Effects of clinical nursing pathway on the surgical site wound infection in patients undergoing knee or hip replacement surgery: A meta-analysis.

To explore the effect of clinical nursing pathway on wound infection in patients undergoing knee or hip replacement surgery. Computerised searches of PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database, China National Knowledge Infrastructure databases were conducted, from database inception to September 2023, on the randomised controlled trials (RCTs) of application of clinical nursing pathway to patients undergoing knee and hip arthroplasty. Literature was screened and evaluated by two researchers based on inclusion and exclusion criteria, and data were extracted from the final included literature. RevMan 5.4 software was employed for data analysis. Overall, 48 RCTs involving 4139 surgical patients were included, including 2072 and 2067 in the clinical nursing pathway and routine nursing groups, respectively. The results revealed, compared with routine nursing, the use of clinical nursing pathways was effective in reducing the rate of complications (OR = 0.17, 95%CI: 0.14-0.21, p < 0.001) and wound infections (OR = 0.29, 95%CI: 0.16-0.51, p < 0.001), shortens the hospital length of stay (MD = -4.11, 95%CI: -5.40 to -2.83, p < 0.001) and improves wound pain (MD = -1.34, 95%CI: -1.98 to -0.70, p < 0.001); it also improve patient satisfaction (OR = 7.13, 95%CI: 4.69-10.85, p < 0.001). The implementation of clinical nursing pathways in clinical care after knee or hip arthroplasty can effectively reduce the incidence of complications and wound infections, and also improve the wound pain, while also improving treatment satisfaction so that patients can be discharged from the hospital as soon as possible.

Screening complications in the postoperative period of orthopedic surgeries by video arthroscopy

To analyze the prevalence and characteristics of late postoperative complications of orthopedic surgeries by video arthroscopy.This was a descriptive cross-sectional study that evaluated, through its own instrument, local and systemic postoperative complications of patients undergoing orthopedic surgeries by video arthroscopy. The study included 270 patients, who were evaluated on days 30(without prosthesis) and 90(with prosthesis placement) of the postoperative period, by telephone service. The selection of participants occurred sequentially and population-based, within the data collection period, from February to July 2020, in a large hospital for medium and high complexity surgeries. Of the 270 procedures performed in the period, 4.4% (n = 12) presented late postoperative infection. The most frequent complications were erythema (83%), edema (75%) and secretion (67%) in the surgical wound. Most used antibiotic therapy (92%) and anti-inflammatory drugs (67%). Hospital readmission was not necessary concerning the complications. Only 50% required medical evaluation before the scheduled time.The need for practices that ensure the quality of perioperative care and improve the active search to assess surgical outcomes is reinforced.

COVID-19 pathway signage for operating theatres.

On 20 August 2020, Public Health England released a new version of the 'COVID-19: Guidance for the remobilisation of services within health and care settings: infection prevention and control recommendations', superseding that of 18 June 2020. In this document, the infection prevention and control principles determine that the treatment, care and support of patients are to be managed in three COVID-19 pathways. These are: 'high risk', 'medium risk' and 'low risk'. In the operating theatre, where procedures may be urgent or planned, and where various surgical and anaesthetic procedures generate airborne particles (aerosols), it is crucial to communicate the infection prevention and control recommendations in a way that is easily understood and followed by all healthcare professionals. The theatre team at one hospital in the East of England produced local alternating signage to communicate the COVID-19 pathway risk during cases in theatres. This signage - named the 'COVID-19 Flag' - is placed outside of the individual theatre to ensure that staff are informed of the infection risk with the cases underway. Furthermore, it is a quick visual guide to be used in conjunction with national guidance and local protocols for appropriate decisions regarding the treatment and care of patients in the operating theatres.

Validation of Harikrishna Periwound Skin Classification for wound assessment.

OBJECTIVE: To validate the accuracy and reliability of Harikrishna Periwound Skin Classification (HPSC) for wound assessment. METHOD: Post-basic students (staff nurses and medical assistants) were given real life pictures showing the wound and periwound area. The students were asked to classify all pictures according to the HPSC at zero months (before attachment) and after two months of attachment. The images were the same but the answers were never given or discussed after the first test. RESULTS: A total of 30 post-basic students participated in the study, assessing wound 30 images. The results showed that there was an increase of 25.42% in accuracy of wound assessment using the HSPC after two months of clinical attachment compared to pre-attachment. The reliability of the HPSC in wound assessment 79.87%. CONCLUSION: Health professionals have to be able to assess and classify wounds accurately to be able to manage them accordingly. Assessment and classifications of the periwound skin are important and need to be validated and integrated as a part of a full wound assessment. With experience and adequate training, health professionals are able to comprehensively assess wounds using the validated tool, to enable effective wound management and treatment, accelerating wound healing and improving the quality of life for patients.

Surgical wound assessment in Vietnam: a think-aloud technique and interview analysis.

OBJECTIVE: To identify the key components of a surgical wound assessment tool that nurses in Vietnam could use when conducting a surgical wound assessment. The study also explored Vietnamese nurses' perceptions of current practices in surgical wound assessment and assessed their requirements for a surgical wound assessment tool. METHOD: Registered nurses from surgical wards in a Vietnamese hospital were invited to participate in this descriptive, qualitative study. A combination of the think-aloud technique and semi-structured interviews was undertaken. Transcribed responses were analysed using inductive content analysis to indicate how Vietnamese nurses undertook wound assessment and the data they collected. RESULTS: A total of 13 nurses took part. Data from both the think-aloud process and interviews indicated that nurses evaluated surgical wounds based on their experience and observation without using standard guidelines. Some components, such as wound edge, periwound skin, exudate volume and signs of infection, were identified by the nurses. Other wound characteristics, such as wound site, wound bed, exudate and pain, and risk factors were less frequently collected. Nurses expressed their need for a tool with comprehensive content, precise terms, user-friendly language and a scoring system to facilitate their wound assessment. CONCLUSION: Hospitals in Vietnam need a standard tool to help nurses improve surgical wound assessment in daily nursing practice, and to enhance multidisciplinary communication and patient care.

Preoperative and postoperative recommendations to surgical wound care interventions: A systematic meta-review of Cochrane reviews.

BACKGROUND: The increasing numbers of surgeries involving high risk, multi-morbid patients, coupled with inconsistencies in the practice of perioperative surgical wound care, increases patients' risk of surgical site infection and other wound complications. OBJECTIVES: To synthesise and evaluate the recommendations for nursing practice and research from published systematic reviews in the Cochrane Library on nurse-led preoperative prophylaxis and postoperative surgical wound care interventions used or initiated by nurses. DESIGN: Meta-review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES: The Cochrane Library database. REVIEW METHODS: All Cochrane Systematic Reviews were eligible. Two reviewers independently selected the reviews and extracted data. One reviewer appraised the methodological quality of the included reviews using A MeaSurement Tool to Assess Systematic Reviews 2 checklist. A second reviewer independently verified these appraisals. The review protocol was registered with the Prospective Register of Systematic Reviews. RESULTS: Twenty-two Cochrane reviews met the inclusion criteria. Of these, 11 reviews focused on preoperative interventions to prevent infection, while 12 focused on postoperative interventions (one review assessed both pre-postoperative interventions). Across all reviews, 14 (63.6%) made at least one recommendation to undertake a specific practice, while two reviews (9.1%) made at least one specific recommendation not to undertake a practice. In relation to recommendations for further research, insufficient sample size was the most predominant methodological issue (12/22) identified across reviews. CONCLUSIONS: The limited number of recommendations for pre-and-postoperative interventions reflects the paucity of high-quality evidence, suggesting a need for rigorous trials to address these evidence gaps in fundamentals of nursing care.

Wound care practices across two acute care settings: A comparative study.

AIMS AND OBJECTIVES: Describe and compare current surgical wound care practices across two hospitals in two health services districts, Australia. BACKGROUND: Surgical site infections (SSI) are a complication of surgery and occur in up to 9.5% of surgical procedures, yet they are preventable. Despite the existence of clinical guidelines for SSI prevention, there remains high variation in wound care practice. DESIGN: Prospective comparative design using structured observations and chart audit. METHODS: A specifically developed audit tool was used to collect data on observed wound care practices, documentation of wound assessment and practice, and patients' clinical characteristics from patients' electronic medical records. Structured observations of a consecutive sample of surgical patients receiving wound care with a convenience sample of nurses were undertaken. The manuscript adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. RESULTS: In total, 154 nurses undertaking acute wound care and 257 surgical patients who received wound care were observed. Across hospitals, hand hygiene adherence after dressing change was lowest (Hospital A: 8/113, 7%; Hospital B: 16/144, 11%; χ2 : 8.93, p = .347). Most wound dressing practices were similar across sites, except hand hygiene prior to dressing change (Hospital A: 107/113, 95%; Hospital B: 131/144, 91%; (χ2 : 7.736, p = .021) and use of clean gloves using nontouch technique (Hospital A: 88/113, 78%; Hospital B: 90/144, 63%; χ2 : 8.313, p = .016). The most commonly documented wound characteristic was wound type (Hospital A: 43/113, 38%; Hospital B: 70/144, 49%). What nurses documented differed significantly across sites (p < .05). CONCLUSIONS: Clinical variations in wound care practice are likely influenced by clinical context. RELEVANCE TO CLINICAL PRACTICE: Using an evidence-based approach to surgical wound management will help reduce patients' risk of wound-related complications.

Post-discharge surveillance of surgical site infections in teaching hospitals in Brazil / Vigilância pós-alta hospitalar das infecções do sítio cirúrgico em hospitais universitários do Brasil / Vigilancia post alta hospitalaria de las infecciones del sitio quirúrgico en hospitales universitarios de Brasil

Abstract Objective: Understanding the reality of surgical site infections post-discharge surveillance in Brazilian teaching hospitals. Method: A cross-sectional study conducted by sending an online questionnaire to nurses from the Hospital Infection Control Committee of Brazilian teaching hospitals registered in the National Registry of Health Establishments. Results: Of the 193 teaching hospitals in Brazil, eight declined to take part as they did not conduct post-discharge surveillance and 36 did not respond. Twenty five of the remaining 149 hospitals provided detailed responses and 96% of responding institutions performed surgical site infection surveillance during hospitalization; active search (29.3%) was the main method, while 84% reported performing post-discharge surveillance mainly by telephone (42.8%). Both surveillance actions have nurses as the main responsible professionals. Conclusion: Nurses play a prominent role in surgical site infection identification/screening actions, and active search during hospitalization allied with post-discharge surveillance by telephone were the preferred methods.

Resumo Objetivo: Compreender a realidade da vigilância pós-alta hospitalar das infecções do sítio cirúrgico em hospitais universitários brasileiros. Método: Estudo transversal conduzido por envio de um questionário on-line para enfermeiros do Comitê de Controle de Infecção Hospitalar dos hospitais universitários brasileiros registrados no Cadastro Nacional de Estabelecimentos de Saúde. Resultados: Dos 193 hospitais universitários do Brasil, oito declinaram participar, já que não fazem vigilância pós-alta, e 36 não responderam. Vinte e cinco dos 149 hospitais restantes forneceram respostas detalhadas e 96% das instituições que responderam realizavam vigilância das infecções do sítio cirúrgico durante a hospitalização; a busca ativa (29,3%) foi o método principal, ao passo que 84% relataram realizar vigilância pós-alta basicamente por telefone (42,8%). Ambas as ações de vigilância tiveram os enfermeiros como os principais profissionais responsáveis. Conclusão: Os enfermeiros têm um papel proeminente nas ações de identificação/triagem das infecções do sítio cirúrgico, e a busca ativa durante a hospitalização aliada à vigilância por telefone pós-alta foram os métodos preferenciais.

Resumen Objetivo: Comprender la realidad de la vigilancia post alta hospitalaria de las infecciones del sitio quirúrgico en hospitales universitarios brasileños. Método: Estudio transversal realizado mediante el envío de un cuestionario en línea a los enfermeros del Comité de Control de Infección Hospitalaria de los hospitales universitarios brasileños inscritos en el Registro Nacional de Establecimientos Sanitarios. Resultados: De los 193 hospitales universitarios de Brasil, ocho declinaron participar, puesto que no hacen vigilancia post alta, y 36 no respondieron. Veinticinco de los 149 hospitales restantes proporcionaron respuestas detalladas y el 96% de los centros que respondieron realizaban vigilancia de las infecciones del sitio quirúrgico durante la hospitalización; la búsqueda activa (29,3%) fue el método principal, mientras que el 84% relataron llevar a cabo vigilancia post alta básicamente por teléfono (42,8%). Ambas acciones de vigilancia tuvieron a los enfermeros como los principales profesionales responsables. Conclusión: Los enfermeros juegan un rol prominente en las acciones de identificación/cribado de las infecciones del sitio quirúrgico, y la búsqueda activa durante la hospitalización aliada a la vigilancia por teléfono fueron los métodos preferentes.

Evaluation of closed incision negative pressure therapy systems on the closure of incisional space model.

OBJECTIVE: The objective of this study was to compare the ability of foam dressing-based and non-foam-based closed incision negative pressure therapy (ciNPT) systems to close isolated incisional deficits in a tissue model. METHODS: Similarly sized foam-based and non-foam-based absorbent ciNPT dressings were applied to ~36cm long, ~3mm and ~6mm wide simulated incisions in gel sheets covered with drape (n=6 dressings/group/experimental condition spread over three respective therapy units). Changes in incision widths were measured directly or with overlying solid gel sheeting (to mimic tissue resistance), at five equally spaced locations before, immediately upon and one hour after initiating negative pressure using associated therapy units. RESULTS: Foam-based ciNPT closed simulated incisions more often than non-foam-based ciNPT in all tested conditions (p<0.05). While foam-based ciNPT almost completely closed the ~3mm wide incisional spaces, unlike non-foam-based ciNPT, the biggest differences between the two groups were observed with the ~6mm incisional width, which allowed maximal inward-stretching of the appositional faces without complete closure. The additional gel layer blunted closure in both groups, but much more with non-foam-based ciNPT. There was minimal impact of negative pressure duration on these results. CONCLUSION: Foam-based ciNPT closed incisional widths in simulated tissue significantly more compared with non-foam-based ciNPT. Different ciNPT systems should not be considered necessarily equivalent in performance.

Use of Negative Pressure Wound Therapy in Surgical Site Infection During Pregnancy: A Case Study.

BACKGROUND: Surgical site infections (SSIs) are a known cause of morbidity and mortality; however, evidence related to management of SSIs during pregnancy is sparse. CASE: A 26-year-old female patient with an adnexal cystic lesion underwent laparotomy at 19 weeks of pregnancy. She experienced a late SSI 10 days after initial surgery, necessitating surgical debridement. She was treated with multiple surgical interventions for wound irrigations and wound closure assisted by a negative pressure wound therapy. CONCLUSION: Negative pressure wound therapy was used for treatment of an SSI during pregnancy without causing premature delivery or requiring a cesearan section.

Management of wounds in the community: five principles.

The care of any wound in the community requires multidisciplinary working between healthcare professionals. In this article, the authors offer five generalisable principles that colleagues providing community care can apply in order to achieve timely wound healing: (1) assessment and exclusion of disease processes; (2) wound cleansing; (3) timely dressing change; (4) appropriate (dressing choice; and (5) considered antibiotic prescription. High-quality wound care is an essential aspect of healthcare practice but lacks an evidence base and standardised practice at present. The practice and teaching of wound care should be more greatly emphasised in healthcare training for all disciplines.

Translation and validation of the Greek version of the "ASEPSIS" scoring method for orthopaedic wound infections.

INTRODUCTION: The ASEPSIS scoring method represents an important instrument for assessing surgical wounds for infections. The purpose of this study was to translate and validate the ASEPSIS in Greek. METHODS: The ASEPSIS was translated from English to Greek, back-translated to English, and reviewed by an expert committee. Reliability and validity analyses were performed in a sample of 111 consecutive orthopaedic patients. Patients were assessed during hospitalisation (using the ASEPSIS) and at three months after discharge (by phone, through questions about wound healing). RESULTS: Face validity was considered to be very good. The surgical wound infection rate was 6.3% with the Centers for Disease Control and Prevention criteria and 3.6% with the ASEPSIS (i.e. score ≥21) (p < 0.001). At three months, 7.4% of the participants reported they were given antibiotics for wound infection and 5.4% needed a rehospitalisation. The ASEPSIS score was correlated to the therapeutic administration of antibiotics (p = 0.001) and the need for rehospitalisation (p < 0.001) during the follow-up. The inter-rater agreement was 90%. CONCLUSIONS: The Greek version of the ASEPSIS can be used by both surgeons and nurses. However, it should be used with caution until more studies are conducted with larger samples and in patients with different surgical procedures.

Patient-reported symptoms of 'calm', 'irritated' and 'infected' skeletal external fixator pin site wound states; a cross-sectional study.

OBJECTIVE: To explore the frequency, severity and variances in patient-reported symptoms of calm, irritated and infected skeletal pin sites. METHODS: A cross-sectional within-subjects repeated-measures study was conducted, employing a self-report questionnaire. Patients (n = 165) treated with lower limb external fixators at 7 English hospitals completed a designed questionnaire. Three sets of retrospective repeated-measures data were collected relating to calm, irritated and infected pin sites. RESULTS: Significant differences were revealed between each of the three pin site states (calm, irritated & infected) in the degree of: redness, swelling, itchiness, pain, wound discharge, heat/burning, shiny skin and odour. In relation to difficulty or pain using the affected arm or leg, difficulty weight bearing on the leg, nausea and/or vomiting, feeling unwell or feverish, shivering, tiredness/lethargy and disturbed sleep, significant differences were demonstrated between infected and irritated states and infected and calm states, but not between irritated and calm. CONCLUSIONS: The findings provide greater depth of understanding of the symptoms of pin site infection and irritation. Patients may be able to differentiate between different pin site states by comparing the magnitude of the inflammatory symptoms and the presence of other specific symptoms that relate solely to infection and no other clinical state. The irritated state is probably caused by a different pathological processother than infection and may be an indication of contact dermatitis.

A Postoperative Care Bundle Reduces Surgical Site Infections in Pediatric Patients Undergoing Cardiac Surgeries.

BACKGROUND: Pediatric patients undergoing cardiac surgeries are at an increased surgical site infection (SSI) risk, given prolonged cardiopulmonary bypasses and delayed sternal closures. At one institution, the majority of cardiac patients developed SSIs during prolonged recoveries in the cardiovascular intensive care unit (CVICU). Although guidelines have been published to reduce SSIs in the perioperative period, there have been few guidelines to reduce the risk during prolonged hospital recoveries. The aim of this project was to study a postoperative SSI reduction care bundle, with a goal of reducing cardiac SSIs by 50%, from 3.4 to 1.7 per 100 procedures. METHODS: This project was conducted at a quaternary, pediatric academic center with a 20-bed CVICU. Historical control data were recorded from January 2013 through May 2015 and intervention/sustainment data from June 2015 through March 2017. A multidisciplinary SSI reduction team developed five key drivers that led to implementation of 11 postoperative SSI reduction care elements. Statistical process control charts were used to measure process compliance, and Pearson's chi-square test was used to determine differences in SSI rates. RESULTS: Prior to implementation, there were 27 SSIs in 799 pediatric cardiac surgeries (3.4 SSIs per 100 surgeries). After the intervention, SSIs significantly decreased to 5 in 570 procedures (0.9 SSIs per 100 surgeries; p = 0.0045). CONCLUSION: This project describes five key drivers and 11 elements that were dedicated to reducing the risk of SSI during prolonged CVICU recoveries from pediatric cardiac surgery, with demonstrated sustainability.

Perioperative Strategies for Surgical Site Infection Prevention.

Surgical site infections (SSIs) are some of the most common and costly health care-associated infections. Although the rate of SSIs has declined significantly in the past decade, patient safety remains at risk. Perioperative nurses employ a variety of evidence-based best practices to prevent SSIs and facilitate a safe surgical experience for their patients, including hand hygiene, preoperative patient skin antisepsis, and antimicrobial irrigation. This article explores the causes of SSIs, such as modifiable and nonmodifiable patient factors and preoperative, intraoperative, and postoperative procedural factors, and discusses some of the specific recommended strategies related to the prevention of SSIs that perioperative nurses can initiate in their workplace.

The use of an antimicrobial primary wound contact layer as liner and filler with NPWT.

In negative pressure wound therapy (NPWT), wound fillers are used to ensure that the negative pressure is applied across the entire wound surface. At present, foam and gauze are the most commonly used fillers. Both ensure equal distribution of negative pressure, but foam is more absorbent, while gauze is more malleable and conformable. There is no strong clinical research evidence demonstrating the superiority of one type of wound filler over another. However, there are reports that foam can cause pain and trauma at dressing change as a result of ingrowth of tissue into its open pore structure. For this reason, when foam is used as a filler, a liner may also be applied as a wound contact layer. This supplement describes preliminary clinical evidence on the use of Cutimed Sorbact as an alternative to foam and gauze during NPWT. Seven cases in which it was successfully used on complex pre- and postoperative wounds are described.