| 1. |
- Iraeus, Johan, 1973-, et al.
(författare)
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Evaluation of chest injury mechanisms in nearside oblique frontal impacts
- 2013
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Ingår i: Annals of advances in automotive medicine. - : Association for the Advancement of Automotive Medicine. - 1943-2461. ; 57, s. 183-196
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Tidskriftsartikel (refereegranskat)abstract
- Despite the use of seat belts and modern safety systems, many automobile occupants are still seriously injured or killed in car crashes. Common configurations in these crashes are oblique and small overlap frontal impacts that often lead to chest injuries.To evaluate the injury mechanism in these oblique impacts, an investigation was carried out using mathematical human body model simulations. A model of a simplified vehicle interior was developed and validated by means of mechanical sled tests with the Hybrid III dummy. The interior model was then combined with the human body model THUMS and validated by means of mechanical PMHS sled tests. Occupant kinematics as well as rib fracture patterns were predicted with reasonable accuracy.The final model was updated to conform to modern cars and a simulation matrix was run. In this matrix the boundary conditions, ΔV and PDOF, were varied and rib fracture risk as a function of the boundary conditions was evaluated using a statistical framework.In oblique frontal impacts, two injury producing mechanisms were found; (i) diagonal belt load and (ii) side structure impact. The second injury mechanism was found for PDOFs of 25°-35°, depending on ΔV. This means that for larger PDOFs, less ΔV is needed to cause a serious chest injury.
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| 2. |
- 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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| 3. |
- 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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| 4. |
- Wistrand, Camilla, 1970-, et al.
(författare)
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Patient experience of preheated and room temperature skin disinfection prior to cardiac device implantation : A randomised controlled trial
- 2020
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 19:6, s. 529-536
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Clinically, patients often comment on the coolness of the skin disinfectant. However, scarce evidence is available regarding patients' experience during intraoperative skin disinfection.AIMS: The aim of this study was to describe and compare intraoperative patient experiences with preheated and room temperature skin disinfectant.METHOD: This randomised controlled trial included 220 patients undergoing cardiac device implantation. Patients allocated to preheated (36°C) or room temperature (20°C) chlorhexidine in 70% ethanol verbally answered an open-ended question regarding their experience with the skin disinfection. Results were assessed using a qualitative approach with comparative quantification.RESULTS: The analysis resulted in nine categories describing the patients' experiences with preheated and room temperature skin disinfection. Most of the patients described the skin disinfection process as a negative experience, which consisted of six categories: cold, smell, change in temperature, unpleasant, wet and painful. In addition, two neutral categories of response (nothing in particular and neither pleasant nor unpleasant) and one positive response (pleasant) emerged through the analysis. Preheated skin disinfection yielded significantly fewer negative experiences in the category cold (85% vs. 15%, P<0.0001) and significantly more positive experiences (66% vs. 34%, P<0.002). Neutral categories (neither pleasant nor unpleasant 65% vs. 35%, P=0.01, nothing in particular 74% vs. 26%, P<0.001) dominated after preheated skin disinfection.CONCLUSION: The use of preheated skin disinfection promotes a positive patient experience with skin disinfection.TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT02260479 ( https://clinicaltrials.gov/ct2/results?cond=preheated+skin+disinfection ).
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| 5. |
- Wistrand, Camilla, 1970-, et al.
(författare)
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Time-dependent bacterial air contamination of sterile fields in a controlled operating room environment : an experimental intervention study
- 2021
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Ingår i: Journal of Hospital Infection. - : Academic Press. - 0195-6701 .- 1532-2939. ; 110, s. 97-102
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Surgical site infections are a global patient safety concern. Due to lack of evidence on contamination, pre-set surgical goods are sometimes disposed of or re-sterilized, thus increasing costs, resource use, and environmental effects.AIM: To investigate time-dependent bacterial air contamination of covered and uncovered sterile goods in the operating room.METHODS: Blood agar plates (n=1584) were used to detect bacterial air contamination of sterile fields on 48 occasions. Each time, three aerobe and three anaerobe plates were used as baseline to model the preparation time, and 60 (30 aerobe, 30 anaerobe) were used to model the time pending before operation; half of these were covered with sterile drapes and half remained uncovered. Plates were collected after 4, 8, 12, 16, and 24 hours.FINDINGS: Mean time before contamination was 2.8 hours (95% CI: 2.1-3.4) in the uncovered group and 3.8 hours (95% CI: 3.2-4.4) in the covered group (P=0.005). The uncovered group had 98 colony-forming units (CFUs) versus 20 in the covered group (P=0.0001). Sixteen different microorganisms were isolated, the most common being Cutibacterium acnes followed by Micrococcus luteus. Of 32 Staphylococcus CFUs, 14 were antibiotic-resistant, including one multidrug-resistant S. epidermidis.CONCLUSION: Protecting sterile fields from bacterial air contamination with sterile covers enhances the durability of sterile goods up to 24 hours. Prolonged durability of sterile goods might benefit patient safety, since surgical sterile material could be prepared in advance for acute surgery, thereby enhancing quality of care and reducing both climate impact and costs.
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