National Survey of Operating Room Nurses' Aseptic Techniques and Interventions for Patient Preparation to Reduce Surgical Site Infections

What have we learned from the surveys of the AEC, AECP and the Observatory of Infection in Surgery? Compliance with postoperative infection prevention measures and comparison with the AEC recommendations

Before planning improvement strategies, it is crucial to know the degree of implementation of preventative measures for postoperative infection. The aggregated results of 3 surveys carried out by the Observatory of Infection in Surgery to members of 11 associations of surgeons and perioperative nurses are presented. The questions were aimed to determine the knowledge of the scientific evidence, personal beliefs and the actual use of the main measures. Of 2295 respondents, 45.1% did not receive feedback on the infection rate of their unit. Insufficient knowledge of some of the main prevention recommendations and some disturbing rates of use were observed. The preferred strategies to improve compliance with preventive guidelines and their degree of implementation were investigated. A gap between scientific evidence and clinical practice in the prevention of infection in different surgical specialties was confirmed.

Important interventions in the operating room to prevent bacterial contamination and surgical site infections

BACKGROUND

The aim of this study was to explore interventions that Swedish operating room (OR) nurses considered important for the prevention of bacterial contamination and surgical site infections (SSIs).

METHODS

A web-based cross-sectional survey with an open-ended question was answered by OR nurses and analyzed using summative content analysis and descriptive statistics.

RESULTS

The OR nurses (n = 890) worked within 11 surgical specialties and most of them worked at university hospitals (37%) or county hospitals (53%). The nurses described twelve important interventions to prevent bacterial contamination and SSI: skin disinfection (25.9%), the OR environment (18.2%), aseptic technique (16.4%), OR clothes (13.4%), draping (9.8%), preparation (6.1%), dressing (3.6%), basic hygiene (3.4%), normothermia (2.1%), communication (0.7%), knowledge (0.3%), and work strategies (0.2%).

DISCUSSION

Skin disinfection was considered the most important intervention in order to prevent bacterial contamination and SSI. The responses indicated that many OR nurses believed the patients' skin to be sterile after the skin disinfection process. This is not a certainty, but skin disinfection does significantly decrease the amount of bacterial growth.

CONCLUSIONS

This study shows that many OR nurses' interventions are in line with recommendations. Although, knowledge regarding the effect of skin disinfection needs further research, and continued education.

Experiences of infection prevention and control in clinical practice of nursing students in the Greater Accra Region, Ghana: An exploratory qualitative study

Introduction

Globally, infections acquired from hospitals pose a major obstacle to patients' safety. Health care workers, especially, nursing students are at high risk for Hospital Acquired Infections (HAIs) as they are always in contact with clients. Therefore, this study aims to explore experiences of infection prevention and control in the clinical practice of nursing students in the Greater Accra Region, Ghana.

Methods

The study utilized a qualitative exploratory design to interview 42 participants (7 focus groups, comprising of 6 members each). A purposive sampling technique was employed to select the participants, who were engaged in 50-90 min' focus group discussions. Data collection lasted for 3 months and was analyzed using content analysis. NVivo version 12 Software was used to identify recurrent themes from the transcribed data.

Results

The results revealed two main themes: preventive practices against hospital-acquired infections and barriers toward infection prevention practices. The subthemes under the preventive practices were as follows: views on HAIs preventive practices, barrier nursing, hand washing and use of sanitizers, aseptic techniques, and sterilization. Increased workload, lack of superior support, and inadequate resources emerged under the barriers toward infection prevention practices.

Conclusion

It was concluded from the study that most of the student nurses had adequate information about HAIs and wish to adhere to the Infection prevention protocols. However, the participants observed poor infection prevention practices among the staff they were learning from. It is therefore recommended that more attention is focused on infection prevention and control in clinical practice among nurses.

Turning a Crisis Into an Opportunity: Promoting Professional Development Among Perioperative Personnel During a Pandemic

The perioperative setting is a complex, high‐risk working environment. Ensuring adequate staffing with highly competent nurses remains a top priority to sustain safe patient care. However, there are barriers to individual professional advancement in hospitals, including costs and lack of support or time, which can lead to decreased nurse satisfaction. After the mandated cancellation of elective surgery in March 2020 resulting from the coronavirus disease 2019 pandemic, leaders at a medical center decided to turn this difficult situation into an opportunity to re‐engage their perioperative personnel in professional development. More than 70 staff members participated in activities related to certification, continuing education, clinical advancement, and cross‐training. Elective surgery has since resumed, and as a result of the pursuit of professional development opportunities, staff member turnover did not increase throughout the transition at the medical center. Interest in professional growth has been reignited and staff members are excited about future development opportunities.

The persistent breach between evidence and practice in the prevention of surgical site infection. Qualitative study

BACKGROUND

Despite the dissemination of guidelines for surgical site infection (SSI) prevention, a gap between the theoretical measures and their compliance persists. Accurate estimates of the implementation of preventative measures is crucial before planning dissemination strategies.

METHODS

A web-based survey was distributed to members of 11 Associations of operative nurses and surgeons. Questions aimed to determine their awareness of evidence, personal beliefs and actual use of the main preventative measures.

RESULTS

Of 1105 responders, 50.5% receive no feed-back of their SSI rate. Responders show a moderate rate of awareness of the recommendations about not removing hair, hair clipping, skin antisepsis with alcoholic solutions, and normothermia. Antibiotic prophylaxis is given for more than 24 h by 18.8% of respondents. Screening for S. aureus is performed by 27.6%. Hair removal by shaving is used by 16.6% of responders. The most common antiseptic solutions are alcoholic chlorhexidine (57.2%) and aqueous povidone (23.3%). 62.8% of surgeons allow the solution to air dry before applying surgical drapes. Adhesive drapes in the surgical field are used routinely in 33.4% of cases. Perioperative normothermia, glucose control and hyperoxia are used in 84.3%, 65.9% and 23.3% of cases. Antimicrobial sutures and negative pressure therapy are used by 20.2% and 43.5% of teams, respectively. Prior to closing the incision, 83.9% replace surgical instruments always or selectively. Wound irrigation before closing is used in 78.1% of cases, mostly with saline. Check-lists, standardized orders, surveillance, feed-back and educational programs were rated most highly by respondents as a means to improve compliance with preventative guidelines, but few of these strategies were in place at their institutions.

CONCLUSION

Gaps in the translation of evidence into practice remain in the prevention of SSI among different surgical specialities. Several areas for improvement have been identified, as some core prevention measures are not in common use.

Operating room nurses' experiences of skin preparation in connection with orthopaedic surgery: A focus group study

BACKGROUND

Preoperative skin preparation is performed differently by different operating room nurses.

AIM

To deepen the understanding of skin preparation within an orthopaedic surgical setting from the operating room nurse perspective and to explore their experiences.

METHODS

A qualitative exploratory design was used. Four focus group interviews were conducted during 2016-2017, at four hospitals in Sweden, using procedures developed by Krueger and Casey. A total of 19 operating room nurses were recruited through purposive sampling.

RESULTS

Statements were categorized into four categories of experiences: (1) Knowing, which related to learning and sources of knowledge; (2) Doing, which related to skin preparation and activities based on tradition and evidence; (3) The Team, which related to the assignment of responsibility and collaboration with patients and other professions; and (4) The Setting, which related to factors around the patient and included feelings of time pressure and access to supplies.

CONCLUSIONS

Theory and practice differ, and some skin preparation used are based on tradition rather than on evidence or recommendations. Elements both within the team in the operating room and within the organization influence the result. Operating room nurses' duty to perform safe skin preparation must be respected in the team.

Patient experience of preheated and room temperature skin disinfection prior to cardiac device implantation: A randomised controlled trial

Background:

Clinically, patients often comment on the coolness of the skin disinfectant. However, scarce evidence is available regarding patients’ experience during intraoperative skin disinfection.

Aims:

The aim of this study was to describe and compare intraoperative patient experiences with preheated and room temperature skin disinfectant.

Method:

This randomised controlled trial included 220 patients undergoing cardiac device implantation. Patients allocated to preheated (36°C) or room temperature (20°C) chlorhexidine in 70% ethanol verbally answered an open-ended question regarding their experience with the skin disinfection. Results were assessed using a qualitative approach with comparative quantification.

Results:

The analysis resulted in nine categories describing the patients’ experiences with preheated and room temperature skin disinfection. Most of the patients described the skin disinfection process as a negative experience, which consisted of six categories: cold, smell, change in temperature, unpleasant, wet and painful. In addition, two neutral categories of response (nothing in particular and neither pleasant nor unpleasant) and one positive response (pleasant) emerged through the analysis. Preheated skin disinfection yielded significantly fewer negative experiences in the category cold (85% vs. 15%, P<0.0001) and significantly more positive experiences (66% vs. 34%, P<0.002). Neutral categories (neither pleasant nor unpleasant 65% vs. 35%, P=0.01, nothing in particular 74% vs. 26%, P<0.001) dominated after preheated skin disinfection.

Conclusion:

The use of preheated skin disinfection promotes a positive patient experience with skin disinfection.

Trial registration:

ClinicalTrials.gov registration number NCT02260479 ( https://clinicaltrials.gov/ct2/results?cond=preheated+skin+disinfection ).

Perioperative routines and surgical techniques for saphenous vein harvesting in CABG surgery: a national cross-sectional study in Sweden

Background

The saphenous vein is the most commonly used conduit for coronary artery bypass grafting (CABG). Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2 to 20%. Patients’ risk factors, perioperative hygiene routines, and surgical technique play important roles in wound complications. Here we describe the perioperative routines and surgical methods of Swedish operating theatre (OT) nurses and cardiac surgeons.

Methods

A national cross-sectional survey with descriptive design was conducted to evaluate perioperative hygiene routines and surgical methods associated with saphenous vein harvesting in CABG. A web-based questionnaire was sent to OT nurses and cardiac surgeons at all eight hospitals performing CABG surgery in Sweden.

Results

Responses were received from all hospitals. The total response rate was 62/119 (52%) among OT nurses and 56/111 (50%) among surgeons.

Chlorhexidine 5 mg/mL in 70% ethanol was used at all eight hospitals. The OT nurses almost always (96.8%) performed the preoperative skin disinfection, usually for three to 5 minutes. Chlorhexidine was also commonly used before dressing the wound.

Conventional technique was used by 78.6% of the surgeons, “no-touch” by 30.4%, and both techniques by 9%. None of the surgeons used endoscopic vein harvesting. Type of suture and technique used for closing the wound differed markedly between the centres.

Conclusions

In this article we present insights into the hygiene routines and surgical methods currently used by OT nurses and cardiac surgeons in Sweden. The results indicate both similarities and differences between the centres. Local traditions might be the most important factors in determining which procedures are employed in the OT. There is a lack of evidence-based hygiene routines and surgical methods.