PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

Mr. KASHINATH, C, SAJJAN

I YEAR M. Sc NURSING

MEDICAL SURGICAL NURSING

YEAR 2010-2011

TULZA BHAVANI COLLEGE OF NURSING

NO, 899/3, NEAR HAJRAT JUNEEDI DARGA, GYANG BAWADI,

BIJAPUR-586101


RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / MR.KASHINATH,C,SAJJAN
I YEAR M.Sc. (NURSING),
TULZA BHAVANI COLLEGE OF NURSING
NEAR HAJRAT JUNEEDI DARGA ,
GYANG BAWADI,
BIJAPUR -586101.
2. / NAME OF THE INSTITUTE / Tulza Bhavani College of Nursing,
No, 899/3, Near Hajrat Juneedi Darga, Gyang Bawadi, Bijapur-586101.
3. / COURSE OF THE STUDY AND SUBJECT / I Year M.Sc. (Nursing),
Medical Surgical Nursing
4. / DATE OF ADMISSION TO THE COURSE / 18 May 2010
5 / TITLE OF THE STUDY / “A study to assess the knowledge regarding risk factors for delayed wound healing and its complications among patients under went for surgery in selected hospital at Bijapur.”

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“I dressed the wound. God healed it."

Skin, the largest organ in the human body, plays a crucial role in the sustenance of life through the regulation of water and electrolyte balance, thermoregulation, and by acting as a barrier to external noxious agents including microorganisms, however, when the epithelial integrity of skin is disrupted.1

A wound is an abnormal break in the skin or other tissue which allows blood to escape. External wounds are complicated by the fact that can enter the tissue and cause infection. The types of wounds are open wound and closed wound, etc. the wound healing involves integrated physiological process. A wound by definition implies that there has been damage to the body tissues. Healing of the wound always follows a regular pattern. Healing occurs in four stages inflammatory, destructive, proliferate and maturation.2

Edwin Smith papyrus (circa 1600 BC) and the Ebers papyrus (circa 1534 BC), provided detailed information of wound healing with the application of various potions. Hippocrates Greek physician and surgeon, 460-377 BC, his father of medicine, used vinegar to irrigate open wounds and “Galen Roman gladiatorial surgeon,” 130-200 AD was first to recognize that pus from wounds inflicted this observation was The link between pus formation and healing was emphasized so strongly that foreign material was introduced into wounds. And Penicillin first was used clinically in 1940 by Howard Florey. With the use of antibiotics, a new era in the management of wound infections.3

Improper care of the wound may be the cause of the problem. This often happens when injuries are dressed and a person carelessly or aggressively removes the dressing. This commonly leads to a reopening of the wound. If a person does not exercise caution when she cleans her injury, she may also retard healing by causing further trauma. Also it has been found that for many wounds, optimal healing occurs when the injured area is kept moist; wounds that are left uncovered tend to dehydrate making recovery slower.4

Delayed wound healing is very likely when infections occur. Wounds commonly get infected when bacteria invade the injured site, because these microorganisms can interrupt the healing process and aggravate the problem. There are increased chances of this happening if a foreign object, such as a rusty hook, penetrated the injury when it was caused or if a foreign object, such as a shard of glass remains in the wound.5

There are a number of ways of development of wound infection in which micro-organisms can gain access to a wound that are transfer from equipment or the hands of careers, micro-organism deposited from the surrounding air, physical migration from the patients skin or gastrointestinal tract.6

There are several complications of delayed wound healing those are Hemorrhage; Wound Infection, Wound dehiscence, A wound evisceration , Fistula, abscess. Cellulitis, Necrosis, Keloids, Pain, fluid collection, fistula, sinus formation ostiomylitis, anemia, hetreotopic calcification septicemia. 7

The newest clinical tools in wound healing, including a state-of-the-art hyperbaric chamber that utilizes pure oxygen to speed up the healing process. The health care team includes physicians specially trained in wound management and hyperbaric medicine and certified wound care nurses. We also provide nutritional assessment and counseling, diabetic teaching, patient and caregiver counseling, pain management, therapy services, Special needs for pressure relief including beds, seat cushions. Bed sheets, seat cushions, management of proper wound healing. No doubt it is responsibility of an health member to educate the patients about there wound and healthy stetergiers .8

6.2 NEED FOR THE STUDY

Wound infections are one of the most common hospital acquired infections and are an important cause of morbidity and account for 70-80% mortality. Development of such infections represent delayed healing, cause anxiety and discomfort for patient,9 A organisms present in the wound and surrounding soft periwound and soft tissue erythema, fever, foul odor ,severe or increasing pain at the wound site ,tenderness at the wound and periwound site and surrounding soft tissue, excessive and/or purulent drainage, warmth of the surrounding soft tissue and periwound skin.10

Surgery is an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable the consistency of care would reduce complications and deaths associated with surgery. According to the health care. System, affecting 5.7 million patients and costing an estimated 20 billion dollars annually.11

Postoperative wound infections are defined as infections that develop within 30 days after surgery. Most wound infections occur within four to eight days following surgery and can be diagnosed and treated in the home or outpatient clinic. Staphylococcus aureus is one of the most common causes of postoperative wound infection. The incidence of infection varies depending on the hospital, surgeon, type of surgery, and the patient. It is estimated that postoperative wound infections develop in about 3 out of every 100 operations performed, accounting for 24 percent of the total number of infections acquired during hospitalization. Studies have shown that the more time the patient spends in the hospital prior to the operation the more likely he or she is to develop an infection after the operation.12

Surgical site infections are not an extinct entity, they account for 14-16% of the estimated 2 million nosocomial infections affecting hospitalized patients in the India A survey sponsored by the World Health Organization demonstrated a prevalence of nosocomial infections varying from 3-21%, with wound infections accounting for 5-34% of the total13 The 2006 survey report by the Nosocomial Infection period between October 1999 and September 2006, indicates that the incidence of hospital acquired infection related to surgical wounds in the United Kingdom is as high as 10% in the United Kingdom with increased morbidity and mortality. Seventy-seven percent of the deaths of surgical patients were related to surgical wound infection.14 SSIs are associated not only with increased morbidity but also with mortality. Kirkland et al calculated a relative risk of death of 2.2 attributable to SSIs, compared to matched surgical patients without infection. 15

The many recent advances in modern surgery, poor wound healing and the development of infections in incisional wounds continue to be the most common complications in wound healing. At least part of the problem is administrative. The lack of standardized wound care documentation across different health care settings and countries means that the number of infected wounds is still underestimated in many countries. In recent years research has focused more on high infection rates, however strategies to prevent wound infection are now rising up the health care agenda.16

The importance of wound infections, in both economic and human terms, should not be underestimated. In a study, on average, patients with a wound infection stay about 6-10 days more than if the wounds heal without infections. This additional stay almost doubles the hospital cost that is equivalent to between £1,168 and £2,398.7.17

Patient knowledge of the level of disease process and wound management-Patient education and compliance are cornerstones to successful wound and skin care.18 the educational needs of the patient should be evaluated on an individual basis, beginning with the nonjudgmental assessment of the patient's current knowledge base relevant to the plan of care. An experienced clinician should direct the educational activities.19.

A study was conducted to assess the knowledge of Inability of patients to self-diagnose wound infections in Department of Emergency Medicine, California. At the time of wound inspection or suture removal, 433 patients were questioned about signs of wound infection. Patients' answers were compared to evaluations by medical examiners. Patients frequently failed to recognize infection and signs of inflammation. When asked if wound infection was present, patients' false positive diagnostic rate was only 8%, but the false negative diagnostic rate was 48%. Medical examiners diagnosed wound infection in 21 wounds, and patients correctly identified their infections in only 11 of these cases. These results indicate that for the population studied, patients cannot be expected to recognize infection in their own wounds using verbal or printed instructions.20

A European wound management association position document list. The following risk factors for delaying wound healing are , ulcer size 10cm, reduced mobility, sever pain, poor general health, psychological factor, male gender, duration of >6 month. Based on the review of literature professional experience and research articles on patient under went for surgery had inadequate knowledge about risk factors for delayed wound healing and its complication as well as lack of knowledge about wound care. Which increases the risk of infection? So the investigator felt the need to conduct this study to determine the knowledge on risk factors for delayed wound healing and its complication, which can enhance knowledge of surgical wound healing. Considerably reduce the infection rate, mortality rate, and morbidity rate.21

6.3. REVIEW OF LITERATURE
References and further reading may be available for this article. To view references and further reading you must purchase this article.

A study was conducted to check the Effect of Episiotomy Pain and Wound Healing. An experimental research, pretest post-test design was adopted for conducting this study. Objectives are assess the level of knowledge regarding wound care and episiotomy in infrared therapy. at A sample of 60 wounded patients were selected for the study. Majority of the participants in both the control group (96.6%) and the experimental group (90%) had moderate pain during observation I, whereas few of them (20%) in control group and majority of them (83.3%) in experimental groupIt was found that 10 percent of the participants in the control group developed mild infection. Equal percentage of participants (60%, 60%) had inadequate knowledge regarding episiotomy care, wound healing and infrared therapy in the control and in the experimental group. The study indicates that the infrared therapy reduces episiotomy pain and enhances wound healing in postnatal mothers.22

A study was conducted an explored the information given to 20 adults who had undergone general abdominal or colorectal surgery. Each participant completed 4 interviews: 1 to 2 days post surgery. For the 11 patients who received routine teaching, the information included wound care, pain management, and mobility guidelines The most common concerns were the incision/wound care, pain management, activity level, monitoring for complications, symptom management, elimination, and quality of life. Because of their clinical knowledge. The third interview, the lack of information was inconsequential for 15 of the patients; however, 5 expressed concerns about odor at the operative site, pain, and voiding. In addition, they may not be concerned about the limitations of their knowledge.23

A prospective cross-sectional study was conducted in surgical patients in Vietnam determined the rate of infectious complications, including wound infections. That after surgical operations, complications such as fistulae as well as abdominal and wound infections were more common among those who had poor nutrition status. It is believed that patients do not have the adequate immune response or ability to heal wounds if they have lost more than 10% of body weight within the past 6 months.24

A study was conducted to Modifying perfusion, nutrition, and stress to promote wound healing in patients with acute wounds. University of Washington Tissue injury is common among patients in acute care settings. The subsequent response to injury, wound healing, follows an intricate but well-defined sequence that, under normal conditions, proceeds to satisfactory repair. However, because of the complexity of the healing response, several factors can intervene to impair normal healing. As a better understanding of how diverse factors influence healing is gained, the use of interventions that modulate these factors becomes possible and potentially beneficial. This article reviews knowledge of perfusion, nutrition, and stress as they relate to healing in patients experiencing acute wounds. Therapeutic implications based on current research are discussed.25

A study was carried out on Obesity: impediment to wound healing. Intrinsic and extrinsic factors affect wound healing. High risk factors for the obese patients include infection, seromas, anastomatic leaks, and incision dehiscence. Tissue perfusion is an issue of great concern and is a key factor in most assessments. Obesity adds another dimension to the needs of the patient and presents challenges to nurses. From routine evaluations to specialized assessments with attention to bariatric equipment needs, a thorough understanding of wound healing and potential problems of obese patients, and knowledge of interventions is needed.26.

A study was condected regarding ICU project to improve pressure ulcer healing rates in Veterans General Hospital. in Chinese. Pressure ulcers represent a very common complication in elderly and patients.Inappropriate management of this condition can lead to delayed healing, serious infections and even mortality. The rate of healing for pressure ulcers in our department was 0% between January and June, 2003. We studied this situation and identified the following problems: (1) improper diagnoses; (2) failure to implement a pressure ulcer care protocol; (3) lack of proper instruments to reduce pressure. (4) failure to care properly for skin following excretion. patient knowledge and practice were not updated with new concepts and methods related to clinical pressure ulcer.27 .