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  • 1.
    Wistrand, Camilla
    Örebro University, School of Health Sciences.
    Swedish operating room nurses preventive interventions to reduce bacterial growth, surgical site infections, and increase comfort in patients undergoing surgery2017Doctoral 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.

    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: 2018-09-04Bibliographically 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
  • 2.
    Wistrand, Camilla
    et al.
    Örebro University, School of Health Sciences.
    Falk-Brynhildsen, Karin
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    National survey of operating room nurses’ aseptic techniques and interventions to reduce surgical site infectionsManuscript (preprint) (Other academic)
  • 3.
    Wistrand, Camilla
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic Surgery and Anesthesiology, Örebro university Hospital, Örebro, Sweden.
    Nilsson, Ulrica
    Centre for Health Care Sciences, Department of Nursing, Umeå University, Umeå, Sweden .
    Effects and experiences of warm versus cold skin disinfection2011In: British Journal of Nursing, ISSN 0966-0461, E-ISSN 2052-2819, Vol. 20, no 3, p. 148-151Article in journal (Refereed)
    Abstract [en]

    The intention of preoperative skin antisepsis is to reduce the risk of postoperative surgical wound infections through the prevention of contamination of the wound site from the patient's skin flora, and to provide a sterile work area. This pilot study aimed to compare warm versus cold skin disinfection with a chlorhexidine solution on bacterial growth, skin temperatures and the experiences of the disinfection. Ten healthy volunteers without any association to Sweden's healthcare services were included in an experimental study with crossover design. The results showed that warm (38°C) disinfection seems to be comparable with cold (20°C) disinfection in reducing bacterial growth. Experiences differ, but warm disinfection is generally considered more pleasant than cold as a result of heat-loss to the skin. However, further research with larger sample sizes and on patients undergoing surgery is needed.

  • 4.
    Wistrand, Camilla
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Nilsson, Ulrica
    Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Sweden.
    Sundqvist, Ann-Sofie
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Patient experience of preheated and room temperature skin disinfection prior to cardiac device implantation: A randomised controlled trial2020In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, article id 1474515119900062Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Clinically, patients often comment on the coolness of the skin disinfectant. However, scarce evidence is available regarding patients' experience during intraoperative skin disinfection.

    AIMS: The aim of this study was to describe and compare intraoperative patient experiences with preheated and room temperature skin disinfectant.

    METHOD: This randomised controlled trial included 220 patients undergoing cardiac device implantation. Patients allocated to preheated (36°C) or room temperature (20°C) chlorhexidine in 70% ethanol verbally answered an open-ended question regarding their experience with the skin disinfection. Results were assessed using a qualitative approach with comparative quantification.

    RESULTS: The analysis resulted in nine categories describing the patients' experiences with preheated and room temperature skin disinfection. Most of the patients described the skin disinfection process as a negative experience, which consisted of six categories: cold, smell, change in temperature, unpleasant, wet and painful. In addition, two neutral categories of response (nothing in particular and neither pleasant nor unpleasant) and one positive response (pleasant) emerged through the analysis. Preheated skin disinfection yielded significantly fewer negative experiences in the category cold (85% vs. 15%, P<0.0001) and significantly more positive experiences (66% vs. 34%, P<0.002). Neutral categories (neither pleasant nor unpleasant 65% vs. 35%, P=0.01, nothing in particular 74% vs. 26%, P<0.001) dominated after preheated skin disinfection.

    CONCLUSION: The use of preheated skin disinfection promotes a positive patient experience with skin disinfection.

    TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT02260479 ( https://clinicaltrials.gov/ct2/results?cond=preheated+skin+disinfection ).

  • 5.
    Wistrand, Camilla
    et al.
    Örebro University, School of Health Sciences.
    Söderquist, Bo
    Örebro University, School of Medical Sciences.
    Falk-Brynhildsen, Karin
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Bacterial growth and recolonization after preoperative hand disinfection and surgery: a pilot studyManuscript (preprint) (Other academic)
  • 6.
    Wistrand, Camilla
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Cardiothoracic Surgery and Vascular Surgery.
    Söderquist, Bo
    Örebro University, School of Medical Sciences. Departments of Laboratory Medicine, Clinical Microbiology, and Infectious diseases, Örebro University Hospital, Örebro, Sweden.
    Falk-Brynhildsen, Karin
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Perioperative Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Exploring bacterial growth and recolonization after preoperative hand disinfection and surgery between operating room nurses and non-health care workers: a pilot study2018In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 18, no 1, article id 466Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To prevent cross infection the surgical team perform preoperative hand disinfection before dressed in surgical gowns and gloves. Preoperative hand disinfection does not make hands sterile and the surgical glove cuff end has been regarded as a weak link, since it is not a liquid-proof interface. The aims were to investigate if there were differences in bacterial growth and recolonization of hands between operating room nurses and non-health care workers as well as to investigate if bacterial growth existed at the surgical glove cuff end during surgery.

    METHODS: This pilot project was conducted as an exploratory comparative clinical trial. Bacterial cultures were taken from the glove and gown interface and at three sites of the hands of 12 operating room nurses and 13 non-health care workers controls directly after preoperative hand disinfection and again after wearing surgical gloves and gowns. Colony forming units were analysed with Mann-Whitney U test and Wilcoxon Sign Ranks test comparing repeated measurements. Categorical variables were evaluated with chi-square test or Fisher's exact test.

    RESULTS: Operating room nurses compared to non-health care workers had significant higher bacterial growth at two of three culture sites after surgical hand disinfection. Both groups had higher recolonization at one of the three culture sites after wearing surgical gloves. There were no differences between the groups in total colony forming units, that is, all sampling sites. Five out of 12 of the operating room nurses had bacterial growth at the glove cuff end and of those, four had the same bacteria at the glove cuff end as found in the cultures from the hands. Bacteria isolated from the glove cuff were P. acnes, S. warneri, S. epidermidis and Micrococcus species, the CFU/mL ranged from 10 to 40.

    CONCLUSIONS: There were differences in bacterial growth and re-colonization between the groups but this was inconclusive. However, bacterial growth exists at the glove cuff and gown interface, further investigation in larger study is needed, to build on these promising, but preliminary, findings.

    TRIAL REGISTRATION: Trial registration was performed prospectively at Research web (FOU in Sweden, 117,971) 14/01/2013, and retrospectively at ClinicalTrials.gov ( NCT02359708 ). 01/27/2015.

  • 7.
    Wistrand, Camilla
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic surgery and Vascular surgery, Örebro University Hospital, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Medicine, Örebro University, Sweden.
    Magnusson, Anders
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The effect of preheated versus room-temperature skin disinfection on bacterial colonization during pacemaker device implantation: a randomized controlled non-inferiority trial2015In: Antimicrobial Resistance and Infection Control, ISSN 2047-2994, E-ISSN 2047-2994, Vol. 4, article id 44Article in journal (Refereed)
    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.

  • 8.
    Wistrand, Camilla
    et al.
    Örebro University, School of Health Sciences.
    Söderquist, Bo
    Örebro University, School of Medical Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Positive impact on heat loss and patient experience of preheated skin disinfection: a randomised controlled trial2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 21-22, p. 3144-3151Article in journal (Refereed)
    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.

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