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Liosatos K, Tobiano G, Gillespie BM. Patient participation in surgical wound care in acute care settings: An integrative review. Int J Nurs Stud 2024; 157:104839. [PMID: 38901124 DOI: 10.1016/j.ijnurstu.2024.104839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/02/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Surgical site infections can significantly impact postoperative recovery. Patient participation, which involves patients actively engaging in wound care, has been linked to improved healing and reduced wound complications. However, there is limited synthesis of the literature that explores the patient's role and participation in the context of surgical wound care. OBJECTIVE To explore patients' perceptions of how they participate in surgical wound care, within 30 days post-operation. DESIGN An integrative review guided by Whittemore and Knafl's methodology. This review was registered with PROSPERO (CRD42022363669). DATA SOURCES Searches were conducted in Medline (Ovid), CINAHL (Complete), and EMBASE (Elsevier) databases in October 2023, supplemented by forward and backward citation searching. REVIEW METHODS Based on a priori eligibility criteria, two authors independently screened articles to select relevant studies. The quality of the included research articles was critically appraised using the Mixed Methods Appraisal Tool. A descriptive and thematic synthesis was used to synthesise the findings. RESULTS Of the 4701 records screened for titles and abstracts, 25 studies using qualitative, quantitative, and mixed-methods designs were included. Three key themes were identified. In theme 1, 'I am healing: how my wound shapes me and my journey,' physical symptoms, psychological factors and previous experiences significantly influenced patients' engagement in wound care. Theme 2, 'Taking charge of my healing: my active engagement in wound care' described how patient participation in surgical wound care goes beyond clinical procedures and can include the use of technology and holistic self-care. Finally, theme 3, 'Navigating the path to recovery: How others shape my experience' showed that effective communication is crucial for promoting participation, yet issues like inadequate information can leave patients unprepared for wound management. CONCLUSIONS This review highlights opportunities to personalise and prioritise a patient-oriented approach to surgical wound care. Clinicians and educators should adopt an individualised approach by tailoring patient participation based on patient factors (i.e. physical symptoms) and adopt patient-centred communication approaches. Researchers should focus on exploring approaches to self-care and technology, as these approaches may enhance patient participation in wound care.
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Affiliation(s)
- Kita Liosatos
- School of Nursing and Midwifery, Griffith Health, Gold Coast Campus, Queensland 4222, Australia.
| | - Georgia Tobiano
- NHMRC Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia; Gold Coast Hospital and Health Service, Queensland 4215, Australia
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith Health, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia; Gold Coast Hospital and Health Service, Queensland 4215, Australia
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Dukes KC, Reisinger HS, Schweizer M, Ward MA, Chapin L, Ryken TC, Perl TM, Herwaldt LA. Examining barriers to implementing a surgical-site infection bundle. Infect Control Hosp Epidemiol 2024; 45:13-20. [PMID: 37493031 PMCID: PMC10782202 DOI: 10.1017/ice.2023.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Surgical-site infections (SSIs) can be catastrophic. Bundles of evidence-based practices can reduce SSIs but can be difficult to implement and sustain. OBJECTIVE We sought to understand the implementation of SSI prevention bundles in 6 US hospitals. DESIGN Qualitative study. METHODS We conducted in-depth semistructured interviews with personnel involved in bundle implementation and conducted a thematic analysis of the transcripts. SETTING The study was conducted in 6 US hospitals: 2 academic tertiary-care hospitals, 3 academic-affiliated community hospitals, 1 unaffiliated community hospital. PARTICIPANTS In total, 30 hospital personnel participated. Participants included surgeons, laboratory directors, clinical personnel, and infection preventionists. RESULTS Bundle complexity impeded implementation. Other barriers varied across services, even within the same hospital. Multiple strategies were needed, and successful strategies in one service did not always apply in other areas. However, early and sustained interprofessional collaboration facilitated implementation. CONCLUSIONS The evidence-based SSI bundle is complicated and can be difficult to implement. One implementation process probably will not work for all settings. Multiple strategies were needed to overcome contextual and implementation barriers that varied by setting and implementation climate. Appropriate adaptations for specific settings and populations may improve bundle adoption, fidelity, acceptability, and sustainability.
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Affiliation(s)
- Kimberly C. Dukes
- Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System (ICVAHCS), Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- College of Public Health, University of Iowa, Iowa City, Iowa
| | - Heather Schacht Reisinger
- Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System (ICVAHCS), Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | - Marin Schweizer
- Department of Internal Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Melissa A. Ward
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Timothy C. Ryken
- MercyOne Northeast Iowa Neurosurgery, Iowa City, Iowa
- Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Trish M. Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Loreen A. Herwaldt
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- College of Public Health, University of Iowa, Iowa City, Iowa
- University of Iowa Hospitals and Clinics (UIHC), Iowa City, Iowa
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Sumrattana S, Asdornwised U, Wongkongkam K, Tantiwongkosri K. Effects of a telehealth program for wound healing promotion on the wound healing level in patients with diabetes undergoing coronary artery bypass graft surgery: A randomized controlled trial. BELITUNG NURSING JOURNAL 2023; 9:428-436. [PMID: 37901370 PMCID: PMC10600705 DOI: 10.33546/bnj.2775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/08/2023] [Accepted: 08/15/2023] [Indexed: 10/31/2023] Open
Abstract
Background Patients with diabetes undergoing coronary artery bypass graft (CABG) are at risk of delayed wound healing. The telehealth program for wound healing promotion (TPWHP) was developed to improve wound healing in patients with diabetes undergoing CABG in a university hospital. Objective This study aimed to examine the effects of the TPWHP on the healing of the sternal wound and saphenous vein graft (SVG) donor site in patients with diabetes undergoing CABG. Methods In this randomized controlled trial, the participants were randomly assigned to the intervention (n = 30) and control (n = 30) groups. The control group received routine nursing care, whereas the intervention group received routine nursing care along with the TPWHP, which provides education and wound monitoring using multimedia and a surgical wound care booklet and monitors the wound through the LINE application on a smartphone after hospital discharge. Data were collected from June to November 2020 at two university hospitals in Bangkok, Thailand, using the demographic and health-related data form and the Thai wound assessment inventory (WAI). Data were analyzed using the Chi-squared, Fisher's exact, and Mann-Whitney U tests. Results The intervention group had significantly lower mean scores-indicating favorable wound healing-for SVG donor site wound healing level than the control group on days 14-21 after surgery (p = 0.012, mean = 0.58 ± 0.54 and 1.08 ± 0.82, respectively). No significant intergroup difference was observed in terms of the sternal wound healing level (p = 0.126); however, the intervention group showed lower mean scores-indicating good wound healing-than the control group. Conclusion The TPWHP promotes effective wound healing of the SVG donor site; however, its efficacy on sternal wound healing was uncertain. Therefore, nurses should implement the TPWHP in collaboration with a multidisciplinary team to improve wound healing after hospital discharge. Trial registration Thai Clinical Trials Registry (TCTR20211112002).
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Affiliation(s)
- Siriporn Sumrattana
- Master of Nursing Science Program in Adult and Gerontological Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Usavadee Asdornwised
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Kessiri Wongkongkam
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Kriangkrai Tantiwongkosri
- Cardiothoracic Division, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Sandy-Hodgetts K, Assadian O, Wainwright TW, Rochon M, Van Der Merwe Z, Jones RM, Serena T, Alves P, Smith G. Clinical prediction models and risk tools for early detection of patients at risk of surgical site infection and surgical wound dehiscence: a scoping review. J Wound Care 2023; 32:S4-S12. [PMID: 37591662 DOI: 10.12968/jowc.2023.32.sup8a.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE Despite advances in surgical techniques, intraoperative practice and a plethora of advanced wound therapies, surgical wound complications (SWCs), such as surgical site infection (SSI) and surgical wound dehiscence (SWD), continue to pose a considerable burden to the patient and healthcare setting. Predicting those patients at risk of a SWC may give patients and healthcare providers the opportunity to implement a tailored prevention plan or potentially ameliorate known risk factors to improve patient postoperative outcomes. METHOD A scoping review of the literature for studies which reported predictive power and internal/external validity of risk tools for clinical use in predicting patients at risk of SWCs after surgery was conducted. An electronic search of three databases and two registries was carried out with date restrictions. The search terms included 'prediction surgical site infection' and 'prediction surgical wound dehiscence'. RESULTS A total of 73 records were identified from the database search, of which six studies met the inclusion criteria. Of these, the majority of validated risk tools were predominantly within the cardiothoracic domain, and targeted morbidity and mortality outcomes. There were four risk tools specifically targeting SWCs following surgery. CONCLUSION The findings of this review have highlighted an absence of well-developed risk tools specifically for SSI and/or SWD in most surgical populations. This review suggests that further research is required for the development and clinical implementation of rigorously validated and fit-for-purpose risk tools for predicting patients at risk of SWCs following surgery. The ability to predict such patients enables the implementation of preventive strategies, such as the use of prophylactic antibiotics, delayed timing of surgery, or advanced wound therapies following a procedure.
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Affiliation(s)
- Kylie Sandy-Hodgetts
- Program Lead, Skin Integrity Research Group, Centre for Molecular Medicine & Innovative Therapeutics, Health Futures Institute Murdoch University, Perth, WA, Australia
- Adjunct Senior Research Fellow, University of Western Australia, Perth, WA, Australia
| | - Ojan Assadian
- Medical Director, Regional Hospital Wiener Neustadt, Austria
- Institute for Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, UK
| | - Thomas W Wainwright
- Professor of Orthopaedics, Orthopaedic Research Institute, Bournemouth University, Bournemouth, UK
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - Melissa Rochon
- Trust Lead for SSI Surveillance, Research & Innovation Surveillance and Innovation Unit, Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
| | | | | | | | - Paulo Alves
- Universidade Católica Portuguesa, Centre for Interdisciplinary Research in Health, Wounds Research Lab, Portugal
| | - George Smith
- Vascular Surgery Unit, Hull York Medical School, York, UK
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Gillespie BM, Walker R, Lin F, Roberts S, Eskes A, Nieuwenhoven P, Perry J, Birgan S, Gerraghy E, Probert R, Chaboyer W. Nurse-delivered patient education on postoperative wound care: a prospective study. J Wound Care 2023; 32:437-444. [PMID: 37405945 DOI: 10.12968/jowc.2023.32.7.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE It is estimated that one in four postoperative wound complications occur within 14 days of hospital discharge. Some estimate that up to 50% of readmissions are preventable with effective postoperative education and closer follow-up. Providing patients with information enables them to detect when medical intervention may be required. The aim of this study was to describe the content of postoperative wound care education given to patients, and to identify demographic and clinical factors that predict receipt of surgical wound care education across two tertiary hospitals in Queensland, Australia. METHOD A prospective correlational design using structured observations, field notes and an electronic chart audit was used. A consecutive sample of surgical patients and a convenience sample of nurses were observed during episodes of postoperative wound care. Field notes were documented to gain a nuanced understanding of the wound care education delivered by nurses. Descriptive statistics were used to describe the samples. A multivariate logistic regression model was developed to describe associations between seven predictors: sex; age; case complexity; type of wound; dietetic consult; the number of postoperative days; and receipt of postoperative wound care education. RESULTS In total, 154 nurses delivering surgical wound care and 257 patients receiving wound care were observed. Across the combined number of patients across the two hospitals, 71/257 (27.6%) wound care episodes included postoperative wound education. The content of the wound care education mainly focused on keeping the wound dressing dry and intact, while the secondary focus was on showing patients how to remove and replace the dressing. In this study, three of the seven predictors were significant: sex (β=-0.776, p=0.013); hospital site (β=-0.702, p=0.025); and number of postoperative days (β=-0.043, p=0.039). Of these, sex was the strongest, with females twice as likely to receive some form of wound care education during the postoperative period. These predictors explained 7.6-10.3% of variance in the postoperative wound care education patients received. CONCLUSION Further research to develop strategies designed to improve the consistency and comprehensiveness of the postoperative wound care education delivered to patients is needed.
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Affiliation(s)
- Brigid M Gillespie
- NHMRC Wiser Wounds Centre of Research Excellence, Menzies Health Institute of Queensland, Griffith University, Australia
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - Rachel Walker
- NHMRC Wiser Wounds Centre of Research Excellence, Menzies Health Institute of Queensland, Griffith University, Australia
- College of Nursing and Health Sciences, Flinders University, South Australia
| | - Frances Lin
- College of Nursing and Health Sciences, Flinders University, South Australia
| | - Shelley Roberts
- Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Ann Eskes
- Department of Surgery, Amsterdam Medical Centre, The Netherlands
| | - Paul Nieuwenhoven
- Surgical and Procedural Services, Gold Coast Hospital and Health Service, QLD, Australia
| | | | - Sean Birgan
- College of Nursing and Health Sciences, Flinders University, South Australia
| | - Elizabeth Gerraghy
- College of Nursing and Health Sciences, Flinders University, South Australia
| | - Rosalind Probert
- Stomal Therapy and Wound Management Department, Princess Alexandra Hospital, QLD, Australia
| | - Wendy Chaboyer
- NHMRC Wiser Wounds Centre of Research Excellence, Menzies Health Institute of Queensland, Griffith University, Australia
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Tobiano G, Chaboyer W, Carlini J, Eskes AM, McInnes E, Latimer S, Boorman R, Moore Z, Fagerdahl AM, Walker RM, Erichsen Andersson A, O'Connor T, Kang E, Probert R, Gillespie BM. Development and validation of a survey designed to measure patient experience of and preference for surgical wound care discharge education: A pilot study. J Tissue Viability 2023:S0965-206X(23)00068-2. [PMID: 37349230 DOI: 10.1016/j.jtv.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/26/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
AIM OF THE STUDY To develop and undertake validation testing of a survey designed to measure patients' experiences of and preferences for surgical wound care discharge education. MATERIALS AND METHODS A literature review and content analysis was undertaken on patients' experiences of and preferences for surgical wound care discharge education. Four themes were uncovered in the literature (wound care discharge education, preferences for discharge education delivery, participation in wound care decisions and patient ability to manage their surgical wound to prevent wound complications), which guided item generation. Three types of validity testing occurred including: 1) face validity testing by the research team; 2) content validity testing (using Delphi study) with an international panel of experts including patients, clinicians and researchers; and 3) content validity (using pilot-testing) of the survey with seven patients from the target population. RESULTS Initially 106 items were generated from the literature, and of these, 55 items were subjected to content validity testing by an international panel of 41 experts. After two Delphi rounds, 18 items were retained. Most patients provided limited and very minor feedback during pilot-testing. However, pilot-testing resulted in a revised survey administration plan to deliver the survey via telephone, including adding prompts and preambles to items. CONCLUSION An 18-item survey comprised of three groups of items and an individual item was rigorously developed. The survey requires further testing among a larger sample of patients to confirm the items reflect important aspects of patients' experiences of and preferences for surgical wound care discharge education.
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Affiliation(s)
- Georgia Tobiano
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Gold Coast Hospital and Health Service, Australia.
| | - Wendy Chaboyer
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia; School of Nursing and Midwifery, Griffith University, Australia; Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Ireland
| | - Joan Carlini
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia; Department of Marketing, Griffith University, Australia; Consumer Advisory Group, Gold Coast University Hospital, Gold Coast Hospital and Health Service, Australia
| | - Anne M Eskes
- School of Nursing and Midwifery, Griffith University, Australia; Department of Surgery, Amsterdam UMC, Netherlands
| | - Elizabeth McInnes
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia; St Vincent's Health Network Sydney, Australia; St Vincent's Hospital Melbourne (SVHM), Australia; Australian Catholic University, Australia
| | - Sharon Latimer
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia; School of Nursing and Midwifery, Griffith University, Australia
| | - Rhonda Boorman
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia
| | - Zena Moore
- School of Nursing and Midwifery, Griffith University, Australia; Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Ireland; School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Ireland; School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Northern Ireland, United Kingdom; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Lida Institute, Shanghai, China; Cardiff University, Cardiff, Wales, United Kingdom; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Ann-Mari Fagerdahl
- Department of Clinical Research and Education, Södersjukhuset, Karolinska Institutet, Sweden
| | - Rachel M Walker
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia; School of Nursing and Midwifery, Griffith University, Australia; Division of Surgery, Princess Alexandra Hospital, Metro South Health, Australia
| | | | - Tom O'Connor
- School of Nursing and Midwifery, Griffith University, Australia; Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Ireland; School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Ireland; Lida Institute, Shanghai, China; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Evelyn Kang
- School of Nursing and Midwifery, Griffith University, Australia
| | - Rosalind Probert
- Stomal Therapy Wound Management Department Division of Surgery, Princess Alexandra Hospital, Metro South Health, Australia
| | - Brigid M Gillespie
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia; Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Gold Coast Hospital and Health Service, Australia; School of Nursing and Midwifery, Griffith University, Australia
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Larsson H, Nyman MH, Brynhildsen KF. Patients' experiences regarding severe leg wound infection associated with coronary artery bypass grafting: A qualitative study. JOURNAL OF VASCULAR NURSING 2023; 41:12-18. [PMID: 36898799 DOI: 10.1016/j.jvn.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 09/15/2022] [Accepted: 12/19/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Coronary artery bypass grafting (CABG) is the most common cardiac surgery throughout the world. The most commonly used graft is the saphenous vein. Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2% to 20%. Surgical site infection can be long-lasting, and the wound healing can be difficult and also presumably troublesome for the patient. CABG patients' experiences of severe infection in the harvesting site have not been studied before. AIM The aim of this study was to describe patients' experiences associated with acquiring a severe infection in the harvesting site after CABG. METHOD A qualitative study with descriptive design was conducted at the department of vascular and cardiothoracic surgery in a Swedish university hospital from May to December 2018. Patients diagnosed with a severe surgical site infection in the harvesting site following CABG were included. Data from 16 face-to-face interviews were analysed with inductive qualitative content analysis. RESULT The main category, varying impact on body and mind, was the core of the patients' experiences of severe wound infection in the harvesting site after CABG. Two generic categories were identified: physical impact and thoughts about the complication. The patients described experiencing different degrees of pain, anxiety, and limitation in daily life. CONCLUSION These findings indicate that a severe infection in the harvesting site after CABG was experienced as an important issue with varying impact. Overall, the participants experienced pain, anxiety, and limitations in daily life. However, most of them were satisfied with the outcome after the wound had healed. Patients should be advised to seek care at an early stage if symptoms of infection occur. Improved individual pain management is needed for those with severe pain, and varied experiences imply a need for person-centred care.
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Affiliation(s)
- Hanna Larsson
- Department of Vascular and Cardiothoracic Surgery, Örebro University Hospital, SE-701 85 Örebro, Sweden; Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82 Örebro, Sweden.
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82 Örebro, Sweden
| | - Karin Falk Brynhildsen
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82 Örebro, Sweden
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Walker RM, Rattray M, Lockwood I, Chaboyer W, Lin F, Roberts S, Perry J, Birgan S, Nieuwenhoven P, Garrahy E, Probert R, Gillespie BM. Surgical wound care preferences and priorities from the perspectives of patients: a qualitative analysis. J Wound Care 2023; 32:S19-S27. [PMID: 36630190 DOI: 10.12968/jowc.2023.32.sup1.s19] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To explore patients' priorities and preferences for optimal care of their acute or hard-to-heal surgical wound(s). METHOD This qualitative study involved semi-structured individual interviews with patients receiving wound care in Queensland, Australia. Convenience and snowball sampling were used to recruit patients from inpatient and outpatient settings between November 2019 and January 2020. Interviews were audio recorded, transcribed verbatim and analysed using thematic analysis. Emergent themes were discussed by all investigators to ensure consensus. RESULTS A total of eight patients were interviewed, five of whom were male (average median age: 70.5 years; interquartile range (IQR): 45-80 years). Four interrelated themes emerged from the data that describe the patients' surgical wound journey: experiencing psychological and psychosocial challenges; taking back control by actively engaging in care; seeking out essential clinician attributes; and collaborating with clinicians to enable an individualised approach to their wound care. CONCLUSION Findings from this study indicate that patients want to actively collaborate with clinicians who have caring qualities, professional skills and knowledge, and be involved in decision-making to ensure care meets their individual needs.
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Affiliation(s)
- Rachel M Walker
- School of Nursing and Midwifery, Menzies Health Institute Queensland (MHIQ), Griffith University, QLD, Australia.,Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Megan Rattray
- School of Nursing and Midwifery, Menzies Health Institute Queensland (MHIQ), Griffith University, QLD, Australia
| | - Ishtar Lockwood
- School of Nursing and Midwifery, Menzies Health Institute Queensland (MHIQ), Griffith University, QLD, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Menzies Health Institute Queensland (MHIQ), Griffith University, QLD, Australia
| | - France Lin
- School of Nursing and Midwifery, Menzies Health Institute Queensland (MHIQ), Griffith University, QLD, Australia.,School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast; Sunshine Coast Health Institute, QLD, Australia
| | - Shelley Roberts
- School of Nursing and Midwifery, Menzies Health Institute Queensland (MHIQ), Griffith University, QLD, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Gold Coast, Australia
| | - Jodie Perry
- Integrated & Ambulatory Services, Nursing, Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - Sean Birgan
- Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Paul Nieuwenhoven
- Surgical Anaesthetic Procedural Services, Nursing, Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
| | - Elizabeth Garrahy
- Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Rosalind Probert
- Division of Surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Menzies Health Institute Queensland (MHIQ), Griffith University, QLD, Australia.,Nursing and Midwifery Education and Research Unit, Gold Coast University Hospital, Gold Coast, Australia
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Norman G, Shi C, Goh EL, Murphy EM, Reid A, Chiverton L, Stankiewicz M, Dumville JC. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev 2022; 4:CD009261. [PMID: 35471497 PMCID: PMC9040710 DOI: 10.1002/14651858.cd009261.pub7] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND Indications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs). Existing evidence for the effectiveness of NPWT on postoperative wounds healing by primary closure remains uncertain. OBJECTIVES To assess the effects of NPWT for preventing SSI in wounds healing through primary closure, and to assess the cost-effectiveness of NPWT in wounds healing through primary closure. SEARCH METHODS In January 2021, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries and references of included studies, systematic reviews and health technology reports. There were no restrictions on language, publication date or study setting. SELECTION CRITERIA We included trials if they allocated participants to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with another. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trials using predetermined inclusion criteria. We carried out data extraction, assessment using the Cochrane risk of bias tool, and quality assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. Our primary outcomes were SSI, mortality, and wound dehiscence. MAIN RESULTS In this fourth update, we added 18 new randomised controlled trials (RCTs) and one new economic study, resulting in a total of 62 RCTs (13,340 included participants) and six economic studies. Studies evaluated NPWT in a wide range of surgeries, including orthopaedic, obstetric, vascular and general procedures. All studies compared NPWT with standard dressings. Most studies had unclear or high risk of bias for at least one key domain. Primary outcomes Eleven studies (6384 participants) which reported mortality were pooled. There is low-certainty evidence showing there may be a reduced risk of death after surgery for people treated with NPWT (0.84%) compared with standard dressings (1.17%) but there is uncertainty around this as confidence intervals include risk of benefits and harm; risk ratio (RR) 0.78 (95% CI 0.47 to 1.30; I2 = 0%). Fifty-four studies reported SSI; 44 studies (11,403 participants) were pooled. There is moderate-certainty evidence that NPWT probably results in fewer SSIs (8.7% of participants) than treatment with standard dressings (11.75%) after surgery; RR 0.73 (95% CI 0.63 to 0.85; I2 = 29%). Thirty studies reported wound dehiscence; 23 studies (8724 participants) were pooled. There is moderate-certainty evidence that there is probably little or no difference in dehiscence between people treated with NPWT (6.62%) and those treated with standard dressing (6.97%), although there is imprecision around the estimate that includes risk of benefit and harms; RR 0.97 (95% CI 0.82 to 1.16; I2 = 4%). Evidence was downgraded for imprecision, risk of bias, or a combination of these. Secondary outcomes There is low-certainty evidence for the outcomes of reoperation and seroma; in each case, confidence intervals included both benefit and harm. There may be a reduced risk of reoperation favouring the standard dressing arm, but this was imprecise: RR 1.13 (95% CI 0.91 to 1.41; I2 = 2%; 18 trials; 6272 participants). There may be a reduced risk of seroma for people treated with NPWT but this is imprecise: the RR was 0.82 (95% CI 0.65 to 1.05; I2 = 0%; 15 trials; 5436 participants). For skin blisters, there is low-certainty evidence that people treated with NPWT may be more likely to develop skin blisters compared with those treated with standard dressing (RR 3.55; 95% CI 1.43 to 8.77; I2 = 74%; 11 trials; 5015 participants). The effect of NPWT on haematoma is uncertain (RR 0.79; 95 % CI 0.48 to 1.30; I2 = 0%; 17 trials; 5909 participants; very low-certainty evidence). There is low-certainty evidence of little to no difference in reported pain between groups. Pain was measured in different ways and most studies could not be pooled; this GRADE assessment is based on all fourteen trials reporting pain; the pooled RR for the proportion of participants who experienced pain was 1.52 (95% CI 0.20, 11.31; I2 = 34%; two studies; 632 participants). Cost-effectiveness Six economic studies, based wholly or partially on trials in our review, assessed the cost-effectiveness of NPWT compared with standard care. They considered NPWT in five indications: caesarean sections in obese women; surgery for lower limb fracture; knee/hip arthroplasty; coronary artery bypass grafts; and vascular surgery with inguinal incisions. They calculated quality-adjusted life-years or an equivalent, and produced estimates of the treatments' relative cost-effectiveness. The reporting quality was good but the evidence certainty varied from moderate to very low. There is moderate-certainty evidence that NPWT in surgery for lower limb fracture was not cost-effective at any threshold of willingness-to-pay and that NPWT is probably cost-effective in obese women undergoing caesarean section. Other studies found low or very low-certainty evidence indicating that NPWT may be cost-effective for the indications assessed. AUTHORS' CONCLUSIONS People with primary closure of their surgical wound and treated prophylactically with NPWT following surgery probably experience fewer SSIs than people treated with standard dressings but there is probably no difference in wound dehiscence (moderate-certainty evidence). There may be a reduced risk of death after surgery for people treated with NPWT compared with standard dressings but there is uncertainty around this as confidence intervals include risk of benefit and harm (low-certainty evidence). People treated with NPWT may experience more instances of skin blistering compared with standard dressing treatment (low-certainty evidence). There are no clear differences in other secondary outcomes where most evidence is low or very low-certainty. Assessments of cost-effectiveness of NPWT produced differing results in different indications. There is a large number of ongoing studies, the results of which may change the findings of this review. Decisions about use of NPWT should take into account surgical indication and setting and consider evidence for all outcomes.
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Affiliation(s)
- Gill Norman
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - En Lin Goh
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Elizabeth Ma Murphy
- Ward 64, St. Mary's Hospital, Manchester Foundation NHS Trust, Manchester, UK
| | - Adam Reid
- School of Biological Sciences, Faculty of Biology, Medicine & Health, Manchester, UK
| | - Laura Chiverton
- NIHR Clinical Research Facility, Great Ormond Street Hospital, London, UK
| | - Monica Stankiewicz
- Chermside Community Health Centre, Community and Oral Health Directorate, Brisbane, Australia
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Tyrer J. Service improvement study to improve care for patients who developed a surgical site infection after discharge. ACTA ACUST UNITED AC 2019; 28:S6-S19. [DOI: 10.12968/bjon.2019.28.15.s6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: many patients develop surgical site infection (SSI) after they have been discharged from hospital. SSI rate is a quality measure intended to support healthcare providers with useful information to improve service and patient outcomes. Aim: the purpose of the study was to gain some local insight into current practice and to inform and improve clinical practice for patients who develop SSIs after they have been discharged. Method: a quantitative approach was taken, using retrospective data collection and analysis of patient records, of patients reviewed by the tissue viability service after discharge over a 1-year period. Findings: a total of 112 patients were included in the study. Of these, 59 were assessed as having developed an SSI, of whom 39 patients presented after discharge. Most of these patients had shorter inpatient stays and many were under the care of community nurses, but referral to the specialist tissue viability service to seek expert advice was often delayed. Conclusion: the study has highlighted the potential value of post-discharge surveillance in contributing to more accurate SSI rates, and the importance of patients and community nurses being provided with clear, understandable information to ensure patients receive timely and effective management, which could reduce the severity of, and duration of treatment for, SSIs.
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Affiliation(s)
- Julie Tyrer
- Tissue Viability Nurse Consultant, Tissue Viability Service, Liverpool Heart and Chest NHS Foundation Trust
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11
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Ousey K, Roberts D, Gefen A. Early identification of wound infection: understanding wound odour. J Wound Care 2019; 26:577-582. [PMID: 28976829 DOI: 10.12968/jowc.2017.26.10.577] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Malodorous wounds can be distressing for patients and their families, negatively impacting on quality-of-life outcomes. For health professionals malodorous wounds can also cause distress manifesting in feelings of disgust when faced with a wound emitting an unpleasant or repulsive odour. There has been investigation into the management of controlling odour particularly in relation to fungating wounds. However, there is limited research that explores techniques for early identification and recognition of wound odours that may be indicative of infection. Electronic nose technology has received some attention, but to date has not been integrated into either diagnostics of infection in wounds or education of health professionals to prepare them for the realities of clinical practice.
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Affiliation(s)
- K Ousey
- Professor, Director, Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - D Roberts
- Foundation of Nursing Studies Professor, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - A Gefen
- Professor, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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12
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Currie K, Melone L, Stewart S, King C, Holopainen A, Clark AM, Reilly J. Understanding the patient experience of health care-associated infection: A qualitative systematic review. Am J Infect Control 2018; 46:936-942. [PMID: 29395507 DOI: 10.1016/j.ajic.2017.11.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/24/2017] [Accepted: 11/25/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The global burden of health care-associated infection (HAI) is well recognized; what is less well known is the impact HAI has on patients. To develop acceptable, effective interventions, greater understanding of patients' experience of HAI is needed. This qualitative systematic review sought to explore adult patients' experiences of common HAIs. METHODS Five databases were searched. Search terms were combined for qualitative research, HAI terms, and patient experience. Study selection was conducted by 2 researchers using prespecified criteria. Critical Appraisal Skills Programme quality appraisal tools were used. Internationally recognized Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied. The Noblit and Hare (1988) approach to meta-synthesis was adopted. RESULTS Seventeen studies (2001-2017) from 5 countries addressing 5 common types of HAI met the inclusion criteria. Four interrelated themes emerged: the continuum of physical and emotional responses, experiencing the response of health care professionals, adapting to life with an HAI, and the complex cultural context of HAI. CONCLUSIONS The impact of different HAIs may vary; however, there are many similarities in the experience recounted by patients. The biosociocultural context of contagion was graphically expressed, with potential impact on social relationships and professional interactions highlighted. Further research to investigate contemporary patient experience in an era of antimicrobial resistance is warranted.
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13
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Martin EK, Beckmann MM, Barnsbee LN, Halton KA, Merollini KMD, Graves N. Best practice perioperative strategies and surgical techniques for preventing caesarean section surgical site infections: a systematic review of reviews and meta-analyses. BJOG 2018; 125:956-964. [DOI: 10.1111/1471-0528.15125] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 12/16/2022]
Affiliation(s)
- EK Martin
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
| | - MM Beckmann
- Mater Health Services; Brisbane QLD Australia
| | - LN Barnsbee
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
| | - KA Halton
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
| | - KMD Merollini
- Faculty of Science, Health, Education and Engineering; University of the Sunshine Coast; Maroochydore QLD Australia
| | - N Graves
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Brisbane QLD Australia
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14
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McCaughan D, Sheard L, Cullum N, Dumville J, Chetter I. Patients' perceptions and experiences of living with a surgical wound healing by secondary intention: A qualitative study. Int J Nurs Stud 2018; 77:29-38. [PMID: 29031127 PMCID: PMC5744862 DOI: 10.1016/j.ijnurstu.2017.09.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 08/14/2017] [Accepted: 09/23/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most surgical wounds heal by primary intention, that is to say, the edges of the wound are brought together with sutures, staples, adhesive glue or clips. However, some wounds may be left open to heal (if there is a risk of infection, or if there has been significant tissue loss), and are known as 'surgical wounds healing by secondary intention'. They are estimated to comprise approximately 28% of all surgical wounds and are frequently complex to manage. However, they are under researched and little is known of their impact on patients' lives. OBJECTIVES To explore patients' views and experiences of living with a surgical wound healing by secondary intention. DESIGN A qualitative, descriptive approach. SETTINGS Participants were recruited from acute and community nursing services in two locations in the North of England characterised by high levels of deprivation and diverse populations. PARTICIPANTS Participants were aged 18 years or older and had at least one surgical wound healing by secondary intention, which was slow to heal. Purposeful sampling was used to include patients of different gender, age, wound duration and type of surgery (general, vascular and orthopaedic). Twenty people were interviewed between January and July 2012. METHODS Semi-structured interviews were conducted, guided by use of a topic guide developed with input from patient advisors. Data were thematically analysed using steps integral to the 'Framework' approach to analysis, including familiarisation with data; development of a coding scheme; coding, charting and cross comparison of data; interpretation of identified themes. FINDINGS Alarm, shock and disbelief were frequently expressed initial reactions, particularly to "unexpected" surgical wounds healing by secondary intention. Wound associated factors almost universally had a profound negative impact on daily life, physical and psychosocial functioning, and wellbeing. Feelings of frustration, powerlessness and guilt were common and debilitating. Patients' hopes for healing were often unrealistic, posing challenges for the clinicians caring for them. Participants expressed dissatisfaction with a perceived lack of continuity and consistency of care in relation to wound management. CONCLUSIONS Surgical wounds healing by secondary intention can have a devastating effect on patients, both physical and psychosocial. Repercussions for patients' family members can also be extremely detrimental, including financial pressures. Health care professionals involved in the care of patients with these wounds face multiple, complex challenges, compounded by the limited evidence base regarding cost-effectiveness of different treatment regimens for these types of wounds.
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Affiliation(s)
- Dorothy McCaughan
- University of York, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre; Jean McFarlane Building, Manchester M13 9PL, UK
| | - Jo Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull and East Yorkshire NHS trust, Hull, HU3 2JZ, UK
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15
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Ding S, Lin F, Marshall A, Gillespie B. Nurses' practice in preventing postoperative wound infections: an observational study. J Wound Care 2017; 26:28-37. [DOI: 10.12968/jowc.2017.26.1.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S. Ding
- Clinical Nurse, School of Nursing and Midwifery, Griffith University, Australia; and Gold Coast Hospital and Health Service
| | - F. Lin
- Senior Lecturer, School of Nursing and Midwifery, Griffith University, Australia; Gold Coast Hospital and Health Service; and Menzies Health Institute Queensland, Griffith University, Australia
| | - A.P. Marshall
- Professor of Acute and Complex Care Nursing, School of Nursing and Midwifery, Griffith University, Australia; Gold Coast Hospital and Health Service; and Menzies Health Institute Queensland, Griffith University, Australia
| | - B.M. Gillespie
- Professor of Patient Safety, School of Nursing and Midwifery, Griffith University, Australia; Gold Coast Hospital and Health Service; Menzies Health Institute Queensland, Griffith University, Australia; and National Centre for Research Excellence in Nursing, Griffith University, Australia
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16
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Megeus V, Nilsson K, Karlsson J, Eriksson BI, Andersson AE. Hand hygiene and aseptic techniques during routine anesthetic care - observations in the operating room. Antimicrob Resist Infect Control 2015; 4:5. [PMID: 25685334 PMCID: PMC4328079 DOI: 10.1186/s13756-015-0042-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 01/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More knowledge is needed about task intensity in relation to hand hygiene in the operating room during anesthetic care in order to choose effective improvement strategies. The aim of this study was to explore the indications and occurrence of hand hygiene opportunities and the adherence to hand hygiene guidelines during routine anesthetic care in the operating room. METHODS Structured observational data on hand hygiene during anesthetic care during 94 surgical procedures was collected using the World Health Organization's observational tool in a surgical department consisting of 16 operating rooms serving different surgical specialties such as orthopedic, gynecological, urological and general surgery. RESULTS A total of 2,393 opportunities for hand hygiene was recorded. The number of hand hygiene opportunities when measured during full-length surgeries was mean = 10.9/hour, SD 6.1 with an overall adherence of 8.1%. The corresponding numbers for the induction phase were, mean =77.5/h, SD 27.4 with an associated 3.1% adherence to hand hygiene guidelines. Lowest adherence was observed during the induction phase before an aseptic task (2.2%) and highest during full-length surgeries after body fluid exposure (15.9%). CONCLUSIONS There is compelling evidence for low adherence to hand hygiene guidelines in the operating room and thus an urgent need for effective improvement strategies. The conclusion of this study is that any such strategy should include education and practical training in terms of how to carry out hand hygiene and aseptic techniques and how to use gloves correctly. Moreover it appears to be essential to optimize the work processes in order to reduce the number of avoidable hand hygiene opportunities thereby enhancing the possibilities for adequate use of HH during anesthetic care.
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Affiliation(s)
- Veronika Megeus
- />The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden
- />Department of Anesthesia, Surgery and Intensive Care, Sahlgrenska University Hospital/Östra, Diagnosvägen 11, 416 85 Gothenburg, Sweden
| | - Kerstin Nilsson
- />The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden
| | - Jon Karlsson
- />Department of Orthopedics, Sahlgrenska Academy, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- />The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Bengt I Eriksson
- />Department of Orthopedics, Sahlgrenska Academy, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- />The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Annette Erichsen Andersson
- />The Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden
- />The Swedish Institute for Health Science, Lund, Sweden
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