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Traditional compared to modified method of disinfection before hip fracture surgery - Experiences of nursing personnel
Örebro University, School of Medical Sciences. Department of Radiology and Centre for Clinical Research, Region Värmland, Karlstad, Sweden.ORCID iD: 0000-0002-7406-5304
Örebro University, School of Health Sciences.ORCID iD: 0000-0002-9209-5179
Örebro University, School of Medical Sciences. Department of Orthopedics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Örebro University, School of Medical Sciences. Department of Geriatrics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.ORCID iD: 0000-0001-7868-4244
2023 (English)In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 49, article id 101002Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: National guidelines in Sweden recommend preoperative full-body disinfection (FBD) with 4% chlorhexidine to prevent surgical-site infection (SSI) after hip fracture surgery, a method causing patients' severe pain. Although, due to little evidence in research, orthopedic clinics in Sweden are wavering in favor of simpler methods such as local disinfection (LD) of the surgical site.

PURPOSE: The aim of this study was to describe the experiences of nursing personnel regarding the performance of preoperative LD on patients prior to hip fracture surgery after having switched from FBD.

METHODS: This study has a qualitative design where data were collected via focus-group discussions (FGDs) including in total 12 participants and analysed using content analysis.

RESULTS: Six categories were identified describing the aim: sparing the patients' physical harm, sparing the patients' psychological distress, involving the patients in the procedure, improving the working environment for personnel, preventing unethical situations and a more adequate utilization of resources.

CONCLUSIONS: All participants considered LD of the surgical site as a favorable method to FBD, witnessing of an increased wellbeing in patients and the method facilitating a better involvement of patients in the procedure, findings that are supported by other studies promoting person-centered care.

Place, publisher, year, edition, pages
Elsevier, 2023. Vol. 49, article id 101002
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-104416DOI: 10.1016/j.ijotn.2023.101002ISI: 000946216900001PubMedID: 36801597Scopus ID: 2-s2.0-85148703950OAI: oai:DiVA.org:oru-104416DiVA, id: diva2:1738582
Funder
Örebro UniversityRegion Örebro CountyAvailable from: 2023-02-22 Created: 2023-02-22 Last updated: 2024-01-02Bibliographically approved
In thesis
1. Patients with hip fracture: A decade of morbidity and surgery
Open this publication in new window or tab >>Patients with hip fracture: A decade of morbidity and surgery
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Hip fracture is a devastating condition causing excess mortality in older people. Over recent time, incidence has declined while mortality remains unchanged, suggesting changes in morbidity. Swedish national guidelines recommend preoperative full-body disinfection (FBD) to prevent surgical site infection (SSI) despite little evidence, a method causing patients’ substantial pain. The aim of this thesis was to investigate differences in comorbidity, malnutrition, sarcopenia, mortality, surgical characteristics, and functional outcome in patients with hip fracture, ten years apart (I-II). Another aim was to compare preoperative FBD with local disinfection (LD) of the surgical site regarding SSI incidence (III) and experiences of nursing personnel (IV). Patients with hip fracture from 2008 and 2018 (I-II)respectively from 2018 to 2019 (III) and orthopedic nursing personnel (IV) were included. Anthropometric measurements were collected prospectively (I-II) and data from medical records (I-III) and the Swedish hip fracture register (II) were collected retrospectively. Focus group discussions were conducted and analyzed by content analysis (IV). Results suggest increasing levels of comorbidity over time while malnutrition and sarcopenia decreased, potentially explaining the unaltered mortality (I). Concurrently, choice of surgical method seems to have changed, potentially contributing to the seen improvements in functional outcome (II). Study III presented no significant difference in SSI incidence between 2018 (FBD) and 2019 (LD) in the adjusted regression analysis and in study IV nursing personnel testified to an increased wellbeing in patients after the switch to LD. In conclusion, patients who succumb to hip fracture today are not the same as they were yesterday, highlighting the importance of continuous adjustment of treatment and care.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2024. p. 92
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 285
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-109439 (URN)9789175295329 (ISBN)9789175295336 (ISBN)
Public defence
2024-01-19, Wermlands museums hörsal, Västra Torggatan 31, Karlstad, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2023-10-27 Created: 2023-10-27 Last updated: 2024-02-08Bibliographically approved

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Probert, NoelleBlomberg, KarinWretenberg, PerAndersson, Åsa

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