Adherence to evidence-based recommendations for surgical site infection prevention: Results among Italian surgical ward nurses

Clinicians' and Patients' Experiences and Perceptions on the Prevention and Management of Surgical Site Infections: A Mixed-Methods Systematic Review

AIM

To explore clinicians' and patients' perceptions of implementing evidence-based practice to improve clinical practice for preventing and managing surgical site infections within hospital acute care settings.

DESIGN

A convergent integrated mixed-methods systematic review using the Joanna Briggs Institute approach.

METHODS

Included studies reported (i) acute care hospital clinicians' and patients' experiences and preferences for preventing and managing surgical site infections and (ii) barriers and facilitators to implementing surgical site infection prevention and management guidelines. The Mixed Methods Appraisal Tool and the Quality Improvement Minimum Quality Criteria Set were used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data and coded all findings into themes. Clinicians' and patients' views were also compared.

DATA SOURCES

English language peer-reviewed studies published from 2009 to March 2023 were identified from Medline, EMBASE, CINAHL, PsycINFO and Cochrane Central Library.

RESULTS

Thirty-seven studies (16 quantitative, 17 qualitative, 3 mixed-methods and 1 quality improvement) met the inclusion criteria. Five main themes represent key factors believed to influence the implementation of evidence-based surgical site infection prevention and management guidelines: (1) Intentional non-adherence to insufficiently detailed and outdated guidelines, (2) Knowledge deficits on evidence-based SSI care bring about inconsistent clinical practice, (3) Collaborative interdisciplinary and patient-provider relationship to enhance guideline uptake, (4) Infection surveillance to improve patient safety and quality of life and (5) Negative physical and psychological impacts on patients.

CONCLUSION

The five themes reflect a need for updated hospital guidelines as a medium to improve surgical site infection knowledge and ensure consistent and evidence-based clinical practice. This review also highlights the significance of interdisciplinary and patient-provider collaboration and infection surveillance to facilitate guideline uptake. The effectiveness of intervention bundles designed to improve these aspects of care will need to be evaluated in future research.

IMPACT

A future intervention bundle that includes (1) ensuring up-to-date hospital guidelines/policies; (2) fostering collaborative interdisciplinary teamwork culture between physicians, nurses, podiatrists, pharmacists and allied health professionals; (3) encouraging patient or carer involvement in shared decision-making and (4) implementing audit and feedback mechanism on infection surveillance is proposed to improve SSI prevention and management in acute care settings.

REPORTING METHOD

This paper followed the PRISMA 2020 checklist guideline for reporting systematic reviews.

PATIENT OR PUBLIC CONTRIBUTION

This mixed-methods systematic review collates evidence of clinicians' and patients' experiences and preferences for preventing and managing surgical site infections. The inclusion of hospital patients' perspectives supports the development of patient-centred interventions.

TRIAL REGISTRATION

The review protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO 2021 CRD42021250885). Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021250885.

Knowledge and Training Needs in Nosocomial Infection among Hospital Staff in the City of Kielce, Poland: A Cross-Sectional Study

Introduction

Nosocomial infections are an integral part of health care services, posing a threat to both patients and medical staff. The duty and role of nursing staff is to prevent nosocomial infections in every hospitalized person. Material and Methodology. The study involved 635 nurses working in various surgical and conservative wards. The technique used was the author's questionnaire, which contained 30 questions and was divided into three components.

Results

The level of knowledge among the surveyed nurses was at a sufficient level for more than half of the total tested population, and its level was influenced by two variables: the specialization held and the level of education. Nurses working in medical wards have a higher level of knowledge in the area of basic concepts related to nosocomial infections, and people who use specialist medical literature and participate in specialist courses have a sufficient level of knowledge. The shortest time since the last training results in a higher level of knowledge and a higher level of knowledge in the area covering the basic concepts of nosocomial infections. The most frequently selected issues on which nurses would like to expand their knowledge were post-exposure procedures and methods of monitoring nosocomial infections.

Conclusions

The knowledge of the nursing staff in the field of nosocomial infections is diverse, and its main determinants are specialization, education, and age. A sufficient level of knowledge among the respondents is conditioned primarily by the use of specialist literature and participation in specialist courses, which determine both the scope and area of knowledge on nosocomial infections.

Healthcare professionals' knowledge and attitudes towards surgical site infection and surveillance: A quasi-experimental study

AIM

SSI is one of the most prevalent healthcare-associated infections and is associated with extended hospital stays, increased need for reoperation and higher hospital readmission rates. Implementing systematic SSI surveillance can reduce these adverse outcomes. Implementing a surveillance system into a hospital is a complex intervention requiring that staff involved in a patient's perioperative journey have the knowledge of SSI prevention, the data required for surveillance, an understanding of how data informs quality improvement initiatives and their role in surveillance. The aim of this study was to evaluate the impact of a complex intervention on the knowledge and attitudes of healthcare professionals towards surgical site infection (SSI), SSI prevention and surveillance in a university hospital setting.

DESIGN

The study used a quasi-experimental pre-test-post-test design.

METHOD

The impact of a complex intervention was evaluated by measuring healthcare professionals' (n = 74) knowledge of and attitudes towards SSI and surveillance. Normalisation process theory (NPT) guided the study and the development of the intervention.

RESULTS

There was a statistically significant increase in scores on the knowledge of SSI and prevention from pre-intervention to post-test. The knowledge of risk factors scores at post-test was significantly higher than that at pre-intervention. Overall attitudes to SSI prevention and surveillance were good both pre-intervention and post-test but there was a significant change in the attitude of participants. The findings reveal an overall positive impact of the complex intervention on the knowledge and attitude of healthcare professionals relating to SSI, SSI prevention and surveillance; however, the extent of the change varied across items measured.

Healthcare professionals' knowledge and attitudes of surgical site infection and surveillance: A narrative systematic review

AIM

This systematic review reports on healthcare professionals' knowledge and attitudes of surgical site infection and surgical site infection surveillance as well as interventions aimed at enhancing healthcare professionals' knowledge and attitudes.

BACKGROUND

Surgical site infection is a serious adverse outcome following surgery. Despite the presence of international guidelines, the prevention of surgical site infections remains a challenge for patients and hospitals. It is critical that healthcare professionals have sufficient knowledge on surgical site infection and on their role in implementing evidence-based prevention strategies.

DESIGN

This review is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines.

METHODS

A search was undertaken in the following databases: Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycARTICLES, PsycINFO and Web of Science for studies published between January 2010 and March 2022. Studies that examined healthcare professionals' knowledge and attitudes in relation to surgical site infection, surgical site infection surveillance and risk factors for their development were included. We also included studies that examined interventions that aimed to enhance healthcare professionals' knowledge and attitude in relation to surgical site infection, surveillance, and risk factors. We also described the impact of such interventions on the incidence of surgical site infections.

RESULTS

A total of 26 studies were included. Results were synthesised narratively according to the review objectives. Findings from this review show that knowledge of what surgical site infection is and its prevention was poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals' role in prevention. Only three studies examined the effects of interventions on healthcare professionals' knowledge of surgical site infection and surgical site infection prevention. Of those, two used multimodal educational interventions and found statistically significant improvement in knowledge.

CONCLUSIONS

Overall knowledge of surgical site infection and its prevention is poor amongst healthcare professionals, while attitudes were positive particularly in relation to healthcare professionals' role in prevention. There is a need for more experimental research to evaluate interventions which aim to address healthcare professionals' knowledge and attitudes towards surgical site infection prevention and surveillance. Such studies should include all healthcare professionals involved in the care of a surgical patient.

TWEETABLE ABSTRACT

Knowledge and attitudes of surgical site infection prevention amongst healthcare professionals.

The Factors Impacting Nurses Awareness on Prevention Healthcare-Associated Infections: A Systematic Review

Background: Healthcare-Associated Infections (HAIs) are significant causes of illness and mortality, and nurses are healthcare professionals with the most consistent contact with patients, therefore nurses need to possess adequate knowledge, and awareness. Aim: this study aim to analyze factors impacting nurses' awareness of the prevention of HAIs, such as their knowledge, attitude, and practice compliance. Methods: A systematic review was conducted from the sources of data collection, namely Proquest, Science Direct, Pubmed, and Google Scholar from 2011-2020, with English guidelines used to review the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Data were obtained through a questionnaire survey, direct observation, and self-report from 4329 nurses with a total of 12 inclusion criteria. The result showed that a significant number of nurses do not possess an acceptable level of knowledge and practice, although nurses have a positive attitude. Hand hygiene and the other protective personal equipment need to be used by nurses and other health personal to prevent Urinary Tract Infection, respiratory, and Surgical Site Infection in the hospital.   Conclusion: nurses need to possess the right knowledge, attitude, and guidelines. Standard precaution is important for patient safety management, nurses need to be adequately trained to increase awareness.  

Skin and mucous membranes colonisation with Staphylococcus aureus or MRSA as a risk factor for surgical site infections in elective Caesarean Section

The purpose of this study was to determine if skin and mucous membrane colonisation with Staphylococcus aureus (S. aureus) and methicillin-resistant Staphylococcus aureus (MRSA) increases the incidence of surgical site infection (SSI) post-elective Caesarean Sections. A prospective study was conducted at a major centre in Jordan, involving 127 patients who underwent elective Caesarean Section surgeries during 2019. Participants were screened for skin and mucous membranes colonisation for S. aureus preoperatively and were followed for 90 days for any signs of SSI. The screening sites were on three parts of the patients' bodies; nose, throat, and groyne. The total SSI incidence was 18.9%. Among participants with SSI; 66.7% had a superficial infection and 33.3% had deep tissue infection. Skin and mucous membrane colonisation was positive in 42 participants (33.1%) in one of the three screening sites. Participants with positive skin and mucous membrane colonisation were found to have SSI incidence 2.43 times more than the non-colonised participants (Fisher's Exact test = 3.832, p = .05, CI: 0.098-6.02). Participants with S. aureus skin and mucous membranes colonisation were significantly 2.94 times with more SSI incidence than those who were not colonised (Fisher's Exact test = 5.485, p = .02, CI: 1.164-7.439). Skin and mucous membrane colonisation was found to increase the incidence of SSI. More attention should be performed to screen for skin and mucous membranes colonisation and subsequent selective skin decolonisation to decrease SSI incidence.IMPACT STATEMENTWhat is already known on this subject? Surgical site infection (SSI) is a challenge that increases the costs of health care. Surgical site infection is associated with high costs mainly due to the increase in the length of hospital stay. Skin screening for S. aureus or MRSA colonisation was found to be important for selective skin decolonisation using appropriate antiseptic preparation and preoperative antibiotic prophylaxis.What do the results of this study add? The incidence of SSI in the colonised group was found to be 2.43 times higher than in the non-colonised group.What are the implications of these findings for clinical practice and/or further research? Screening for colonisation and subsequent selective skin decolonisation should be a part of SSI prevention policies.

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing “bacterial load” perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single “clinical pack”, applied rigorously in all settings involving prosthetic joint implantation. In addition, “anti-infective” implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.