RESUMO
BACKGROUND: To investigate abdominal hysterectomy surgical site infection (SSI) rates before and after implementation of an SSI care bundle. METHODS: An SSI bundle for abdominal hysterectomies was introduced in our hospital in April 2014 to reduce the SSI rate. The practices were divided into bundle elements around preoperative, intraoperative, and postoperative care. We conducted a retrospective cohort study around implementation of the SSI care bundle. Women were included if they underwent abdominal hysterectomy between 2012 and 2015. They were then divided into 2 study groups: prebundle and postbundle. The primary study outcome was SSI rate. The superficial SSI rate was the secondary outcome. RESULTS: The overall SSI rate was 6.18% in the prebundle group, with a median monthly SSI rate of 7.03%. After bundle implementation, the overall SSI rate declined to 2.51% (Pâ¯=â¯.02). The reduction remained significant after multivariate analysis (adjusted odds ratio 0.38; 95% confidence interval 0.15-0.88; Pâ¯=â¯.03) indicating a 62% reduction in SSI postbundle as compared to prebundle.When comparing rates based on infection classification, superficial SSIs declined significantly from 3.73% in the prebundle group to 0.90% in the postbundle group (Pâ¯=â¯0.02). Patient demographics and pre-existing medical conditions were similar pre- and postbundle. Compliance with bundle elements was high. CONCLUSIONS: A significant reduction in SSI rate in abdominal hysterectomies was seen following implementation of an infection prevention bundle.
Assuntos
Pacotes de Assistência ao Paciente , Infecção da Ferida Cirúrgica , Feminino , Humanos , Histerectomia/efeitos adversos , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controleRESUMO
BACKGROUND: This study investigated cesarean delivery surgical site infection (SSI) rates before and after implementation of a SSI care bundle. METHODS: A SSI bundle for cesareans was introduced in our hospital in April 2014 to reduce the SSI rate. The practices were divided into bundle elements that reflected preoperative, intraoperative, and postoperative care. We conducted a retrospective cohort study to evaluate implementation of the SSI care bundle. Women were included if they had a gestational age of at least 23 0/7 weeks and delivered a liveborn neonate(s) between 2012 and 2015. They were then divided into 2 study groups: pre-bundle and post-bundle. The primary study outcome was SSI rate. Secondary outcomes included comorbidities, perioperative factors, and SSI classification. RESULTS: The overall incidence of cesarean SSIs during the study time period was 1.89 (76 SSIs in 4014 cesarean deliveries). The pre-bundle mean was 2.44 and decreased to 1.1 following implementation of the SSI bundle (Pâ¯=â¯.013). This represents a 221% reduction in the SSI rate. Patient demographics and pre-existing medical conditions were similar pre- and post-bundle. Compliance with bundle elements was high. CONCLUSIONS: A significant reduction in SSI rate in cesarean deliveries was seen following implementation of an infection prevention bundle.
Assuntos
Cesárea/efeitos adversos , Pacotes de Assistência ao Paciente/métodos , Assistência Perioperatória/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Feminino , Implementação de Plano de Saúde , Humanos , Incidência , Gravidez , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The Baby-Friendly Hospital Initiative is a global initiative that aims to protect, promote, and support breastfeeding. This study explores and describes the process of attaining Baby-Friendly designation from nurses' perspectives. A purposive sampling design was used to recruit registered nurse participants in a large, safety-net, tertiary care facility. Data were collected via semistructured interviews and were analyzed using descriptive interpretative analysis. The following themes were revealed: Resistance, Culture, Investment in the Journey, Teamwork, and Source of Pride. Results indicate that comfortable yet antiquated practices led to fear of change and resistance. Initial culture shock was mediated by a successful education model, powerful experiences, and positive outcomes.
Assuntos
Aleitamento Materno , Promoção da Saúde/normas , Enfermagem Materno-Infantil/normas , Mães/educação , Cuidado Pós-Natal/normas , Provedores de Redes de Segurança/organização & administração , Adulto , Atitude do Pessoal de Saúde , Feminino , Saúde Global/normas , Fidelidade a Diretrizes , Promoção da Saúde/métodos , Humanos , Recém-Nascido , Capacitação em Serviço/métodos , Capacitação em Serviço/normas , Enfermagem Materno-Infantil/educação , Enfermagem Materno-Infantil/métodos , Pessoa de Meia-Idade , Estudos de Casos Organizacionais , Educação de Pacientes como Assunto , Cuidado Pós-Natal/métodos , Gravidez , Pesquisa Qualitativa , Provedores de Redes de Segurança/normas , Apoio Social , Estados Unidos , Organização Mundial da SaúdeRESUMO
A focus group study was conducted to describe bachelor of science-prepared registered nurses' (n = 10) use of research in their everyday practice. Results indicate that participants feel prepared to use research upon entry into the workforce and do so to better patient care. However, research use is both positively and negatively affected by nursing leadership and the research culture of the workplace. The author includes implications for nursing professional development specialists and educators.