Case Study. You are the Chair of the Department of Surgery at a large urban medi
ID: 221650 • Letter: C
Question
Case Study.
You are the Chair of the Department of Surgery at a large urban medical center. The infection control nurse makes an appointment to see you to review infection data she has been gathering over the last year. Although you have had regular meetings with and reports from her, she felt it was important to go over some data that was somewhat disturbing. She presents data to you that indicate the medical center has an unusually high surgical site infection rate following gallbladder surgery. The rates are three to four times higher than the national average.
You ask her several questions, including:
Do these cases all belong to the same surgeon?
Are they happening in the same operating room?
Is anybody on the team consistent in the majority of these case?
Are we sure that the protocols for sterilization and cleaning the operating rooms are being followed correctly?
She states that she does not know the answers to all these questions and will begin a detailed investigation and collection of data.
After meeting with the Perioperative Director, the Infection Control Nurse, and the Chief of General Surgery, you have determined that there are no physicians that are constant with respect to these injections. You also have determined that there is no common operating room or staff involved with these cases. Furthermore, the infections disease control nurse has discussed this issue with the head of pathology and the doctor in charge of infectious disease and not common organism is identified in these infections.
ESSAY QUESTIONS
What are the major issues presented in the case?
What are the many possible causes of these types of infections?
What are the clinical, financial, and legal implications of these infections? (Hint: Is the patient’s length of stay increased?)
What are the typical impact objectives expected from implementing a set of new procedures to reduce the number of surgical site infections?
Explanation / Answer
Major issues are: 1. increased incidence of surgical site infections
2. proper infection control measures are not taken
3. increased length of stay of patients following surgery
4. multiple drug resistance among organisms
5. increased treatment costs.
possible causes of these types of infections are:
(a) iartrogenic source( from medical instruments/devices) of infection.
(b) nosocomial infections(hospital acquired, from hands of healthcare worker)
(c) emergence of multidrug resistant organisms
(d) no disinfection, cleaning of operation theatres
(e) no implementation of infection control measures
Clinical implications of these diseases are: systemic infections, other complications, no response to first line of drugs, no treatment options, increased length of stay.
Financial and Legal implications of these types of infections are: due to increased length of stay, cost of treatment , hosptal bills increases, ethical issues related with the patients and diseases.
Objectives for new rules of reducing surgical site of infections:
(a) to implement infection control measures in ward
(b) to keep check on emergence of new pathogens
(c) to sterilize wards, instruments and to implement hand wash practices among health care workers.
(d) to routinely screen surgery patients for surgical site infection.
(e) to ensure no outsiders inside ward of surgery patients.