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Safeguarding from surgical site infections: A mutual responsibility between the patient, caregiver and the perioperative healthcare leaders
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.ORCID iD: 0000-0002-5173-9484
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Sustainable development
SDG 3: Ensure healthy lives and promote well-being for all at all ages
Abstract [en]

Aim: The overall aim of this thesis is to describe and explore preventive measuresand risks for surgical site infections.

Methods: Study I, a registry based and observational design study, includes 35 056cases analysed for risks for reoperation caused by periprosthetic joint infection afterelective total hip arthroplasty. Data are analysed with Cox regression. Study II is ahypothesis testing study and uses an experimental design. Comparative statisticswere used to compare contamination of agar plates after 15 hours for twoconditions: single drape covering or double drape covering. Study III, an interviewstudy that uses a reflective lifeworld research methodology, includes 15 operatingroom nurses who were interviewed regarding the phenomenon of intraoperativeprevention of surgical site infections. Study IV, also an interview study, includes 14orthopaedic patients who were interviewed regarding their experience with at-homepreoperative skin disinfection. Data were analysed using manifest content analysisaccording to Graneheim and Lundman.

Results: Study I shows an increased risk of reoperation caused by periprostheticjoint infection after planned total hip arthroplasty for age, male sex, morbidity (ASAclass III-IV), obesity, lateral approach to the hip, general anaesthesia, and prolongedoperative time. Study II shows reduced contamination of agar plates after 15 hoursstorage with double drape covering compared to single drape covering. Study IIIshows that prevention of surgical site infections is a struggle against an invisible anddelayed threat. Another key finding is the importance of operating room nurseslegitimacy and collaboration within the operating team to prevent surgical siteinfections. Study IV describes the patients’ experiences with at-home preoperativeskin disinfection. The result points out obstacles with the procedure and theimportance of identifying those patients who are not suitable for self-care regardingthis preventive measure

Conclusion: Safeguarding from surgical site infections is a mutual responsibility ofthe patient, caregivers, and perioperative healthcare leaders. Therefore, this complexphenomenon is difficult to assess. Prevention of surgical site infections needs to bea collaborative effort involving patient, caregivers, and perioperative healthcareleaders. The high-risk care of performing surgery requires confident and safeprofessionals in each position. Well-functioning teamwork and collaboration arekey factors for ensuring stability inside the operating room and providing conditionsfor safe care.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2021. , p. 84
Series
Linnaeus University Dissertations ; 427
Keywords [en]
Operating Room, Perioperative care, Prevention, Qualitative content analysis, Reflective lifeworld research, Surgical site infection, Operating room nurse, Teamwork
National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-108180ISBN: 9789189460256 (print)ISBN: 9789189460263 (electronic)OAI: oai:DiVA.org:lnu-108180DiVA, id: diva2:1613514
Public defence
2021-12-10, N 1007 Ikea-salen, växjö, 15:57 (Swedish)
Opponent
Supervisors
Available from: 2022-01-12 Created: 2021-11-22 Last updated: 2024-03-06Bibliographically approved
List of papers
1. Covering surgical instruments with single- or double-layer drape pending surgery: an experimental study in a perioperative setting
Open this publication in new window or tab >>Covering surgical instruments with single- or double-layer drape pending surgery: an experimental study in a perioperative setting
2021 (English)In: Journal of Infection Prevention, ISSN 1757-1774, Vol. 22, no 3, p. 126-131Article in journal (Refereed) Published
Abstract [en]

Background: Surgical site infections (SSI) constitute a severe threat to surgery patients. The surgical environment must be as free of contaminating microorganisms as possible. Using sterile surgical instruments while performing surgery is an absolute necessity for ensuring quality of care in perioperative settings.

Aim: To compare bacterial contamination of agar plates after 15 h on set surgical instrument tables covered with a single- or double-layer drape.

Methods: An experimental design was used consisting of set instrument tables with six agar plates on each table: four instrument tables were covered with a single-layer drape and four instrument tables were covered with a double-layer drape. This set-up was repeated on nine occasions during the period of data collection, making 76 set instrument tables in total. As a control, one instrument table was uncovered on four of those occasions.

Results: The double-layer drape cover showed a significantly (P = 0.03) lower number of colony forming units (CFU) per agar plate than the single-layer drape covering. As expected, the uncovered instrument tables were highly contaminated.

Discussion: Our results indicate that it is good practice to cover instruments properly with at least a single-layer drape before a surgical procedure. If there is difficulty achieving optimal conditions while setting the instrument tables (e.g. positioning the patient for general anaesthesia), it is a better option to set the instrument tables earlier and cover them with a double-layer drape. These precautions will help protect the patient from harm and unnecessary SSI by lowering microbiological burden, a key factor in developing SSI.

Place, publisher, year, edition, pages
Sage Publications, 2021
Keywords
colony forming unit, perioperative care, surgical instrument, surgical site infection
National Category
Surgery
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-103020 (URN)10.1177/1757177420973753 (DOI)000775468300004 ()34234845 (PubMedID)2-s2.0-85097307093 (Scopus ID)2020 (Local ID)2020 (Archive number)2020 (OAI)
Available from: 2021-05-05 Created: 2021-05-05 Last updated: 2022-04-19Bibliographically approved
2. Intraoperative prevention of Surgical Site Infections as experienced by operating room nurses
Open this publication in new window or tab >>Intraoperative prevention of Surgical Site Infections as experienced by operating room nurses
2019 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, p. 1-8, article id 1632109Article in journal (Refereed) Published
Abstract [en]

Aim: This study examines how OR nurses experience intraoperative prevention of SSIs. Introduction: Infections related to surgical procedures create both great patient suffering and high costs for society. Therefore, prevention of Surgical Site Infections (SSIs) should be a high priority for all surgical settings. All details of intraoperative care need to be investigated and evaluated to ensure best practices are evidence-based. Methods: This study uses the Reflective Lifeworld Research (RLR) approach, which is grounded in phenomenology. Participants were OR nurses with at least one year of clinical experience. In total, 15 participants from seven hospitals made contact and were included in this interview study. Results: Prevention of SSIs takes both head and hand. It requires long-term, continuous, and systematic work in several parallel processes, both intellectually and organisationally. The hierarchical tradition of the operating room is often ambiguous, shielded by its safe structures but still restricted by traditional patterns. Confident relations and resolute communication within the team generate favorable conditions for preventing SSIs. Conclusions: By setting up mutual platforms and forums for quality development, increasing legitimacy for OR nurses and establishing fixed teams, prevention of SSIs will continue to improve, ensuring the patients' safety during intraoperative care.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Intraoperative care, Operating room, Prevention, Surgical Site Infection, Surgical team
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-86967 (URN)10.1080/17482631.2019.1632109 (DOI)000473526500001 ()31256748 (PubMedID)2-s2.0-85068214200 (Scopus ID)
Available from: 2019-07-23 Created: 2019-07-23 Last updated: 2022-04-19Bibliographically approved
3. Patients’ experiences with at-home preoperative skin disinfection before elective hip replacement surgery
Open this publication in new window or tab >>Patients’ experiences with at-home preoperative skin disinfection before elective hip replacement surgery
Show others...
2017 (English)In: Journal of Perioperative Practice, ISSN 1750-4589, Vol. 27, no 7-8, p. 162-166Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to describe patients' experiences with preoperative skin disinfection carried out in their home before elective hip replacement surgery with the aim of lowering the microbial burden and avoiding surgical site infections. The literature was reviewed for relevant studies. Optimal preparations before surgery depend on patients being able to assimilate preoperative information and instructions. The study was based on 14 interviews with patients who had undergone elective hip replacement surgery. Data were analysed with qualitative manifest content analysis according to Graneheim and Lundman (2004). The main categories of findings were: patients' experience of obstacles and limitations, the importance of supportive surroundings, and personal resources as strength when performing preoperative skin disinfection. The findings of this study agree with earlier studies showing a lack of compliance to preoperative skin disinfection. The findings also suggest reasons for non-compliance. Preoperative skin disinfection involves many important steps that need to be accomplished to ensure the maximum effect on microbial burden on skin surface. These steps can be difficult for some patient groups. Perioperative dialogue is one way to identify patients' individual needs and to help patients participate in the process. The study concludes that patients who carried out skin disinfection at home before surgery have a great responsibility to prepare themselves. The challenge for perioperative nurses who work with preoperative information is to identify and individually guide those patients who need extended support so that all patients with elective hip replacement surgery receive the same quality of care. Further research should focus on how caregivers discover individuals with extended needs and on identifying the kind of support that is effective to achieve optimal conditions for hip replacement surgery.

Place, publisher, year, edition, pages
Sage Publications, 2017
National Category
Nursing
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-67252 (URN)10.1177/1750458917027007-804 (DOI)2-s2.0-85051617431 (Scopus ID)
Available from: 2017-08-15 Created: 2017-08-15 Last updated: 2022-04-19Bibliographically approved

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