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Wound healing process
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Review of Literature
Wound infections in adult patients after cardiac surgery have been used in several domains. We had searched for it in three different databases which are used in many areas such as in practice, research, and education. The number of articles that we acquired from CINAHL database when we searched Scholarly (Peer Reviewed) Journals from 2011 to 2016 were 21,946 articles. On the other hand, the appropriate articles that we obtained from MEDLINE database (2011 to 2016) were 47 articles. Whereas, when we chose ProQuest Nursing & Allied Health Source from 2011 to 2016 by using wound infections in adult patients after heart surgery, there were 1,684 articles. Many of those articles that we acquired are related to the sternal wound
infections after open heart surgery. Sternal wound infection was a most significant factor which led to increase mortality, stay patients in the intensive care unit, and second reoperation. (Dubert, Pourbaix, Alkhoder, Mabileau, Lescure, Ghodhbane, . . . Lucet, 2015). In this case, it is required that patients have to stay in the hospital in order to receipt more antibiotics such as vancomycin and gentamicin to control the infection which is caused by staphylococcus aureus. While I was working in Duhok private hospital in Duhok city, it was recommended to give antibiotics before major surgery like heart surgery to reduce sepsis and then minimize the mortality rates after open heart surgery. There were 160 patients from 4407 who developed a sternal wound infection and the needed reoperation. Also, Clients with CDC+ SWI needed antibiotic therapy for longer duration (Dubert, Pourbaix, Alkhoder, Mabileau, Lescure, Ghodhbane, . . . Lucet, 2015). A mortality rate of 17% as compared to 3% in patients with CDC- SWI (p = 0.025). Rates of superinfection (10% and 9%) and the need for a second reoperation (12% and 17%) were similar. CDC+ and CDC- SWI received basically the same management, but CDC+ SWI had a more significant outcome (Dubert, Pourbaix, Alkhoder, Mabileau, Lescure, Ghodhbane, . . . Lucet, 2015).
The guidelines’ first focus is the definition of sepsis, which makes sense, because there is no way to effectively treat sepsis without an accurate and categorical definition of the term. The guidelines define sepsis as “the presence (probable or documented) of infection together with systemic manifestations of infection”. Such systemic manifestations can include fever, tachypnea, AMS, WBC >12k, among others; these manifestations are listed in full in Table 1 of the guidelines. The definition for severe sepsis builds on to the definition of sepsis, bringing organ dysfunction and tissue hypoperfusion (oliguria, hypotension, elevated lactate) into the picture; full diagnostic criteria is listed in Table 2. The guidelines recommend that all
In 1865 before an operation, he cleansed a leg wound first with carbolic acid, and performed the surgery with sterilized (by heat) instruments. The wound healed, and the patient survived. Prior to surgery, the patient would need an amputation. However, by incorporating these antiseptic procedures in all of his surgeries, he decreased postoperative deaths. The use of antiseptics eventually helped reduce bacterial infection not only in surgery but also in childbirth and in the treatment of battle wounds.
Melling, C. A., Baqar, A., Eileen, M. S., & David, J. L. (2001, September 15). Effects of preoperative warming on the incidence of wound infection after clean surgery; a randomised control trial. The Lancet, 358, 876-880.
Pressure ulcers development occurs in every hospital and it remains a major worldwide health problem for many years. However, pressure ulcers have received minimal attention when we talk about it as a patient safety issue. It is a patient safety issue as it can lead to serious damage such as life-threatening infections and pain (Richardson & Barrow, 2015). On a med/surg unit, individuals may experience long or short hospital stays depending on the situation. For the short stays, the focus of care is often on regaining activities of daily living (Registered Nurses’ Association of Ontario, 2011). Therefore, assessment and education regarding pressure ulcers is often minimal or non-existent (RNAO, 2011). Every client who is at risk needs to be assessed and educated regarding pressure ulcers and the subsequent skin breakdown (Cooper, 2013). During the hospital stay, clients may have limited movement and pressure ulcers can extend into the muscle, tendon, and bone (RNAO, 2011). In many cases, clients do not notice the formation of an ulcer and as it may be in areas that are out of sight such as the coccyx. Often,
A blood blister on lip does not only make you unconfident about your visage, but can point out an underlying health issue. Nonetheless, lip blisters in numerous cases are not a thing to get so worried, but should be handled with care to evade new infections. Conversely, a blister that occurs on the inside part of the lip may have resulted from a bite, which off cause doesn't need much attention since it will disappear after a short time, as the injury heals.
Life History and Characteristics: Staphylococcus aureus is a gram positive bacterium that is usually found in the nasal passages and on the skin of 15 to 40% of healthy humans, but can also survive in a wide variety of locations in the body. This bacterium is spread from person to person or to fomite by direct contact. Colonies of S. aureus appear in pairs, chains, or clusters. S. aureus is not an organism that is contained to one region of the world and is a universal health concern, specifically in the food handling industries.
Necrotizing Fasciitis (flesh eating bacteria ) from an essay by Katrina Tram Duong, edited by S.N. Carson M.D.
Hochadel, M. (2014). Mosby's Drug Reference for Health Care Professionals (fourth edition ed.). : Elsevier.
Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et al., 2014).
Around the world, Joseph Lister is considered to be the “father of modern surgery” (Pitt & Aubin, 2012). Joseph Lister was a surgeon in England that not only influenced the surgery techniques of surgeons in England, but who also played a major role in the sterilization techniques that surgeons use in our country. He realized that the infections and deaths that occurred after surgery were caused by bacteria and was able to come up with a sterilization technique that would minimize the deaths of the patients. The sterilization technique that Lister used was an antiseptic method. By using the antiseptic method that used carbolic acid, Lister was able to prevent any contamination of the wound or medical instruments that were involved in performing the surgery in order to decrease the amount of deaths that occurred from infections by bacteria. Through the creation of this antiseptic technique, Joseph Lister introduced to the world an invention that improved the safety of surgery and influenced the way surgeons in other countries, such as Germany and the United States, would view microorganisms’ effect on surgical wounds eventually leading to the modernization of surgery.
The normal wound healing process mainly consists of four main stages being haemostasis, inflammation, proliferation or new tissue formation, and tissue remodeling or resolution. For a wound to heal well the above mentioned stages should occur in a sequential and orderly manner. Disturbances, abnormalities and delays in any of the above stages may lead to impaired healing or even chronic wounds. In adults, this process of normal healing takes place in the following steps (1)rapid haemostasis (2)appropriate inflammation (3)mesenchymal cell differentiation, proliferation, and migration to the wound site (4)suitable angiogenesis (5)prompt re-epithelialization and (6) proper synthesis, cross-linking, and alignment of collagen to provide strength to the healing tissue.
Hospital acquired infections are spread by numerous routes including contact, intravenous routes, air, water, oral routes, and through surgery. The most common types of infections in hospitals include urinary tract infections (32%), surgical site infections (22%), pneumonia (15%), and bloodstream infections (14%). ( book). The most common microorganisms associated with the types of infections are Esherichila coli, Enterococcus species, Staphylococcus auerus, Coagulase-negative staphylococci, or Pseudomonas aeruginosa.(secondary) Urinary tract infections occur when one or more of microorganisms enter the urinary system and affect the bladder and/or the kidneys. These infections are often associated improper catheterization technique. Surgical site infections occur after surgery in the part of the body where the surgery took place. These infections may involve the top of the skin, the tissue under the skin, organs, or blood vessels. Surgical site infections sometimes take days or months after surgery to develop. The infections can be cause by improper hand washing, dressing change technique, or improper surgery procedure. Pneumonia can also become a hospital acquired infection. Ventilator-associated pneumonia is a type of lung in...
Inflammation which is part of the innate immune system is a process by which the body reacts to injury protecting it from infection and foreign substances with the help of the body’s white blood cells “Inflammation can be defined as the body’s local vascular and cellular response to injury caused by factors that invade and injure the body from the outside (exogenous factors) or factors within the body that result in cellular or tissue injury (endogenous) factors” (Battle, 2009, P 238). Factors such as bacteria, viruses, burns, frostbite, chemical irritants, immune reactions and physical injury are examples of factors that can cause inflammation through different mechanisms. It is a protective mechanism with rapid response that neutralizes or destroys agents that causes injury and creates a barrier that limit the injury and prevents its spread to normal tissues (Battle, 2009). Also, it has elements that removes debris and heals the wound generated by the injury. It can be divided into acute and chronic inflammation.
The Infection Prevention and Control (IPC) Program is an essential force maximizing quality, patient centered care, and safety throughout the Veterans Affairs North Texas Health Care System (VANTHCS). The VANTHCS “... is a progressive health care provider in the heart of Texas ... we serve more than 117,000 Veterans and deliver 1.4 million outpatient episodes of care each year to Veterans in 38 Texas counties and two counties in southern Oklahoma” (“VA North Texas,” 2016, para. 1). The purpose of the IPC Program is to guide a facility-wide approach toward identifying, preventing, controlling, and eliminating healthcare-associated infections (HAIs). This approach is facilitated through infection control (IC) practitioner’s role-modeling behaviors of assessing, supporting, guiding, and/or directing healthcare providers (HCPs) in the application of evidence-based practices (EBPs) to prevent HAIs. According to the Centers for Disease Control and Prevention (CDC), HAIs are often preventable adverse events that pose a major threat to patient safety (“Centers for Disease,” 2016). As a result, IC practitioners recognize the importance of preparing nurse faculty to engage clinical staff in the application of EBPs to prevent infections.
Our approach in managing wounds was far from being optimal in our own setting. After having read the article of Sibbald et al (1) and assisting to presentations during the first residential week-end, our approach at St. Mary 's Hospital Center 's Family Medicine Clinic must change. We were not classifying wounds as healable, maintenance or non-healable. We were always considering the wounds in our practice as healable despite considering the system 's restraints or the patients ' preferences. In the following lines, I will define and summarize the methods one should use in order to initial management of wounds and how to integrate it better to our site. The first goal we need to set is to determine its ability to heal. In order to ascertain if a wound is healable, maintenance or a non-healable wound.