Operative Site Care

Operative Site Care
How ASCs can Facilitate the Healing Process

By Kris Ellis

Postoperative infection is a major cause of patient injury, mortality, and cost to the healthcare system, according to the Institute for Healthcare Improvement (IHI); an estimated 2.6 percent of nearly 30 million operations are complicated by surgical site infections every year.¹

Mary Brown, of 3M Consumer Health Care, notes that the development of an infection is the most significant risk involved with poor operative- site care. Poor care may also cause the incision to re-open, staples to tear, and scarring. “All of these can lead to a longer healing time and increased pain,” Brown continues. “To help reduce the amount of scarring, continuing to support the wound even after the surface tissue has healed is recommended. Underlying tissue can take six months to 12 months to completely heal. Using a supportive skin closure, such as Nexcare™ Steri-Strip™ Skin Closures, during that time can help improve cosmetic results.”

Surgical site infection remains a major concern after operative procedures, explains Thuy Vi Quach-Braig of 3M Consumer Health Care. “Physicians, nurses, and most of all, patients want successful outcomes following an operative procedure,” she says. “Implementing the Association for periOperative Registered Nurses (AORN)’s Standards, Recommended Practices and Guidelines2 for perioperative care and surgical site preparation is a key step in ensuring good surgical site healing.”

The wound-healing process is something that clinical staff members should be knowledgeable about, adds Debra Thayer, MS, RN, CWOCN, a technical service specialist with 3M Medical Division. “They should also be able to recognize chronic conditions that may adversely affect wound closure, such as vascular disease, diabetes, poor nutrition, and smoking.

Nurses can update their knowledge on the latest information and treatment recommendations on post-operative site care with continuing education (CE) offerings.” One such CE opportunity is “Optimized Healing for Post-Surgical Incisions,” which is offered by 3M at www.nexcare.com/aftersurgerycare. 

Instructing patients on proper surgical site care and how to recognize complications is another vital effort that surgery centers must undertake, Thayer says. “Before being discharged, patients or their caregivers should be able to verbalize the signs and symptoms of infection, and who they should call if problems arise.” The utilization of pre-printed wound-care instructions that can be customized for each patient according to his or her physician’s preference can also be helpful. “Simple language is a must, and illustrations are ideal for patients who do not speak English,” Brown adds.

In terms of caring for their operative site, Brown suggests a three-step “clean, protect, and cover” process, which will help promote surgical site healing:

Clean: Keep the incision or surgical site clean. Instruct the patient as to when he or she may bathe or shower with the dressing off. A wound cleanser or antiseptic wipe may be used around the surgical site to remove old drainage. Instruct the patient to wash his or her hands thoroughly before changing a dressing or cleansing the site.

Protect: Use an alcohol-free barrier fi lm, such as 3M™ Cavilon™ No Sting Barrier Film to protect at-risk skin around the operative site from adhesive tape trauma and wound drainage.

Cover: Cover the site with an appropriate sterile dressing such as 3M™ Tegaderm™ Transparent Dressing if no drainage or minimal drainage is expected. Using moisture-retentive, breathable dressings will protect the surgical site and promote patient comfort. Transparent fi lm dressings maintain a moist wound-healing environment, which has been shown to enhance the healing process by preventing scab formation and dehydration of the wound bed. This type of dressing is also waterproof, which allows patients to shower or bathe while protecting their surgical site from moisture. In addition, it protects the surgical site from friction that can occur when clothing rubs. An “island-type” dressing such as 3M™ Tegaderm™ + Pad Transparent Dressing can be used as a cover dressing if drainage is expected.

If the patient or caregiver will be performing dressing changes at home, Thayer also notes that ASC personnel should demonstrate the use of the dressing prior to discharge.

According to Quach-Braig, many drug stores are now expanding their wound care offerings as the number of outpatient surgical procedures continues to increase, which can help provide surgery centers with cost-effective solutions. CVS, for example, offers a comprehensive selection of wound care items that allow the patient to follow the clean, protect, and cover process. This includes Nexcare Incision Care Kits from 3M, which provide everything a patient typically needs until his or her incision heals, all in one kit.

“These kits include hospital-proven products, such as Cavilon No Sting Barrier Film and Tegaderm Transparent Dressings, which have been used by medical professionals for years,” Quach-Braig continues. “With the availability of professional-quality supplies in easy-to-use kit formats, surgery centers can now discharge patients with instructions to access supplies at retail centers. This can help reduce inventory and supply costs while promoting better patient healing at the same time.”

1. Surgical Site Infections: Case for Improvement. http://www.ihi.org/IHI/Topics/Patient-Safety/SurgicalSiteInfections/ 

2. AORN Standards, Recommended Practices and Guidelines. 2006. http://www.aorn.org/products/standards.htm