Include education as part of infection control methods
Knowledge of signs and symptoms for early detection
To prevent infection following surgery, proper education is important and hand washing needs to be at the top of the list.
Improper hand washing is the No. 1 way infections are spread, says Sharon B. Hampton, MSN, RN, CAPA, PC, nurse manager for the ACB post-anesthesia care unit, pre-op holding unit, short-stay unit, and IR recovery unit at the University of Texas MD Anderson Cancer Center in Houston.
She adds that patients are taught to sing the birthday song while they wash their hands to make sure they have scrubbed for the proper amount of time before changing a dressing or doing anything with their catheter.
Also important is to teach the early signs of infection; this would include redness, pain or increased drainage from the site or warmth around the wound. Some patients think an elevated temperature is a sign of infection, but often there are other symptoms that might occur before a patient's temperature reaches 101 degrees that should trigger a phone call to the physician.
Patients need to know the early signs of infection so they can receive antibiotics if necessary, says Hampton.
When instructions are not followed correctly, it is usually because patients didn't clearly understand them, says Hampton. For example, they may not have heard the instructions, "Change the dressing every three days," she explains.
To remedy this, a family member or responsible adult who will help the patient with his or her care is asked to come to the bedside during discharge instructions. The patient and caregiver both verbalize the instructions including the signs and symptoms of infection.
Hampton says most patients in the areas she supervises are having outpatient surgery, but those who are hospitalized overnight are shown a video on dressing changes.
Interpreters are used to help families understand the instructions when English is not their primary language.
Education is important for there are many reasons for infection at the site of surgery. Co-morbidities such as diabetes, obesity, pour wound healing conditions such as low blood protein, surgical technique, skin preparation, and surgical volume can all contribute to surgical site infections, says Hampton. In addition, surgeries that last longer than three hours put a patient at greater risk as well as having drains or a weakened immune system.
In addition to patient education, several protocols have been set in place at MD Anderson Cancer Center to improve infection control. Patients who have certain health problems such as a history of diabetes or a body mass index greater than 35 have their blood sugar checked and are treated when it is high to keep it within normal limits.
Also, certain types of surgery trigger an antibiotic protocol. Patients receive the antibiotic as they are wheeled into the operating room.
"Depending on the surgery, there are certain types of antibiotics that are more effective on whatever the bacteria is that is common to that procedure," explains Hampton.
In addition, housekeeping washes the stretchers once or twice a week during evening hours. Of course, in between patients, they are wiped down with a germicidal disposable wipe.
After a patient is discharged, he or she receives a follow-up phone call as a final precaution. During the conversation, patients are asked if they have any issues with the incision, which provides an opportunity to tell the nurse about drainage or redness. They are also asked if they have any questions about the discharge instructions.
"We check on them all to make sure everything is OK and so that they can express their concerns," says Hampton.
SOURCE
For more information about infection control education and methods, contact:
- Sharon B. Hampton, MSN, RN, CAPA, PC, nurse manager: ACB post-anesthesia care unit, pre-op holding unit, short-stay unit & IR recovery unit, University of Texas MD Anderson Cancer Center-Box 1244, Room ACB 4.2537, Houston, TX 77030. Phone: (713) 563-6598. E-mail: [email protected].
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