To Örebro University

Background: Safe and efficient surgical care depends on structured perioperative routines that minimise infection risk while ensuring preparedness for emergencies. Although Swedish guidelines permit storage of sterile instruments (<= 15 h), little is known about operating room (OR) staff's experiences of this practice. We therefore explored OR nurses' and nurse assistants' experiences of working with a pre-prepared sterile surgical setup routine, both during on-call service and in daily routine work.

Methods: A descriptive qualitative design was adopted. Sixteen nurses with on-call duties at a cardiothoracic surgery unit participated in interviews conducted 2022-2024. Data were analysed inductively using qualitative content analysis.

Results: The overarching theme was "Balancing efficiency, safety, and standardisation through trust for a sustainable work environment"; this captured a dynamic interaction between workflow optimisation and professional responsibility. Pre-prepared setups were perceived to reduce time pressure, cognitive load, and stress, enhancing preparedness and teamwork. However, participants described ambivalence concerning autonomy, loss of control, and uncertainty about sterility. Variation in setup routines generated inefficiencies and tension between individual practices and organisational standards. Trust, reflective practice, and interprofessional communication emerged as critical for maintaining safety and acceptance of new routines.

Conclusion: Pre-prepared sterile instrument setups were perceived to improve workflow efficiency and reduce stress. However, participants also described ambivalence related to autonomy, loss of control, and uncertainty about sterility. Sustainable implementation therefore requires balancing standardisation with professional autonomy and fostering trust and shared understanding within the perioperative team to support patient safety. Further research should explore factors influencing long-term implementation.

BACKGROUND: Pectus excavatum is the most common congenital chest wall deformity. Minimally invasive repair for pectus excavatum (MIRPE) has demonstrated positive and psychsocial outcomes. The aim of this study was to gain a comprehensive understanding of health-related quality of life (HRQoL) in patients undergoing MIRPE.

METHODS: This prospective cohort study applied a modified mixed methods convergent design and included 19 individuals scheduled for MIRPE with follow-up 18 months postoperatively. The Nuss Questionnaire modified for Adults 10-item version (NQ-mA-10) and RAND-36 were administered pre- and postoperatively. Postoperative individual interviews explored participants' lived experiences. Quantitative and qualitative data were integrated for a comprehensive analysis.

RESULTS: Significant improvements were observed in NQ-mA-10 total and subscale scores, whereas no significant changes were found in RAND-36 domains. Improvements in disease-specific HRQoL were supported by interview data. Integration of findings generated four themes: self-perceived exercise capacity, stronger sense of self, increased freedom in life and persistent chest-related issues.

DISCUSSION: Participants reported a stronger sense of self and greater freedom in life after MIRPE: However, persistent pain and fatigue highlight the need for further research and individualized postoperative care.

In this study, a nurse-led supportive family health conversation intervention delivered through one to three video-conferencing sessions was evaluated for patients undergoing open-heart surgery and their self-selected family members. Based on the Family Systems Nursing framework, the intervention aimed to improve family well-being, functioning, and involvement by fostering shared understanding and challenging limiting beliefs. Patients and family members were randomized into two groups. Both received usual surgical care, while the intervention group also participated in digital family health conversations before and after surgery. Participants completed questionnaires at baseline and at 30 and 90 days after discharge. The analysis included 101 patients (control = 54, intervention = 47) and 99 family members (control = 52, intervention = 47). The intervention was not superior to usual care for the primary outcome, family well-being. Most secondary outcomes showed no effect, although some aspects of quality of life improved. Further research should examine long-term effects, feasibility, and appropriate outcome measures.

Clinical trials register number and URL: NCT05045196, https://clinicaltrials.gov/study/NCT05045196?cond=NCT05045196 & rank=1;

BACKGROUND: Using Patient Reported Experience Measures (PREM) is one way of assessing children's perspectives in identifying areas for improvement in paediatric care. The generic questionnaire Children and Young People - Patient Reported Experience Measure (CYP-PREM) has been adapted to the Swedish paediatric healthcare context to enable children to evaluate their care on issues important to them.

AIM: The aim of the study was to pilot the Swedish versions of the CYP-PREM questionnaire in paediatric care. METHODS: This pilot study used a descriptive cross-sectional design. Children aged 8-16 years were included when discharged from an inpatient ward or after an outpatient visit. The participating children were asked to complete two questionnaires: Swedish CYP-PREM (Swe-CYP-PREM) appropriate for their inpatient or outpatient visit and the age of the child, and a study-specific questionnaire to evaluate the children's opinions of the Swe-CYP-PREM.

FINDINGS: Out of the 319 invited children, 296 agreed to participate, of whom 189 children submitted the questionnaires, resulting in a response rate of 59.5 %. The Swe-CYP-PREM was well accepted by the target population and considered to provide good data completeness and few response errors. The Swe-CYP-PREM captured a range of experiences from children's healthcare visits, with predominantly positive responses. In the open-ended question about what was good or bad about the visit, 66 children had provided comments, which added value to the closed questions in the questionnaire.

CONCLUSION: The Swe-CYP-PREM can be used in clinical practice to enable children to voice their experiences after a healthcare visit.

BACKGROUND: There is still only limited evidence regarding how bacterial air contamination of sterile items changes over time in the operating room, even when protected by sterile covers. This review aimed to synthesize the available data to inform safe handling and preparation of sterile equipment.

METHODS: A systematic search was conducted for controlled studies that assessed time-related bacterial contamination of covered sterile items in operating rooms and that reported the outcome as colony forming units (CFU) measured at two or more time points, generating distinct timelines. Six databases were searched from inception to 1 September 2025: Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL, the Cochrane Database of Systematic Reviews, Embase, and Web of Science. A meta-analysis was performed using linear regression with CFU as the dependent variable and time (minutes) as the independent variable. The review followed PRISMA guidelines and was registered in PROSPERO (CRD420251018280).

RESULTS: Five timelines from four studies evaluating CFU counts yielded an R2 of 0.085, indicating that time explained 8.5% of CFU variation. Similarly, analysis of eight timelines from four studies assessing mean CFU values produced an R2 of 0.070, attributing 7% of variation to time. Neither analysis demonstrated a statistically significant linear association between time and CFU count (p = 0.176, CI: -1.319 < β < 4.863) or mean CFU values (p = 0.108, CI: 0.191 < β < 0.420) when sterile covers were used. Three additional timelines excluded from the meta-analysis showed mixed results: two indicated a positive association, while one showed no relationship.

CONCLUSIONS: Time has only a modest impact on bacterial contamination of sterile items when protective covers are used, with minimal increases in CFU over different waiting periods. Clinically, this confirms that properly covered sterile items can be prepared in advance without compromising microbial safety, thus supporting efficient operating room organization and workflow. These findings reinforce the effectiveness of sterile covers as a key measure to reduce the risk of surgical site infections and ensure the safe handling of sterile equipment. Although covered storage appears safe, minimizing unnecessary waiting time, even with coverage, is good clinical practice.

I Sverige lever cirka 2000 personer med dövblindhet. En del av dem är föräldrar.Kunskapen om hur det är att vara barn till en förälder med dövblindhet är begränsad.Inte desto mindre är det viktigt att öka kunskapen inom detta område. Det är ocksåviktigt att öka kunskapen om vilka behov och strategier föräldrarna har för att kunnautöva sitt föräldraskap och främja barnets hälsa och utveckling. Ökad kunskap ärspeciellt viktig i en tid med ekonomiska åtstramningar, där personer med döv-blindhet riskerar att i mindre utsträckning beviljas det samhälleliga stöd de önskar.I detta kapitel beskriver vi, ur barnets och ur föräldrarnas perspektiv, hur det är attvara barn i en familj där en förälder har dövblindhet. Huvudsakligen baseras kapitletpå aktuell svensk forskning. Barn och föräldrar har intervjuats om sina erfarenheteroch besvarat enkäter om livskvalitet, känsla av sammanhang och familjeklimat.Resultaten visar att barn till föräldrar med dövblindhet lever ett vanligt liv – menändå inte. Barnen beskriver att de lever ett familjeliv precis som sina vänner och attde agerar som andra barn. De beskriver också att deras liv i vissa avseenden är oliktandras, och att de måste anpassa sig efter förälderns behov. Barnen beskriver att debehöver finnas där för föräldern och att de hjälper och skyddar föräldern från attskada sig. Det kan ta sig uttryck genom att barnen städar undan sina leksaker ellerlägger tillbaka saker på sin förutbestämda plats. Barnen gör det för att föräldern inteska snubbla på leksakerna och för att de lätt ska kunna hitta saker, vilket barnenupplever skapar en trygghet hos föräldern. Barnen kan också uppleva sigkänslomässigt påverkade och de beskriver känslor av frustration, medkänsla och ettbehov av stöd. En del upplever ekonomiska påfrestningar på grund av föräldernsfunktionsnedsättning.Föräldrarna beskriver att de har många strategier som de använder i sitt föräldra-skap, och att de får stöd från familj, vänner, barnets lärare etcetera. De är medvetnaom att deras barn kanske tar lite större ansvar än andra barn, men vill inte att barnetska ta för stort ansvar i hemmet. Föräldrar kan uppleva att de inte alltid har fått detsamhälleliga stöd som de behövt i olika faser av sitt föräldraskap, vilket oroar dem i relation till barnets rätt till hälsa och utveckling.

Barn till föräldrar med dövblindhet har i detta kapitel getts en röst. För att kunnahjälpa dessa barn behöver professionella som möter föräldrar med dövblindhet(exempelvis inom habilitering/rehabilitering) fråga om de har barn och ocksåidentifiera om barnen behöver extra stöd. Detsamma gäller de professionella sommöter dessa barn i deras vardagsmiljö (såsom i skola, elevhälsa och barnhälsovård).I tillägg behöver föräldrars behov av stöd i sitt föräldraskap tillgodoses, för attminska risken för att deras dövblindhet negativt påverkar barnets rätt till hälsa ochutveckling. Samverkan mellan olika instanser kan vara nödvändig.

BACKGROUND: There is limited knowledge regarding how long prepared sterile goods can wait before becoming contaminated. We investigated whether surgical goods could be prepared the day before surgery and kept sterile overnight in the operating room, if protected by sterile covers.

METHODS: Sterile surgical goods for open-heart surgeries (n=70) were randomized to preparation on the morning of the operation or on the previous evening. Exposure time was the total time between preparation and use. Primary outcome was bacterial growth reported as colony forming units (cfu), isolated on 840 agar plates. The protocol was registered with ClinicalTrials.gov (NCT05597072).

RESULTS: When the agar plates were protected with sterile covers, exposure time had no impact (intervention group: 7 cfu, control group: 17 cfu). Without protection, longer exposure time was associated with more cfu (p=0.016). A total of 499 cfu were isolated, displaying 59 different types of bacteria including 13 resistant Staphylococcus epidermidis, 6 (46%) of which were multidrug resistant.

CONCLUSIONS: Sterile goods could wait in the operating room for at least 15 hours before use without increased risk of bacterial air contamination, if protected with sterile covers. However, if the goods were not covered, bacterial air contamination occurred over time.

BACKGROUND: As open-heart surgery can be stressful for the patient and their family, the objective of this study was to generate knowledge on how to support families in relation to open-heart surgery based on important situations.

AIM: The aim was to explore and describe the experiences and actions of important situations of family involvement as expressed by family members of patients who underwent elective open-heart surgery in Sweden.

METHODOLOGICAL DESIGN AND JUSTIFICATION: The critical incident technique used is a qualitative method appropriate for identifying issues relating to clinical problems.

ETHICAL ISSUES AND APPROVAL: Ethical approval was obtained from the Swedish Ethical Review Authority. Allowance was made for the unexpected presence of the patient.

RESEARCH METHODS: Individual interviews with 29 family members of patients who underwent open-heart surgery in Sweden in 2023 were analysed using the critical incidence technique, as applied in nursing and healthcare sciences.

RESULTS: The family members experienced being-or not being-seen as significant and were fearing the loss of normal life in relation to open-heart surgery. Actions taken during important situations were building confidence to relinquish control and relieving burdens to improve well-being.

CONCLUSIONS: Family involvement, in terms of being informed and welcomed, led to an improved ability to care for their loved ones. Emotionally supportive interventions targeting families should be considered in relation to a loved one's open-heart surgery.

BACKGROUND: Surgical site infection (SSI) and antimicrobial resistance are a worldwide problem affecting patient safety. It is lacking randomised controlled trials (RCT) regarding how the number of personnel in the operating room (OR) affects the air quality. We aimed to investigate the effect the number of personnel in the OR have on bacterial air contamination during the preparation of sterile surgical goods, to identify the species and antibiotic susceptibility of the bacteria isolated, and to describe the number of SSIs together with causative microorganisms.

METHODS: This RCT used an intervention group in which two individuals prepared the surgical goods and a control group in which five individuals prepared the goods. Bacteria were isolated on aerobic and anaerobic plates, and bacterial growth was measured as colony forming units (CFU). All isolates were typed, and types known to cause SSI were tested for susceptibility to eight antibiotics. Data were analysed with the Mann-Whitney U test, the chi-square test, or Fisher's exact test.

RESULTS: Results were based on 69 open-heart surgeries and 414 plates. When sterile surgical goods were prepared with two personnel, the median CFU was 2 with an IQR of 2, compared with five personnel, the median CFU was 5, with an IQR of 5 (p < 0.001). The 272 CFU represented 45 different bacterial species, with 38 species isolated in the control group and 21 in the intervention group. The most frequently isolated bacteria were Cutibacterium acnes (82/272, 30%), and Staphylococcus epidermidis (36/272, 13%). Of the 36 S. epidermidis isolates, 11 (31%) were drug-resistant, including three multidrug-resistant. One patient in the control group was infected by Staphyloccocus aureus and Staphylococcus lugdunensis, neither of which was isolated during the preparation of sterile goods. One patient in the intervention group developed an SSI caused by C. acnes, Corynebacterium kroppenstedtii, and S. epidermidis. C. acnes and S. epidermidis were isolated during the preparation.

CONCLUSIONS: Minimising the number of personnel in the OR during preparation of sterile surgical goods is important to reduce the bacterial load.

TRIAL REGISTRATION: Prospectively 15 May 2022 at FoU Sweden (275659) and retrospectively 22 October 2022 at ClinicalTrials.Gov (NCT05597072).