| 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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| 10. |
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| 11. |
- 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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| 12. |
- Wistrand, Camilla, 1970-, et al.
(författare)
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Positive impact on heat loss and patient experience of preheated skin disinfection : a randomised controlled trial
- 2016
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Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell Publishing Inc.. - 0962-1067 .- 1365-2702. ; 25:21-22, s. 3144-3151
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: The aim of this study was to compare the effect of preheated (36 °C) and room-temperature (20 °C) skin disinfectant solution on skin temperature and patients' experience of the skin disinfection process.Background: To prevent surgical site infections, it is important to disinfect skin prior to invasive surgery. In clinical practice, conscious patients often comment on the coldness of the preoperative skin disinfection solution. Evidence is lacking, as to whether preheated skin disinfectant has any positive effects during preoperative skin disinfection.Design: Randomised controlled trial.Methods: A total of 220 patients undergoing pacemaker, implantable cardioverter-defibrillator, or cardiac resynchronisation therapy under local anaesthesia were included and randomly allocated to preheated or room-temperature skin disinfection. Skin temperature was assessed before and after skin disinfection at the planned incision site; in addition, three study-specific questions were used to assess how patients experienced the temperature.Results: Patients experienced the skin disinfection process with preheated disinfectant as significantly more pleasant. They felt less cold and reported increased satisfaction with the temperature of the solution compared to patients who were disinfected with room-temperature solution. Skin disinfection with preheated solution also yielded a significantly higher mean skin temperature compared to room-temperature solution.Conclusions: Preoperative skin disinfection with preheated disinfectant may prevent heat loss and contributes to a more pleasant experience for patients.Relevance to clinical practice: Skin disinfection with preheated skin disinfectant is an easy and inexpensive nursing intervention that has a positive impact on heat loss and on patients' experience of the disinfection process.
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| 13. |
- Wistrand, Camilla, 1970-
(författare)
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Swedish operating room nurses preventive interventions to reduce bacterial growth, surgical site infections, and increase comfort in patients undergoing surgery
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Surgical site infection is a major postoperative complication that causes patient suffering and is costly for society. The general aim of this thesis was to test and describe interventions performed by operating room (OR) nurses to prevent bacterial growth in surgical patients, with the intent to prevent surgical site infections (SSIs) whilst increase patients comfort.In studies I and II, 220 pacemaker patients were tested to compare pre-heated skin disinfection with room-temperature skin disinfection regard-ing bacterial growth, skin temperature and patient experience. Preheated skin disinfection was not less effective compared to room-temperature skin disinfection in reducing bacterial growth after skin disinfection and there were no differences regarding SSIs three month postoperatively. Preheated skin disinfection reduces skin heat loss and was perceived as more pleas-ant compared to room-temperature skin disinfection.In study III, 12 OR nurses were examined regarding bacterial growth on their hands and at the sterile glove cuff end after surgical hand disinfec-tion and again after wearing sterile surgical gloves during surgery. They were compared with a control group of 13 non-health care workers. OR nurses’ hands had higher amounts of bacterial growth at two of three culture sites after surgical hand disinfection compared with the control group, and the bacterial growth increased in both groups with time during surgery. There seems to be a risk of bacterial growth at the glove cuff end during surgery, involving the same type of bacteria as isolated from the hands.In study IV, 890 OR nurses answered an online questionnaire describ-ing OR nurses interventions guided by national guidelines to reduce SSIs, such as preparation of the patient skin, patient temperature, and OR ma-terials used. The proportion of the OR nurses who complied with the national guidelines preventive interventions was high: skin disinfection solution (93.5%), drapes (97.4%) and gowns (83.8%), and double gloves (73%). However, when guidelines were lacking the interventions differed.
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| 14. |
- Wistrand, Camilla, 1970-, et al.
(författare)
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The effect of preheated versus room-temperature skin disinfection on bacterial colonization during pacemaker device implantation : a randomized controlled non-inferiority trial
- 2015
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Ingår i: Antimicrobial Resistance and Infection Control. - London, United Kingdom : BioMed Central (BMC). - 2047-2994. ; 4
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Tidskriftsartikel (refereegranskat)abstract
- Background: In clinical practice, patients who are awake often comment that cold surgical skin disinfectant is unpleasant. This is not only a problem of patients’ experience; heat loss during the disinfection process is a problem that can result in hypothermia. Evidence for the efficacy of preheated disinfection is scarce. We tested whether preheated skin disinfectant was non-inferior to room-temperature skin disinfectant on reducing bacterial colonization during pacemaker implantation.Methods: This randomized, controlled, non-inferiority trial included 220 patients allocated to skin disinfection with preheated (36 °C) or room-temperature (20 °C) chlorhexidine solution in 70 % ethanol. Cultures were obtained by swabbing at 4 time-points; 1) before skin disinfection (skin surface), 2) after skin disinfection (skin surface), 3) after the incision (subcutaneously in the wound), and 4) before suturing (subcutaneously in the wound).Results: The absolute difference in growth between patients treated with preheated versus room-temperature skin disinfectant was zero (90 % CI −0.101 to 0.101; preheated: 30 of 105 [28.6 %] vs. room-temperature: 32 of 112 [28.6 %]). The pre-specified margin for statistical non-inferiority in the protocol was set at 10 % for the preheated disinfectant. There were no significant differences between groups regarding SSIs three month postoperatively, which occurred in 0.9 % (1 of 108) treated with preheated and 1.8 % (2 of 112) treated with room-temperature skin disinfectant.Conclusion: Preheated skin disinfection is non-inferior to room-temperature disinfection in bacterial reduction. We therefore suggest that preheated skin disinfection become routine in clean surgery.
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| 15. |
- 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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