Capstone Project: Milestone 2

List the topic and include the citation for the systematic review you have selected from our approved list (optional: an additional scholarly source of support):

For my PICOT question: In surgical patients, does preoperative bathing showering with skin antiseptic solution compared to bath or showering with non antiseptic solution will reduced risk of postperative surgical site infections?.

(P) Surgical patients, (I) Intervention: Bathing or showering with skin antiseptics, (C)Comparison: Bathing with non antiseptics, (O) Outcome: Reduced risk of postoperative site infection, (T) 6 weeks

Preoperative bathing or showing with skin antiseptics to prevent surgical site infection:

Webster, J., & Osborne, S. (2015). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004985. doi:10.1002/14651858.CD004985.pub5.

Cowperthwaite, L., Holm, R. L., Cowperthwaite, L., & Holm, R. L. (2015). Featured article: Guideline Implementation: Preoperative Patient Skin Antisepsis. AORN Journal, 10171-80. doi:10.1016/j.aorn.2014.11.009

Jakobsson, J., Perlkvist, A., & Wann-Hansson, C. (2011). Searching for Evidence Regarding Using Preoperative Disinfection Showers to Prevent Surgical Site Infections: A Systematic Review. Worldviews On Evidence-Based Nursing, 8(3), 143-152. doi:10.1111/j.1741-6787.2010.00201.x

Al Maqbali, M. A. (2013). Preoperative antiseptic skin preparations and reducing SSI. British Journal Of Nursing, 22(21), 1227.

What is the nursing practice issue you have identified related to the topic you have chosen?

Working in the medsurg area for many years now, I always come in contact with surgical site infections, in men, women and children in any part of the body. Surgical site infection are major issue in hospitals settings. When surgical site infection rates rise, an intervention needs to be in place to decrease the problen and reduce the rates of infections. According to Al Maqbali (2013), “Surgical Site Infections(SSIs) can affect the quality of care and increase the morbidity and mortality rate in after-surgical procedure. The use of an antiseptic skin preparation agent before the procedure can reduce the pathogens in the skin surface around the incision” Indicating the type of skin antiseptic preparation could prevent the surgical infection site with non-antiseptics solutions. The factors associated with choosing the skin antiseptics solutions, such as patients’ allergies, skin condition and environmental risk, are also taken into account. The use of antiseptics has been added to patient’s preoperative instruction, because have seen several skin irritation and breakdown from skin antiseptics bath or showering which there should be need to look in it, if there is need to change the regimen or strenght of the antiseptic solution to help patient with sensitive skin compare to non antiseptics solutions.

Fully describe the scope of the practice issue:

Antiseptics solutions were defined as liquid soaps products containing an antimicrobial ingredient such as chlorhexidine, triclosan, hexachlorophine, providone-iodine or benzalkonium chloride. I dont want to be specific on any solution. Each patient has a specific solution that suits a specific patient skin, so that it will reduce or stop skin irritation. The factors associated with choosing the skin antiseptics solutions, such as patients’ allergies, skin condition and environmental risk, are also taken into account. The use of preoperative bathing or showing with antiseptics solution during surgery is very important compared to bathing or showering with non-antiseptic solutions. Patient’s preoperative instruction on how to use the preoperative antiseptic solutions has also been added to the instructions.

What is the practice area?

_X__ Clinical

__X_ Education

___ Administration

___ Other (List):

How was the practice issue identified? (check all that apply)

___ Safety/risk management concerns

_X__ Unsatisfactory patient outcomes

_X_ Wide variations in practice

___ Significant financial concerns

___ Difference between hospital and community practice

___ Clinical practice issue is a concern

___ Procedure or process is a time waster

___ Clinical practice issue has no scientific base

__ Other:

Describe the rationale for your checked selections:

The unsatisfactory patient outcomes was checked, because the patients expressing their opinion was the reason that we noticed that there was an issue. The patients were complaining that they couldn’t complete their pre-operative solution regimen while some patient are scared of postoperative bathing allergies. We, as a hospital, have been looking at ways to lower surgical site infections and the surgeons found research suggesting the use of antiseptic solutions would decrease the chance that a surgical site infection would occur.

The wide variations in practice box was checked because every hospitals has different setting for their own surgical department for the pre-operative cleansing regimen. Some hospitals only uses the chlorhexidine solutions, while other hospitals use more than one antiseptic solutions. All hospital has different protocols.

__X_ Literature search

___ Guidelines

___ Expert Opinion

__X_ Patient Preferences

___ Clinical Expertise

___ Financial Analysis

___ Standards (Regulatory, professional, community)

___ Other

Describe the rationale for your checked selections:

Finding research that shows what preoperative regimen the patients should follow that best protects patients from obtaining a surgical site infection is a key component. The key points include the need for the patient to take a preoperative bathing or showering and need for perioperative personnel to select safe and effective antiseptic for the patient to perform a safe preoperative akin antiseptic solution. Research literature obtained will also have the length of time patients should use the products along with the strength of the antiseptic solution. Since the patients are the ones that are actually using the solution, I think it would be best to ask patients as to which regimen is easier for them and which solution caused the least amount of itchiness and irritation.

Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:

The problem in practice is that study by both review authors independently using a piloted data extraction sheet: type of study, study setting, number of participants, sex, mean age, predisposing risk factors, type of antiseptic solutions, use of prophylactic antibiotics, procedure and timing for full body wash, period of community follow-up, all primary and secondary outcome descriptions and outcome measures reported, including infection rates and study authors’ conclusions

.

Type the complete APA reference for the systematic review article you chose from the list provided. It must be relevant to the practice issue you described above. Include the APA reference for any additional optional supplemental scholarly source related to the review you wish to use.

Webster, J., & Osborne, S. (2015). Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database of Systematic Reviews 2015, Issue 2. Art. No.: CD004985. doi:10.1002/14651858.CD004985.pub5.

Cowperthwaite, L., Holm, R. L., Cowperthwaite, L., & Holm, R. L. (2015). Featured article: Guideline Implementation: Preoperative Patient Skin Antisepsis. AORN Journal, 10171-80. doi:10.1016/j.aorn.2014.11.009

Jakobsson, J., Perlkvist, A., & Wann-Hansson, C. (2011). Searching for Evidence Regarding Using Preoperative Disinfection Showers to Prevent Surgical Site Infections: A Systematic Review. Worldviews On Evidence-Based Nursing, 8(3), 143-152. doi:10.1111/j.1741-6787.2010.00201.x

Al Maqbali, M. A. (2013). Preoperative antiseptic skin preparations and reducing SSI. British Journal Of Nursing, 22(21), 1227.

Identify the objectives of the article:

The objectives to review the evidence for preoperative bathing or showering with antiseptics solution in order to reduced the risk of surgical site infections. The authors are looking for evidence that suggest that preoperative bathing or showering with skin antiseptic solutions compared to bathing or showering with non-antiseptic solutions. We therefore accepted the defination used by the original authors to determine the proportion of patient who develop any surgical site infection before and after discharge fro the hospital.

Provide a statement of the questions being addressed in the work and how these relate to your practice issue:

This systematic review is questioning whether or not the use of preoperative bathing or showing with skin antiseptics to prevent surgical site infection. This relates to my practice problem because this can help to identify that patients using preoperative bathing or showering with skin antiseptics solutions will reduced risk of postoperative surgical infections compared to patients bathing

or showering with non-antiseptic solutions

Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.

This systematic review is questioning whether or not the use of preoperative bathing or showering with antiseptics for the prevention of surgical site infections This relates to my practice problem because this can help to identify that patients using preoperative bathing or showering antiseptic solutions will reduced the risk of surgical site infections.

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome. Consider the relevance to your project proposal for the Milestone 2 project paper. (If an optional supplemental source is also used, include a statement of relevance to it as well.)

This author looked at studies that have all published and unpublished randomised controlled trials(RCTs) that allocat surgical patient individually comparing any antiseptic solution used for preoperative full body wash or showering with non-antiseptic solution. Quasi-randomised trials were not included ( ie trials that allocate treatment by day of the week medical recorde number sequential admitted order. Both reviews indepedently assessed the titles and abstracts of reference identified by the search strategy. Full report of all potentially relevant trails were then retrieved for assessment of eligiblity based on the inclusion creteria. Reference lists of retrieved studies were screened to identified further studies, which were also retrieved. Differences of opinion were settled by consensus or referral to the editorial based of the wounds groups.This study concludes that the use of preoperative bathing or showering skin antiseptic solution to prevent surgical site infections. This will help to support the fact to find with anseptic solution is appropriate for each patient.This research will also help to illustrate the fact that preoperative bathing or showering skin antiseptic solution helps to reduce the risk of surgical. site infections.

Outline evidence-based solutions that you will consider for your project.

The author of this study used antiseptic bathing or showing solutions in comparison to non-antiseptic solutions. When a surgical site infection happens, it causes a chain.When a patient acquires this consition, the hospital is also now responsible for the cost of the patient for the rest of the length of stay. This can include increase re-admission within thirty-eight days. One intervention that has been proven to be factor in helping to reduced the risk of surgical site infections is the use of preoperative bathing or showering skin antiseptic solution prior to the patient’s arrival to the hospital. Research shows that when compared to using non-antiseptic solutions. There is a statistical significance in using antiseptic preoperatively to pevent surgical site infections. Antiseptic help to reduce the number flora on the skin. Patient are advised to use preoperative antiseptic bathing or showering regimen as order to reduce the risk of surgical site infections. Some hosiptal suggest three days regimen while other hospital prefer just bathing or showering a night before surgery.

Discuss any limitations to the studies that you believe impacts your ability to utilize the research in your project.

The limitations to the studies that I believe impact ability to utilize the research in my project is that they do not follow-up preoperative bathing or showing skin antiseptic solution regime before surgery and after discharge. They only looked at the time that the patients were actually inject the hospital for surgery until their first discharge from the facility. Many patients now days go home just a few hours following surgeries.