Knowledge and Practice of Health Care Professionals Regarding the Prevention of Surgical Site Infections at Tertiary Hospitals in Rwanda.

Surgical Wound Infections

Surgical site infection, ultraclean ventilated operating theatres and prosthetic joint surgery: where now?

Chlorhexidine (CH) and povidone-iodine (PI) are the most commonly used preoperative skin antiseptics at present. However, the prevention of the surgical site infection (SSI) and the incidence of skin adverse events do not reach a consistent statement and conclusion. This meta-analysis aimed to evaluate the efficacy of chlorhexidine and povidone-iodine in the prevention of postoperative surgical site infection and the incidence of corresponding skin adverse events. Substantial studies related to "skin antiseptic" and "surgical site infection" were consulted on PUBMED, Web of Science, EMBASE, and CNKI. The primary outcome was the incidence of postoperative SSI. The secondary outcome was associated with skin adverse events. All data were analyzed with Revman 5.3 software. A total of 30 studies were included, including 29,006 participants. This study revealed that chlorhexidine was superior to povidone-iodine in the prevention of postoperative SSI (risk ratio [RR], 0.65; 95% confidence interval [CI], 0.55-0.77; p < 0.00001, I2 = 57%). Further subgroup analysis showed that chlorhexidine was superior to povidone-iodine in the prevention of postoperative SSI in clean surgery (risk ratio [RR], 0.81; 95% confidence interval [CI], 0.67-0.98; p = 0.03), I2 = 28%) and clean-contaminated surgery (risk ratio [RR], 0.58; 95% confidence interval [CI], 0.47-0.73; p < 0.00001, I2 = 43%). However, there was no statistically significant difference in the incidence of skin adverse events between CH and PI groups. Chlorhexidine was superior to povidone-iodine in preventing postoperative SSI, especially for the clean-contaminated surgery. However, there was no statistically significant difference in the incidence of skin adverse events between CH and PI groups.

AimThis 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. BackgroundSurgical 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. DesignThis review is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines. MethodsA 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. ResultsA 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. ConclusionsOverall 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 abstractKnowledge and attitudes of surgical site infection prevention amongst healthcare professionals.

Antibiotic Prophylaxis for the Prevention of Surgical Site Infection after Tension-Free Hernia Repair: A Bayesian and Frequentist Meta-Analysis

Surgical site infection prevention care bundles in colorectal surgery: a scoping review

Despite adopted precautions, surgical site infection (SSI) rate in orthopaedic surgery and its consequences still remain a major problem. Worldwide, infection prevention and control in perioperative settings are considered of primary importance for every healthcare system. The management of perioperative infections carries a heavy psychological and financial burden, since patients who experience SSI have increased hospital length of stay, morbidity and mortality rates, and higher hospital costs. As the treatment of such infections is particularly difficult in the presence of an implanted biomaterial, the prevention of SSI in orthopaedic surgery represents a challenging key issue, requiring the integration of a range of measures before, during and after surgery. In fact, over the years several aspects of SSI prevention have been studied in order to identify the best SSI prevention strategies and set out appropriate clinical practices. This article will review and summarize the recent international guidelines released on this subject together with other published relevant evidence.

British Journal of Healthcare AssistantsVol. 12, No. 8 ClinicalSeries 3. Wound infection 3:4. Prevention and treatment of surgical site infectionsMenna Lloyd JonesMenna Lloyd JonesSearch for more papers by this authorMenna Lloyd JonesPublished Online:10 Aug 2018https://doi.org/10.12968/bjha.2018.12.8.382AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Harrington P. Prevention of surgical site infection. Nurs Stand. 2014 Aug 5; 28(48):50–58. doi: https://doi.org/10.7748/ns.28.48.50.e8958 Crossref, Google ScholarJeffery S, Leaper D, Armstrong D. Using negative pressure wound therapy to prevent surgical site infection. J Wound Care. 2018 Mar 1; 27(Sup3):S5–S13. doi: https://doi.org/10.12968/jowc.2018.27.Sup3.S5 Link, Google ScholarMilne J, Vowden P, Fumarola S, Leaper D. Postoperative incision management. 2012. https://tinyurl.com/y8ad3jff (accessed 18 July 2018) Google ScholarNational Institute for Health and Care Excellence. Surgical site infection. Prevention and treatment of surgical site infection. NICE guideline 74. 2008a. nice.org.uk/guidance/cg074 (accessed 18 July 2018) Google ScholarNational Institute for Health and Care Excellence. Hypothermia: prevention and management in adults having surgery. Updated December 2016. 2008b. nice.org.uk/guidance/cg65 (last accessed June 2018). Google ScholarNational Institute for Health and Care Excellence. Surgical site infection. Evidence update June 2013. 2013. https://tinyurl.com/y9mwsgqe (accessed 18 July 2018) Google ScholarLeaper DJ, Tanner J, Kiernan M et al.. Surgical site infection: poor compliance with guidelines and care bundles. Int Wound J. 2015 Jun; 12(3):357–362. doi: https://doi.org/10.1111/iwj.12243. Epub 2014 Feb 25 Crossref, Google ScholarPublic Health England. Monitoring surgical wounds for infection. Information for patients. 2013. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/526979/Monitoring_surgical_wounds_for_infection_Leaflet.pdf (accessed 18 July 2018) Google ScholarWorld Health Organisation. Global guidelines for the prevention of surgical site infection. 2016. http://www.who.int/gpsc/ssi-prevention-guidelines/en/ (accessed 18 July 2018) Google Scholar FiguresReferencesRelatedDetails 2 August 2018Volume 12Issue 8ISSN (print): 1753-1586ISSN (online): 2052-4420 Metrics History Published online 10 August 2018 Published in print 2 August 2018 Information© MA Healthcare LimitedPDF download

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

Background: The most common complication in the first 10 days after a cesarean section is surgical site infection (SSI), leading to poorer health outcomes, financial consequences, and maternal mortality. However, about 40 to 60% of such complications are preventable. Objectives: The present study aimed to examine the effect of a care bundle on the prevention of post-cesarean surgical site infection. Methods: This clinical trial was conducted on pregnant women undergoing cesarean section at Ali Ibne Abitalib Hospital, Zahedan, in the summer of 2022. A total of 60 full-term pregnant women who were candidates for cesarean section were selected using convenience sampling based on the inclusion criteria and were divided into two groups (each with 30 members) using random permuted blocks. The patients in the intervention group received preoperative, intraoperative, and postoperative care using an infection prevention care bundle, while the patients in the control group received routine care in the surgical department and operating room. The participants’ demographic, pregnancy, and surgical data were collected through interviews with the patients and by reviewing their medical files and were recorded in a checklist. The surgical incision was checked using the wound assessment checklist and the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) Scale, 24 hours after surgery and on the 10th and 30th days after surgery to confirm or reject wound infection. A score greater than 6 confirmed a surgical site infection. The data were analyzed with SPSS-21 software using independent samples t-test and chi-square test. The level of significance in this study was set at P &lt; 0.05. Results: The data in this study showed that the patients in the two groups did not have statistically significant differences in terms of demographic, pregnancy, and surgical variables, except for the history of infection (P &gt; 0.05). The mean REEDA scores for the patients in the intervention group 24 hours after surgery and on the 10th and 30th days after surgery were 2.52 ± 4.6, 1.3 ± 2.7, and 0, respectively. The corresponding values for the patients in the control group were 3.64 ± 5.26, 1.7 ± 3.07, and 0.08 ± 0.3, respectively. The independent samples t-test showed that the mean REEDA scores in the intervention and control groups 24 hours after surgery and on the 10th and 30th days after surgery did not have a statistically significant difference (P &gt; 0.05). Moreover, 2 patients (6.67%) in the intervention group and 5 patients (16.67%) in the control group showed signs and symptoms of SSI, but the chi-square test did not show a significant intergroup difference (P &gt; 0.05). Conclusions: The findings suggested that the care bundle was not effective in the prevention of cesarean wound infection, but we cannot deny the positive effects of care bundles on the prevention of surgical site infections. Thus, the components of the care bundle should be carefully examined, and any potential issues need to be more carefully analyzed in subsequent studies, especially intraoperative interventions that should be performed with extensive collaboration between surgical and operating room nurses and technicians.

How to Prevent Surgical Site Infection in Vascular Surgery: A Review of the Evidence

Perioperative Nurses: Key to Surgical Site Infection Prevention.

WHO Guidelines to prevent surgical site infections

Optimizing patient-centered, inclusive care in oncology: Healthcare professionals' knowledge, attitudes, and practices in caring for LGBTQ2+ individuals

A commentary on "Surgical site infection prevention through bundled interventions in hip replacement surgery: A systematic review" (Int J Surg 2021;95:106149)