Nurses’ Prevention of Surgical Site Infections

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Table of Contents

Background
Methods of Study
Results of Study
Ethical Considerations
Outcomes Comparison
References

Background

The problem of post-surgery infections has been relevant over the years. When the organism is healing after surgery, it becomes especially vulnerable to infection due to which pathogen organisms may enter the area of incision. Post-surgery infections often lead to severe complications and increase in mortality rate. The significance of this problem to nursing lies with the fact that nurses work in surgeries and it is their task to take care of patients in the aftermath of operations. By being negligent and not prudent enough while changing patients’ bondages, a nurse may let the infection penetrate the incision. The purposes of the study is to make surgical patients less exposed to surgical cite infections (SSIs) and improve the quality of their lives and to assess nurses’ understanding of evidence-based prevention of surgical site infections. The objective is to find methods that would allow to do that with practical evidence from operating rooms and to describe how nurses’ knowledge is related to selected sociodemographic factors. The research question is: how can operating room nurses use evidence-based care in prevention of Surgical Site Infections and reduce patient exposure to them. Another question is what is the level of nurses’ knowledge regarding evidence based guidelines for the prevention of SSIs in acute care settings.

The articles chosen for the research discuss the issue of surgical cite infections through the lens of nurses’ involvement in the process. The article entitled The Persistent Breach between Evidence and Practice in the Prevention of Surgical Site Infection portrays the possibilities of the intra-operative prevention of SSIs by operating room nurses. The article called Intraoperative Prevention of Surgical Site Infections as Experienced by Operating Room Nurses examines what factors may stand in the way of implementation of SSIs prevention practices. The relevance of the first article in regard to my PICOT question is that it provides an example of the SSI prevention system, constructed by the article’s authors and legitimate enough to be implemented. The relevance of the second article to my PICOT question lies with the fact that in it is necessary to explore all the obstacles on the way to translate evidence into practice.

The article called Compliance and barriers facing nurses with surgical site infection prevention guidelines deals with difficulties nurses may face in trying to act according to the instructions. The article entitled Jordanian nurses’ knowledge of preventing surgical site infections in acute care settings dwells on the nursing practice regarding the factors influencing caregivers’ knowledge of evidence-based care to prevent SSIs. These articles answer the Picot question of whether operating room nurses could use evidence-based nursing care to prevent Surgical Site Infections and reduce patient exposure to these issues.

When it comes to Qvistgaard et al. (2019), their intervention lied with the fact of interviewing practicing operating nurses. Comparison groups were patterns in the interviewees’ answers that were used to build clusters of meaning. These clusters of meaning served as a determinant of a core meaning, which constituted a phenomenon’s essence. Badia et al. (2020) used a Web-based questionnaire as their intervention method. The questionnaire was distributed among practicing operating nurses across the country. The answers to this questionnaire were compared against recommended guidelines of clinical practice from renowned organizations.

Qasem & Hweidi (2017) chose to ask nurses fill questionnaires within 15 minutes and return at the same visit time. From the PICOT question, the intervention is evidence-based, which is consistent with Mohsen et al. (2020), who conducted self-reported surveys from caregivers in selected hospitals. My PICOT questions interventions and comparisons look similar to the ones provided in the articles: interventions are aimed at polling practicing professionals in the field, and comparison groups are universally accepted in the field guidelines.

Methods of Study

Qvistgaard et al. (2019) chose the study method of Reflective Lifeworld Research, or RLR. Qvistgaard et al. (2019) state that this method allows the researches to embrace peculiarities as well as generalities of the phenomena they research. Therefore, RLR’s methodological principles are openness, discernment, and contemplation – principles that aim at grasping the phenomenon’s essential nature and its variations. Badia et al. (2020) were not specific about the methods used and only stated that their project was put on record in the United States clinical trials registry and reported in accordance with the criteria for Reporting Qualitative Research. However, responses to a questionnaire were put into a computer base, which was analyzed using statistical software suite.

Qasem & Hweidi (2017) used a cross-sectional design, and nurses from four hospitals participated. The authors calculated this sample size using power analysis and presented multiple-choice questionnaires to test the nurses’ knowledge. Mohsen at al. (2020) employed a cross-sectional descriptive research, collecting data from surgical units in four hospitals which involved self-reported survey.

Therefore, methods described in the studies differ significantly: Qvistgaard et al. (2019) focus on their own openness and unbiasedness, whereas Badia et al. (2020) give attention to the technical side of the question. Qvistgaard et al. (2019) rely solely on the results of the interviews while Badia et al. (2020) compare the results of questionnaire to published guidelines. Qasem & Hweidi (2017) and Mohsen et al. (2020) both used a cross-sectional study design, which captures information from participants with different characteristics. However, Qasem & Hweidi (2017) used sample size calculation to make their results more reliable, while Mohsen et al. (2020) stuck to descriptive research methods.

The benefits and drawbacks of the methods used are as follows. Qvistgaard et al. (2019) demonstrate their willingness to admit any result they may get by placing emphasis on openness and unbiased character of the analysis. Moreover, they try to discern the generalization from peculiarities building reliable framework for further researchers. The possible limitation of this method lies with the fact that, by trying to consider every valuable opinion on the subject and viewing it from every possible angle, researchers might not come to any definite conclusion. In such cases, additional tools to lean on are necessary – for instance, as with Qvistgaard et al. (2019), comparison groups.

The approach of Badia et al. (2020) has the advantage of being totally transparent. By entering data in a computer form and allowing the machine to analyze it, the authors reduce to zero the probability of a mistake. However, by choosing to focus on the technical side only, researchers might lose the sight of more important issues, such as integrity and representativeness. The key advantage of a cross-sectional study employed by Qasem & Hweidi (2017) and Mohsen et al. (2020) is that the findings approve or disapprove study assumptions, which informs in-depth research. However, the design cannot assess behavior over a specified period because it captures information at a particular time, while other variables such as income, experience, and age change with time

Results of Study

Results of studies depended largely on the methods used; however, all studies managed to come up with applicable results in nursing practice which makes them beneficial for the study. Qvistgaard et al. (2019) discovered that SSI prevention is not only dependent on the team’s function but also on an individual’s personal and organizational legitimacy. Seeing themselves as a part of a team responsible for its performance, nurses should remember that in order to be of use and do no harm in an operating room, they have to be prepared. Badia et al. (2020), in their turn, found that among the most widely used SSI preventive measures are those that surgeons and nurses have got used to resort to in their practice. Qasem & Hweidi (2017) found significant difference in the understanding of caregivers at intensive care units and those attending other departments. Qasem & Hweidi (2017) imply that practical experience enhances knowledge and boosts ability, while theoretical education is often not enough to be of use in operating rooms. Mohsen e al. (2020) found that most of the nurses had poor practice and knowledge of SSIs and had to get additional practical education to count in operating rooms.

The implications of all studies lead one to the same conclusion: the practice of SSI prevention in the operating room needs to be taken more seriously. A nursing specialist must rely not only on the work of their team but also on their specific actions. It is essential that these actions correspond with one’s beliefs: while most of the professionals tend to be trained properly, it does not mean much unless it makes difference in their working environment. Additionally, a nursing specialist must be aware of the responsibility they have every time they enter the operating room — especially to the patient, who might be harmed by any careless movement. Moreover, there must be consistency in regard to the practices recommended to implement in order to insure SSI prevention.

Ethical Considerations

It is essential to take into account ethical considerations when conducting a research. One of the most important considerations is the process of consent. Volunteers have to know exactly what they agree to and have an opportunity to withdraw from further participation at any stage of the process. The other essential consideration is the correspondence to criteria of ethical conduct established by the Codes of Ethics and Code of Practice. Qvistgaard et al. (2019) state, that their study was approved by the ethical committee of the country they conducted it in (Sweden) and that all ethical considerations met the guidelines of the Declaration of Helsinki. Badia et al. (2020) report that if a person with relevant qualifications expressed no desire to be questioned or wished to refuse during the process, they faced no obstacles or repercussions. Qasem & Hweidi (2017) stated that their research questions ran inline with Code of Ethics and Code of Practice’s recommendations. Mohsen e al. (2020) asserted that all participants of the study took part in it willingly with the aim to improve the quality of care in surgical sites.

Outcomes Comparison

The anticipated outcomes for the PICOT question include the significance of evidence-based care in controlling SSI and an elaboration of how scientific care prevents patient exposure to SSIs. Moreover, anticipated outcomes include elaboration of measures that would reduce cases of negligence to a zero and provide guidelines for better practical application of theoretical knowledge. Concerning the outcomes for the PICOT question, the articles proved that evidence-based nursing is crucial in preventing SSI and that poor knowledge of SSI contributed to more facility related diseases among patients.

The outcomes of the four articles examined in this study partially coincide with the expected outcomes. Both expected and actual outcomes state that quality nursing care is crucial for reducing the number of SSIs among surgical patients; both underline the necessity of practical experience in additions to theoretical knowledge. However, the articles fell short of elaborating measures that would increase the quality of nursing care in surgical sites, even though they highlight the lack of knowledge among nursing staff.

References

Badia, J. M., Rubio-Pérez, I., López-Menéndez, J., Diez, C., Bolaños, B. A. R., Ocaña-Guaita, J.,… & Balibrea, J. M. (2020). The persistent breach between evidence and practice in the prevention of Surgical Site Infection. Qualitative study. International Journal of Surgery, 82, 231-239.

Qasem, M. N., & Hweidi, I. M. (2017). Jordanian nurses’ knowledge of preventing surgical site infections in acute care settings.Scientific Research, 7(5).

Qvistgaard, M., Lovebo, J., & Almerud-Österberg, S. (2019). Intraoperative prevention of Surgical Site Infections as experienced by operating room nurses. International Journal of Qualitative Studies on Health and Well-Being, 14(1), 1632109.

Mohsen, M. H., Riad, N. A., & Badawy, A. I. (2020). Compliance and barriers facing nurses with surgical site infection prevention guidelines. Scientific Research, 10(1).

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