Include patient education as part of infection control
Info on symptoms allows 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 nosocomial infections are spread, says Sharon B. Hampton, MSN, RN, CAPA, patient care nurse manager for the ambulatory care unit, post-anesthesia care unit, pre-op holding unit, short-stay unit, and interventional radiology recovery unit at the University of Texas MD Anderson Cancer Center in Houston. Most patients in the areas Hampton supervises are having outpatient surgery.
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, Hampton says.
Also important is to teach the early signs of infection, including 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°F 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 usually is 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 problem, 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 verbalize the instructions including the signs and symptoms of infection.
Interpreters are used to help families understand the instructions when English is not their primary language. Some facilities print instructions in other languages.
Education is important because there are many reasons for infection at the site of surgery. Diabetes, obesity, surgical technique, skin preparation, surgical volume, and poor wound healing conditions such as low blood protein all can 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 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. 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 also are 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, Patient Care Nurse Manager, Ambulatory Care Unit (ACB), 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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