.

Question 1.5 Classify & Identify measures to reduce the incidence of Surgical Site Infections.

Answer

There has to be a concerted effort both before and after surgery to reduce the likelihood of surgical site infections (SSIs). Improving the patient’s nutritional status, stopping smoking, and managing any chronic conditions should be prioritized before to surgery in order to optimize the patient’s health (Wilson et al., 2009). Thoroughly washing hands, sterilising instruments, and using barriers to prevent the transmission of germs are important measures to take before, during, and after surgery. Adherence to evidence-based practices for the pre-incisional administration of antibiotics may significantly lower SSI rates. Patient education on wound care procedures, close observation of the site for early signs of infection, and maintenance of a clean and protected wound environment are essential postoperative measures (Owens & Stoessel, 2008). A bundle approach, which comprises integrating many medications with evidence-based backing, has the potential to significantly reduce the prevalence of SSIs.

Part 2

Question 2.1 Define Sepsis

Answer

Sepsis is essentially an overactive immune system. The purpose of the immune system is not only to fight disease, but also to prevent damage to the body’s tissues and diseases (Levy et al., 2018). These inflammatory diseases cause changes in the body that affect the functioning of important organs. Sepsis is characterized by the ability to progress from control of infection to severe disease leading to multiple organ failure (MODS), where failure of more than one organ results in the patient’s life. Understanding sepsis must recognize that it is an emergency requiring immediate treatment and that time is critical for intervention to reverse the death of sepsis (Rhodes et al., 2017).

Question 2.2 Discuss the progression of Sepsis

Answer

Progress from direct infection to sepsis, severe disease and finally septic shock where the body and the body are unable to function. Initially, the body responds to the infection with local symptoms such as redness, swelling, and fever (Levy et al., 2018). However, when infection occurs, diagnostic criteria for sepsis include high heart rate, fever, increased breathing, and suspicion of infection. As pain worsens, symptoms of organ failure such as hypoxemia, oliguria, lactic acidosis, or brain changes may occur, indicating that the body is experiencing an edema process. Septic shock is the most serious condition caused by persistent high blood pressure despite fluid therapy and its negative effects on the body. This development highlights the dangers of sepsis and the need for urgent intervention to prevent fatal outcomes (Whiles et al., 2017).

Question 2.3 Identify investigations to confirm Sepsis

Answer

Various tests should be performed to confirm the diagnosis of sepsis and guide its treatment. Blood cultures are important because identifying the source of infection allows antibiotic treatment. A complete blood count may show leukocytosis or leukopenia, both of which indicate an immune system attack (Stassi et al., 2020). Lactate levels are an important indicator of tissue perfusion and sepsis severity; A high level indicates that the situation is not good. Procalcitonin levels may help differentiate sepsis from other inflammatory diseases because it tends to increase inflammation. Blood tests can provide insight into a patient’s respiratory and metabolic status, including the presence of acidosis, a common complication of chronic diseases. Research shows that the location of the infection can identify abscesses, the location of the infection, or complications of sepsis. Together, these studies provide general guidelines for diagnosing sepsis, assessing its severity, and planning effective treatment (Inai et al., 2023).

Question 2.4 briefly explain the Sepsis

Answer

There is strong evidence that following the Sepsis Six, a brief procedure that summarizes the first key stages in sepsis management, improves patient outcomes (Robson & Daniels, 2008).

1- Because severe sepsis is characterized by a hypoxic condition, it is important to ensure that critical tissues get enough oxygen by administering high-flow oxygen.

2- In order to determine which antibiotics will be most effective in treating sepsis, it is essential to collect blood cultures as soon as possible before giving any medication.

3- Prior to culture results becoming available, it is essential to administer broad-spectrum antibiotics since they target a large variety of possible bacteria.

4- The consequences of sepsis-induced vasodilation and capillary leak are countered by intravenous fluids, which assist restore appropriate blood pressure and organ perfusion.

5- The severity of sepsis and tissue hypo perfusion may be assessed by measuring lactate levels, which in turn guide resuscitation attempts.

6- Finally, one of the most important ways to gauge kidney function and the success of fluid resuscitation is to keep an eye on urine output. Stabilizing the patient, reducing the severity of sepsis, and preventing septic shock are the goals of this coordinated treatment to sepsis (Burke et al., 2018).

Part 3

Question 3.1 Define an Antibiotic. Example how you would administer Vancomycin / diluents / rate / side effects etc. and also explain the use of PAM Charts (Prescribing, administering, monitoring)

Answer

Antibiotics are important in modern medicine and form the basis of the treatment of diseases. They use many techniques to kill bacteria or inhibit their ability to grow and multiply. Vancomycin is a powerful antibiotic used to treat serious infections caused by Gram-positive bacteria, including those that are resistant to other antibiotics (such as MRSA).

The fact that Vancomycin application is a rapid process shows the importance of the treatment. Dosage depends on the patient’s weight and kidney function; For adults, usually start with 15-20 mg/kg every 8-12 hours. However, to prevent allergy, blood sugar needs to be carefully monitored with a target of 10-20 µg/ml depending on the type of infection (Lazar et al., 2014).

Diluting Vancomycin for vascular control is important to prevent complications (Scarano et al., 2022). To reduce the risk of infusion-related reactions, the drug should be diluted in a solution such as 0.9% saline or 5% dextrose in 100-250 ml of water and infused for at least one hour. Side effects are a major concern with Vancomycin and include nephrotoxicity, ototoxicity, histamine-induced flushing, and “red man syndrome,” which can be alleviated by reducing infusion.

The efficacy and safety of Vancomycin are greatly influenced by the PAM diagram. They help physicians choose the correct prescription for patients, how much to give them, and how to track their reaction to it. In order to make sure the therapy is safe and successful, it is necessary to monitor side effects, change the dosage in the blood, and check kidney function (Landes et al., 2008).

Question 3.2 briefly explain The Principles of Antibiotic Stewardship

Answer

The goal of antimicrobial stewardship is to reduce and optimize antibiotic use in healthcare settings. Selecting an appropriate antibiotic and administering it at the appropriate time are cornerstones of treatment (Pickens & Wunderink, 2019). The goals of antibiotic stewardship programs include better drug discovery and use, lessening the likelihood of resistance, lessening morbidity, and improving patient outcomes.

Epidemiologists, pharmacists, microbiologists, and nurses must work together as a cohesive team for management to be effective. Methods include teaching medical professionals about the link between pesticide usage and poverty, revising recommendations, outlawing some pesticides to curb abuse, and doing away with cultural solutions (Akinboyo & Gerber, 2020). Achieving efficient disease treatment while safeguarding antibiotic purity for generations to come is the ultimate objective.

Question 3.3 briefly explain Antimicrobial Resistance.

Answer

One of the most pressing health issues in the modern era is antimicrobial resistance (AMR). This happens when microorganisms like bacteria and viruses evolve to the point that they no longer respond to treatment, which stops the body from getting well and the sickness keeps coming back. Inadequate protection and management, together with the abuse and misuse of pesticides by people, animals, and even plants, accelerates this resistance even further (Lipsitch & Samore, 2002).

Increased medical expenses, longer hospital stays, and greater death rates are among the major adverse consequences of antibiotics. New medications, vaccinations, and diagnostic technologies; improved healthcare and antibiotics; and public education and health awareness about antibiotic avoidance and use are all necessary components of a holistic response to the immune system’s complexity (Holmes et al., 2016).

Part 4

Question 4.1 Describe and discuss measures to decrease the risk from this occurring again to a different patient. Include terms such as decontamination, cleaning, enhanced cleaning, and disinfection by chemical and/or physical means.

Answer

A number of interventions may be implemented to reduce the likelihood that another patient would have a similar episode. Chemical and physical methods are used in these operations with the goals of decontamination, cleaning, improved cleaning, and disinfection. Here is an argument that delves deeper:

Methods for Decontamination:

Methods for decontamination are an important part of lowering the risk of infection transmission to patients. If we want to make sure that no other patient has to go through what this one did, we need to implement effective decontamination procedures:

It is critical to establish detailed standards for decontamination that include the procedures needed to ensure that all surfaces and medical equipment in patient care areas have been cleaned thoroughly. Included in these standards should be specifications for the right decontamination processes and chemicals (Zhong et al., 2021).

Establishing a regular decontamination schedule It is critical to establish a regular routine for decontaminating high-touch surfaces and equipment. Products such as doorknobs, bedside tables, and medical equipment are all examples of goods that are covered in this category of products. The risk of patients contracting and transmitting diseases from one another may be reduced via the regular practice of decontamination (Albert et al., 2021).

Cleaning

Cleaning process is an essential step that must be carried out before disinfection can take place. This is because cleaning helps remove visible dirt, debris, and organic matter from surfaces. Disinfection is more likely to be effective when it is carried out properly, and when it is carried out correctly, the risk of infections that are connected with healthcare is reduced. The following is a list of some of the possible actions that may be taken to improve cleaning policies and procedures:

Enhanced Cleaning Protocols include development and implement enhanced cleaning protocols with the main objective of completely cleaning all surfaces by using the appropriate cleaning products and procedures. Put these protocols into action (Martelli et al., 2017).

Training & Education means to educate healthcare workers on the right cleaning procedures and provide them with detailed education about these approaches. Ensure that the staff is aware of the necessity of careful cleaning and sticking to the processes that have been established. This is something that you should make sure they are aware of.

Enhanced cleaning

Enhanced Cleaning is a form of cleaning that goes beyond the scope of ordinary operations and especially targets areas that are more likely to be polluted. The phrase “Enhanced Cleaning” refers to this kind of cleaning process. Any number of things may be done to make cleaning more efficient, including:

Pay close attention to locations that pose a significant danger. It is important to prioritize extra cleaning of high-risk locations, such as patient rooms, restrooms, and communal spaces.

Specialized cleaning techniques, including the vaporization of hydrogen peroxide or the disinfection of ultraviolet (UV) radiation, should be considered as an addition to the standard cleaning procedures (Rosenberger et al., 2011).

Disinfection by Chemical & Physical means

Disinfection is the practice of using physical or chemical treatments to kill or incapacitate bacteria on surfaces and equipment. In order to get the outcomes you want, you have to do this. Effective disinfection measures, as will be explained in the following paragraphs, are crucial for reducing the likelihood of disease transmission.  While shopping for disinfectants, it’s important to choose products that kill a wide variety of germs and won’t harm the surfaces and tools used in healthcare settings (De Sanctis et al., 2016).

It is crucial that healthcare workers acquire proper training in efficient disinfection procedures to guarantee that they are able to care for patients effectively. This skill set include the ability to properly dilute disinfectants, apply them, and determine contact periods.  Implementing methods to ensure disinfection processes’ effectiveness is only one way to verify disinfection procedures’ efficiency. One other way to determine if disinfection worked is to test surfaces for microbes afterward.

References

1. Amri, R. et al. (2017) ‘Risk stratification for surgical site infections in colon cancer’, JAMA Surgery, 152(7), p. 686. doi:10.1001/jamasurg.2017.0505.
2. Akinboyo, I.C. and Gerber, J.S. (2020) ‘Principles, policy and practice of antibiotic stewardship’, Seminars in Perinatology, 44(8), p. 151324. doi:10.1016/j.semperi.2020.151324.
3. Albert, T. et al. (2021) ‘Physical methods for the decontamination of meat surfaces’, Current Clinical Microbiology Reports, 8(2), pp. 9–20. doi:10.1007/s40588-021-00156-w.
4. Berger, R.L. et al. (2013) ‘Development and validation of a risk-stratification score for surgical site occurrence and surgical site infection after open ventral hernia repair’, Journal of the American College of Surgeons, 217(6), pp. 974–982. doi:10.1016/j.jamcollsurg.2013.08.003.
5. Burke, J. et al. (2018) ‘Improving outcome of sepsis on the ward: Introducing the “sepsis Six” bundle’, Nursing in Critical Care, 24(1), pp. 33–39. doi:10.1111/nicc.12358.
6. Burrell, C.J., Howard, C.R. and Murphy, F.A. (2017a) ‘Pathogenesis of virus infections’, Fenner and White’s Medical Virology, pp. 77–104. doi:10.1016/b978-0-12-375156-0.00007-2.
7. Burrell, C.J., Howard, C.R. and Murphy, F.A. (2017b) ‘Pathogenesis of virus infections’, Fenner and White’s Medical Virology, pp. 77–104. doi:10.1016/b978-0-12-375156-0.00007-2.
8. De Sanctis, M. et al. (2016) ‘Integration of an innovative biological treatment with physical or chemical disinfection for wastewater reuse’, Science of The Total Environment, 543, pp. 206–213. doi:10.1016/j.scitotenv.2015.11.006.
9. Delano, M.J. and Ward, P.A. (2016) ‘The immune system’s role in sepsis progression, resolution, and long‐term outcome’, Immunological Reviews, 274(1), pp. 330–353. doi:10.1111/imr.12499.
10. Holmes, A.H. et al. (2016) ‘Understanding the mechanisms and drivers of antimicrobial resistance’, The Lancet, 387(10014), pp. 176–187. doi:10.1016/s0140-6736(15)00473-0.
11. Inai, K. et al. (2023) ‘Exploration of sepsis assisting parameters in hospital autopsied-patients: A prospective study’, Scientific Reports, 13(1). doi:10.1038/s41598-023-37752-3.
12. Landes, G. et al. (2008) ‘Prevention of surgical site infection and appropriateness of antibiotic prescribing habits in plastic surgery’, Journal of Plastic, Reconstructive & Aesthetic Surgery, 61(11), pp. 1347–1356. doi:10.1016/j.bjps.2008.02.008.
13. Lazar, H.L. et al. (2014) ‘Topical vancomycin in combination with perioperative antibiotics and tight glycemic control helps to eliminate sternal wound infections’, The Journal of Thoracic and Cardiovascular Surgery, 148(3), pp. 1035–1040. doi:10.1016/j.jtcvs.2014.06.045.
14. Levy, M.M., Evans, L.E. and Rhodes, A. (2018) ‘The surviving sepsis campaign bundle: 2018 update’, Intensive Care Medicine, 44(6), pp. 925–928. doi:10.1007/s00134-018-5085-0.
15. Lipsitch, M. and Samore, M.H. (2002) ‘Antimicrobial use and antimicrobial resistance: A population perspective’, Emerging Infectious Diseases, 8(4), pp. 347–354. doi:10.3201/eid0804.010312.
16. Martelli, F. et al. (2017) ‘Evaluation of an enhanced cleaning and disinfection protocol in salmonella contaminated pig holdings in the United Kingdom’, PLOS ONE, 12(6). doi:10.1371/journal.pone.0178897.
17. Owens, C.D. and Stoessel, K. (2008) ‘Surgical site infections: Epidemiology, Microbiology and Prevention’, Journal of Hospital Infection, 70, pp. 3–10. doi:10.1016/s0195-6701(08)60017-1.
18. Pickens, C.I. and Wunderink, R.G. (2019) ‘Principles and practice of antibiotic stewardship in the ICU’, Chest, 156(1), pp. 163–171. doi:10.1016/j.chest.2019.01.013.
19. Rhodes, A. et al. (2017) ‘Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016’, Intensive Care Medicine, 43(3), pp. 304–377. doi:10.1007/s00134-017-4683-6.
20. Robson, W.P. and Daniels, R. (2008) ‘The sepsis Six: Helping patients to survive sepsis’, British Journal of Nursing, 17(1), pp. 16–21. doi:10.12968/bjon.2008.17.1.28055.
21. Rosenberger, S. et al. (2011) ‘Principles of an enhanced MBR-process with mechanical cleaning’, Water Science and Technology, 64(10), pp. 1951–1958. doi:10.2166/wst.2011.765.
22. Scarano, M. et al. (2022) ‘Risk of thrombophlebitis associated with continuous peripheral infusion of vancomycin: The effect of dilution’, The Journal of Vascular Access, 25(1), pp. 107–112. doi:10.1177/11297298221095778.
23. Smyth, E.T.M. and Emmerson, A.M. (2000) ‘Surgical site infection surveillance’, Journal of Hospital Infection, 45(3), pp. 173–184. doi:10.1053/jhin.2000.0736.
24. Stanic, S. et al. (2017) ‘Examination of risk factors for the development of surgical site infections’, Materia Socio Medica, 29(2), p. 134. doi:10.5455/msm.2017.29.134-137.
25. Stassi, C. et al. (2020) ‘Post-mortem investigations for the diagnosis of sepsis: A review of literature’, Diagnostics, 10(10), p. 849. doi:10.3390/diagnostics10100849.
26. Tuomanen, E.I., Austrian, R. and Masure, H.R. (1995) ‘Pathogenesis of pneumococcal infection’, New England Journal of Medicine, 332(19), pp. 1280–1284. doi:10.1056/nejm199505113321907.
27. van Walraven, C. and Musselman, R. (2013) ‘The surgical site infection risk score (SSIRS): A model to predict the risk of surgical site infections’, PLoS ONE, 8(6). doi:10.1371/journal.pone.0067167.
28. Whiles, B.B., Deis, A.S. and Simpson, S.Q. (2017) ‘Increased time to initial antimicrobial administration is associated with progression to septic shock in severe sepsis patients’, Critical Care Medicine, 45(4), pp. 623–629. doi:10.1097/ccm.0000000000002262.
29. Wilson, J., Burman-Roy, S. and Leaper, D. (2009) ‘Preventing and managing surgical site infections’, British Journal of Hospital Medicine, 70(4), pp. 184–185. doi:10.12968/hmed.2009.70.4.41617.
30. Young, P.Y. and Khadaroo, R.G. (2014) ‘Surgical site infections’, Surgical Clinics of North America, 94(6), pp. 1245–1264. doi:10.1016/j.suc.2014.08.008.
31. Zhong, L. et al. (2021) ‘Existing and potential decontamination methods for radioactively contaminated metals-a review’, Progress in Nuclear Energy, 139, p. 103854. doi:10.1016/j.pnucene.2021.103854.