Does Prophylactic Antibiotics Administered Before Surgery Decrease Risk of Post Operation Infection

Does Prophylactic Antibiotics Administered Before Surgery Decrease Risk of Post Operation Infection ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Does Prophylactic Antibiotics Administered Before Surgery Decrease Risk of Post Operation Infection I’m working on a Health & Medical exercise and need support. Does Prophylactic Antibiotics Administered Before Surgery Decrease Risk of Post Operation Infection Please look at example clinical problem paper 2 as a template to follow for this paper Please use Literature Table attached as a guide to develop Part II of your Clinical Problem Paper. Part II – page length 3 ½ – 4 ½ pages (consider 3/4 page FOR EACH ARTICLE = 3 ½ to 4 ½ pages – PLUS: Literature Table, Part I, APA title page and references ) Written in 3rd person PICO is located in part one clinical paper attached Included is example of annotated bibliography. Needs to have Literature Search Method (Use subheading: Method) –1 paragraph-see Method Template/Exemplar – include search engines, key words, inclusion and exclusion criteria, and yield Annotated Bibliography (Use subheading: Annotated Bibliography) – FOUR ARTICLES – 3/4 -1 page per article -Four Peer-Reviewed RESEARCH STUDIES (Quantitative or Qualitative – must answer or clearly address your PICO) – Attach PDF (not link) of each article in your annotated bibliography -Articles must answer or clearly address your PICO – include authors, title, purpose, research question if included, method/design, Level of Evidence (LOE), population, sample, setting, data collection, findings (STATS or qualitative themes), limitations Literature Grid ( Use subheading: Literature Table) Included is literature table example and template. The literature table template needs to include authors, title, purpose, research question if included, method/design, Level of Evidence (LOE), population, sample, setting, data collection, findings (STATS or qualitative themes), limitations II. REFERENCE LIST Relevance of references III. FORMAT APA Style Mechanics (grammar, punctuation, sentence structure, etc.) Organization of ideas ( transition of paragraphs; use of subheadings ) NOTE: Paper Format: APA including title page, Running head, citations and references. Title must reflect your topic (not the name of the assignment) Paper should not exceed suggested page length. ( excluding Title and Reference pages ). Please proofread for spelling and punctuation errors. literature_table_template__1_.docx literature_table___exemplar_cauti__1_.docx clinical_problem_paper_part_ii_exemplar_cauti_1__1_.doc clinical_paper_part_2_needed_revisions.pdf 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. Does Prophylactic Antibiotics Administered Before Surgery Decrease Risk of Post Operation Infection 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). Does Prophylactic Antibiotics Administered Before Surgery Decrease Risk of Post Operation Infection 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). Does Prophylactic Antibiotics Administered Before Surgery Decrease Risk of Post Operation Infection 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).Does Prophylactic Antibiotics Administered Before Surgery Decrease Risk of Post Operation Infection 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. Does Prophylactic Antibiotics Administered Before Surgery Decrease Risk of Post Operation Infection 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. Does Prophylactic Antibiotics Administered Before Surgery Decrease Risk of Post Operation Infection 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. Does Prophylactic Antibiotics Administered Before Surgery Decrease Risk of Post Operation Infection 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 … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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