| 1. |
- Falk-Brynhildsen, Karin, 1959-, et al.
(författare)
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Swedish translation, cultural adaptation and psychometric evaluation of the pressure ulcer knowledge assessment tool for use in the operating room
- 2023
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Ingår i: International Wound Journal. - : John Wiley & Sons. - 1742-4801 .- 1742-481X. ; 20:5, s. 1534-1543
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to psychometrically evaluate the Swedish operating room version of PUKAT 2.0. In total, 284 Swedish operating room nurses completed the survey of whom 50 completed the retest. The item difficulty P-value of 14 items ranged between 0.38 and 0.96 (median 0.65). Three items were found to be too easy (0.90-0.96). The D-value of 14 items ranged between 0.00 and 0.42 (median 0.46). Three items had a D-value lower than 0.20 (0.11-0.16) and eight items scored higher than 0.40 (0.45-0.61). The quality of the response alternatives (a-value) ranged between 0.00 and 0.42. This showed that nurses with a master's degree had a higher knowledge than nurses with a professional degree (respectively 9.4/14 versus 8.6/14; t = -2.4, df = 199, P = 0.02). The ICC was 0.65 (95% CI 0.45-0.78). The ICCs for the domains varied from 0.12 (95% CI = -0.16-0.39) to 0.59 (95% CI = 0.38-0.75). Results indicated that 11 of the original items contributed to the overall validity. However, the low participation in the test-retest made the reliability of the instrument low. An extended evaluation with a larger sample should be considered in order to confirm aspects of the psychometric properties of this instrument.
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| 2. |
- Falk-Brynhildsen, Karin, 1959-, et al.
(författare)
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The Swedish version of the attitude towards pressure ulcer prevention instrument for use in an operating room context (APUP-OR) : A nationwide psychometric evaluation
- 2022
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Ingår i: JOURNAL OF TISSUE VIABILITY. - : Elsevier. - 0965-206X .- 1876-4746. ; 31:1, s. 46-51
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: To assess operating room (OR) nurses' attitudes towards pressure ulcer prevention, the Attitude towards Pressure Ulcer Prevention (APuP) instrument was developed. Aim: The aim of this study was to psychometrically evaluate the Attitude towards Pressure Ulcer Prevention (APuP) instrument in a Swedish OR context. Materials and methods: A psychometric evaluation study was conducted, using a convenience sample, between February and August 2020. Validity (content, construct, discriminatory power) and reliability (stability and internal consistency) were evaluated. Results: The first survey (test) was completed by 284 Swedish OR nurses, of whom n = 50 (17.6%) completed the second survey (retest). A Principal Component Analysis was conducted for the 13-item instrument. The KMO value for this model was 0.62. Bartlett's test for sphericity was statistically significant (p 0.001). Five factors were identified which accounted for 56% of the variance in responses related to attitudes toward pressure ulcer prevention. The Cronbach's a for the instrument "attitude towards Pressure Ulcer Prevention" was 0.66. The intraclass correlation coefficient was 0.49 (95% CI = 0.25-0.67). Conclusion: This Swedish version of the APuP- OR is the first step in the development of an instrument to measure OR nurses' attitudes towards PU prevention in a Swedish OR context. The reliability of the instrument was low and the validity moderate. A larger sample and the revision or addition of items related to the context of the operating room should be considered in order to confirm aspects of the psychometric properties.
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| 3. |
- Sandström, Nadia, 1995-, et al.
(författare)
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The presence of skin bacteria in the sternal wound and contamination of implantation materials during cardiac surgery
- 2023
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Ingår i: Journal of Hospital Infection. - : Academic Press. - 0195-6701 .- 1532-2939. ; 135, s. 145-151
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sternal wound infections (SWI) and aortic graft infections (AGI) are serious complications after cardiac surgery. Staphylococcus aureus and coagulase-negative staphylococci are the most common causes of SWI, while AGI are less studied. AGI may occur from contamination during surgery or postoperative haematogenous spread. Skin commensals, such as Cutibacterium acnes, are present in the surgical wound; however, their ability to cause infection is debated.AIM: The aim of this study was to investigate the presence of skin bacteria in the sternal wound and to evaluate their possible ability to contaminate surgical materials.METHODS: We included 50 patients that underwent coronary artery bypass graft surgery and/or valve replacement surgery at our centre from 2020 to 2021. Cultures were collected from skin and subcutaneous tissue at two time points during surgery, and from pieces of vascular graft and felt that were pressed against subcutaneous tissue. The most common bacterial isolates were tested for antibiotic susceptibility with disk diffusion and gradient tests.FINDINGS: Cultures from skin had bacterial growth in 48% of patients at surgery start and in 78% after two hours, and cultures from subcutaneous tissue were positive in 72% and 76% of patients, respectively. The most common isolates were C. acnes and S. epidermidis. Cultures from surgical materials were positive in 80-88%. No difference in susceptibility was found for S. epidermidis isolates at surgery start compared to after two hours.CONCLUSIONS: The results suggest that skin bacteria are present in the wound and may contaminate surgical graft material during cardiac surgery.
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| 4. |
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| 5. |
- Wistrand, Camilla, 1970-, et al.
(författare)
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Effectiveness of reducing bacterial air contamination when covering sterile goods in the operating room setting : a systematic review and meta-analysis
- 2024
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Ingår i: Journal of Hospital Infection. - : Academic Press. - 0195-6701 .- 1532-2939. ; 145, s. 106-117
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Postoperative surgical site infection is a serious problem. Coverage of sterile goods may be important to protect the goods from bacterial air contamination while awaiting surgery.AIM: We aimed to evaluate the effectiveness of this practice in a systematic review covering five databases using search terms related to bacterial contamination in the operating room and on surgical instruments.METHODS: We searched MEDLINE, Cochrane, CINAHL, EMBASE, and Web of Science from database inception to February 13, 2023, for randomized and non-randomized controlled studies of covering interventions conducted in the operating room setting. The outcome was bacterial air contamination measured as colony forming units, and a meta-analysis was performed in separate time periods of coverage. This systematic review and meta-analysis is reported according to the PRISMA statement, and the protocol was prospectively registered in PROSPERO (CRD42022323113). The time points ranged from 30 minutes to 24 hours.FINDINGS: The results showed that covering sterile goods significantly prevented bacterial air contamination as compared to uncovered goods. The meta-analysis was in favour of covering sterile goods for protection from bacterial air contamination, and showed an effect size Z of 4.76 (p<0.00001, CI: -1.94 to -0.81). The heterogeneity analysis showed a heterogeneity of 83%.CONCLUSION: No negative effects regarding bacterial contamination were found, and so we conclude that protection with a sterile cover decreases bacterial air contamination of sterile goods while waiting for surgery to start.
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| 6. |
- Wistrand, Camilla, 1970-, et al.
(författare)
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Effects and experiences of warm versus cold skin disinfection
- 2011
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Ingår i: British Journal of Nursing. - : Mark Allen Group. - 0966-0461 .- 2052-2819. ; 20:3, s. 148-151
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Tidskriftsartikel (refereegranskat)abstract
- The intention of preoperative skin antisepsis is to reduce the risk of postoperative surgical wound infections through the prevention of contamination of the wound site from the patient's skin flora, and to provide a sterile work area. This pilot study aimed to compare warm versus cold skin disinfection with a chlorhexidine solution on bacterial growth, skin temperatures and the experiences of the disinfection. Ten healthy volunteers without any association to Sweden's healthcare services were included in an experimental study with crossover design. The results showed that warm (38°C) disinfection seems to be comparable with cold (20°C) disinfection in reducing bacterial growth. Experiences differ, but warm disinfection is generally considered more pleasant than cold as a result of heat-loss to the skin. However, further research with larger sample sizes and on patients undergoing surgery is needed.
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| 7. |
- Wistrand, Camilla, 1970-, et al.
(författare)
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Exploring bacterial growth and recolonization after preoperative hand disinfection and surgery between operating room nurses and non-health care workers : a pilot study
- 2018
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Ingår i: BMC Infectious Diseases. - : BioMed Central. - 1471-2334. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To prevent cross infection the surgical team perform preoperative hand disinfection before dressed in surgical gowns and gloves. Preoperative hand disinfection does not make hands sterile and the surgical glove cuff end has been regarded as a weak link, since it is not a liquid-proof interface. The aims were to investigate if there were differences in bacterial growth and recolonization of hands between operating room nurses and non-health care workers as well as to investigate if bacterial growth existed at the surgical glove cuff end during surgery.METHODS: This pilot project was conducted as an exploratory comparative clinical trial. Bacterial cultures were taken from the glove and gown interface and at three sites of the hands of 12 operating room nurses and 13 non-health care workers controls directly after preoperative hand disinfection and again after wearing surgical gloves and gowns. Colony forming units were analysed with Mann-Whitney U test and Wilcoxon Sign Ranks test comparing repeated measurements. Categorical variables were evaluated with chi-square test or Fisher's exact test.RESULTS: Operating room nurses compared to non-health care workers had significant higher bacterial growth at two of three culture sites after surgical hand disinfection. Both groups had higher recolonization at one of the three culture sites after wearing surgical gloves. There were no differences between the groups in total colony forming units, that is, all sampling sites. Five out of 12 of the operating room nurses had bacterial growth at the glove cuff end and of those, four had the same bacteria at the glove cuff end as found in the cultures from the hands. Bacteria isolated from the glove cuff were P. acnes, S. warneri, S. epidermidis and Micrococcus species, the CFU/mL ranged from 10 to 40.CONCLUSIONS: There were differences in bacterial growth and re-colonization between the groups but this was inconclusive. However, bacterial growth exists at the glove cuff and gown interface, further investigation in larger study is needed, to build on these promising, but preliminary, findings.TRIAL REGISTRATION: Trial registration was performed prospectively at Research web (FOU in Sweden, 117,971) 14/01/2013, and retrospectively at ClinicalTrials.gov ( NCT02359708 ). 01/27/2015.
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| 8. |
- Wistrand, Camilla, 1970-, et al.
(författare)
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Important interventions in the operating room to prevent bacterial contamination and surgical site infections
- 2022
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Ingår i: American Journal of Infection Control. - : Elsevier. - 0196-6553 .- 1527-3296. ; 50:9, s. 49-1054
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to explore interventions that Swedish operating room (OR) nurses considered important for the prevention of bacterial contamination and surgical site infections (SSIs).Methods: A web-based cross-sectional survey with an open-ended question was answered by OR nurses and analyzed using summative content analysis and descriptive statistics.Results:The OR nurses (n=890) worked within 11 surgical specialties and most of them worked at university hospitals (37%) or county hospitals (53%). The nurses described twelve important interventions to prevent bacterial contamination and SSI: skin disinfection (25.9%), the OR environment (18.2%), aseptic technique (16.4%), OR clothes (13.4%), draping (9.8%), preparation (6.1%), dressing (3.6%), basic hygiene (3.4%), normothermia (2.1%), communication (0.7%), knowledge (0.3%), and work strategies (0.2%).Discussion: Skin disinfection was considered the most important intervention in order to prevent bacterial contamination and SSI. The responses indicated that many nurses believed the patients’ skin to be sterile after the skin disinfection process. This is not a certainty, but skin disinfection does significantly decrease the amount of bacterial growth.Conclusions: This study shows that many OR nurses' interventions are in line with recommendations. Although, knowledge regarding the effect of skin disinfection needs further research and continued education.
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| 9. |
- Wistrand, Camilla, 1970-, et al.
(författare)
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National Survey of Operating Room Nurses' Aseptic Techniques and Interventions for Patient Preparation to Reduce Surgical Site Infections
- 2018
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Ingår i: Surgical Infections. - : Mary Ann Liebert. - 1096-2964 .- 1557-8674. ; 19:4, s. 438-445
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Surgical site infection (SSI), the third most common type of nosocomial infection in Sweden, is a patient injury that should be prevented. Methods of reducing SSIs include, for instance, disinfecting the skin, maintaining body temperature, and ensuring an aseptic environment. Guidelines for most of these interventions exist, but there is a lack of studies describing to what extent the preventive interventions have been implemented in clinical practice. We describe the daily clinical interventions Swedish operating room (OR) nurses performed to prevent SSIs following national guidelines.METHODS: A descriptive cross-sectional study using a Web-based questionnaire was conducted among Swedish OR nurses. The study-specific questionnaire included 32 items addressing aspects of the interventions performed to prevent SSI, such as preparation of the patient skin (n = 12), maintenance of patient temperature (n = 10), and choice of materials (n = 10). The response format included both closed and open-ended answers.RESULTS: In total, 967 nurses (43% of the total) answered the questionnaire; of these, 77 were excluded for various reasons. The proportions of the OR nurses who complied with the preventive interventions recommended in the national guidelines were high: skin disinfection solution (93.5%), sterile drapes (97.4%) and gowns (83.8%) for single use, and the use of double gloves (73.0%). However, when guidelines were lacking, some interventions differed, such as the frequency of glove changes and the use of adhesive plastic drapes.CONCLUSION: To standardize OR nurses' preventive interventions, implementing guidelines seems to be the key priority. Overall, OR nurses have high compliance with the national guidelines regarding interventions to prevent bacterial growth and SSIs in the surgical patient. However, when guidelines are lacking, the preventive interventions lose conformity.
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