A Comparison of the Effects of Chlorhexidine and Sodium Bicarbonate Mouthwashes on COVID-19-Related Symptoms.

Background: Some studies have reported that mouthwashes can decrease the viral load in the mouth, but there is not much information about the effectiveness of mouthwashes on coronavirus disease 2019 (COVID-19). This study was conducted to compare the impact of using two types of mouthwash, chlorhexidine and sodium bicarbonate, on COVID-19 symptoms and infection. Materials and Methods: The present three-group, double-blind clinical trial examined 116 operating room nurses and anesthesia personnel of certain hospitals of Isfahan University of Medical Sciences, Isfahan, Iran. The participants were randomly assigned to three groups: intervention group 1 (chlorhexidine mouthwash), intervention group 2 (sodium bicarbonate mouthwash), and the control group (placebo). Mouthwash was used twice a day (morning and night) for 2 weeks. The participants were monitored in terms of COVID-19-related symptoms for 4 weeks, from the first day of mouthwash use. Results: Fisher's exact test indicated a significant difference between the chlorhexidine and control groups in terms of the onset of COVID-19-related symptoms (p = 0.02). There was no significant difference in the symptoms of COVID-19 between the groups, but the groups were significantly different in terms of all symptoms at a 4-week interval (p = 0.04). Furthermore, headache was less observed in the chlorhexidine (p = 0.007) and sodium bicarbonate (p = 0.03) groups compared to the control group. Conclusions: The use of 0.2% chlorhexidine mouthwash can decrease the onset of COVID-19-related symptoms in health-care workers. In addition, this mouthwash can partially reduce the symptoms of this disease in comparison to the control and sodium bicarbonate groups.

The Effect of Soundproof Headphones During Orthopedic Surgery Under Spinal Anesthesia on Patients' Physiological Indices and Duration of Recovery: A Randomized, Controlled, Clinical Trial.

PURPOSE: With spinal anesthesia, the patient remains awake and may hear different noises when undergoing orthopedic surgery, and these noises may lead to some discomfort. The aim of this study was to investigate the effect of wearing soundproof headphones during orthopedic surgery under spinal anesthesia on the patients' physiological indices and duration of recovery. DESIGN: This was a randomized clinical trial with a control group. METHODS: The sample included 184 patients selected through convenience sampling, who were then randomly allocated to the control and intervention groups. Data were collected by observation and by filling out a researcher-made checklist. Soundproof headphones were placed on the patients' ears during surgery in the intervention group, while the patients in the control group underwent surgery with no headphones. Physiological indices were measured at five time points, and the patients' length of stay in the postanesthesia care unit (PACU) was also measured. FINDINGS: The mean changes in systolic and diastolic blood pressure were significantly lower in the intervention group (P < .02 and P < .005) at two of the time points. The mean changes in heart rate were also significantly lower in the intervention group (P < .003, P < .01) at four time points. The respiratory rate and oxygen saturation were both significantly higher in the intervention group (P < .001, P < .03, P < .002, P < .008) at four time points. The two groups also had significant differences (P = .004) in terms of the length of stay in the PACU, which was shorter in the intervention group. CONCLUSIONS: Reducing the exposure to noise via soundproof headphones may improve patients' physiological indices in noisy orthopedic surgeries, and may also decrease their length of stay in the PACU. This method is recommended as an easy and applicable way to ameliorate the patients' experiences of this surgery.

Examining workload variations among different surgical team roles, specialties, and techniques: a multicenter cross-sectional descriptive study.

BACKGROUND: A high workload may negatively impact the surgical team's performance and jeopardize patient safety. The aim of this study was to measure the workload of the surgical team across different surgical roles, specialties, and techniques in several hospitals. METHODS: This cross-sectional multicenter study was performed in the operating rooms of eight teaching hospitals affiliated with Isfahan University of Medical Sciences, Iran. At the conclusion of each surgical procedure, all members of the surgical team completed the Surgery Task Load Index (SURG-TLX) questionnaire to assess workload levels. Descriptive statistics, analysis of variance (ANOVA), and Pearson correlations, were performed to compare surgical roles, specialties, techniques, and surgical time on workload overall and by subscale. RESULTS: A total of 409 workload questionnaires were obtained from 76 surgical teams or cases, involving 346 surgical team members. The total workload among all participants was 32.41 ± 17.21. Surgical complexity, physical demands, and mental demands were the highest workload subscales and distraction was the lowest workload subscale. Cardiovascular specialty had a higher workload compared to other specialties. Open techniques resulted in a higher workload compared to minimally invasive techniques. Surgical technologists who act in both the role of circulating and scrub nurse (C&Ss) experienced the highest workload, followed by surgical residents and surgeons. CONCLUSIONS: The results of the study showed that the workload for some members of the surgical team is disproportionately high and is influenced by factors such as specialty, technique, role, and surgical duration. By knowing the distribution of workload among the members of the surgical team, efforts can be made to optimize the team members' workload.

Development and implementation of an intraoperative documentation protocol for enhancing patient safety in the operating room: A mixed methods protocol study.

BACKGROUND: Documentation is an important part of the patient care process; however, there is no regular program for documenting intraoperative care in Iran. This study was conducted to design an intraoperative documentation for enhancing patient safety in the operating room (OR). MATERIALS AND METHODS: This exploratory, mixed-methods, qualitative-quantitative study (in 2021) consists of four phases. The first phase involves a conventional content analysis of healthcare providers in the OR to identify the needs, strategies, and content of a pertinent documentation. In this phase, purposeful sampling will be used to collect data through semi-structured interviews. In the second phase, a literature review will be carried out to extract the documentation procedures in the intraoperative period in many other countries. In the third phase, a panel of experts is recruited and the classic Delphi (RAND) technique is run to validate the initial draft of the designed program and, the protocol is then finalized. In the last phase, the designed protocol will be implemented through a quasi-experimental study in one group (before and after intervention), and the effectiveness of the intervention will be evaluated. DISCUSSION: To design a protocol for intraoperative documentation, healthcare providers' experiences during surgery in the Iranian healthcare setting, where the lack of documentation might forensically harm both the healthcare providers and the patients, will be explored. This information alongside some universal standards developed in other countries should help improve patients' safety in ORs.

Competency assessment of the operating room staff and some related factors: A multi-center cross-sectional study.

Background: Operating Rooms (ORs) are complicated environments that necessitate the improvement of OR staff's knowledge and skills to remain clinically competent and secure patient safety. The aim of this study was to assess clinical competence of OR staff in accordance with some related factors. Materials and Methods: This descriptive analytical cross-sectional study was conducted on 227 OR staff in nine academic hospitals. Sampling was performed from the beginning to the end of May 2019 and the samples were selected by quota sampling. Data were collected using a researcher-made questionnaire encompassing six dimensions of competency including general knowledge, specialized knowledge, general practical skills, specific practical skills, personality, and motivation. Data analysis was performed using descriptive and interpretive statistics. Results: The mean (SD) total score of competence was 80.99, which was optimal (11.28). The lowest score was related to the dimension of general practical skills with the mean (SD) score of 53.32 (10.26). The mean score of specialized practical skills was significantly higher in single-specialty ORs (F = 21.53, p < 0.001). Based on multiple linear regression test, it was possible to predict clinical competency through the age and work experience (R-squared = 0.96, beta = 0.31, p = 0.022). Conclusions: Specialized training has overshadowed the general practical skills that are related to the observation of basic principles of patient safety apart from surgical specialization. Strengthening of competence in general practical skills need to be prioritized in empowerment programs. We need a fixed and permanent space for the continuation of educational programs designed to promote perioperative general practical skills.

The Effects of Surgery Cancellation on Patients, Families, and Staff: A Prospective Cross-Sectional Study.

PURPOSE: This study aimed to investigate the effects of surgery cancellation, as a common and never-ending problem within preoperative care, and its related factors on patients, family members, and medical staff. DESIGN: The research design implemented a prospective cross-sectional type. METHODS: This study was conducted for four months in two main teaching/general medical centers. The data collection tool was comprised of three researcher-made questionnaires for patients, families, and medical staff, separately. The samples also included a total number of 315 patients, family members, and medical staff. FINDINGS: The results revealed that the frequency distribution of all physical and emotional effects was higher in men than in women though it was not statistically significant. Each patient had been fasting for an average of 13.26 hours until the announcement of surgery cancellation. The most prevalent physical effects in the patients were hunger, thirst, and headache, respectively. The average cost of each surgery cancellation for the patients was almost twice that for the family members. There was a significant correlation between emotional effects in the patients and the families and the reason for cancellation and informants. CONCLUSIONS: Each surgery cancellation increased fasting time in patients by an average of 5 to 7 hours. Cancellation also correspondingly led to economic harms for the patients and the families, waste of operating room resources, and duplications. Since the most common reasons for surgery cancellation were patient-related and a significant correlation was observed between the reason for cancellation and emotional effects in the patients and the families, our recommendation is to strengthen patient protocols in terms of preoperative preparation and to review admission and information processes for patients undergoing surgeries.

Prevalence of surgical site infection after orthopaedic surgery with two types of drainage at three public hospitals in Iran.

INTRODUCTION: Orthopaedic surgical site infections (SSIs) are among the most important and prevalent because implanted devices are used in such surgeries which increase the risk of infection. This study aimed to examine the incidence of infection in orthopaedic surgeries and related factors in a group of public hospitals in Iran. METHODS: This analytical cross-sectional study was condcuted in 2018. Data were collected about the incidence of infection and related factors including use/non-use of drains and well as types of drain . The presence of SSIs were determined using a researcher-devised Wound Infection Checklist (WIC) and microbial cultures. RESULTS: Of 110 included patients undergoing orthopaedic surgeries, 18.2% had an infection. The highest rate of infection was associated with lower extremity surgeries following tibia and fibula fractures. The incidence of infection among individuals under the age of 35 years was also higher. Emergency procedures demonstrated a higher incidence of infection. No significant relationship was observed between use of wound drains and development of SSIs. CONCLUSION: Reducing the incidence of orthopaedic infection can be achieved by focusing more attention on open fractures occurring in the lower extremity. Use of surgical drains for the sole purpose of reducing the rate of infection is not effective. Accordingly, infection provention protocols should be implemented in orthopaedic surgery units to control and reduce rates of infection.

Effect of cleaning guidelines implementation on microbial colony count of laparoscopic instruments: A study in a public hospital in Iran.

INTRODUCTION: Some countries have implemented reuse of laparoscopic instruments for cost-effective purposes. An accurate cleaning as the first step of reprocessing would lead to the effective sterilization. The purpose was to evaluate the effect of cleaning guidelines implementation on microbial load of laparoscopic instruments which were used in laparoscopic cholecystectomy surgery. METHODS: This experimental study was done in an educational hospital, in 2017 and included a total of 128 laparoscopic instruments randomly selected from cholecystectomy surgeries and divided into two cleaning groups. The instruments were checked out in terms of number (colony-forming units [CFU]/mL) and type of microorganisms in two groups of routine cleaning and according to guideline cleaning. This guideline was indigenous and taken from successful instruction in this context that was presented by the Association for the Advancement of Medical Instrumentation (AAMI). The appropriate statistical analysis was conducted by SPSS version 19. RESULTS: The average microbial load was 2.4 × 106 CFU/100 mL after clinical use. It was reduced to 7.2 × 105 CFU/100 mL in the control group and 3.4 × 104 CFU/100 mL in the intervention group, after the cleaning process. The most common microorganisms that were isolated immediately after clinical use were Escherichia coli 81.2%, Pseudomonas 68.8%, Klebsiella 57.8%, and spp., and so on. CONCLUSION: The AAMI cleaning method is recommended to be utilized by operating room nurses for laparoscopic instruments.

Evaluation of Warming Effectiveness on Physiological Indices of Patients Undergoing Laparoscopic Cholecystectomy Surgery: A Randomized Controlled Clinical Trial.

PURPOSE: The present study aimed to evaluate the impact of warming on physiological indices of patients undergoing laparoscopic cholecystectomy. DESIGN: The study was a three-group randomized controlled clinical trial. METHODS: In the present study, 96 patients were assigned to three groups: forced-air warming system group; warmed intravenous fluid group; and control group. The intervention was performed immediately after the anesthesia induction. Physiological indices (core body temperature, blood pressure, and heart rate) were evaluated at 15-minute intervals, and postoperative shivering was also recorded. FINDINGS: The mean systolic blood pressure and the mean heart rate were significantly different in each warming group before, during, and after surgery, but the three groups had no significant differences in terms of physiological indices at any time (P > .05). Postoperative shivering was not seen in any group. CONCLUSIONS: Both interventions had similar effects on physiological indices. Therefore, the recommendation is to use the warming method according to patient's other conditions.

Effect of Incise Drape on Contamination Rate of Surgical Wound during Surgical Procedures of Lumbar Spine.

BACKGROUND: The aim of this study was to investigate the effect of the incise drape (ID) on surgical wound bacterial contamination during lumbar spine surgical procedures in treatment group (with ID) and control group (without ID). MATERIALS AND METHODS: The present study was conducted on 88 patients who were a candidate for lumbar spine surgery. The patients were randomly assigned to one of the two groups, treatment and control. The ID was only used in the treatment group. The surgical wound sampling for bacterial culture was done in two steps, immediately after surgical incision (IASI) and immediately prior to the surgical wound closure (IPSWC). The samples were then sent to the laboratory. RESULTS: The mean total bacterial count of the surgical wound in the stage IASI was not significantly different between treatment and control groups (0.09 vs. 0.02, P = 0.31). However, this means in the stage IPSWC in treatment group was significantly more than the control group (18.6 vs. 0.41, P = 0.04). The frequency distribution of Staphylococcus aureus (25% vs. 3%, P = 0.02) and Staphylococcus epidermidis (36.4% vs. 9.1%, P = 0.002) was significantly higher in the treatment group compared with control group in the stage IPSWC. CONCLUSION: The results suggest that the use of ID is unable to reduce surgical wound bacterial contamination in clean lumbar spine surgery. Therefore, based on the results obtained in our study, the application of ID is not recommended as an essential action for the prevention of surgical wound contamination.

Reduced Mental Workload of Neonatal Intensive Care Unit Nurses through a Self-designed Education Class: A Randomized Controlled Trial.

BACKGROUND: One of the factors affecting the behavior and performance of nurses is mental workload. Training programs can improve the attitude, knowledge, and performance of nurses. However, the impact of these programs on mental workload is not clear. Therefore, the study aimed to evaluate and compare the effect of two conventional and self-designed education classes on the mental workload of neonatal intensive care unit (NICU) nurses. MATERIALS AND METHODS: This study was conducted on 68 nurses, divided into two intervention and control groups. Subjects of the intervention group attended a social awareness reinforcement class, in which one of the dimensions of emotional intelligence was introduced and covered. Research tool was the mental workload questionnaire of National Aeronautics and Space Administration Task Load Index (NASA-TLX). RESULTS: In this research, results of the paired t-test were indicative of a significant decrease in the mean score of mental workload immediately after the intervention (t = 1.48, p < 0.001) and one month later (t = 1.11, p = 0.007). Moreover, a significant difference was observed in the mean score of mental workload of the intervention group between before and after the conventional education class, and before and 1 month after the self-designed class using repeated-measures analysis of variance (F = 21.31, p < 0.001). CONCLUSIONS: According to the results of the study, the conventional education class had no impact on the mental workload, whereas the self-designed class significantly decreased mental workload. Therefore, it is suggested that education programs be conducted for NICU nurses to improve their emotional intelligence, which leads to decreased level of mental workload.

Does Plastic Incise Drape Prevent Recolonization of Endogenous Skin Flora during Lumbar Spine Procedures?

BACKGROUND: The aim of this study was to compare the PID with bare skin (without PID) regarding bacterial recolonization and bacterial regrowth of the adjacent skin of surgical incision in lumbar spine surgery patients. METHODS: This quasi-experimental study was conducted from February to May 2018 on 88 patients who were candidate for lumbar spine surgery. Patients were assigned to one of two groups, treatment (with PID) and control (without PID). Skin sampling (adjacent of surgical incision) for bacterial culture was done in two steps, immediately after surgical skin prep (IASSP) and immediately after surgical wound closure (IASWC) by researcher. Finally, samples were sent to the laboratory. RESULTS: The mean total bacterial count of patient's skin in stage IASSP was not significantly different between treatment and control groups (0.34 vs 0.27, P = 0.68). However, mean total bacterial count in stage IASWC in treatment group was significantly higher than control group (2.2 vs 0.93, P = 0.03). The frequency distribution of S. aureus (P = 0.04) and S. epidermidis (P = 0.02) was significantly higher in treatment group compared with control group in stage IASWC. CONCLUSIONS: The results showed that using PID is unable to reduce recolonization and regrowth of bacteria on patients' skin adjacent to surgical wound in clean lumbar spine surgeries. However, making a definite decision about using or not using of PID requires further studies.

The effect of an empathy role-play program for operating room nursing students.

PURPOSE: The purpose of this research was to investigate the effect of a role-playing training program for empathetic communication with patients on empathy scores of operating room nursing students. METHODS: This clinical trial was carried out on 77 operating room nursing students from the first to the fourth years studied in the School of Nursing and Midwifery at Isfahan University of Medical Sciences in the academic year 2017-2018. The intervention administered on the experimental group included a 12-hour training program with the theme of expressing empathy to patients using a role-playing technique. The Jefferson Scale of Empathy-Health Profession Students' Version was completed before, immediately after, and one month after the intervention by the samples. Comparison analysis was done among three stages. RESULTS: Comparing the total mean empathy scores before intervention in the control group and the experimental one did not reveal a significant difference (P=0.50); however, the total mean empathy scores in the experimental group, immediately after and one month after the intervention, was higher than that in the control group (P<0.001). CONCLUSION: Empathy training through a role-playing technique was effective on improving the empathy scores of operating room nursing students and it also highlighted the fact that empathy could be promoted by education. Making changes in educational curriculum of operating room nursing students was indispensable in order to make them familiar with the concept of empathy in operating room.

High-Frequency Jet Ventilation in Nonintubated Patients.

OBJECTIVES: High-frequency jet ventilation (HFJV) is a convenient method for providing ventilation during fiberoptic bronchoscopy. We describe an incipient approach of high-frequency jet ventilation via the working channel of a flexible bronchoscope for nonintubated patients who suffer from hypoxemia during bronchoscopy. The aim of this study was to test the efficacy of this incipient approach and determine the possible complications related to it. MATERIALS AND METHODS: Sixteen patients who had oxygen saturation below 70% that did not resolve with nasal oxygen for 20 s during interventional bronchoscopy were included in the study. High-frequency jet ventilation was administrated via the working channel of a bronchoscope for 3 min. Arterial blood gas circumscriptions were compared before and after jet ventilation. RESULTS: Oxygen saturation increased to >90% in all patients 30 s after jet ventilation. Mean arterial oxygen saturation pressure increased from 54.84 to 111.98 mmHg with jet ventilation (p=0.0001). Arterial carbon dioxide tension decreased after jet ventilation. The body mass index had no consequential effect on arterial carbon dioxide pressure after jet ventilation in our patients (p=0.1). Complications such as pneumothorax and working channel damage were not observed. CONCLUSION: High-frequency jet ventilation via the working channel of the bronchoscope is a novel method that can provide optimal ventilation with minimal complications to nonintubated patients suffering from hypoxemia during bronchoscopy. This method also reduces the duration of bronchoscopy procedures.

Iranian Nurses' Status in Policymaking for Nursing in Health System: A Qualitative Content Analysis.

Presence of nurses in policy making will result improvement of nursing practice, and increase qualification of patients' care, but still few nurses are involved in policy debates and health reforms and their status in policy making for nursing is not clear. The aim of this study was to elucidate Iranian nurses' status in policy making for nursing in health system. This is a qualitative study. Using purposive sampling 22 participants were interviewed to gain deep understanding from the phenomenon of status of nurses in policy making. Of these 2 were not nurses but the members of Iran's council for health policy making. Data were analyzed by employing conventional content analysis. Nurses' status in policy making declared base on the implications of three main themes including "the policy making framework", "perceived status of nurses in policy making", and "the manner of nurses' participation in policy making". The conclusion of the present study is that Policy making for nursing is a subcategory of Iran's macro health policies. What made the status of nurses more efficient in policy making for nursing was their practice and rate of participation in the appointed positions and the society. Results of this study represented major points of weakness in nursing policies and some recommendations for modifications.

Modification of nursing education for upgrading nurses' participation: a thematic analysis.

BACKGROUND: The product of the educational nursing programs in Iran is training nurses who less have professional apprehension and commitment for participating in professional decisions. Whereas nurses especially those in high academic levels are expected to more involve in professional issues. OBJECTIVE: The aim of this study was to explore Iranian nurse leaders' experiences of making educational nursing policy with emphasizes on enhancement of nurses' participation in professional decisions. METHODS: We used a qualitative design with thematic analysis approach for data gathering and data analysis. Using purposive sampling we selected 17 experienced nurses in education and making educational nursing policies. Data gathered by open deep semi-structured face to face interviews. We followed six steps of Braun and Clarke for data analysis. RESULTS: In order to enhance nurses' participation in professional decisions they need to be well educated and trained to participate in community and meet community needs. The three main themes that evolved from analysis included opportunities available for training undergraduate students, challenges for PhD nurses and general deficiencies in nursing education. The second theme includes three sub-themes; namely, the PhD curriculum, PhD nurses' attitudes and PhD nurses' performance. CONCLUSIONS: We need for revising and directing nursing education toward service learning, community based need programs such as diabetes and driving accidents and also totally application of present educational opportunities. The specialization of nursing and the establishment of specialized nursing associations, the emphasis on teaching the science of care and reinforcing the sense of appreciation of pioneers of nursing in Iran are among the directions offered in the present study.

Proposing a syllabus for the operation room B.S. courses in Iran.

BACKGROUND: Education is based upon the knowledge, skills, and attitudes that are required for an occupation, and the changes occurring in the occupations and duties as well as in the ideals and values necessitate constant needs analysis. Furthermore, owing to the transformations in sciences, especially medical sciences, the current syllabus for the operation room courses at associate level will not meet the requirements for operation room personnel in future. Therefore, the syllabus for operation room B.S. was developed and proposed in a research project entitled "Study of the international syllabus for the operation room courses and proposing an appropriate syllabus for the courses in Iran." Since the operation room courses at B.S. level are supposed to be introduced in Iranian universities, we intended to learn about the opinions of other people related to this subject in Iran. METHODS: In this research, a questionnaire was used that contained the syllabus proposed for the operation room B.S. courses, which was the result of a research project entitled "Study of the international syllabus for the operation room courses and proposing an appropriate syllabus for the courses in Iran." To develop this syllabus, 12 heads of the operation room departments in universities across Iran in which the subject matter was being taught at associate level were consulted. RESULTS: The study showed that 14 out of the 53 courses proposed in the syllabus had a desirability level of 100%, 22 courses were desirable at levels of 91-100%, 19 were 75-90% desirable, and no courses had a desirability level less than 75%. After carrying out some modifications to the syllabus, the problems were resolved and the opinions were again asked. When a consensus of greater than 70% was reached, the syllabus for the operation room courses at B.S. level was finalized and proposed. The regulations from the Development, Planning, and Evaluation Office of the Ministry of Health were also followed. CONCLUSIONS: Although all the courses showed a desirability level of greater than 70%, receiving appropriate suggestions about some courses led the research team to carry out major or minor modifications to some of the courses.