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Swedish operating room nurses preventive interventions to reduce bacterial growth, surgical site infections, and increase comfort in patients undergoing surgery
Örebro University, School of Health Sciences.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Surgical site infection is a major postoperative complication that causes patient suffering and is costly for society. The general aim of this thesis was to test and describe interventions performed by operating room (OR) nurses to prevent bacterial growth in surgical patients, with the intent to prevent surgical site infections (SSIs) whilst increase patients comfort.

In studies I and II, 220 pacemaker patients were tested to compare pre-heated skin disinfection with room-temperature skin disinfection regard-ing bacterial growth, skin temperature and patient experience. Preheated skin disinfection was not less effective compared to room-temperature skin disinfection in reducing bacterial growth after skin disinfection and there were no differences regarding SSIs three month postoperatively. Preheated skin disinfection reduces skin heat loss and was perceived as more pleas-ant compared to room-temperature skin disinfection.

In study III, 12 OR nurses were examined regarding bacterial growth on their hands and at the sterile glove cuff end after surgical hand disinfec-tion and again after wearing sterile surgical gloves during surgery. They were compared with a control group of 13 non-health care workers. OR nurses’ hands had higher amounts of bacterial growth at two of three culture sites after surgical hand disinfection compared with the control group, and the bacterial growth increased in both groups with time during surgery. There seems to be a risk of bacterial growth at the glove cuff end during surgery, involving the same type of bacteria as isolated from the hands.

In study IV, 890 OR nurses answered an online questionnaire describ-ing OR nurses interventions guided by national guidelines to reduce SSIs, such as preparation of the patient skin, patient temperature, and OR ma-terials used. The proportion of the OR nurses who complied with the national guidelines preventive interventions was high: skin disinfection solution (93.5%), drapes (97.4%) and gowns (83.8%), and double gloves (73%). However, when guidelines were lacking the interventions differed.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2017. , p. 90
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 73
Keywords [en]
skin disinfection, patient experience, skin temperature, intra-operative, surgical site infection, bacterial growth, recolonization
National Category
Other Health Sciences
Identifiers
URN: urn:nbn:se:oru:diva-59394ISBN: 978-91-7529-213-7 (print)OAI: oai:DiVA.org:oru-59394DiVA, id: diva2:1136191
Public defence
2017-11-10, Universitetssjukhuset i Örebro, Wilandersalen, Södra Grev Rosengatan, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-08-25 Created: 2017-08-25 Last updated: 2017-12-05Bibliographically approved
List of papers
1. The effect of preheated versus room-temperature skin disinfection on bacterial colonization during pacemaker device implantation: a randomized controlled non-inferiority trial
Open this publication in new window or tab >>The effect of preheated versus room-temperature skin disinfection on bacterial colonization during pacemaker device implantation: a randomized controlled non-inferiority trial
2015 (English)In: Antimicrobial Resistance and Infection Control, ISSN 2047-2994, E-ISSN 2047-2994, Vol. 4, article id 44Article in journal (Refereed) Published
Abstract [en]

Background: In clinical practice, patients who are awake often comment that cold surgical skin disinfectant is unpleasant. This is not only a problem of patients’ experience; heat loss during the disinfection process is a problem that can result in hypothermia. Evidence for the efficacy of preheated disinfection is scarce. We tested whether preheated skin disinfectant was non-inferior to room-temperature skin disinfectant on reducing bacterial colonization during pacemaker implantation.

Methods: This randomized, controlled, non-inferiority trial included 220 patients allocated to skin disinfection with preheated (36 °C) or room-temperature (20 °C) chlorhexidine solution in 70 % ethanol. Cultures were obtained by swabbing at 4 time-points; 1) before skin disinfection (skin surface), 2) after skin disinfection (skin surface), 3) after the incision (subcutaneously in the wound), and 4) before suturing (subcutaneously in the wound).

Results: The absolute difference in growth between patients treated with preheated versus room-temperature skin disinfectant was zero (90 % CI −0.101 to 0.101; preheated: 30 of 105 [28.6 %] vs. room-temperature: 32 of 112 [28.6 %]). The pre-specified margin for statistical non-inferiority in the protocol was set at 10 % for the preheated disinfectant. There were no significant differences between groups regarding SSIs three month postoperatively, which occurred in 0.9 % (1 of 108) treated with preheated and 1.8 % (2 of 112) treated with room-temperature skin disinfectant.

Conclusion: Preheated skin disinfection is non-inferior to room-temperature disinfection in bacterial reduction. We therefore suggest that preheated skin disinfection become routine in clean surgery.

Place, publisher, year, edition, pages
London, United Kingdom: BioMed Central, 2015
Keywords
Perioperative, Skin disinfection, Bacterial growth, Non-inferiority
National Category
Medical and Health Sciences Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-46423 (URN)10.1186/s13756-015-0084-1 (DOI)000367371700001 ()26539295 (PubMedID)2-s2.0-85006223174 (Scopus ID)
Note

Funding Agencies:

Örebro County Council Research Committee, Örebro, Sweden

Örebro University

Available from: 2015-11-04 Created: 2015-11-04 Last updated: 2018-07-02Bibliographically approved
2. Positive impact on heat loss and patient experience of preheated skin disinfection: a randomised controlled trial
Open this publication in new window or tab >>Positive impact on heat loss and patient experience of preheated skin disinfection: a randomised controlled trial
2016 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 21-22, p. 3144-3151Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: The aim of this study was to compare the effect of preheated (36 °C) and room-temperature (20 °C) skin disinfectant solution on skin temperature and patients' experience of the skin disinfection process.

Background: To prevent surgical site infections, it is important to disinfect skin prior to invasive surgery. In clinical practice, conscious patients often comment on the coldness of the preoperative skin disinfection solution. Evidence is lacking, as to whether preheated skin disinfectant has any positive effects during preoperative skin disinfection.

Design: Randomised controlled trial.

Methods: A total of 220 patients undergoing pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronisation therapy under local anaesthesia were included and randomly allocated to preheated or room-temperature skin disinfection. Skin temperature was assessed before and after skin disinfection at the planned incision site; in addition, three study-specific questions were used to assess how patients experienced the temperature.

Results: Patients experienced the skin disinfection process with preheated disinfectant as significantly more pleasant. They felt less cold and reported increased satisfaction with the temperature of the solution compared to patients who were disinfected with room-temperature solution. Skin disinfection with preheated solution also yielded a significantly higher mean skin temperature compared to room-temperature solution.

Conclusions: Preoperative skin disinfection with preheated disinfectant may prevent heat loss and contributes to a more pleasant experience for patients.

Relevance to clinical practice: Skin disinfection with preheated skin disinfectant is an easy and inexpensive nursing intervention that has a positive impact on heat loss and on patients' experience of the disinfection process.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2016
Keywords
Experience, intraoperative, perioperative, randomised controlled trial, skin disinfection, temperature
National Category
Dermatology and Venereal Diseases Nursing
Research subject
Caring sciences
Identifiers
urn:nbn:se:oru:diva-50606 (URN)10.1111/jocn.13263 (DOI)000388922700006 ()27256458 (PubMedID)2-s2.0-84973308967 (Scopus ID)
Note

Funding Agency:

Örebro County Council

Available from: 2016-06-08 Created: 2016-06-08 Last updated: 2017-11-30Bibliographically approved
3. Bacterial growth and recolonization after preoperative hand disinfection and surgery: a pilot study
Open this publication in new window or tab >>Bacterial growth and recolonization after preoperative hand disinfection and surgery: a pilot study
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-61555 (URN)
Available from: 2017-10-16 Created: 2017-10-16 Last updated: 2017-10-16Bibliographically approved
4. National survey of operating room nurses’ aseptic techniques and interventions to reduce surgical site infections
Open this publication in new window or tab >>National survey of operating room nurses’ aseptic techniques and interventions to reduce surgical site infections
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-61556 (URN)
Available from: 2017-10-16 Created: 2017-10-16 Last updated: 2017-10-16Bibliographically approved

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