Introduction
Root cause analysis is a significant approach that helps determine the cause of a sentinel event, which helps establish the right interventions to use to address the problem present. The nursing practice is guided by the need to make use of the health policies and procedures and other regulations that help prevent any adverse outcomes for the patients. It is essential for nurses to participate in gathering and analyzing data to help solve health issues, which enhances the implementation of quality improvement measures. As a matter of fact, patient safety continues to be encountered each day, and the role of nurses is critical in helping formulate quality improvement plans. Root cause analysis and quality improvement plans are done to help address sentinel issues such as patient falls, medication errors, hospital-acquired infections, and wrong-site surgery events. This involves a systematic approach to identifying the problem, which revolves around identifying the system check for errors and process failures. Determined failures help develop a safety plan that offers vital information to health professionals, including nurses, who aim to improve health outcomes and protect the patient’s well-being.
This root cause analysis paper is based on the subject of healthcare-associated infections, which pose a significant health concern among patients. In this sense, healthcare-associated infections increase the mortality rates, morbidity levels, the cost of treatments, and the demand for antimicrobial agents whose risk for resistance increases. Healthcare-associated infections affect patients when in the care facilities as the care process continues or the condition begins during admission. Most healthcare-associated infections are linked to surgical site infection, ventilator-associated pneumonia, and catheter-associated urinary tract infections. According to the CDC, at least 722,000 cases of healthcare-associated infection occur every year. If such patients are not well managed, they are at risk of death, which is a significant concern that needs to be addressed in the current world.
Sentinel case scenario:
The paper is based on the case of a 65-year-old Caucasian male client who was admitted for a routine surgical procedure. The patient was a known diabetic and hypertensive client on treatments. During the treatment process in the hospital, the patient develops an infection on the surgical site, which causes a substantial threat to his recovery. The recovery process was prolonged and complicated due to the infections, hence eventually leading to a poor recovery process and a significantly high cost of care.
Root cause analysis
There are several potential causes of healthcare-associated infections after surgery. In this case, the patient being diagnosed with hypertension and diabetes translates to an immune system compromised, which are chronic severe illnesses. Overall, persons with poor immune system function are at risk of infections from the care processes. Compromised immunity makes the body unable to fight the pathogens, especially after surgery. On the other hand, hospital exposure presents the patient with the risk of infection, which requires effective infection control measures.
Poor infection control and prevention practices, such as lack of use of sterilized instruments and clean surroundings, provide microorganisms in the environment, which could cause infection in the patients. On the other hand, there is a high risk of surgical site infection post-surgical process among hospitalized patients, which could result from the use of incorrect antibiotics, which makes one resistant to various strains of bacteria (Mukagendaneza et al., 2019). Addressing such issues is a significant aspect that helps prevent the occurrence of such infections among hospitalized patients.
The prevalence of surgical site infection is high, and there exists a high risk of infections among patients from public hospitals compared to those in private facilities (FIsha et al., 2019). Dirty wounds, clean-contaminated wounds, hospital stays, prolonged operations, and procedures conducted by general and resident practitioners are linked with surgical site infection (Fisha et al., 2019). In this case, dirty wounds and clean-contaminated wounds, hospitalization, and prolonged operations are predictors of surgical site infections in public facilities. In contrast, dirty wounds, clean-contaminated wounds, and rural dwelling facilities are predictors of surgical site infections among patients from private facilities (Fisha et al., 2019). In this case, the prevalence of surgical site infection in public facilities stands at 13.4% compared to 6.5% in private hospitals (Fisha et al., 2019).
On the other hand, there has been evidence that premorbid illnesses such as diabetes, as in the case of the patients, increase the risk for surgical site infection, which occurs due to low immunity and slow healing processes (Mezemir et al., 2020). There is a high risk of surgical site infection among diabetic patients compared to hypertensive clients (Mezemir et al., 2020).
An increase in age, blood transfusion, and emergency surgeries also predispose one to a risk of surgical site infections. Various bacteria and microorganisms that are known to cause such infections include staphylococcus aureus, acinetobacter, proteus spp, Escherichia coli, and coagulase-negative staphylococci (Mukagendaneza et al., 2019). Such microorganisms are linked with variable levels of antibiotic resistance, which include 98.8% for amoxyclavilinic acid, 78.1% for ciprofloxacin, 92.6% for gentamicin, and 53.3% for ceftriaxone (Mukagendaneza et al., 2019). On the other hand, only imipenem and amikacin have been found to have the most effective microbial control from isolated pathogens, having 100% sensitivity (Mukagendaneza et al., 2019).
Use of evidence-based intervention to handle the situation
Despite modern surgical techniques and infection prevention measures using antibiotics for prophylaxis, infections at the surgical site remain a significant burden among patients and the healthcare system (Mezemir et al., 2020). It is a core cause of morbidity, prolonged hospitalizations, and increased cost of care. In this sense, the prevalence of surgical site infection is 24.6%, where 10% accounts for deep site infections, 9.2% for organ spaced, and 5.2% for superficial surgical site infections (Mezemir et al., 2020). 54.3% of the patients undergo orthopedic surgeries, and 30% undergo abdominal surgeries (Mezemir et al., 2020). Premorbid illnesses such as diabetes, educational status, duration of the hospitalization stay, and the type of wound are linked with infections.
There are several solutions to the occurrence of healthcare-associated infections. To begin with, there is a need to adhere to rigorous infection control measures, which include the need for the caregivers to offer proper hygiene-based interventions with adherence to strict sterilization demands and proper instrument cleanliness. Complying with the present guidelines is essential since this is highly dependent on recurrent staff training and progressive infection surveillance to determine the desirable areas of improvement and promote effective practice in the predominant areas.
On the other hand, preventing infections among surgical patients requires effective utilization of antibiotics, which helps prevent antimicrobial agent resistance. The use of sterilized equipment during surgery, high-tech tools, and robotics can also promote the prevention of commensal infection burden that occurs from medical procedures. Such evidenced-based interventions are significant components of an all-inclusive aspect to bring together an integrated approach to the elimination and prevention of healthcare-associated infections, hence promoting patient safety.
On this note, around 0.5 to 3 % of patients who undergo surgery in the current healthcare scenarios end up with prolonged hospitalization compared with those with no infections. In this case, maintenance of normothermia, decolonization with intranasal antistaphylococcal agent, use of chlorhexidine gluconate with alcohol-based skin preparations, use of negative pressure wound therapy, control of perioperative glucose concentration are helpful to reduce the risk of surgical site infection (Seidelman et al., 2023).
Quality improvement plan for healthcare-associated infections on surgical sites
To facilitate the patient’s safety from surgical site infections, especially for immunocompromised clients with chronic issues like diabetes, there is a need to consider various aspects. In this case, there is a need for effective wound care practices for the patients and monitoring of the diabetic patients’ well-being, which includes sugar levels and adherence to treatment. The use of prophylactic antibiotics could be a significant step towards the prevention of infections after surgery, which is based on the current practice guidelines. Also, there is a need for effective wound dressing and care processes, which include adherence to sterile procedures when dressing. Here, hand hygiene and the use of sterile tools should be appreciated since the risk of infection, especially among immunocompromised patients, is imminent. Proper documentation of the patient’s data and progress with the use of electronic health records is another aspect that promotes communication and care handover for the patients, hence reducing the risk of patient mismanagement. The environment should be kept clean and decontaminated, and the wound should always be covered from free-air microorganisms. This is a significant aspect of promoting patient safety and well-being.
Sufficient caregivers, which includes a complete team of nurses, surgical team, pharmacists, and quality assurance professionals, need to be incorporated into the care process, which promotes the delivery of safe care for the patients. The facility also needs real-time recording systems and reporting networks, which help track the occurrence of surgical site infections for inpatients, hence promoting prompt patient identification and management. The patient especially has immune issues; there is a need to offer them adequate education regarding the ways to prevent infections, which could include frequent wound dressing, practicing hand hygiene, and covering it from exposure to dust.
Organizational resources to use to address the sentinel event
To address the issue of infections among diabetic patients who have undergone surgery, there is a need for a comprehensive and well-versed approach to be used. Some of the critical resources to be used include the guidelines from the World Health Organization and other organizations, such as those centered on disease control and prevention. Such guidelines are aimed at promoting the safety of the patients and preventing and treating any occurring infections. On the other hand, there is a need to develop infection control policies and guidelines in the facility, which include sterilization of instruments and wound care routine for the patients with the right tools, such as disinfectants. The staff also needs to undergo education and training that help focus on preventing infections with unique consideration of patients with immune issues, such as diabetic clients whose care should be patient-centered. The use of in-service sessions, workshops, and online resources are important aspects. When managing patients, there is a need to foster a collaborative approach to patient care where crucial insights and interventions are offered to manage the patients.
Care collaboration ensures that all the vital issues the patient has are addressed well and effectively managed. The facility also requires a robust surveillance monitoring system that helps track any infections, especially for the surgical sites among post-surgical clients. Having such data is crucial to determine the trend, potential gaps to improve, and patterns of infection occurrence. Among the patients, they need to be enlightened on signs of infections, which include the presence of pus drainage, pain, and fever, while encouraging them to adhere to the provided treatment options, such as antibiotics, which help prevent the occurrence of infections. Practical health information recording systems such as electronic health records and proper data analysis systems are essential to determine real-time occurrences of infections among surgical patients, hence establishing the cues and the right interventions to undertake. The patient needs to undergo follow-up care, which helps determine the progress of the patient and the recovery process, which could include outpatient clinic checkups, phone calls, and telemedicine services available for patients from rural areas.
Finally, there is a need to have regular audits on adherence to the infection control measures in the facility, which include sterilization processes, hand hygiene protocol adherence, decontamination processes, and administration of prophylactic antibiotics, which are helpful to prevent the risk of infections hence offering vital feedback to drive progressive improvement for the patient’s well-being.
Conclusion
Healthcare-associated infections are among the severe health issues affecting the patient’s health outcomes and satisfaction levels. This becomes a significant health issue to address in the current world of medicine. Failure to establish the proper measures and interventions becomes a worrying aspect, which makes it difficult to counter the infections. The role of care professionals, such as nurses, is to plan for the patient’s care and implement safety measures and procedures that help promote the health outcomes of the patients after surgery and during hospitalization, especially for patients with chronic illnesses. Within the medical facilities, there is a need to have safety culture promotion approaches, which help to ensure that suitable measures are adhered to. Proper resource utilization, adherence to the care standards, and the need to develop safety improvement plans are essential to help minimize healthcare-associated infections, hence promoting overall patient safety and health outcomes. Evidence-based interventions, technology, and patient-centered care are essential to help counter such health issues in the population.
References
Fisha, K., Azage, M., Mulat, G., & Tamirat, K. S. (2019). The prevalence and root causes of surgical site infections in public versus private hospitals in Ethiopia: A retrospective observational cohort study. Patient Safety in Surgery, 13. https://doi.org/10.1186/s13037-019-0206-4
Mezemir, R., Seid, A., Gishu, T., Demas, T., & Gize, A. (2020). Prevalence and root causes of surgical site infections at an academic trauma and burn center in Ethiopia: a cross-sectional study. Patient Safety in Surgery, 14(1). https://doi.org/10.1186/s13037-019-0229-x
Mukagendaneza, M.J., Munyaneza, E., Muhawenayo, E. et al. Incidence, root causes, and outcomes of surgical site infections in a tertiary care hospital in Rwanda: a prospective observational cohort study. Patient Saf Surg 13, 10 (2019). https://doi.org/10.1186/s13037-019-0190-8
Seidelman, J. L., Mantyh, C. R., & Anderson, D. J. (2023). Surgical Site Infection Prevention: A Review. JAMA, 329(3), 244–252. https://doi.org/10.1001/jama.2022.24075
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