Coronavirus Disease 2019 Pandemic and Reduced Surgical Site Infection After Cardiac Surgery: A Potential Blessing in Disguise

Background: The coronavirus disease 2019 (COVID-19) pandemic has brought about drastic hygienic measures, one upside of which might be the mitigated occurrence of surgical site infection (SSI). This study investigated the association of the pandemic with SSI occurrence after cardiac surgeries. Patients and Methods: From 2014 to 2022, patients undergoing cardiac surgery were included and categorized into pre-pandemic and during-pandemic groups. Surgical site infections were classified into harvest-site, superficial sternal, and complex sternal infection. Multiple logistic regression and inverse probability weighting assessed the association of the pandemic with SSI. Results: Among a total of 26,143 patients, 793 SSIs occurred. The during-pandemic patients were younger (61.87 ± 10.58 vs. 65.64 ± 11.82) with a higher male proportion (70.1% vs. 67.4%) and a higher prevalence of all studied comorbidities/risk factors (expect cigarette smoking). Total SSI rate decreased substantially from 3.3% before COVID-19 to 1.8% afterward (p < 0.001). Inverse probability weights analyses evinced an independent association of the pandemic with a reduced risk of total (adjusted odds ratio [OR]; 0.59; 95% confidence interval [CI], 0.45-0.78), harvest-site (adjusted OR, 0.36; 95% CI, 0.19-0.70), and superficial sternal infection (adjusted OR, 0.60; 95% CI, 0.43-0.81). No significant association was observed with complex sternal site infection (adjusted OR, 1.05; 95% CI, 0.55-2.01). Multivariable regression recapitulated these findings. Conclusions: The COVID-19 pandemic independently pertained to more than a 40% reduction in SSI occurrence, particularly affecting harvest-site and superficial sternal infections. However, there remains the possibility of the implications of other known and unknown confounders on the observed association. To some extent, the decrease in SSIs after the pandemic can be justified by reinforced hygienic precautions, emphasizing the necessity of extending the adherence to these measurements into the post-COVID-19 era to maintain the status quo.

Acute care nurses' experience in providing evidence-based care for patients with laparotomy wounds: A scoping review

To systematically search and synthesise available literature on barriers and enablers to evidence-based care for patients with laparotomy wounds reported by acute care nurses. Specifically, we focused on wound assessment, infection control techniques, wound products used, escalation of care, dressing application, documentation and holistic care. The Preferred Reporting Items for Systematic review and Meta-Analyses extension for Scoping Reviews Checklist and explanation documents directed the review. The methodology framework created by Arksey and O'Malley, updated by Levac et al., and the Joanna Briggs Institute were utilised to assist the scoping review process. Data synthesis was guided by the Theoretical Domains Framework. Six qualitative and mixed methods studies were selected for the review. Most reported barriers and enablers were mapped to knowledge, skills, beliefs about consequences, environmental context and resources and beliefs about capability domains. The main barriers were limited access to and utilisation of wound assessment tools and clinical practice guidelines for wound management and suboptimal time management skills. Inconsistent management of laparotomy wounds was related to ward culture and nurses' lack of knowledge and skills in surgical wound assessment and aseptic technique during wound encounters. The reported enablers were knowledge of multi-factorial risk factors for surgical wound recovery, valuing education and reflective practice and believing that protocols should be utilised alongside comprehensive wound assessments. Holistic wound care included patient education on the role of mobilisation and nutrition in wound healing. Acute care nurses do not routinely incorporate comprehensive, evidence-based care recommendations for laparotomy wound management. Further research on evidence-based care behaviours in managing laparotomy wounds is required. The results indicate a need for standardising the practice of laparotomy wound management while acknowledging the current challenges faced in the ward environment.

Post-operative nursing activities to prevent wound complications in patients undergoing colorectal surgeries: A scoping review

AIMS

To identify postoperative interventions and quality improvement initiatives used to prevent wound complications in patients undergoing colorectal surgeries, the types of activities nurses undertake in these interventions/initiatives and how these activities align with nurses' scope of practice.

DESIGN

A scoping review.

DATA SOURCES

Three health databases were searched, and backward and forward citation searching occurred in April 2022. Research and quality improvement initiatives included focussed on adult patients undergoing colorectal surgery, from 2010 onwards. Data were extracted about study characteristics, nursing activities and outcomes. The 'Dimensions of the scope of nursing practice' framework was used to classify nursing activities and then the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework was used to synthesise the review findings.

RESULTS

Thirty-seven studies were included. These studies often reported negative wound pressure therapy and surgical site infection bundle interventions/initiatives. Nurses' scope of practice was most frequently 'Technical procedure and delegated medical care' meaning nurses frequently acted under doctors' orders, with the most common delegated activity being dressing removal.

CONCLUSION

The full extent of possible interventions nurses could undertake independently in the postoperative period requires further exploration to improve wound outcomes and capitalise on nurses' professional role.

IMPACT STATEMENT

Nurses' role in preventing postoperative wound complications is unclear, which may inhibit their ability to influence postoperative outcomes. In the postoperative period, nurses undertake technical activities, under doctors' orders to prevent wound infections. For practice, nurses need to upkeep and audit their technical skills. New avenues for researchers include exploration of independent activities for postoperative nurses and the outcomes of these activities.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

There may be opportunities to broaden nurses' scope of practice to act more autonomously to prevent wound complication.

REPORTING METHOD

Scoping Reviews (PRISMA-ScR) checklist.

PATIENT OR PUBLIC CONTRIBUTION

A health consumer interpreted the data and prepared the manuscript.

The Level of Awareness Among Surgical Physicians Regarding Surgical Site Infections and the Risks Associated With Wound Infections in Makkah

Background and aims: Surgical site infections (SSIs) are a significant contributor to mortality rates globally; therefore, to avoid these lethal complications, it is critical to incorporate patient safety and high-quality treatment approaches. This study aims to assess surgical physicians' awareness of SSIs and risks of wound infections in Makkah City, Saudi Arabia. Methods: A descriptive cross-sectional study was performed among surgical physicians and interns in Makkah city hospitals through an online questionnaire from February 2023 to March 2023.  Results: 122 surgical physicians were enrolled in the study. The age of the majority of participants was between 20 and 30 (52.5%). According to the data, 55.7% of respondents had fair knowledge. Conclusion: Only 4.1% of physicians had a good level of knowledge. Thus, we recommend Makkah hospitals offer academic sessions to surgical physicians about preventive measures for high-quality care of SSIs in order to raise their levels of awareness and knowledge.

Investigation of the selection and use of "other" personal protective equipment to prevent mucous membrane exposure in nurses: A cross-sectional study

BACKGROUND

Selection and use of personal protective equipment (PPE) to prevent non-percutaneous body fluid exposure (NP BFE) is determined by a clinical assessment of risk. The aim of this study was to explore the selection and use of PPE, particularly masks and eye protection to prevent NP BFE, by nurses.

METHODS

This quantitative single-site two-phased study was guided by the Health Belief Model (HBM). Phase 1 was a retrospective electronic database audit of body fluid exposure surveillance data. Phase 2 included a cross-sectional survey.

RESULTS

The highest incidence of reported NP BFE to non-intact skin and mucous membranes during the study period were identified in the emergency department (ED) at 51.3% (20/39), intensive care unit (ICU) at 30.8% (12/39), operating theatre (OT) with 12.9% (5/39), and inpatient renal ward with 5.1% (2/39). Reported PPE use during NP BFE was: 0% face shields or masks, 10% gown/apron, and 15% goggles. Survey results related to Prevention of mucocutaneous exposures were similar across all high-risk units, though ED nurses reported poorer compliance with the use of PPE to prevent exposure. Risk assessment for prevention of NP BFE was reported, yet there was a lack of compliance. The ICU results indicated a positive safety culture in contrast to the ED.

CONCLUSION

The findings are consistent with research identifying inadequate prevention of NP BFE, although nurses are aware of the importance of risk assessment. The HBM has the potential to increase understanding of the differences in nurses' perceptions of risk in safety culture.

Nurse-delivered patient education on postoperative wound care: a prospective study

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.

Management of acute surgical wounds in Saudi Arabia: nursing staff knowledge and practice

OBJECTIVE

Nursing staff play a crucial role in postoperative wound care and management; it is therefore imperative that their knowledge is kept up to date to avoid complications. The overarching objective of this study was to assess the knowledge and practice of nursing staff regarding various aspects of the management of acute surgical wounds.

METHOD

We conducted a cross-sectional study to assess nurses' clinical knowledge and practices in the management of acute wounds in four large hospitals in Saudi Arabia. The eligible participants included nurses who were working in the medical or surgical departments and those who were employed by the Ministry of Health. We administered a study questionnaire and conducted descriptive analysis to report frequencies and proportions of knowledge and practice aspects.

RESULTS

A total of 360 nurses responded to the survey, giving a response rate of 70%. A total of 221 nurses completed all survey questions. Of the participants, 56.56% were ≥30 years old, 95.48% were female, and 50.02% had >6 years' working experience. With regards to nurses' knowledge: 71.9% of the participants had updated their knowledge about wound care in the past two years; 54.3% perceived their knowledge of the availability of wound products as good; 74.66% correctly reported the classic signs of inflammation; 66.97% correctly identified general signs of wound infection; 84.62% of the sample considered surgical site infection as one complication of surgical wound infection. Only 61.09% of the nurses reported following wound care guidelines, 48.42% considered wound appearance as a highly important factor that influences nurses' choice of surgical dressing products, and 41.63% considered hospital policies and practices as important in making evidence-based decisions in wound management.

CONCLUSION

This study found that nurses' knowledge about the management of wounds was generally good; however, there were gaps in the practical component which need to be filled to avoid wound complications.

Specialized Nurse-led Care of Chronic Wounds During Hospitalization and After Discharge: A Randomized Controlled Trial

OBJECTIVE

To evaluate the effectiveness of specialized nurse-led care of patients with chronic wounds, provided both during hospitalization and postdischarge, on wound healing and readmission rates.

METHODS

An unblinded randomized controlled trial was conducted. Participants were patients with chronic wounds, randomly assigned to either the experimental group (cared for by wound care nurses both during hospitalization and postdischarge) or to the control group (cared for according to standard practice). Wound healing was identified as the primary outcome.

RESULTS

Overall, 1,570 patients were randomized, 1,298 of whom were included in the per-protocol analysis (707 in the experimental group and 591 in the control group). Nurse-led wound care quadrupled the probability of healing and reduced the number of treatment weeks and hospital readmissions.

CONCLUSIONS

Chronic wound care that was entrusted to specialized nurses improved outcomes in terms of wound healing, repair and regeneration, length of treatment, and rate of readmission, compared with standard practice. Future studies should evaluate the impact of care provided by specialized wound care nurses on patients' quality of life and healthcare costs. Nurse managers should promote the implementation of chronic wound clinical-care pathways entrusted to specialized nurses to improve patients' clinical outcomes and reduce hospital readmissions.

Perception of Nursing Staff in ICU Regarding Measures to Prevent Hospital-Acquired Infections: A Qualitative Approach

Background Hospital-acquired infections are a common problem in Intensive Care Units and are associated with significant morbidity, mortality, and cost of hospitalization. Despite the development of prevention and control strategies, the incidence of hospital-acquired infections remains consistently high in ICUs and is often associated with the practices of healthcare professionals in patient care. Purpose The aim of the study was to investigate the perceptions of ICU nursing staff regarding measures for the prevention of hospital-acquired infections. Methods and materials This is an ethnographic qualitative study. It was performed in the Intensive Care Unit and the Cardiac Care Unit of a General Hospital in North Greece. Seventeen nurses recounted their perceptions regarding infection prevention and control through semi-structured interviews. Thematic analysis using inductive and deductive approaches was conducted. This manuscript adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Findings The two basic themes that emerged are (1) infection prevention measures in practice, and (2) factors that affect compliance with infection prevention measures. Conclusions The results of this study demonstrate the need for training and compliance of ICU nursing staff regarding measures to prevent hospital-acquired infections. There are several barriers that need to be addressed, such as culture, working conditions, and communication problems through documented interventions in the education, working environment, and professional identity of nursing staff.

Surgical site infection prevention practice and associated factors among nurses working at public hospitals of the western part of southern nation, nationalities, and peoples’ region, Ethiopia: A cross-sectional study

Background

Surgical site infection is a major hazard for surgical patients and compromises their quality of life. Its effect is higher in developing countries compared to developed countries. Most of the studies done in Ethiopia regarding surgical site infection prevention practice on nurses who were not directly exposed to wound care, thus it produces less reliable results. Therefore, we aimed to assess surgical wound infection prevention practice among nurses who are directly involved in the care.

Objective

To assess surgical site infection prevention practice and associated factors among nurses working at public hospitals in the western part of the southern nation, nationalities, and peoples’ regions from March 1–31, 2020.

Methods

An institutional-based cross-sectional study design was conducted from March 1–31, 2020 among randomly selected 402 study participants. A structured and pretested questionnaire was used. EpiData Version 3.1 and Statistical Package for Social Science Version 20 were used for analysis. Bivariable and multivariable analysis was undertaken and p-value less than 0.05 at a 95% confidence interval was considered statistically significant.

Results

The overall good self-reported surgical site infection prevention practice of nurses was 46% (95% CI: 41.3, 50.7). Nurses who were BSc degree (AOR = 2.04; 95% CI: 1.31, 3.18), working in the units having surgical site infection prevention guidelines (AOR = 2.45; 95% CI: 1.34, 4.47), had ever taken infection prevention training (AOR = 2.23; 95% CI: 1.42, 3.49), had good knowledge (AOR = 1.82;95% CI: 1.13, 2.90) and had good attitude (AOR = 2.61;95% CI: 1.67, 4.10) performed good surgical site infection prevention activities as compared to their counterparts.

Conclusion

Nurses’ surgical site infection prevention practice was found to be low. To upgrade nurses’ practice the hospitals should develop their surgical site infection prevention guidelines based on WHO recommendations and provide training on it.

Effect of Operating Room Nursing Management on Nosocomial Infection in Orthopedic Surgery: A Meta-Analysis

Objective

This study aimed to provide scientific management methods to prevent nosocomial infection based on the systematical evaluation of the effect of operating room nursing management on nosocomial infection in orthopedic surgery.

Methods

PubMed, Web of Science, Embase, China National Knowledge Internet, and Wanfang Databases were systematically searched for relevant studies published from 2013 to 2020. In this meta-analysis, comprehensive estimates of effect size estimates and 95% confidence intervals (CIs) for nursing satisfaction and incidence of infection were obtained.

Results

Twenty studies with 2962 orthopedic patients were included in the meta-analysis. The experimental group received operating room nursing management while the routine nursing management was given for the control group. Meta-results showed that, in comparison with the control group, the nursing satisfaction in the experimental group was increased (OR = 6.22, 95% CI: 4.63–8.35, P < 0.001), while the incidence of infection was reduced (OR = 0.20, 95% CI: 0.15–0.28, P < 0.001), and the differences had statistical significance.

Conclusions

Operating room nursing management could reduce the incidence of infection while prevent nosocomial infection in orthopedic surgery, which could be utilized to guide the hospital management.

Postoperative wound assessment documentation and acute care nurses' perception of factors impacting wound documentation: A mixed methods study

BACKGROUND

Wound care documentation is an essential component of best practice wound management in order to enhance inter-disciplinary communication and patient care. However, evidence suggests that wound care documentation is often carried out poorly and sporadically.

OBJECTIVES

Determine postoperative wound assessment documentation by acute care nurses and explore their perception of factors constraining adequate nursing documentation.

METHODS

A two-phase sequential exploratory mixed methods design was used. Phase one: A retrospective clinical chart audit of nurses' documentation was undertaken. A random selection of 200 medical records were reviewed over 3 months at a provincial hospital in Vietnam. Phase two: semi-structured interviews were conducted with 13 surgical nurses to explore their perceptions of factors influencing appropriate documentation. Inductive qualitative content analysis was applied for qualitative data. This manuscript adheres to COREQ guidelines for reporting the qualitative phase.

FINDINGS

Phase one: 200 records were audited. Less than 10% of preoperative factors (such as co-morbidities, smoking and nutrition status) related to the risk of delayed wound healing were documented. During the first 5 days postoperation, there was no documentation about incision location, wound dimension, wound bed (in wounds healing by secondary intention) or odour. In less than 10% colour and type of exudate were recorded. Phase two: Emerging key categories were: unimportance of nursing documentation, difficulty to change existing practice, and personal factors.

CONCLUSION

This study indicated that surgical wound assessment documentation was insufficient and inconsistent among nurses. Nurses viewed the wound assessment documentation as unimportant. Therefore, extensive exploration of strategies is required to enhance the quality of wound assessment documentation.

Relationships between predischarge and postdischarge infectious complications, length of stay, and unplanned readmissions in the ACS NSQIP database

BACKGROUND

Postoperative complications, length of index hospital stay, and unplanned hospital readmissions are important metrics reflecting surgical care quality. Postoperative infections represent a substantial proportion of all postoperative complications. We examined the relationships between identification of postoperative infection prehospital and posthospital discharge, length of stay, and unplanned readmissions in the American College of Surgeons National Surgical Quality Improvement Program database across nine surgical specialties.

METHODS

The 30-day postoperative infectious complications including sepsis, surgical site infections, pneumonia, and urinary tract infection were analyzed in the American College of Surgeons National Surgical Quality Improvement Program inpatient data during the period from 2012 to 2017. General, gynecologic, vascular, orthopedic, otolaryngology, plastic, thoracic, urologic, and neurosurgical inpatient operations were selected.

RESULTS

Postoperative infectious complications were identified in 5.2% (137,014/2,620,450) of cases; 81,929 (59.8%) were postdischarge. The percentage of specific complications identified postdischarge were 73.4% of surgical site infections (range across specialties 63.7-93.1%); 34.9% of sepsis cases (27.4-58.1%); 26.5% of pneumonia cases (18.9%-36.3%); and 53.2% of urinary tract infections (48.3%-88.0%). The relative risk of readmission among patients with postdischarge versus predischarge surgical site infection, sepsis, pneumonia, or urinary tract infection was 5.13 (95% confidence interval: 4.90-5.37), 9.63 (8.93-10.40), 10.79 (10.15-11.45), and 3.32 (3.07-3.60), respectively. Over time, mean length of stay decreased but postdischarge infections and readmission rates significantly increased.

CONCLUSION

Most postoperative infectious complications were diagnosed postdischarge. These were associated with an increased risk of readmission. The trend toward shorter length of stay over time was observed along with an increase both in the percentage of infections detected after discharge and the rate of unplanned related postoperative readmissions over time. Postoperative surveillance of infections should extend beyond hospital discharge of surgical patients.

Evaluating the Implementation of a Multi-Component Intervention to Prevent Surgical Site Infection and Promote Evidence-Based Practice

BACKGROUND

Published clinical practice guidelines on surgical site infection prevention are available; however, adherence to these guidelines remains suboptimal.

AIMS

The aim of this study was to evaluate the effectiveness and perceived benefits of intervention and implementation strategies co-created by researchers and clinicians to prevent surgical site infections.

METHODS

This mixed-method evaluation study involved an audit of nurses' wound care practices, followed by focus group and individual interviews to understand the perceived benefits of the intervention and implementation strategies. Descriptive statistical analyses were used to compare post-intervention audit data with baseline results. Deductive and inductive content analyses were undertaken on the qualitative data.

RESULTS

The audit showed improvements in using aseptic technique and wound care documentation practices following intervention implementation. Nurses perceived the change champion as effective in role-modelling good practice. Education strategies including a poster and using a scenario-based quiz were viewed as easy to understand and helpful for nurses to apply aseptic technique in practice. The instructions and education conducted to improve documentation were considered important in the success of the Wound Care Template implementation.

LINKING EVIDENCE TO ACTION

The integrated knowledge translation approach used in this study ensured the intervention and the implementation strategies employed were appropriate and meaningful for clinicians. Such strategies may be used in other intervention studies. The change champion played an important role in driving change and acted as a vital partner during the co-creation and the implementation processes. Ongoing education, audit and feedback became integrated in the ward nurses' routine practice, which has the potential to continuously improve and sustain evidence-based practice.

Challenges faced by nurses in complying with aseptic non-touch technique principles during wound care: a review

BACKGROUND

Surgical and wound site infections (SWSIs) are the second most frequent type of healthcare-associated Infection. One way of preventing SWSIs is by adhering to the principles of asepsis. However, many nurses struggle to apply the principles of aseptic non-touch technique (ANTT) during wound management.

AIM

To identify the barriers and enablers that influence nurses' adherence to the principles of ANTT during wound care.

METHOD

A literature search using a systematic approach was carried out. Four databases were searched to identify relevant studies published between January 1993 and December 2018. Titles and abstracts were reviewed. Studies that met the inclusion criteria were reviewed for quality. The extracted data were then synthesised.

FINDINGS

A total of seven studies fulfilled the requirements for inclusion. Three themes emerged and were found to be the most dominant factors influencing adherence to the principles of ANTT: material and resources, nurse education, and nurses' behaviour.

CONCLUSION

Nurses' compliance with aseptic practice is directly influenced by environmental and psychological factors. Ensuring compliance to ANTT may require an integrated approach involving local, national and worldwide organisations, in collaboration with higher education institutions that teach nurses and similar healthcare professionals.

Acute wound infections management: the 'Don'ts' from a multidisciplinary expert panel

Introduction: The management of acute wounds may be affected by malpractices leading to poor outcome, prolonged hospital stay and inappropriate use of antibiotic therapy.Areas covered: Acute wound infections are represented by surgical site and post-traumatic infections. The aim of this expert opinion is to identify a list of inadvisable actions and to provide a guide for an optimal management of acute wound infections. A literature search using Pubmed/MEDLINE database was performed. Articles pertaining to areas covered published until December 2019 were selected. We identified the most common malpractices in this setting and, using the Choosing Wisely methodology, we proposed a list of "Don'ts" for an easy use in clinical practice.Expert opinion: Malpractices may occur from the surgical prophylaxis to the discharge of patient. A prolonged surgical prophylaxis, the underestimation of signs and symptoms, the omission of source control, the inappropriate collection of wound swab, the improper use of clinical microbiology and pharmacology, the lack of hygiene measures and the delay of discharge are all factors that may lead to unfavorable outcome. A multidisciplinary approach is needed to optimally manage these patients. The "Don'ts" refer to all professional figures involved in the management of patients with acute wound infections.

Wound care practices across two acute care settings: A comparative study

AIMS AND OBJECTIVES

Describe and compare current surgical wound care practices across two hospitals in two health services districts, Australia.

BACKGROUND

Surgical site infections (SSI) are a complication of surgery and occur in up to 9.5% of surgical procedures, yet they are preventable. Despite the existence of clinical guidelines for SSI prevention, there remains high variation in wound care practice.

DESIGN

Prospective comparative design using structured observations and chart audit.

METHODS

A specifically developed audit tool was used to collect data on observed wound care practices, documentation of wound assessment and practice, and patients' clinical characteristics from patients' electronic medical records. Structured observations of a consecutive sample of surgical patients receiving wound care with a convenience sample of nurses were undertaken. The manuscript adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement.

RESULTS

In total, 154 nurses undertaking acute wound care and 257 surgical patients who received wound care were observed. Across hospitals, hand hygiene adherence after dressing change was lowest (Hospital A: 8/113, 7%; Hospital B: 16/144, 11%; χ² : 8.93, p = .347). Most wound dressing practices were similar across sites, except hand hygiene prior to dressing change (Hospital A: 107/113, 95%; Hospital B: 131/144, 91%; (χ² : 7.736, p = .021) and use of clean gloves using nontouch technique (Hospital A: 88/113, 78%; Hospital B: 90/144, 63%; χ² : 8.313, p = .016). The most commonly documented wound characteristic was wound type (Hospital A: 43/113, 38%; Hospital B: 70/144, 49%). What nurses documented differed significantly across sites (p < .05).

CONCLUSIONS

Clinical variations in wound care practice are likely influenced by clinical context.

RELEVANCE TO CLINICAL PRACTICE

Using an evidence-based approach to surgical wound management will help reduce patients' risk of wound-related complications.

Awareness and Level of Knowledge About Surgical Site Infections and Risks of Wound Infection Among Medical Physicians in King Abdulaziz University Hospital: Cross-Sectional Study

Background

Surgical site infections (SSIs) are one of the leading causes of death, and its prevention is a key element of applying the concept of patient safety and quality care.

Objective

This study aimed to assess the level of knowledge about SSIs and risks of wound infection among medical physicians in King Abdulaziz University Hospital.

Methods

All surgical and medical consultants, specialists, residents, and medical interns were invited to participate in the study. A 20-Item multiple-choice questionnaire was developed by reviewing the previous literature and with the help of a group of certified surgeons to assess the level of knowledge in all participants.

Results

A total of 119 doctors were included in this study. Among all respondents, 92 (77.3%) were intern doctors, 16 (13.4%) were resident doctors, and 11 (9.2%) were specialist doctors. Moreover, 66 (55.5%) doctors knew the definition of SSI. Only one-quarter, that is, 30 (25.2%) doctors knew about the incidence of SSI. In addition, 8 doctors (6.7%) had good knowledge, 75 (63.0%) had fair knowledge, and 36 (30.2%) had poor knowledge regarding SSI according to this study.

Conclusions

Level of knowledge about SSIs and risks of wound infections among medical physicians should be improved to ensure better wound care and quality care for the patients.

Precautions Taken by Nurses about the Prevention of Hospital-Acquired Infections in Intensive Care Units

Objective

To determine the precautions that nurses take for avoiding hospital-acquired infections in intensive care units of a State University Medical Faculty Hospital in Istanbul.

Methods

The research data were collected by a questionnaire developed by the authors. The study was conducted in intensive care units of a medical faculty hospital of a state university in Istanbul province. 85 nurses working in different various intensive care units and providing informed consent participated in the study.

Results

Intravenous catheterization, urinary catheterization, ventilator-associated infections and surgical site infections were assessed. The questionnaire was scored by applying a conversion of 100 to the total scores obtained, with the highest score being 100 and lowest score being 0. The percentage of nurses that practised all of the approaches about preventing hospital-acquired infections was estimated to be 8.2% for catheter-related bloodstream infections, 67.1% for surgical site infections, 72.9% for catheter-associated urinary tract infections, 27.1% for ventilator-associated infections, 29.4% for isolation preventions and 62.5% for attempts related to sterilization/disinfection of the medical devices.

Conclusion

It was seen that nurses use most of the effective measures in order to prevent hospital-acquired infections. The guidelines generated for intensive care units should be updated according to international standards as needed. These guidelines should be used effectively; the differences between intensive care units should be resolved and all nurses should be trained at certain intervals.