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Literature Review

Eunice

Literature Review

Surgical site infections are one of the most common healthcare-associated infections and lead to increased morbidity, prolonged admission, and higher costs of health care. SSI prevention is essential for improving patient outcomes, but providing cost-effective health care is crucial. The application of evidence-based infection control protocols has proved to minimize the rate of SSIs: Literature Review.

This literature review has tried to explore how current research supports the PICOT question: In hospitalized patients with surgical wounds (P), how does a standardized infection control protocol (I) compared to the usual infection control practices (C) affect the rate of surgical site infections (O) within a 30-day postoperative period (T)? This review reflects on eight peer-reviewed articles concerning the stated purpose of the studies, the population sampled, the synthesized conclusion, limitations, and suggestions for future studies.

A Summary of The Purpose of The Studies

The studies reviewed collectively assessed various interventions and protocols intended to prevent SSIs. Anderson et al. (2020) examined the effectiveness of SPC charts in monitoring infection trends and initiating timely interventions. De Simone et al. (2020) updated the guidelines on intraoperative infection control for abdominal surgery, emphasizing antiseptic protocols and adherence to sterility.

Li et al. (2022) conducted a meta-analysis evaluating the effectiveness of wound-edge protectors in preventing SSIs after abdominal surgery. Matz et al. (2024) discussed the role of antibacterial sutures in reducing SSIs after elective abdominal surgery.

Other studies related to novel approaches and bundled care strategies. Mueller et al. (2022) researched the role of intraoperative peritoneal antiseptic irrigation in reducing SSIs in gastrointestinal operations. Scrimshire et al. (2020) evaluated the QIST program, which includes infection control and anemia management protocols.

Seidelman et al. (2023) synthesized the best available evidence on SSI prevention practices for many surgical procedures. Finally, Wolfhagen et al. (2022) conducted a meta-analysis to assess the actual effects of the introduction of perioperative care bundles on SSI rates.

A Comparison of Sample Populations

The sample populations were all different in size, demographic composition, and surgical settings. Anderson et al. (2020) included several inpatient surgical units for a more diverse patient population. De Simone et al. (2020) had no primary data collection but synthesized data from various inpatient and outpatient settings—Li et al. (2022) combined data from 20 RCTs involving thousands of patients undergoing abdominal surgeries. Matz et al. (2024) enrolled patients 200 between 18 and 75 years who underwent routine elective open abdominal surgeries undergoing operations in an operating theatre single surgical center.

Mueller et al. (2022) planned to evaluate antiseptics irrigation or saline irrigation, which was intended to be subjected to a randomized trial covering 300 candidates. Scrimshire et al. (2020) employed a large sample associating surgical rounds from several cooperating hospitals. Seidelman et al. (2023) reported an overall review covering a broader range of several surgical populations, while Wolfhagen et al. (2022) included patients of more than 10,00 from various RCTs for studies.

A Synthesis of The Studies’ Conclusions

The findings of the studies could be summarized in several key themes. First is the effectiveness of standardized protocols: Anderson et al. (2020) found that SPC charts significantly decreased the rate of SSIs by identifying the problem as early as possible and being able to act on it early. Similarly, Scrimshire et al. (2020) have demonstrated that structured care bundles cut SSIs, improving patient outcomes. Intraoperative measures were also emphasized by De Simone et al. (2020) and Mueller et al. (2022), who, while identifying the importance of intraoperative antiseptic measures such as irrigation and sterility, also provided detailed descriptions regarding the prevention of SSIs.

The conclusion reached was that for such measures to be successful, strict adherence to them is paramount. Indeed, Li et al. (2022) and Matz et al. (2024) found physical barriers and sutures effective. Indeed, these authors were able to provide evidence for wound-edge protectors and antibacterial sutures in reducing SSIs. Moreover, the measures, on top of being highly effective, are quite inexpensive and easy to adopt.

Other key themes included perioperative care bundles. Wolfhagen et al. (2022) demonstrated that implementing perioperative care bundles, such as preoperative antibiotics and postoperative wound care, was associated with significant reductions in SSI rates. Seidelman et al. (2023) supported these findings, stating that evidence-based care bundles should be universally implemented.

A Summary of The Limitations of The Studies

Even though their results were highly valued, several limitations have been identified in the studies. Several of these studies had small samples, like those by Matz et al. (2024) and Mueller et al. (2022), and their populations may not be representative. Other studies, including De Simone et al. (2020) and Seidelman et al. (2023), were based on literature reviews and expert consensus without primary data collection and prone to bias.

Wolfhagen et al. (2022) indicated significant heterogeneity in the reviewed care bundles, which diminished the comparability of the findings. Also, Mueller et al. (2022) presented results of a preliminary analysis; thus, the efficacy of antiseptic irrigation needs further studies to be confirmed. These are the limitations through which it was underlined how and where robust, high-quality research is required.

Conclusion and Recommendations

This literature review has identified that standardized infection control protocols have a significant impact on reducing SSIs. The cumulative data from these studies provide collective support for structured bundles of care, antiseptic measures, and some novel interventions, such as SPC charts and antibacterial sutures. Further research is needed to help overcome some of the limitations identified in this review, including larger multi-center trials that would improve generalizability. Additionally, a larger number of studies compare infection control protocols.

Implementation of standardized infection control practices in the surgical setting is critical in reducing SSIs and thus improving the outcomes of patients. The results from this review can help in clinical practice and may act as a guide in further research toward the development of more effective SSI prevention strategies.

References

Anderson, D. J., Ilieş, I., Foy, K., Nehls, N., Benneyan, J. C., Lokhnygina, Y., & Baker, A. W. (2020). Early recognition and response to increases in surgical site infections using optimized statistical process control charts—the Early 2RIS Trial: a multicenter cluster randomized controlled trial with stepped wedge design. Trials, 21(1). https://doi.org/10.1186/s13063-020-04802-4

De Simone, B., Sartelli, M., Coccolini, F., Ball, C. G., Brambillasca, P., Chiarugi, M., Campanile, F. C., Nita, G., Corbella, D., Leppaniemi, A., Boschini, E., Moore, E. E., Biffl, W., Peitzmann, A., Kluger, Y., Sugrue, M., Fraga, G., Di Saverio, S., Weber, D., & Sakakushev, B. (2020). Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines. World Journal of Emergency Surgery, 15(1). https://doi.org/10.1186/s13017-020-0288-4

Li, X., Lin, H., Zhu, L., Chen, J., Lei, S., Li, B., & Su, S. (2022). The clinical effectiveness of wound edge protectors in reducing surgical site infection after abdominal surgery: meta-analysis. BJS Open, 6(3). https://doi.org/10.1093/bjsopen/zrac065

Matz, D., Engelhardt, S., Wiencierz, A., Savas Deniz Soysal, Misteli, H., Kirchhoff, P., & Oleg Heizmann. (2024). Do Antibacterial Skin Sutures Reduce Surgical Site Infections After Elective Open Abdominal Surgery?—A Prospective, Randomized Controlled Single-Center Trial. Journal of Clinical Medicine, 13(22), 6803–6803. https://doi.org/10.3390/jcm13226803

Mueller, T., Kehl, V., Egert-Schwender, S., Friess, H., Novotny, A., & Reim, D. (2022). Peritoneal antiseptic irrigation to prevent surgical site infection after laparotomy for hepatobiliary or gastrointestinal surgery (PAISI)—protocol for a randomized controlled study. Trials, 23(1). https://doi.org/10.1186/s13063-022-06975-6

Scrimshire, A. B., Booth, A., Fairhurst, C., Reed, M., Tadd, W., Laverty, A., Corbacho, B., Torgerson, D., & McDaid, C. (2020). Scaling up Quality Improvement for Surgical Teams (QIST) – avoiding surgical site infection and anemia at the time of surgery: protocol for a cluster randomized controlled trial. Trials, 21(1). https://doi.org/10.1186/s13063-020-4152-3

Seidelman, J. L., Mantyh, C. R., & Anderson, D. J. (2023). Surgical Site Infection Prevention. JAMA, 329(3), 244–252. https://doi.org/10.1001/jama.2022.24075

Wolfhagen, N., Boldingh, Q. J. J., Boermeester, M. A., & de Jonge, S. W. (2022). Perioperative care bundles for the prevention of surgical-site infections: meta-analysis. British Journal of Surgery, 109(10). https://doi.org/10.1093/bjs/znac196

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Question

While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone project change proposal, the literature review enables students to map out and move into the active planning and development stages of the project.

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the PICOT question from the earlier “PICOT Question” template and information from the “Literature Evaluation Table” assignment to develop a review.

Using eight peer-reviewed articles, write 750-1,000-word review that includes the following sections:

You are required to cite a minimum of eight peer-reviewed articles to complete this assignment. Sources must be published within the past 5 years (From 2020 onwards), appropriate for the assignment criteria, and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

PICOT QUESTION:

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