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

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

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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. 9 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 10 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. 11 PERI-OPERATIVE PROPHYLACTIC TREATMENT 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 12
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