Surgical sites infections are caused by operations involving poor or no preoperative and postoperative disinfection or the use of poor quality disinfectants. The consequences are far-reaching and can result in much suffering regarding pain and poor social life. The medical society has contributed a lot in preventing and managing such scenarios, but more changes still need to be done to further reduce the possibility of the occurrence of surgical site infections. This project will involve the collection of data on the contributions made by surgical facilities such as availing of enough disinfectants throughout the hospital's lifespan and the knowledge of the surgeons and teams involved in the subject of disinfection. A questionnaire will be administered, and willing participants will be recorded either visually or through audio recording. The activity will be conducted within two months but cover a maximum of 30 active days. The research team will consist of eight active members, three of whom will have additional responsibilities and the other five members. The team will plan, prepare, collect, report, analyze and present the data collected from a 16 days collection.
How Progressive Organizations Address the Issue of Reducing Surgical Site Infections
According to Mission to Care Initiative, a collaborative work organized by Florida’s hospital association, 2017, in order to manage and reduce the occurrence of surgical site infections the following progressive measures should be implemented.
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Performance of a gap analysis to identify the loopholes in the protocols followed during surgeries.
Analysis of data related to the surgical site infection cases to include information such as patient demographics, operational protocols, other health care providers, location and organisms involved in each of the particular infection.
Enlisting of a specialist who will act as a champion of safer surgical procedures by suggesting insights and invaluable experiences.
Adoption of strategies that are innovative, revolutionary, and cross-cutting in the clinical practices such as UP campaign strategies for hygienic strategies, and enhanced recovery after the surgery (ERS)
The World Health Organization (WHO) has a list of 29 proposals aimed at managing and reducing the rate of surgical sites infections. The list contains 13 preoperative practices and 16 postoperative practices aimed at reducing surgical sites infection (WHO, 2016). Some of these practices include admonition to patients to take a bath before surgery, surgical team to wash their hands before performing any operation however simple it may be considered, proper disinfection of surgical sites, appropriate time for administering antibiotics and the type of disinfectants and sutures to be used before and after operations (WHO, 2016). WHO encourages patients to take precautionary measures such as asking their doctor if they are complying with the WHO standards on safe surgical operations (WHO, 2016). The use of antibiotics is an effective measure of preventing surgical infections. However, the research for better antibiotics is an expensive and time-consuming process that the WHO is trying to spare both the researchers and the sponsors of such procedures. Therefore, WHO insists that antibiotics be used only before and during surgery and not after surgery to prevent the development of pathogenic resistance to the antibiotics, which will necessitate continuous expensive and tedious researches (WHO, 2016).
The Size of the Team and Specific Positions of Each Member
Sponsor
The sponsor of the team will be the course instructor. We expect to borrow a lot from the course instructor in accomplishing this task. The instructor’s experience with a previous class on this task, experience in a facility if any, and invaluable knowledge in health care provision will prove invaluable to us as a team.
The sponsor, being an independent member of the team, will help the team in navigating forward by removing obstacles such as circumstances requiring recommendation from an experienced and credible individual, he will help the team obtain relevant but rare materials, provide the team with starting goals, monitor its progress and provide other supports as opportunity will demand.
The sponsor will also be responsible for identifying specific procedures to be followed in the accomplishment of the project, time, and quantifiable outcomes. The team must accomplish for a successful project to avoid cases such as working on unproductive procedures and time wastage. Finally, the sponsor will be responsible, together with the team leader, for appointing team members and their specific roles in the accomplishment of the project.
Team Leader
The team leader will be selected from among the team members, in case the sponsor had none in mind and will be expected to fulfill duties ranging from streamlining communication among team members and with external parties such as the sponsor. The team leader will also be expected to help in clearing unexpected barriers and ensuring that the team is working out relevant procedures towards the achievement of the team’s goals.
Facilitator
The facilitator will work in close association with the team leader. However, the facilitator's obligations will center in ensuring that the meetings are held in time, communications are passed effectively, discussions are relevant to the team goals, soften hardliners by encouraging cooperation among team members, facilitate data collection, analysis and presentation, and completion of the team goals in time.
It is important to note here that the team facilitator should be an independent party like the sponsor, lacking any stake in the project, experienced and knowledgeable in the related field.
Number of the Team
One person will fill the position of the team sponsor, leader, and facilitator gave that their roles involve restraint, which is better served by one authority in each case. The team will also need other additional five members who will perform general tasks such as data collection, examination, analysis, and additional input during discussions. Therefore, the team will total eight members whose descriptions are identified in the table below
Table 1 Description of Team Members
| DESCRIPTION | NAME | EXPERTISE/SPECIALIZATION |
| Team leader | ||
| Sponsor | ||
| Facilitator | ||
| Team member 1 | ||
| Team member 2 | ||
| Team member 3 | ||
| Team member 4 | ||
| Team member 8 |
Problem Statement
The history of surgical infections has come a long way from the periods in which mortality rates were recorded as high as 60% and infections resulting from contamination at 80% to lower levels today, as low as 3.4% ( Sabbatani et al., 2016 ) . According to Lindsjö et al. (2015 ) , the occurrence of surgical sites infection was found to be 5% before and 6.5% after introduction of a disinfection procedure. The population used in the study was not constant. Therefore, the percentages might not compare directly. Nonetheless, the significant part of this study is that surgical sites infections are a reality that must be recognized. Even though the percentage seems to be small, the affected persons undergo extra costs, pain, and social challenges in handling the surgical infections acquired from the surgery beds. This necessitates the need for protecting such vulnerable people and ensuring that such cases are eliminated in the future.
Another study by Carvalho et al. (2017) on surgeries conducted between the years 2008 to 2011 places the percentage at 3.4% and associates the occurrence of the surgical infections to long preoperative stays in the hospital, and contamination. This evidence further augments the occurrence of surgical sites infections.
A final study conducted by Sanger, et al. (2016), involving a population of 851 patients places the percentage at 19.4% which is a much higher percentage in comparison to the previous statistics. Given that these three pieces of evidence indicate the occurrence of surgical infection, it is reasonable to conclude that surgical site infections are likely to occur in case disinfection protocols are not followed properly.
Team Charter
Goal
Identify progress staged to reduce surgical infection occurrences, factors accelerating their occurrence, and practitioners' knowledge of surgical site infections prevention and management.
Project Scope
Conduct research assessing the improvements that have been done in the surgical sector and identify those inputs that have been revolutionary as well as practices that are proving a setback towards the goal of ensuring a 0% surgical site infection cases.
Measures
The following factors will be quantified to determine the factors causing infections in surgical procedures
Cases of managed surgical site infections
Cases of critical surgical sites infection
Totals of Reported surgical site infections
Rating of the facility’s management support for the acquisition of disinfectants/ frequency of replenishing surgical disinfectants
General view of the health practitioners on the subject of surgical sites infection, its prevention, and management using a questionnaire
Deliverables
The project should be completed within two months period beginning 7 th September and ending 26 th October 2018. All data should be collected, analyzed, and presented within this period and factors determined that hold back the reduction of surgical site infections to a 0% level and recommendations made on factors that should be done to reduce the occurrence of surgical sites infection.
Draft agenda
The project will be completed sequentially as follows
Week one
First meeting
The members of the team will be expected to meet in the first week following the formation of the team. The team will be constituted under the guidance of the sponsor and assisted by the appointed team leader. It will discuss the agendas, establish rules of conduct, and agree on a timeline for accomplishing the study.
Week Two
Preparation of questionnaires
The team will outline the questionnaire to be used in interviewing surgical teams. The team facilitator will guide the team discussions and identify someone good in data collection, analysis, and present the analysis.
Delegation of tasks
In this meeting, the team will delegate responsibilities to team members to work as a group or individually on specific portions of the project.
Week 3-5
Data collection
From the third week to the fourth week, the team will be committed to the collection and recording of data through questionnaires, audio capturing and video capturing where participants are willing to do the last two options. The team members are expected to report any difficulty and consult with the team facilitator and leader.
Week 6
Data reporting
Week six will be devoted to reporting of data collected from the field. All members will be expected to converge at the agreed place and time and present all materials including any tool that was availed to any by the group.
Week 7
Data analysis
The team will meet in the seventh week of the project to analyze the data as stipulated by the team facilitator.
Week 8
Data presentation
The final week of the study will be spent on data preparation of the results in soft and printed formats for review and storage by relevant authorities. The team members are encouraged to corporate throughout the entire project.
Timeline
Table 2 project timeline
| Event | Activity | Start Time | Duration (Days) | Stop Time |
| Sponsor selects team facilitator and constitution of the team. | Constitution of the team | 7/9/2018 | 1 | 7/9/2018 |
| First Meeting |
Discussion of goal Setting rules |
10/9/2018 | 1 | 10/9/2018 |
| Second Meeting |
Designing of questionnaire Delegation of tasks |
12/9/2018 | 1 | 12/9/2018 |
| Fieldwork | Data collection | 17/9/2018 | 16 | 7/10/2018 |
| Third Meeting | Data reporting | 10/10/2018 | 3 | 12/10/2018 |
| Fourth Meeting | Data analysis | 17/10/2018 | 5 | 21/10/2018 |
| Fifth Meeting | Data presentation | 24/10/2018 | 3 | 26/10/2018 |
The study is expected to go for 30 days beginning from 7 th September to 26 th October 2018. The weekends are excluded from the days count. In this timeline, data collection is given the maximum number of days, 16 in total, given its tasking requirements and engagement. Data analysis follows with a duration of 5 days, and this is followed by data reporting and presentation having three days each. The constitution of the team, first meeting, and second meeting are given the same amount of time, one day each, given that they are less demanding and involve fewer activities that can be accomplished in a single day.
Conclusion
Surgical site infection has reduced drastically over the years since the beginning of surgery. The staggering percentages were up to 60-80%, but this has reduced to as low as 3.4%. The factor that has improved over the years include the introduction of better technologies and most important advancement in the field of disinfectants in pre and post-operative stages of surgery. Even though the percentage is low today, this percentage can be lowered even further below the present level. The purpose of this study is to obtain practitioners insight, input by facilities such as replenishing of disinfectant supplies, and use this data to determine factors that are still holding the downward reduction of surgical sites infections to levels as low as 0%. The research project will be conducted over a period of 30 days through the corporation of a team consisting of team sponsor, team leader, facilitator, and five members holding no position. The data will be collected systematically as indicated in the timeline and reflected in the Gantt chart. I hope that the project will create a clear distinction between practices that help in preventing surgical sites infection and those that enhance it and that this information will be availed to the public for scrutiny and implementation.
References
Carvalho, R. L. R. D., Campos, C. C., Franco, L. M. D. C., Rocha, A. D. M., & Ercole, F. F. (2017). Incidence and risk factors for surgical site infection in general surgeries. Revista Latino-Americana De Enfermagem, 25.
Lindsjö, C., Sharma, M., Mahadik, V. K., Sharma, S., Lundborg, C. S., & Pathak, A. (2015). Surgical site infections, occurrence, and risk factors, before and after an alcohol-based hand rub intervention in a general surgical department in a rural hospital in Ujjain, India. American Journal of Infection Control, 43 (11), 1184-1189.
Mission to Care. (2017). Reducing Surgical Site Infections – Colon Resource Guide. Retrieved from http://www.fha.org/files/HIIN/SSI-Colon-Resource-Guide-2017-06-26.pdf
Sabbatani, S., Catena, F., Ansaloni, L., Sartelli, M., & De Simone, B. (2016). The Long and Dramatic History of Surgical Infections. Arch Med, 8 , 6.
Sanger, P. C., van Ramshorst, G. H., Mercan, E., Huang, S., Hartzler, A. L., Armstrong, C. A., ... & Evans, H. L. (2016). A prognostic model of surgical site infection using daily clinical wound assessment. Journal of the American College of Surgeons, 223 (2), 259-270.
WHO. (2016). WHO recommends 29 ways to stop surgical infections and avoid superbugs . Retrieved from http://www.who.int/news-room/detail/03-11-2016-who-recommends-29-ways-to-stop-surgical-infections-and-avoid-superbugs
Exhibits
Project Charter
Goal
Collect information on surgical sites infection: causes and prevention
Project scope
Gather information from relevant authorities such as hospitals particularly the register, and purchase departments and surgical team within the facility.
Measures
Quantify the number of surgical sites infection cases, practitioners' general knowledge, and frequency of replenishing disinfectants.
Deliverables
An in-depth analysis and presentation of the data collected within two months
Draft agenda
The project will be completed sequentially as follows
Week one
First Meeting
Discuss the agendas, establish rules of conduct, and agree on the timeline for accomplishing the study.
Week Two
Preparation of Questionnaires
The team will outline the questionnaire to be used in interviewing surgical teams and organize for their printouts.
Delegation of Tasks
The delegation of responsibilities to team members
Week 3-5
Data Collection
Collection and recording of data through questionnaires, audio capturing and video capturing
The team members are expected to report any difficulty and consult with the team facilitator and leader.
Week 6
Data Reporting
Reporting of data collected from the field. Presentation of all materials; including any tool availed to any by the group.
Week 7
Data analysis
Analysis of the reported data
Week 8
Data presentation
Data presentation in soft and hard copies
Project Timeline
Table 3 project timeline
| Activity | Start Date | Duration | End Date |
| Sponsor selecting team facilitator and constitution of the team. |
7-Sep-18 |
1 |
7-Sep-18 |
| First meeting |
10-Sep-18 |
1 |
10-Sep-18 |
| Second meeting |
12-Sep-18 |
1 |
12-Sep-18 |
| Fieldwork |
17-Sep-18 |
16 |
7-Oct-18 |
| Third meeting |
10-Oct-19 |
3 |
12-Oct-18 |
| Fourth meeting |
17-Oct-18 |
5 |
21-Oct-18 |
| Fifth meeting |
24-Oct-18 |
3 |
26-Oct-18 |
