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  • 1.
    Falk-Brynhildsen, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    The effect  of peroperative skin preparation on bacterial growth during cardiac surgery2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Routine products are used and procedures are followed in order to prevent and minimize the bacterial contamination of the surgical wound, and thus reduce the risk of postoperative wound infections. The overall aim of this thesis was to investigate the effect of different preoperative skin preparation before cardiac surgery.

    In study I, 10 healthy volunteers were compared in time to recolonization of the skin and bacterial growth with or without plastic adhesive drape. Bacterial samples were taken as paired samples on both side of the sternum. Plastic drape on disinfected skin seems to hasten recolonization compared with bare skin.

    In study II, 135 cardiac surgery patients were comparing plastic adhesive drape versus bare skin on the chest regarding intra-operative bacterial growth. Plastic adhesive drape did not reduce the bacterial recolonization or wound contamination, P. acnes colonizes males more often than females and P. acnes is not affected by disinfection with 0.5% chlorhexidine in ethanol.

    Study III, compared the leg harvesting site with or without microbal skin sealant in 135 CABG patients regarding intraoperative bacterial growth and postoperative wound infection. Almost no bacterial growth was found during surgery regardless of the use of microbial skin sealant and bare skin. A high incidence of postoperative wound infections (16.8%) in 2 month follow up was present and SSI was largely caused by S. aureus, i.e. other bacterial species than observed intraoperative.

    Study IV, a descriptive study using phenotypic and genotypic methods investigate susceptibility to chlorhexidine among S. epidermidis indicating that S. epidermidis isolates following preoperative skin disinfection are sensitive tochlorhexidine.

    List of papers
    1. Bacterial colonization of the skin following aseptic preoperative preparation and impact of the use of plastic adhesive drapes
    Open this publication in new window or tab >>Bacterial colonization of the skin following aseptic preoperative preparation and impact of the use of plastic adhesive drapes
    2013 (English)In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 15, no 2, p. 242-248Article in journal (Refereed) Published
    Abstract [en]

    Surgical site contamination, for example, with coagulase-negative staphylococci, probably derives from both the patient’s own skin flora and those of the surgical team. Despite preoperative antiseptic preparation with chlorhexidine solution, complete sterilization of the skin is not possible and gradual recolonization will occur. Plastic adhesive drape is an established method used to prevent direct wound contamination from adjacent skin. In this study, the time to skin recolonization after antiseptic preparation was measured and the impact of using plastic adhesive drape on this recolonization was evaluated. Repeated bacterial sampling using three different methods over 6 hr was conducted after antiseptic preparation in 10 volunteers. Recolonization of skin was observed after 30 min with plastic drape and after 60 min without plastic drape; there were significantly more positive cultures with the plastic drape than without (31% vs. 7.5%, respectively, p < .001). Sampling with a rayon swab was the most sensitive sampling method. In conclusion, covering the skin with a plastic adhesive drape seems to hasten recolonization of the skin after antiseptic preparation. However, clinical trials to confirm this finding are warranted.

    Keywords
    recolonization, disinfection, plastic drape, chlorhexidine solution
    National Category
    Surgery Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-25334 (URN)10.1177/1099800411430381 (DOI)000314367500015 ()22278031 (PubMedID)2-s2.0-84873426936 (Scopus ID)
    Note

    Karin Falk-Brynhildsen is also affiliated to Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital 

    Bo Söderquist i also affiliated to Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden 

    Ulrica G. Nilsson is also affiliated to Department of Nursing, Umeå University, Umeå, Sweden 

    Available from: 2012-08-27 Created: 2012-08-27 Last updated: 2018-05-15Bibliographically approved
    2. Bacterial recolonization of the skin and wound contamination during cardiac surgery: a randomized controlled trial of the use of plastic adhesive drape compared with bare skin
    Open this publication in new window or tab >>Bacterial recolonization of the skin and wound contamination during cardiac surgery: a randomized controlled trial of the use of plastic adhesive drape compared with bare skin
    2013 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 84, no 2, p. 151-158Article in journal (Refereed) Published
    Abstract [en]

    Background: Sternal wound infection after cardiac surgery is a serious complication. Various perioperative strategies, including plastic adhesive drapes, are used to reduce bacterial contamination of surgical wounds.

    Aim: To compare plastic adhesive drape to bare skin regarding bacterial growth in wound and time to recolonization of the adjacent skin intraoperatively, in cardiac surgery patients.

    Methods: This single-blinded randomized controlled trial (May 2010 to May 2011) included 140 patients scheduled for cardiac surgery via median sternotomy. The patients were randomly allocated to the adhesive drape (chest covered with plastic adhesive drape) or bare skin group. Bacterial samples were taken preoperatively and intraoperatively every hour during surgery until skin closure.

    Results: Disinfection with 0.5% chlorhexidine solution in 70% alcohol decreased coagulase-negative staphylococci (CoNS), while the proportion colonized with Propionibacterium acnes was not significantly reduced and was still present in more than 50% of skin samples. P. acnes was significantly more common in men than in women. Progressive bacterial recolonization of the skin occurred within 2-3 h. At 120 min there were significantly more positive cultures in the adhesive drape group versus bare skin group for P. acnes (63% vs 44%; P = 0.034) and for CoNS (45% vs 24%; P = 0.013). The only statistically significant difference in bacterial growth in the surgical wound was higher proportion of CoNS at the end of surgery in the adhesive drape group (14.7% vs 4.4%; P = 0.044).

    Conclusion: Plastic adhesive drape does not reduce bacterial recolonization. P. acnes colonized men more frequently, and was not decreased by disinfection with chlorhexidine solution in alcohol.

    Place, publisher, year, edition, pages
    London, United Kingdom: Saunders Elsevier, 2013
    Keywords
    Coagulase-negative staphylococci, Contamination, Plastic adhesive drape, Propionibacterium acnes, Recolonization, Sex differences
    National Category
    Medical and Health Sciences Surgery Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-29852 (URN)10.1016/j.jhin.2013.02.011 (DOI)000319213200010 ()23623487 (PubMedID)2-s2.0-84878121765 (Scopus ID)
    Note

    Funding Agencies:

    Research Committee of Örebro County Council 

    Nyckelfonden at Örebro University Hospital 

    Available from: 2013-06-28 Created: 2013-06-28 Last updated: 2018-09-11Bibliographically approved
    3. Bacterial growth and wound infection following saphenous vein harvesting in cardiac surgery: a randomized controlled trial of the impact of microbial sealant
    Open this publication in new window or tab >>Bacterial growth and wound infection following saphenous vein harvesting in cardiac surgery: a randomized controlled trial of the impact of microbial sealant
    2014 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 33, no 11, p. 1981-1987Article in journal (Refereed) Published
    Abstract [en]

    The aim of the present study was to compare microbial skin sealant versus bare skin on the leg regarding intraoperative bacterial presence in the surgical wound and time to recolonization of the adjacent skin at the saphenous vein harvesting site. A second aim was to evaluate the incidence of leg wound infection 2 months after surgery. In this randomized controlled trial, 140 patients undergoing coronary artery bypass grafting (CABG) between May 2010 and October 2011 were enrolled. Bacterial samples were taken preoperatively and intraoperatively at multiple time points and locations. OF the patients, 125 (92.6 %) were followed up 2 months postoperatively regarding wound infection. Intraoperative bacterial growth did not differ between the bare skin (n = 68) and the microbial skin sealant group (n = 67) at any time point. At 2 months postoperatively, 7/61 patients (11.5 %) in the skin sealant versus 14/64 (21.9 %) in the bare skin group (p = 0.120) had been treated with antibiotics for a verified or suspected surgical site infection (SSI) at the harvest site. We found almost no intraoperative bacterial presence on the skin or in the subcutaneous tissue, irrespective of microbial skin sealant use. In contrast, we observed a relatively high incidence of late wound infection, indicating that wound contamination occurred postoperatively. Further research is necessary to determine whether the use of microbial skin sealant reduces the incidence of leg wound infection at the saphenous vein harvest site.

    Place, publisher, year, edition, pages
    Springer, 2014
    Keywords
    intra-operative, skin sealant, saphenous vein graft harvesting, SSI, contamination
    National Category
    Infectious Medicine Microbiology in the medical area
    Identifiers
    urn:nbn:se:oru:diva-32650 (URN)10.1007/s10096-014-2168-x (DOI)000344071600014 ()24907853 (PubMedID)2-s2.0-84911005344 (Scopus ID)
    Note

    Funding agencies are:

    Research Comittee of Örebro County Council

    Nyckelfonden at Örebro University Hospital

    Available from: 2013-12-06 Created: 2013-12-06 Last updated: 2018-08-27Bibliographically approved
    4. Decreased susceptibility to chlorhexidine and prevalence of disinfectant resistance genes among clinical isolates of Staphylococcus epidermidis
    Open this publication in new window or tab >>Decreased susceptibility to chlorhexidine and prevalence of disinfectant resistance genes among clinical isolates of Staphylococcus epidermidis
    Show others...
    2014 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 122, no 10, p. 961-967Article in journal (Refereed) Published
    Abstract [en]

    Staphylococcus epidermidis, despite regarded as a commensal, is recognized as a nosocomial pathogen usually by acting as an opportunist, especially in infections associated with implanted foreign body materials. Pre-operative antiseptic preparation is an important strategy for reducing the risk of complications such as surgical site infection (SSI). The currently most widely used antiseptic compounds are alcohols and quaternary ammonium compounds (QACs), predominantly chlorhexidine.

    The aim of this study was to investigate if decreased susceptibility to chlorhexidine among S. epidermidis was present in our setting. S. epidermidis (n=143) were obtained from prosthetic joint infections (PJI) (n=61), commensals (n=24), post-operative infections after cardiothoracic surgery (n=31), and the skin of the chest after routine disinfection prior cardiothoracic surgery (n=27). Determination of MIC of chlorhexidine was performed on Müeller Hinton agar plates supplemented with serial dilutions of chlorhexidine. Five QAC resistance genes; qacA/B, smr, qacH, qacJ, and qacG, were detected using PCR.

    Decreased susceptibility to chlorhexidine was found in 54% of PJI isolates, 68% of cardiothoracic isolates, 21% of commensals, and 7% of isolates obtained from the skin of cardiothoracic patients, respectively.

    The qacA/B gene was present in 62/143 isolates (43%), smr in 8/143 (6%) and qacH in one isolate (0.7%). The qacA/B gene was found in 52% of PJI isolates, 61% of cardiothoracic isolates, 25% of commensals, and 19% of isolates obtained from the skin of cardiothoracic patients. In conclusion, decreased susceptibility to chlorhexidine as well as QAC resistance genes was highly prevalent among S. epidermidis causing deep SSIs.

    Place, publisher, year, edition, pages
    Hoboken, USA: Wiley-Blackwell, 2014
    Keywords
    Staphylococcus epidermidis, chlorhexidine, prosthetic joint infection, biocide resistance, nosocomial infection
    National Category
    Immunology in the medical area Microbiology in the medical area
    Identifiers
    urn:nbn:se:oru:diva-32651 (URN)10.1111/apm.12239 (DOI)000342341100008 ()24628476 (PubMedID)2-s2.0-84895913075 (Scopus ID)
    Note

    Funding Agency:

    Örebro County Council Research Committee

    Available from: 2013-12-06 Created: 2013-12-06 Last updated: 2018-06-04Bibliographically approved
  • 2.
    Falk-Brynhildsen, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, Örebro, Sweden; .
    Friberg, Örjan
    Örebro University Hospital. Department of Cardiothoracic Surgery and Anesthesiology, Örebro University Hospital, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica G.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences; Department of Nursing, Umeå University, Umeå, Sweden.
    Bacterial colonization of the skin following aseptic preoperative preparation and impact of the use of plastic adhesive drapes2013In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 15, no 2, p. 242-248Article in journal (Refereed)
    Abstract [en]

    Surgical site contamination, for example, with coagulase-negative staphylococci, probably derives from both the patient’s own skin flora and those of the surgical team. Despite preoperative antiseptic preparation with chlorhexidine solution, complete sterilization of the skin is not possible and gradual recolonization will occur. Plastic adhesive drape is an established method used to prevent direct wound contamination from adjacent skin. In this study, the time to skin recolonization after antiseptic preparation was measured and the impact of using plastic adhesive drape on this recolonization was evaluated. Repeated bacterial sampling using three different methods over 6 hr was conducted after antiseptic preparation in 10 volunteers. Recolonization of skin was observed after 30 min with plastic drape and after 60 min without plastic drape; there were significantly more positive cultures with the plastic drape than without (31% vs. 7.5%, respectively, p < .001). Sampling with a rayon swab was the most sensitive sampling method. In conclusion, covering the skin with a plastic adhesive drape seems to hasten recolonization of the skin after antiseptic preparation. However, clinical trials to confirm this finding are warranted.

  • 3.
    Falk-Brynhildsen, Karin
    et al.
    Department of Cardiothoracic Surgery, Örebro University Hospital, Sweden.
    Nilsson, Ulrica
    Department of Cardiothoracic Surgery and Centre for Health Care Sciences, Örebro University Hospital, Sweden.
    Cardiac surgery patients' evaluation of the quality of theatre nurse postoperative follow-up visit2009In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 8, no 2, p. 105-111Article in journal (Refereed)
    Abstract [en]

    Theatre nurses at the Department of Cardiothoracic Surgery in Orebro, Sweden, have since 2001 routinely conducted a follow-up visit to postoperative cardiac patients. A model with a standardized information part and an individual-caring conversation including both a retrospective and a prospective part designed the visit. The purpose of this study was to evaluate the quality of the postoperative follow-up visit conducted by the theatre nurses and find out if the quality was related to gender or type of admission. The method was prospective and explorative, including 74 cardiac surgery patients who had had a postoperative follow-up visit by a theatre nurse in Sweden. The instrument measuring quality, from the patient's perspective, measured the quality of the visit, and consisted of 16 items modified to suit the study. The results showed an overall high quality rating, with statistically significant higher scores for six items between patients who had undergone emergency surgery, in comparison with elective patients. When comparing gender, women had statistically significant higher scores in two items. In conclusion, this postoperative follow-up visit by the theatre nurse was a valuable and useful tool especially for the patients who had undergone emergency surgery. In the follow-up visit the theatre nurse creates a caring relationship by meeting the patient as an individual with his/her own experience and needs for information about the surgery, intra and postoperative care, and recovery.

  • 4.
    Falk-Brynhildsen, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology ,Örebro University Hospital, Örebro, Sweden.
    Friberg, Örjan
    Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Bacterial growth and wound infection following saphenous vein harvesting in cardiac surgery: a randomized controlled trial of the impact of microbial sealant2014In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 33, no 11, p. 1981-1987Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to compare microbial skin sealant versus bare skin on the leg regarding intraoperative bacterial presence in the surgical wound and time to recolonization of the adjacent skin at the saphenous vein harvesting site. A second aim was to evaluate the incidence of leg wound infection 2 months after surgery. In this randomized controlled trial, 140 patients undergoing coronary artery bypass grafting (CABG) between May 2010 and October 2011 were enrolled. Bacterial samples were taken preoperatively and intraoperatively at multiple time points and locations. OF the patients, 125 (92.6 %) were followed up 2 months postoperatively regarding wound infection. Intraoperative bacterial growth did not differ between the bare skin (n = 68) and the microbial skin sealant group (n = 67) at any time point. At 2 months postoperatively, 7/61 patients (11.5 %) in the skin sealant versus 14/64 (21.9 %) in the bare skin group (p = 0.120) had been treated with antibiotics for a verified or suspected surgical site infection (SSI) at the harvest site. We found almost no intraoperative bacterial presence on the skin or in the subcutaneous tissue, irrespective of microbial skin sealant use. In contrast, we observed a relatively high incidence of late wound infection, indicating that wound contamination occurred postoperatively. Further research is necessary to determine whether the use of microbial skin sealant reduces the incidence of leg wound infection at the saphenous vein harvest site.

  • 5.
    Falk-Brynhildsen, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic and Vascular Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Laboratory Medicine, Clinical Microbiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Friberg, Örjan
    Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Region Örebro County, Örebro, Sweden.
    Bacterial recolonization of the skin and wound contamination during cardiac surgery: a randomized controlled trial of the use of plastic adhesive drape compared with bare skin2013In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 84, no 2, p. 151-158Article in journal (Refereed)
    Abstract [en]

    Background: Sternal wound infection after cardiac surgery is a serious complication. Various perioperative strategies, including plastic adhesive drapes, are used to reduce bacterial contamination of surgical wounds.

    Aim: To compare plastic adhesive drape to bare skin regarding bacterial growth in wound and time to recolonization of the adjacent skin intraoperatively, in cardiac surgery patients.

    Methods: This single-blinded randomized controlled trial (May 2010 to May 2011) included 140 patients scheduled for cardiac surgery via median sternotomy. The patients were randomly allocated to the adhesive drape (chest covered with plastic adhesive drape) or bare skin group. Bacterial samples were taken preoperatively and intraoperatively every hour during surgery until skin closure.

    Results: Disinfection with 0.5% chlorhexidine solution in 70% alcohol decreased coagulase-negative staphylococci (CoNS), while the proportion colonized with Propionibacterium acnes was not significantly reduced and was still present in more than 50% of skin samples. P. acnes was significantly more common in men than in women. Progressive bacterial recolonization of the skin occurred within 2-3 h. At 120 min there were significantly more positive cultures in the adhesive drape group versus bare skin group for P. acnes (63% vs 44%; P = 0.034) and for CoNS (45% vs 24%; P = 0.013). The only statistically significant difference in bacterial growth in the surgical wound was higher proportion of CoNS at the end of surgery in the adhesive drape group (14.7% vs 4.4%; P = 0.044).

    Conclusion: Plastic adhesive drape does not reduce bacterial recolonization. P. acnes colonized men more frequently, and was not decreased by disinfection with chlorhexidine solution in alcohol.

  • 6.
    Falk-Brynhildsen, Karin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Friberg, Örjan
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Ulrica G.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Response to MH Stevens and NM Klinger, re: Bacterial recolonization of the skin and wound contamination during cardiac surgery2013In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 85, no 4, p. 325-325Article in journal (Refereed)
  • 7.
    Gillespie, Brigid M.
    et al.
    School of Nursing & Midwifery, Griffith University, Gold Coast QLD, Australia; Gold Coast Hospital and Health Service, Gold Coast QLD, Australia; National Centre of Research Excellence in Nursing, Griffith University, Gold Coast QLD, Australia.
    Harbeck, Emma B.
    National Centre of Research Excellence in Nursing, Griffith University, Gold Coast QLD, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast QLD, Australia.
    Falk-Brynhildsen, Karin
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Perceptions of perioperative nursing competence: a cross-country comparison2018In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 17, article id 12Article in journal (Refereed)
    Abstract [en]

    Background: Throughout many countries, professional bodies rely on yearly self-assessment of competence for ongoing registration; therefore, nursing competence is pivotal to safe clinical practice. Our aim was to describe and compare perioperative nurses' perceptions of competence in four countries, while examining the effect of specialist education and years of experience in the operating room.

    Methods: We conducted a secondary analysis of cross-sectional surveys from four countries including; Australia, Canada, Scotland, and Sweden. The 40-item Perceived Perioperative Competence Scale-Revised (PPCS-R), was used with a total sample of 768 respondents. We used a factorial design to examine the influence of country, years of experience in the operating room and specialist education on nurses' reported perceived perioperative competence.

    Results: Regardless of country origin, nurses with specialist qualifications reported higher perceived perioperative competence when compared to nurses without specialist education. However, cross-country differences were dependent on nurses' number of years of experience in the operating room. Nurses from Sweden with 6-10 years of experience in the operating room reported lower perceived perioperative competence when compared to Australian nurses. In comparing nurses with >10 years of experience, Swedish nurses reported significantly lower perceived perioperative competence when compared to nurses from Australia, Canada and Scotland.

    Conclusion: Researchers need to consider educational level and years of experience in the perioperative context when examining constructs such as competence.

  • 8.
    Jaensson, Maria
    et al.
    Örebro University, School of Health Sciences.
    Falk-Brynhildsen, Karin
    Örebro University, School of Health Sciences.
    Gillespie, Brigid M.
    Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, Australia.
    Wallentin, Fan Y.
    Department of Statistics, Uppsala University, Uppsala, Sweden.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Psychometric Validation of the Perceived Perioperative Competence Scale-Revised in the Swedish Context2018In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 33, no 4, p. 499-511Article in journal (Refereed)
    Abstract [en]

    Purpose: To psychometrically test the Perceived Perioperative Competence Scale-Revised (PPCS-R) in the Swedish context.

    Design: Cross-sectional survey.

    Methods: The 40-item PPCS-R was translated into Swedish using a forward-translation approach. A census of 2,902 registered nurse anesthetists (RNAs) and operating room (OR) nurses was drawn from a database of a national association in Sweden.

    Finding: The response rate was 39% (n = 1,033; 528 RNAs and 505 OR nurses). Cronbach alpha for each factor was 0.78 to 0.89 among OR nurses and 0.79 to 0.88 among RNAs. Confirmatory factor analysis showed good model fit in the six-factor model.

    Conclusions: Psychometric testing of the Swedish translation of the PPCS-R suggests a good construct validity, and the construct and its six factors are conceptually relevant among the Swedish OR nurses and RNAs.

  • 9.
    Nilsson, Ulrica
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Falk Brynhildsen, Karin
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Hur har ni det med kompetensen?2016Conference paper (Other (popular science, discussion, etc.))
  • 10.
    Nilsson, Ulrica
    et al.
    Örebro University, School of Health Sciences.
    Falk-Brynhildsen, Karin
    Örebro University, School of Health Sciences.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Hur har ni det med kompetensen?2017Conference paper (Other academic)
  • 11.
    Prag, Gustaf
    et al.
    Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Falk-Brynhildsen, Karin
    Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
    Jacobsson, Susanne
    Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Hellmark, Bengt
    Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Unemo, Magnus
    Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden; Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    Decreased susceptibility to chlorhexidine and prevalence of disinfectant resistance genes among clinical isolates of Staphylococcus epidermidis2014In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 122, no 10, p. 961-967Article in journal (Refereed)
    Abstract [en]

    Staphylococcus epidermidis, despite regarded as a commensal, is recognized as a nosocomial pathogen usually by acting as an opportunist, especially in infections associated with implanted foreign body materials. Pre-operative antiseptic preparation is an important strategy for reducing the risk of complications such as surgical site infection (SSI). The currently most widely used antiseptic compounds are alcohols and quaternary ammonium compounds (QACs), predominantly chlorhexidine.

    The aim of this study was to investigate if decreased susceptibility to chlorhexidine among S. epidermidis was present in our setting. S. epidermidis (n=143) were obtained from prosthetic joint infections (PJI) (n=61), commensals (n=24), post-operative infections after cardiothoracic surgery (n=31), and the skin of the chest after routine disinfection prior cardiothoracic surgery (n=27). Determination of MIC of chlorhexidine was performed on Müeller Hinton agar plates supplemented with serial dilutions of chlorhexidine. Five QAC resistance genes; qacA/B, smr, qacH, qacJ, and qacG, were detected using PCR.

    Decreased susceptibility to chlorhexidine was found in 54% of PJI isolates, 68% of cardiothoracic isolates, 21% of commensals, and 7% of isolates obtained from the skin of cardiothoracic patients, respectively.

    The qacA/B gene was present in 62/143 isolates (43%), smr in 8/143 (6%) and qacH in one isolate (0.7%). The qacA/B gene was found in 52% of PJI isolates, 61% of cardiothoracic isolates, 25% of commensals, and 19% of isolates obtained from the skin of cardiothoracic patients. In conclusion, decreased susceptibility to chlorhexidine as well as QAC resistance genes was highly prevalent among S. epidermidis causing deep SSIs.

  • 12.
    Wistrand, Camilla
    et al.
    Department of Cardiothoracic and Vascular Surgery, University Hospital, Örebro, Sweden.
    Falk-Brynhildsen, Karin
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences. Department of Cardiothoracic and Vascular Surgery, University Hospital, Örebro, Sweden; Centre for Perioperative Nursing, Örebro University, Örebro, Sweden.
    National Survey of Operating Room Nurses' Aseptic Techniques and Interventions for Patient Preparation to Reduce Surgical Site Infections2018In: Surgical Infections, ISSN 1096-2964, E-ISSN 1557-8674, Vol. 19, no 4, p. 438-445Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Surgical site infection (SSI), the third most common type of nosocomial infection in Sweden, is a patient injury that should be prevented. Methods of reducing SSIs include, for instance, disinfecting the skin, maintaining body temperature, and ensuring an aseptic environment. Guidelines for most of these interventions exist, but there is a lack of studies describing to what extent the preventive interventions have been implemented in clinical practice. We describe the daily clinical interventions Swedish operating room (OR) nurses performed to prevent SSIs following national guidelines.

    METHODS: A descriptive cross-sectional study using a Web-based questionnaire was conducted among Swedish OR nurses. The study-specific questionnaire included 32 items addressing aspects of the interventions performed to prevent SSI, such as preparation of the patient skin (n = 12), maintenance of patient temperature (n = 10), and choice of materials (n = 10). The response format included both closed and open-ended answers.

    RESULTS: In total, 967 nurses (43% of the total) answered the questionnaire; of these, 77 were excluded for various reasons. The proportions of the OR nurses who complied with the preventive interventions recommended in the national guidelines were high: skin disinfection solution (93.5%), sterile drapes (97.4%) and gowns (83.8%) for single use, and the use of double gloves (73.0%). However, when guidelines were lacking, some interventions differed, such as the frequency of glove changes and the use of adhesive plastic drapes.

    CONCLUSION: To standardize OR nurses' preventive interventions, implementing guidelines seems to be the key priority. Overall, OR nurses have high compliance with the national guidelines regarding interventions to prevent bacterial growth and SSIs in the surgical patient. However, when guidelines are lacking, the preventive interventions lose conformity.

  • 13.
    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)
  • 14.
    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)
  • 15.
    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.

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