Patients' Experience and Satisfaction Regarding the Pre-Operative Shower: The PRODOUCH Multicenter Descriptive Survey.

Background: Patients' experience of the pre-operative shower remains poorly assessed in the literature although it is an essential step in the prevention of surgical site infection. For obese patients, a pre-operative shower could be challenging. The goal was to assess patient satisfaction and experience with the process of pre-operative shower, and the effect of obesity status. Patients and Methods: This study was a multicenter prospective survey of consecutive surgical patients from nine hospitals. Data on the pre-operative shower were collected via telephone interview two to four weeks after surgery, and included the place (hospital, home), time, information received, difficulties experienced, the presence or absence of a visual assessment of skin cleanliness by a healthcare professional after the pre-operative shower, and overall patient satisfaction with the pre-operative shower technique. Data on the surgical procedure and patients' characteristics were collected from patients' records, and included age, gender, and body mass index. Factors associated with patient satisfaction were assessed. Results: Among 430 patients, 91.6% declared having received information on the pre-operative shower and 94.8% were very or rather satisfied with the pre-operative shower. Two factors were independently associated with satisfaction: showering at home and having received information on the pre-operative shower, but not obesity status. Only 17% of patients reported a visual assessment of skin cleanliness by a healthcare professional after the pre-operative shower. Discussion: Overall, regardless of obesity status, patients were satisfied with the pre-operative shower and reported no difficulties. However, this survey highlights the fact that skin cleanliness was seldom assessed by healthcare professionals, which may represent an unidentified weakness in skin preparation before surgery.

La douche préopératoire chez les patients obèses : ce qu'en disent les patients et les soignants.

Introduction : At least one preoperative shower is recommended to avoid surgical site infection. Caregivers must explain the showering technique, help the patient if necessary, and assess skin cleanliness after showering.Context : Showering may be more difficult for obese patients because of inadequate equipment and difficulties moving, as well as insufficient explanation regarding the showering technique and an insufficient skin cleanliness assessment from caregivers.Objective : to assess whether patients and/or caregivers report difficulties in the preoperative shower process that could be linked to patient obesity. Methods : pilot qualitative survey with semi-structured interviews conducted with 9 obese surgery patients and 11 surgery caregivers.Results : Patients did not report feelings of discrimination. They described no problem with equipment, but declared having received little explanation on the showering technique and no visual skin cleanliness assessment. Caregivers reported equipment as inadequate, they stated having delivered detailed information, but found the skin cleanliness assessment difficult.Discussion : The lack of skin cleanliness assessment by caregivers after preoperative showering is new information. Limits : preliminary study with a small number of interviews and no non-obese patients.Conclusion : the subject warrants additional work with both quantitative and qualitative surveys to better understand the difficulties with preoperative showering.

The role of dependency in a norovirus outbreak in a nursing home.

PURPOSE: The objectives of the epidemiological investigation were to describe factors associated with prolonged transmission of acute gastroenteritis in a nursing home during a norovirus outbreak. METHODS: A retrospective cohort study was conducted among residents (N = 89) and staff members (N = 86) of the nursing home. Outbreak description was performed in both residents and staff members. Among residents, attack rates and relative risks and their 95% confidence interval (95% CI) associated with different identified risk factors including consumption of normal, mixed and choped meal, score of dependency were calculated. A multivariate logistic regression model was fitted to assess the independent association between risk factors and the occurrence of acute gastroenteritis over the entire outbreak duration. Environmental investigations and review of practices were carried out among staff. RESULTS: Respectively 49/89 respondent residents (AR 58%) and 9/47 respondent staff members (AR 19%) reported gastrointestinal symptoms between September 17 and October 21, 2016. Norovirus type II was isolated in five stool samples. Residents with dependency score (Gir) below 4 were at higher risk of acute gastroenteritis [RR 2.1 (95% CI 1.1-4.1)] compared to those autonomous. It was the only identified risk factor. In addition, the review of practices in staff identified several breaks in the application of hygiene control standards including misuse of personal protective equipment (gloves were not changed between caring for different patients), inappropriate hand hygiene technique, and disinfection of environmental surfaces with an ineffective product on norovirus. CONCLUSIONS: This episode reminds the importance of early recognition of acute gastroenteritis cases and the implementation of rigorous management measures in order to limit the spread of the epidemic in a highly vulnerable dependent population.