Literature Table
Author/
Title/ Year
Purpose/
Problem
Research
Question
(if presented)
Method/
Design
Hierarchy
of
Evidence
high/mod/low
Population/ Setting
Sample size
Data
collection
Findings
Limitations
(how collected)
Survey/
pt record/etc
(RAR19SP)
RAR FA17
Literature Table
Author/
Title/ Year
Purpose/
Problem
Research
Question
Method/
Design
Hierarchy
of
Evidence
high/mod/l
ow
Population/ Setting
Sample
size
Data collection
(how collected)
Survey/
pt record/etc
Findings
Limitations
quasiexperimental
FADE QI
methodology
Quality
Improvement
Project
Moderate
NSICU
patients
322 pts
during study
period
compared to
497 pts prior
use of
ultrasonographic
bladder scanning
and intermittent
catheterization
when necessary for
urinary retention.
Computer based
Education pre-post
test averaged 90%
One unit –
smaller sample
(if presented)
Alexaitis, I.,
& Broome,
B. (2014).
Implementati
on of a nursedriven
protocol to
prevent
catheterassociated
urinary tract
infections.
Introduce a nursedriven system
None
presented
Focusing on the
problem (CAUTIs);
Analyzing data
(catheter utilization,
CAUTIs, CAUTI
rates, compliance
with urinary catheter
guidelines, and
nurses’ knowledge
of guidelines);
Developing a plan to
reduce CAUTIs; and
Executing the plan
and Evaluating
results against
targeted goals.
And 107 RNs
working on
the unit
NSICU.
30 bed
unit
Although not
statistically significant
– it was clinically
significant
Average catheter duration
decreased by 2.5 days,
although utilization
increased from 74.14% to
76.2% (P = .791); average
CAUTI rate decreased by
20.5% (from 3.85 to 3.06
per 1000 catheter days; P =
.296), average CAUTIs per
month decreased by 14.1%
(from 2.33 to 2.0 per
month; P = .495). Cost of
medications and supplies
w/treating CAUTIs
decreased 40.7% (from
$334 to $198 per patient; P
= .514) . Average LOS for
pts w/ CAUTIs increased
8.14% (from 39.3 to 42.5; P
= .775).
RAR FA17
Dy, MajorJoynes, B.,
Pegues, D.,
& Bradway,
C. (2016). A
nurse-driven
protocol for
removal of
indwelling
urinary
catheters
across a
multihospital
academic
healthcare
system.
Implement NDRP
-reduce IUC and
CAUTI
None
presented
Pilot -quasiexperimental
moderate
365,414
patient days
with 65,133
IUC days
3 hospitals
within one
HC
system
compared CAUTI
rates and IUC
device utilization
for the 12- month
baseline period
Provider selection of
the NDRP for 40% to
60% of all IUC
orders, and enhanced
the decision-making
skill and autonomy of
the nurse providing
direct patient care in
assessing the daily
need for an IUC.
Assessment of
provider
barriers
19% reduction in
CAUTI rates per
1,000 IUC days
compared to the
baseline period (p =
0.13)
The NDRP was
associated with
negligible reduction
(0.5%, p = 0.32) in the
overall IUC device
utilization
Not statistically
significant although
clinically significant
Elpern, E.,
Killeen, K.,
Ketchem, A.,
Wiley, A.,
Patel, G., &
Lateef, O.
(2009).
Reducing use
of indwelling
urinary
catheters and
associated
reduce CAUTIs in
the MICU by
limiting use of
indwelling urinary
catheters. Our
specific aims were
as follows: •
Implement an
intervention to
limit use of
indwelling urinary
catheters by
No RQ
but,
The
hypothesis
was that
days of use
of urinary
catheters
and
number of
CAUTIs
would
quasiexperimental
moderate
337 patients
had a total of
1432 days of
urinary
catheterizatio
n
58% were
women. The
age range
was 18 to 99
years, with a
a 613-bed,
nonprofit,
inner city
academic
medical
center.
The
MICU
was a 21bed unit
Chart review
duration of use was
significantly reduced
to a mean of 238.6
d/mo from the
previous rate of 311.7
d/mo (p=.01). The
number of catheterassociated urinary
tract infections per
1000 days of use was
a mean of 4.7/mo
before the intervention
Single unit,
single
institution, 6
month, prior
data did not
account for
patients arriving
with indwelling
catheters place
at outside
facility or ER
RAR FA17
urinary tract
infections.
conducting daily
evaluations of the
appropriateness of
catheter use •
Recommend
removal of
catheters when
appropriate
indications were
not present •
Compare urinary
catheter use and
catheter associated
urinary tract
infection rates
before and after the
intervention
decrease
during the
interventio
n months
compared
with the 11
months
before the
interventio
n
Wenger, J.
(2010).
Cultivating
quality:
Reducing
rates of
catheterassociated
urinary tract
infection
In response to
CAUTI rates, the
hospital
assembled a
team to assess
the best
practices for
decreasing the
incidence of
CAUTI.
None
Descriptive –
presented quasi
experimental
mean of 61
years.
Lowmoderate
CAUTis and
catheter
days from
March
2007-June
2009
and zero (p=.001)
during the 6-month
intervention period.
150 bed
communi
ty
hospital
Focus groups to
assess barriers,
chart review
First Education
barriers were assessed
– found 30% incorrect
urine collection –
education given
Awareness of NDRP
- no statistically
significant difference
between fiscal year
2007 and 2008 (P =
1). But when
comparing fiscal year
2008 with fiscal year
2009, there was a
statistically significant
reduction in the
CAUTI rate of 1.23
per 1,000 Foley
catheter days (95%
confidence interval
[CI], 0.6 – 1.87; P =
0.001). Comparing
fiscal year 2007 with
Unable to
separate
effect of each
individual
intervention
RAR FA17
2009, there was a
statistically significant
reduction in the
CAUTI rate of 1.72
per 1,000 Foley
catheter days (95%
CI, 0.68 – 2.77; P = <
0.001).
Experience has shown
that such a protocol
has the most impact
when used in concert
with education and the
best products
available.
Discussion: benefits
of “trips to the
bathroom”—
decreasing the risk of
deep vein thrombosis,
pulmonary embolism,
pneumonia, and skin
breakdown
(RAR19SP)
RAR FA17
Running head: NURSING ACTIONS TO REDCUE USE OF URINARY CATHETERS
Nursing Actions to Reduce Use of Urinary Catheters in Intensive Care Units
Name
College
1
NURSING ACTIONS TO REDCUE USE OF URINARY CATHETERS
2
Research Question
In adult intensive care patients (P), does a nurse-driven catheter removal protocol (I)
compared with the standard practice of catheter removal per physician order (C) reduce rate of
Catheter Associated Urinary Tract Infections (O)?
Method: (How you searched the literature)
TEMPLATE: A literature search was conducted using the databases CINAHL, Medline, and
PubMed. Keywords were ____, ___, ___, _______, and ________. Inclusion criteria were ____.
Articles were excluded if were duplicate articles, lower levels of evidence, or populations not
pertaining to the topic. Four articles were reviewed, list types (cite). See exemplar below.
Method
A literature search was performed using PubMed, CINAHL, and Medline with the
keywords, Catheter associated urinary tract infection, CAUTI, CAUTI prevention, CAUTI
prevention ICU, intermittent urinary catheterization, and CAUTI prevention ICU nurse-driven.
Articles initially considered for inclusion were full-text, peer-reviewed articles published in
English between 2008-2018 that studied adult intensive care (ICU) patients. Exclusion criteria
were animal studies, duplicate studies, and studies not focused on the topic or conducted in nonhospital settings. Four articles were chosen for closer examination. All were quasi-experimental
studies conducted in the United States (Alexaitis & Broome, 2014; Dy, Major-Joynes, Pegues, &
Bradway, 2016; Elpern et al., 2009, Wenger, 2010).
NURSING ACTIONS TO REDCUE USE OF URINARY CATHETERS
3
Annotated Bibliography
Alexaitis, I., & Broome, B. (2014). Implementation of a nurse-driven protocol to prevent
catheter-associated urinary tract infections.
Alexaitis and Broome (2014) published a quality-improvement project piloted in a 30bed neurosurgical intensive care unit (NSICU) in an academic medical center after a high rate of
CAUTI. The purpose of the quality improvement project was to introduce a nurse-driven system
for managing urinary catheters which included nursing assessment of the continued necessity of
the catheter and removal if it was no longer necessary. The design was quasi-experimental
(moderate level of evidence). The rate of CAUTI during the study period (measured in number
of CAUTI per 1000 catheter days) was compared to the rate of CAUTI in the time period
preceding the experiment.
The study protocol focused on the use of ultrasonographic bladder scanning and
intermittent catheterization when necessary for urinary retention. The authors describe a
thorough training process completed by nearly all the registered nurses of the NSICU. The
average catheter duration decreased by 2.5 days, although utilization increased from 74.14% to
76.2% (P = .791). The average CAUTI rate decreased by 20.5% (from 3.85 to 3.06 per 1000
catheter days; P = .296). The average CAUTIs per month decreased by 14.1% (from 2.33 to 2.0
per month; P = .495). In addition, cost of medications and supplies w/treating CAUTIs decreased
40.7% (from $334 to $198 per patient; P = .514) and the average LOS for pts w/ CAUTIs
increased 8.14% (from 39.3 to 42.5; P = .775). Although statistically not significant, the decrease
in events were clinically significant. Apart from lack of statistical significance, other limitations
to this study include the fact that it was conducted on only one patient care unit and no
concurrent control group was used.
NURSING ACTIONS TO REDCUE USE OF URINARY CATHETERS
4
Dy, S., Major-Joynes, B., Pegues, D., & Bradway, C. (2016). A nurse-driven protocol for
removal of indwelling urinary catheters across a multi-hospital academic healthcare system.
Dy, Major-Joynes, Pegues, and Bradway (2016) published a quality-improvement project
attempted simultaneously at three hospitals within one academic healthcare system. The average
daily census of the combined hospitals was around 1600 patients. The largest of the hospitals
had the highest rate of CAUTI prior to the trial. The purpose of the study was two-fold: to
reduce the rate of catheter use and to reduce the rate of CAUTI. The design was quasiexperimental (moderate level of evidence). The trial took place over 12 months, and this data
was compared to the data from the 12 months preceding the beginning of the trial. Data were
reported for each hospital individually as well as for the entire healthcare system.
The project was to introduce a nurse-driven catheter removal protocol (NDRP). Nurses
were trained to assess the continued need for a urinary catheter and (if the NDRP was ordered by
the physician) were empowered to remove it when no longer needed. At the largest hospital, the
rate of catheter use declined significantly (6%, p < 0.001) and CAUTI rates also declined (by
28%, p = 0.05). However, at one of the smaller hospitals, little change was seen. The average
decline in catheter use across the healthcare system was only 0.5% (p = 0.32) and the reduction
in CAUTI was 19% (p = 0.13). In addition, NDRP was ordered and used in 40% to 60% of
patients with catheters. One significant limitation to this study, apart from lack of a concurrent
control group and the variation in results seen between the three hospitals, is the fact that the
results are reported in terms of CAUTI per 1000 catheter days across the hospital system with no
attempt to correlate whether the CAUTI rate was different in patients for whom the NDRP was
ordered.
Elpern, E., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of
NURSING ACTIONS TO REDCUE USE OF URINARY CATHETERS
5
indwelling urinary catheters and associated urinary tract infections.
Elpern et al. (2009) conducted a quality improvement project in the medical intensive
care unit (MICU) of an academic medical center over a six-month period. During the study
period, 337 patients had urinary catheters, totaling 1432 catheter days. The authors hypothesized,
days of use of urinary catheters and number of CAUTIs would decrease during the intervention
months compared with the 11 months before the intervention. The study design was quasiexperimental (moderate level of evidence), with the six months prior to the initiation of the
NDRP used as the comparison group.
Elpern et al. (2009) showed that reductions in catheter days and in CAUTI were
associated with the NDRP. Education for nursing staff focused on assessment of the need for a
catheter and when a patient was identified as inappropriately having a catheter, it was removed.
Senior nursing staff consulted with the bedside nurses throughout the trial of the NDRP.
Catheter days were reduced from 311.7 days/month to 238 days/month (p = 0.01) and CAUTI
were reduced from 4.7 per 1000 catheter days to zero CAUTI during the study period (p <
0.001). Limitations to this study include the lack of a concurrent control group and a lack of data
from the baseline period which could be used to identify confounding factors such as duration of
indwelling catheter use that could affect the rate of CAUTI. In addition, the authors noted prior
data did not account for patients arriving with indwelling catheters place at outside facility or
ER.
Wenger, J. (2010). Cultivating quality: Reducing rates of catheter-associated urinary tract
infection.
Wenger (2010) reported on the process over a two-year period by a 150-bed community
hospital in their attempt to reduce CAUTI. This hospital’s CAUTI rate was substantially higher
NURSING ACTIONS TO REDCUE USE OF URINARY CATHETERS
than the national average, especially in its intensive care patients. Education barriers among
nurses were assessed and found 30% using incorrect urine collection techniques. Education was
provided education for nurses regarding catheter management (such as perineal cleansing,
drainage bag positioning, and the use of anchoring devices). The Implementation phase of
NDRP was a quasi-experimental design (moderate level of evidence), with CAUTI rates per
1000 catheter days during the study being compared to rates prior to study initiation.
No statistically significant change in CAUTI rates was seen during the first year of the
study (fiscal year 2007 and 2008, p = 1). However, during the second year (which included the
introduction of the NDRP), there was a statistically significant reduction in the CAUTI rate of
1.23 per 1,000 foley catheter days (95% confidence interval [CI], 0.6 – 1.87; P = 0.001).
Comparing fiscal year 2007 with 2009, there was a statistically significant reduction in the
CAUTI rate of 1.72 per 1,000 Foley catheter days (95% CI, 0.68 – 2.77; P = < 0.001).
Limitations to this study include the sequential introduction of several CAUTI prevention
measures, which (as the author notes) make it impossible to establish a correlation between any
one intervention and the reduction in CAUTI.
6
NURSING ACTIONS TO REDCUE USE OF URINARY CATHETERS
7
References
Alexaitis, I., & Broome, B. (2014). Implementation of a nurse-driven protocol to prevent
catheter-associated urinary tract infections. Journal of Nursing Care Quality, 29(3), 245252. doi:10.1097/NCQ.0000000000000041
Dy, S. Major-Joynes, B., Pegues, D., & Bradway, C. (2016). A nurse-driven protocol for
removal of indwelling urinary catheters across a multi-hospital academic healthcare
system. Urologic Nursing, 36(5), 243-249. doi:10.7257/1053- 816X.2016.36.5.243
Elpern, E., Killeen, K., Ketchem, A., Wiley, A., Patel, G., & Lateef, O. (2009). Reducing use of
indwelling urinary catheters and associated urinary tract infections. American Journal of
Critical Care, 18(6), 535-542. doi:10.4037/ajcc2009938
Wenger, J. (2010). Cultivating quality: Reducing rates of catheter-associated urinary tract
infection. The American Journal of Nursing, 110(8), 40-45. doi:
10.1097/01.NAJ.0000387691.47746.b5
Running head: PERI-OPERATIVE PROPHYLACTIC TREATMENT
Peri-Operative Prophylactic Treatment to Prevent the Risk of Patients Acquiring Bacterial
Infections and Sepsis after Surgical Operations
Michael Cole RN
College of Central Florida
NUR4165
1
PERI-OPERATIVE PROPHYLACTIC TREATMENT
Introduction
The question as to whether the use of prophylactic antibiotics in post-op patients does within
24 hours after surgery would lead to a decrease in the risk of post-op infection compared to no use
of prophylactic antibiotics remains a subject of debate. None the less, it is a common practice that
physicians and nurses use prophylactic antibiotics in the hospital setting to help patients undergoing
major surgery reduce the exposure to bacterial infection post-surgery. While this is in line with the
national guidelines, there are other cases where the patients may be given the prophylactic
antibiotics too soon before the surgical operation, thus reducing the drugs’ ability to prevent
infections. The same is the case faced when the or drug intake is prolonged after surgery. These
two scenarios are the major concerns of antimicrobial resistance (Bouvet et al., 2014).
There is often an effort to provide treatment for bacterial infections among patients prior to
surgical operations. However, the impacts of treatment for existing bacterial conditions remains
questionable, particularly because the treatment for the bacterial infections has never been primary
practice, but rather common practice among most practitioners. The risk of patients acquiring
bacterial infections and sepsis after surgical operations is important because of its association with
the increasing cost of treatment, the increasing length of hospital stay, and could increase the risk of
patients acquiring bacterial infections, sepsis, and infected implants post-operation
Why the Problem is Significant
According to the research conducted by Hagel & Scheuerlein (2014), acquiring bacterial
infections and sepsis post operation would lead to an increase in the cost of healthcare provision by
20% of the original cost of care. This increase translates to an average of $20,000 per patients
annually. Surprisingly, this increase in costs is not attributed to administrative costs or time lost
2
PERI-OPERATIVE PROPHYLACTIC TREATMENT
during the medical intervention. Clearly, the cost of care increases due to the inherent issues such as
increased length of stay in hospital to receive additional treatments. Unfortunately, the patient and
the hospital have to incur the extra costs out of pocket and do not qualify for reimbursement from
the Centers for Medicaid Services. The increased cost of care is even more worrying, given the fact
that data from the findings of Hagel & Scheuerlein (2014) shows that the United States spends over
213 million dollars to acquire bacterial infections and sepsis annually.
When patients acquire bacterial infections and sepsis after surgical operations, they will
require additional treatments and care, thus increasing their length of stay in hospital and increasing
recovery time. This increase in the length of hospital stay may be linked to the risk of complications
that comes as a result of the inherent infection such as muscular deconditioning and deep vein
thromboses which ultimately reduce the patient’s ability. According to Gifford, Christelis & Cheng
(2011), 1.5% of the hospital admission cases reported in 2014 were attributed to acquiring bacterial
infections and sepsis which causes an average of additional four days in hospitals.
The pre-operative treatment required by the patients could reduce the risk of patients
acquiring bacterial infections, sepsis, and infected implants post-operation.
This was confirmed by the findings of Enzler, Berbari & Osmon (2011) which noted that bacterial
infections and sepsis account for the highest number of infections relative to other infections,
however, the development of alternative nursing intervention would lead to the prevention of this
issue. Given the related risk of patients acquiring bacterial infections and sepsis after surgical
operations, it is essential to explore interventions that would help decrease such incidences.
Conclusion and Gap of Knowledge
About 95% of healthcare facilities treat their patients for Urinary Tract Infections before
they are subjected to the surgical procedure (Bouvet et al., 2014). During this process, the patients
receive one intravenous shot of the peri-operative dose as a means of reducing the virulence of the
3
PERI-OPERATIVE PROPHYLACTIC TREATMENT
bacterial infection. The prophylactic treatment is given to control the chances of extensive infection
on the patient's post-treatment. However, it has never been effective in all cases, given the fact that
the impacts of treatment for existing bacterial conditions remain questionable since it a common
practice among most practitioners. Thus, there is a need to initiate a nursing intervention to enhance
the use of peri-operative prophylactic treatment to prevent the risk of patients acquiring bacterial
infections and sepsis after surgical operations. Therefore, the purpose of this paper is to investigate
whether pre-treatment of bacterial infection plays ought to be a necessity for the control of the said
bacterial infections post-surgery.
PICO
Among adult postoperative patients, (P), how does peri-operative prophylactic treatment (I)
compared to No prophylactic treatment (C) help prevent the risk of patients acquiring bacterial
infections and sepsis after surgical operations (O)?
Method
A literature search was performed using PubMed, CINAHL, and Medline using the
keywords, Peri-Operative Prophylactic, Bacterial Infections, Sepsis, and Surgical Operations. The
inclusion criteria used were full-text articles which are peer-reviewed and published in English
between 2008-2018 on the topic of Prophylactic in a surgical operation. However, articles that study
animal studies, or those that duplicated studies or never focused on the use of Peri-Operative
Prophylactic in post-surgical operations were not were excluded from the meta-analysis. Also, the
articles that study Peri-Operative Prophylactic in non-hospital settings, articles with lower levels of
evidence, and those which relied on a population that does not pertain to the topic were excluded
from the study. Based on this criteria, four articles were selected from quasi-experimental studies
4
PERI-OPERATIVE PROPHYLACTIC TREATMENT
conducted in various locations namely Enzler, Berbari, & Osmon, (2011), Gifford, Christelis &
Cheng, (2011), Hagel & Scheuerlein, (2014), and Chopra, Zhao, Alangaden, Wood & Kaye, (2010).
Annotated Bibliography
Article 1: Enzler, M. J., Berbari, E., & Osmon, D. R. (2011). Antimicrobial prophylaxis
in adults. Mayo Clinic Proceedings, 86(7), 686–701. doi:10.4065/mcp.2011.0012.
https://doi.org/10.1093/bjaceaccp/mkr028
Enzler, Berbari & Osmon, (2011) conducted a study to evaluate the effectiveness of
antimicrobial prophylaxis in adults who have been subjected to surgical procedure. The setting of
the study was the hospital environment where a number of adult patients had been subjected to
surgical procedure, there by necessitating the need to prevent surgical site infections. The authors
analyzed the proceedings of Mayo Clinic on how antimicrobial prophylaxis has become a common
medication as a preventive measure for infectious diseases. The purpose of the study was to
examine the level of response of adult patients to antimicrobial prophylaxis post-surgical
procedures. The authors were interested in ascertaining the most effective way through which postsurgical infections of the surgical site would be prevented, thereby guaranteeing the safety of the
patients.
The design in this study was a systematic review of the literature to compare the findings of
various studies on the efficacy of antimicrobial prophylaxis among adult patients. A number of
literature that have studied the use of preoperative prophylaxis were obtained from various
databases searchers, and then their findings analyzed to conclude the outcome of each study in
respect to the use of preoperative prophylaxis. The study protocol entails a comparison of the
outcome of antimicrobial prophylaxis among adult patients who have undergone surgery against the
patient who has not been subjected to any antimicrobial prophylaxis before surgery.
5
PERI-OPERATIVE PROPHYLACTIC TREATMENT
Although the authors recommended the use of antimicrobial prophylaxis in various surgical
procedures as a measure to prevent site infections after surgery. There is a need to ensure that the
optimal antimicrobial agents are used as a prophylaxis post-surgery. The recommended
antimicrobial prophylaxis was therefore found to be one which is nontoxic, inexpensive,
bactericidal, and active against common disease-causing pathogens with a high risk of causing
postoperative surgical site infection. The authors describe how the use of antimicrobial prophylaxis
among adult patients post-surgery imply reeducating their risk exposure to bacterial infections due
to the wound caused by surgical procedures.
As a way of maximizing the effectiveness of this antimicrobial prophylaxis, the
perioperative prophylaxis intervention should be conducted intravenously and administered within
30 to 60 minutes before the patient is subjected to a surgical incision. The short duration of the
antimicrobial prophylaxis will, therefore, help to reduce the chances of the antimicrobial
prophylaxis causing antimicrobial resistance and toxicity in the human body. It also reduces the
overall cost of care during surgery. This study faces the limitation of failing to use a concurrent
control group in the selection of articles used in the meta-analysis, thus exposing the findings to a
wide variation caused by the bias in the selection of articles. As a result, the outcome of the study
cannot be explained from one side of the meta-analysis.
Article 2: Gifford, C., Christelis, N., & Cheng, A. (2011). Preventing postoperative
infection: the anaesthetist's role. Continuing Education in Anaesthesia, Critical Care & Pain,
11(5), 151-156.
Gifford, Christelis & Cheng (2011) conducted a randomised control trial and a systematic
review of the anaesthetist' role in the prevention of postoperative infection. The authors focused on
the responsibility of anaesthetists when conducting surgical operations on patients with respect to
6
PERI-OPERATIVE PROPHYLACTIC TREATMENT
ensuring that patients outcome does not expose the patients to opportunistic infection. The purpose
of the study was to examine the mechanism of impairing critical immune mechanics like neutrophil
phagocytosis bacteria during perioperative surgical procedures. The design of the study was a
systematic review of previous literature to ascertain the potentially perioperative factors that can be
modified through anesthetist control so that they create a positive influence on the possibility of a
patient experiencing surgical site infections. Using this design, the authors sort to examine the role
of the anesthetist in enacting patient safety against post-surgical wound infections.
The study protocol in this article focused on ascertaining the appropriate antibiotics that
should be used to achieve effective prophylaxis during surgical operations. Consequently, the
authors recommend that appropriate antibiotics be administered on patients before the surgical
operation as per the survey of WHO on surgical safety checklists. The finding established that the
use of perioperative antibiotic prophylaxis after the surgical operations prevents infections after
surgical operations. The authors concluded that the medical professionals bear the ultimate
responsibility of considering methods of minimizing hospital-acquired infections through the use of
appropriate perioperative prophylaxis to reduce the significant burden that this post-surgical
bacterial infection poses to the healthcare. Using this conclusion, the authors established a clinical
implication of this study, which can be sued to provide a conceptual framework on how to
undertake future research on preoperative prophylaxis to reduce surgical site infections.
In particular, the article places the responsibility of identifying the most effective
preoperative prophylaxis on anesthetists and are thus required to utilize all available professional
judgment to reduce the risk of infection using antibiotic prophylaxis that is appropriately timed and
targeted to minimize these risks reduce this risk. One major limitation of this study is that it never
took into consideration the presence of a control group in the selection of the articles used in the
7
PERI-OPERATIVE PROPHYLACTIC TREATMENT
systematic review of data. Therefore, there was no data from a baseline period which would have
served as a foundation of identifying the similarities and differences in the study outcomes.
Therefore, there are a number of confounding factors such as the duration it takes to indwelling into
the application of prophylaxis antimicrobial to prevent surgical site wound, thereby preventing
infection. This limitation caused a huge inconsistency in the data sued by the authors to make a
conclusion.
Article 3: Hagel, S., & Scheuerlein, H. (2014). Perioperative Antibiotic Prophylaxis and
Antimicrobial Therapy of Intra-Abdominal Infections. Viszeralmedizin, 30(5), 310–316.
doi:10.1159/000368582
Hagel, S., & Scheuerlein, H. (2014). Conducted a meta-analysis review of literature on
perioperative Antibiotic Prophylaxis and Antimicrobial Therapy of Intra-Abdominal Infections. The
purpose of the meta-analysis peer review qualitative study was to ascertain the level of increase in
antimicrobial-resistant to first and second-line antibiotics with particular focus on the Gramnegative bacteria. The article also focused on establishing the lack of novel antimicrobial substances
which have become a major challenge in the medical intervention and treatment of abdominal
infection. The design was a meta-analysis peer review of literature conducted in the previous studies
with the hope of ascertaining the similarities and differences in the findings by this literature. As a
result, a search in various databases was conducted with the inclusions criteria being 8888. The
articles that never met this inclusion criterion were left out of the study.
The study protocol in this article focused on ascertaining the efficacy and safety of the
perioperative antibiotic prophylaxis during the conduct of a visceral surgery from previous metaanalyses. Consequently, the authors describe a thorough administration of perioperative antibiotic
prophylaxis before and after a surgical procedure on a patient to help the patient reduce the chances
8
PERI-OPERATIVE PROPHYLACTIC TREATMENT
of bacterial infection. The finding established that the use of perioperative antibiotic prophylaxis
after the surgical operations should be stopped since it does not reduce the chances of patients
having wound infection. Rather, the use of these antibiotic drugs only leads to an increase in the
side effects on the patients, such as developing resistance to the antimicrobial.
Further, the article noted that antimicrobial management of severe infection arising after
surgical intervention requires a delicate balance to ensure that they get an optimal benefit from the
empirical therapy to achieve a positive outcome while at the same time reducing the necessary
application of the antimicrobials. The authors carefully demonstrated how antimicrobial prophylaxis
could be used to manage surgical wounds to prevent bacterial infections among patients, thereby
ensuring that the patients recover effectively and regain good health.
The authors concluded that the use of antimicrobial resistance is a serious threat to the life of
the patients undergoing surgery and therefore there is a need to shift to the use of antibiotics to
prevent the spread of the adverse implications of the antimicrobials including perioperative
prophylaxis when treating intra-abdominal infections. This study faces the limitation of relying on
the sequential introduction of numerous modes of preventing surgical site wound infection, making
it very difficult to establish the level of safety and effectiveness of each the antimicrobial
preoperative prophylaxis in preventing bacterial infections among patients.
As a result, the limitation makes it difficult to ascertain the correlation between any one
intervention and the reduction in n risk exposure to surgical site wound infection. Therefore, this
study provides a research gap that can be explored in future studies to ascertain the most effective
approach that can be used to achieve a better outcome with preoperative prophylaxis among
surgical patients.
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PERI-OPERATIVE PROPHYLACTIC TREATMENT
Article 4: Chopra, T., Zhao, J. J., Alangaden, G., Wood, M. H., & Kaye, K. S. (2010).
Preventing surgical site infections after bariatric surgery: the value of perioperative antibiotic
regimens. Expert review of pharmacoeconomics & outcomes research, 10(3), 317–328.
doi:10.1586/erp.10.26
Chopra, Zhao, Alangaden, Wood & Kaye (2010) conducted an expert review of
pharmacoeconomics & outcomes research study to ascertain the value of perioperative antibiotic
regimes when used to prevent surgical site infection after bariatric surgery. The authors reviewed
research articles that have studied the use of preoperative prophylaxis in preventing bacterial
infections in surgical site wounds after operations. According to the authors, preoperative
prophylaxis has become a major intervention measure of preventing surgical site infection, which is
experienced after a bariatric surgical procedure and the ensuing SSI prevention.
The purpose of the study was two-fold: to define different types of SSIs which may be
encountered post-bariatric surgery and to conduct a meta-analysis of the present literature on the
significant aspects of SSI prevention as well as the appropriate application of surgical antimicrobial
prophylaxis during a bariatric surgical procedure. The authors reviewed a case involving the
administration of an antibiotic prophylaxis piperacillin/tazobactam dosed at 3.375 g in a 4-hour
interval in an obese patient (BMI: 50). The focus was to identify the obesity patients who had
undergone bariatric surgery and faced the danger of getting surgical site infections due to the
surgical wound inflicted on their abdomen.
The protocol of the study was the use of perioperative regimes to ascertain the value of
antimicrobial prophylaxis to prevent surgical site infections. The design used in this article was a
meta-analysis review of previous literature that has researched in this filed to ascertain whether the
use of prophylaxis among surgical patient had a significant implication in the efforts toward
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PERI-OPERATIVE PROPHYLACTIC TREATMENT
reducing the risks exposure to surgical site infections attributed to the wounds inflicted to the
patient during surgery. The findings noted that such intervention leads to an increased value and a
reduced level of concentration of peak serum of the antibiotic in the patients.
Conversely, the authors concluded that the antimicrobial activity of prophylaxis among
morbidly obese patients could be optimized through alteration of the dose regimens. The article,
therefore, notes that despite the benefits attributed to bariatric surgery, the postoperative
complications arising from the use of antimicrobials have a server implication patient mortality. The
lack of statistical significance in this study was partly attributed to the limitation of lack of
concurrence in the meta-analysis of the articles that were sampled for the purpose of this study. As a
result, it became very difficult for the study to substantiate the differences between the various
preoperative prophylaxes interventions used to prevent the surgical site infection among patients.
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References
Chopra, T., Zhao, J. J., Alangaden, G., Wood, M. H., & Kaye, K. S. (2010). Preventing surgical site
infections after bariatric surgery: the value of perioperative antibiotic regimens. Expert
review of pharmacoeconomics & outcomes research, 10(3), 317–328. doi:10.1586/erp.10.26
Enzler, M. J., Berbari, E., & Osmon, D. R. (2011). Antimicrobial prophylaxis in adults. Mayo
Clinic Proceedings, 86(7), 686–701. doi:10.4065/mcp.2011.0012.
https://doi.org/10.1093/bjaceaccp/mkr028
Gifford, C., Christelis, N., & Cheng, A. (2011). Preventing postoperative infection: the anesthetist's
role. Continuing Education in Anaesthesia, Critical Care & Pain, 11(5), 151-156.
Hagel, S., & Scheuerlein, H. (2014). Perioperative Antibiotic Prophylaxis and Antimicrobial
Therapy of Intra-Abdominal Infections. Viszeralmedizin, 30(5), 310–316.
doi:10.1159/000368582
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