Patients In Surgical Wards Research Articles

Interprofessional collaboration between nurses and doctors for treating patients in surgical wards

ABSTRACT Interprofessional collaboration will be one of the main factors in the effort to increase patient safety in the coming years. Research has identified several challenges to interprofessional collaboration between nurses and doctors, where fragmentation of both education and clinical practice contributes to a strong affiliation to one’s own profession with little emphasis on collaboration. The aim of this study was to generate more knowledge about how nurses and doctors experience interprofessional collaboration in observation and treatment of patients on a surgical ward. The study was conducted in 2018 and used an explorative qualitative design that was based on four semi-structured focus group interviews. The respondents were 11 nurses and seven doctors with experience from different surgical specialties and employed in three different surgical wards in a Norwegian hospital. The data were analyzed using systematic text-condensation. The following three main categories, each with two subcategories, emerged: 1) Organization and culture: a lack of interprofessional meeting places and experience-based hierarchy; 2) Communication: use of communication tools and little room for professional discussions; and 3) Trust and respect: dependence and recognition and a blurred distribution of responsibility. Both nurses and doctors wished for closer interprofessional collaboration in observation and treatment in the surgical ward; however, organizational limitations with few interprofessional meeting places and time pressure made this difficult.

Knowledge, Attitude and Practice of Hepatitis B among Informal Caregivers at Ndola Teaching Hospital

Introduction: Hepatitis B is a highly contagious infection. It is 50 to 100 times more infectious than HIV. It is the world’s most common liver infection, which is caused by a DNA-virus, the hepatitis B virus and is transmitted between people through blood, semen, vaginal fluids and mucous membranes. Basic knowledge about hepatitis B is necessary; with more knowledge people take preventive actions against hepatitis B, such as using stick proof cannulas. The general objective of this study was to assess the knowledge, attitude and practice of HBV infection among informal caregivers at Ndola Teaching Hospital, Ndola, Zambia. Method: A Cross sectional study was carried out at Ndola Teaching Hospital from June 2020 to September 2020. Systematic random sampling was used using questionnaire based interviews to consenting informal caregivers above the age of 18 years who were waiting for their patients in Gynecological ward, surgical wards and internal medicine wards. Results: A total number of 165 informal caregivers at Ndola Teaching Hospital were interviewed using a pretested questionnaire. The highest age group (44.2%) interviewed was between 25 to 34 years of age. The majority of informal caregivers (52.1%) went up to secondary education level and 63.0% of the informal caregivers were females. Most informal caregivers (53.3%) only had an average knowledge about hepatitis B infection. Informal caregiver’s education level was directly associated with the level of knowledge about Hepatitis B (p-value<0.001). Majority (87.3%) of the informal caregivers had good attitude towards hepatitis B. There was a direct association (p value <0.001) between informal caregiver’s knowledge on hepatitis B with their attitude. All the informal caregivers (100%) had bad practices on Hepatitis B and majority of the respondents 159 (96.4%) were not vaccinated only 6 (3.6%) were vaccinated against HBV. Conclusion: Hepatitis B is a major health problem globally casting an enormous burden on the health-care system a major source of patient’s misery. This illness or disease is preventable. In this study, the majority of the participants had good attitudes making knowledge as the main determinant of their practices. Therefore, primary prevention approach be taken by extensively and frequently teaching all informal care givers in all hospitals and clinics on how to protect themselves from the disease. Pictorial Posters depicting the proper way of handling patients by informal caregivers be displayed in health centers (wards and OPDs).

Bacterial isolates and their antibiotic sensitivity pattern of surgical site infections among the surgical ward patients of Asella Referral and Teaching Hospital

BackgroundSurgical site infection (SSI) is the most typical problem for patients who undergo operative procedures. It remains a typical and widespread problem causing morbidity and mortality, partly related to a rise in infections due to antimicrobial-resistant bacterial pathogens. The study was purposed to evaluate the bacterial isolates and their drug susceptibility patterns in patients with postoperative surgical site infection.ResultsThe rate of postoperative surgical site infections was studied at Asella Referral and Teaching Hospital and found to be 23.3%. One hundred fifty specimens of pus and surface swabs were collected from the surgical site-infected patients over the period of March 2016 to May 2017, and from that, a total of 147 bacterial pathogens were recovered. The predominant organisms associated with postoperative surgical site infections were Klebsiella species 38 (26%, n=147), Escherichia coli 31 (21%, n=147), Staphylococcus aureus 25 (17%, n=147), and Pseudomonas aeruginosa 18 (12%, n=147).ConclusionHigher number of bacterial isolates were recovered. The predominant isolates were Klebsiella species, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa. The majority of gram-negative bacterial species which were isolated were found to be resistant to the commonly prescribed antimicrobial agents in the study setting. Thus, to achieve effective therapy for wound infections and to reduce/stop the appearance of multidrug-resistant (MDR) pathogens, continuous monitoring is essential with the fair use of antimicrobial agents.

Adaptive threshold-based alarm strategies for continuous vital signs monitoring

Continuous vital signs monitoring in post-surgical ward patients may support early detection of clinical deterioration, but novel alarm approaches are required to ensure timely notification of abnormalities and prevent alarm-fatigue. The current study explored the performance of classical and various adaptive threshold-based alarm strategies to warn for vital sign abnormalities observed during development of an adverse event. A classical threshold-based alarm strategy used for continuous vital signs monitoring in surgical ward patients was evaluated retrospectively. Next, (combinations of) six methods to adapt alarm thresholds to personal or situational factors were simulated in the same dataset. Alarm performance was assessed using the overall alarm rate and sensitivity to detect adverse events. Using a wireless patch-based monitoring system, 3999 h of vital signs data was obtained in 39 patients. The clinically used classical alarm system produced 0.49 alarms/patient/day, and alarms were generated for 11 out of 18 observed adverse events. Each of the tested adaptive strategies either increased sensitivity to detect adverse events or reduced overall alarm rate. Combining specific strategies improved overall performance most and resulted in earlier presentation of alarms in case of adverse events. Strategies that adapt vital sign alarm thresholds to personal or situational factors may improve early detection of adverse events or reduce alarm rates as compared to classical alarm strategies. Accordingly, further investigation of the potential of adaptive alarms for continuous vital signs monitoring in ward patients is warranted.

Prevalence and Associated Factors of Depression among Admitted Adult Patients in Surgical and Medical Wards of Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.

Background Depression is a leading cause of major public health problems globally, and its prevalence has been increasing, particularly in low- and middle-income countries including our country. Therefore, this study is aimed at exploring depression symptoms and their determinants among admitted medical and surgical patients which is important to get optimal care for patients. Methods An institution-based cross-sectional study was conducted from May to June 2019, on adults' medical and surgical admitted patients at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. The systematic random sampling technique was used to get a total of 590 samples. The standardized hospital anxiety and depression scale (HADS) was used to assess individual depression symptoms. We computed the bivariate and multivariate binary logistic regression analyses to identify factors associated with depression symptoms. Statistical significance was declared at P < 0.05. Result The prevalence of depression symptoms was found to be 53.9% (95% CI: 50.2, 57.0). In the multivariable logistic regression, female sex (AOR = 2.04, 95% CI: 1.35, 3.09), being single (AOR = 3.65, 95% CI: 3.48, 2.10, 5.78), widowed (AOR = 2.82, 95% CI: 1.27, 6.30), unable to read and write (AOR = 2.71, 95% CI: 1.14, 6.47), admission at medical ward (AOR = 1.59, 95% CI: 1.02, 2.46), history of mental illness (AOR = 1.59, 95% CI: 1.02, 2.46), and poor social support (AOR = 2.82, 95% CI: 1.57, 5.11) were factors significantly associated with depression symptoms. Conclusion The prevalence of depression symptoms among admitted patients was high. Female sex, being single, widowed, unable to read and write, admission at medical ward, history of mental illness, and poor social support were factors significantly associated with depression symptoms. It is better for the Ministry of Health to give training on how to screen depression among medical and surgical patients, and interventions that would be addressing the awareness of the above factors would be beneficial to prevent further complications.

Evaluation of medication errors in pediatric patients using antibiotics.

Medication errors are frequently seen in pediatric patients. Medication error studies on pediatric cases were found to not only be limited but also the collaboration of clinical pharmacists and physicians on this topic was not published in Turkey. This study aimed to identify drug-related problems, especially in antibiotics. This study was a point prevalence study with pediatric inpatients that used at least one antibiotic at a pediatric tertiary care reference hospital on November 16, 2016. Medications of patients were evaluated by clinical pharmacists in terms of drug-related problems and by physicians in terms of correct indications. Eighty-nine hospitalized patients were using antibiotics at the time of the study. The median age was 42 months (range: 1-226 months), and 49 (55.1%) of the patients were male. Clinical pharmacists detected a total of 210 potential drug-drug interactions in 46 (51.7%) patients. Approximately 48.5% of the patients in pediatric wards and 52.4% of the patients in surgical wards had at least one potential drug-drug interaction. A total of 39 medication errors were identified in 36 patients` drug orders. Most of the errors (51.3%) were due to dosing and administration time errors (35.9%). The number of errors per patient in surgical services was higher (0.47) than the pediatric services (0.42). Forty-three percent of errors were antimicrobial-related, and 70.5% of them were classified as dosing errors. Evaluation of patients` drug usage by a clinical pharmacist in terms of drug-related problems such as drug interactions, side effects and prescribing errors leads to better pharmaceutical care.

Assessing Knowledge, Attitudes and Practices Towards COVID-19 Public Health Preventive Measures Among Patients at Mulago National Referral Hospital.

BackgroundCOVID-19 has become a major global health challenge, with Uganda reporting over 20,000 cases. There is, however, a scarcity of data on the perception of patients in Uganda towards the highly infectious disease. We aimed to assess the awareness, knowledge, attitudes, and practices towards COVID-19 preventive measures among patients at Mulago National Referral Hospital (MNRH), Uganda.MethodsA cross-sectional quantitative survey was conducted in August, 2020, among patients in surgical and medical wards at MNRH. An interviewer-administered, pre-validated questionnaire was used to collect data that was entered into Google Forms and analyzed using Microsoft Excel and STATA 16. Descriptive statistics was used to present data from univariate analysis. Patients whose knowledge and practice scores were greater or equal to the average score were regarded to have good knowledge and practices respectively. Chi-square, Fisher’s Exact tests and binary logistic regression were used to assess factors associated with COVID-19 knowledge and practices. A P<0.05 was statistically significant.ResultsOverall, 114 patients were approached and 102 consented to participate. Most were females (53.8%), aged above 45 years (31.4%) with 40.2% reporting primary level as the highest level of education. About 55.9% (n=57) had adequate knowledge for COVID-19 and its related practices, and 52% (n=53) had good COVID-19 related practices. Knowledge significantly differed by marital status at bivariate analysis (P=0.020), however this lost significance at logistic regression. Female patients were thrice more likely to have good COVID-19 prevention practices compared to males (COR: 2.59, 95% CI: 1.2 to 5.8, P=0.020). Some 47 (46.1%) participants perceived that COVID-19 preventive measures were not difficult at all to observe.ConclusionAbout half of the patients at Mulago National Referral Hospital lack adequate knowledge and practice on COVID-19 prevention. Continued patient education is required to increase knowledge which will in turn improve adherence to COVID-19 preventive practices.

Evaluation of a wearable wireless device with artificial intelligence, iThermonitor WT705, for continuous temperature monitoring for patients in surgical wards: a prospective comparative study

ObjectivesTo evaluate a new-generation, non-invasive, wireless axillary thermometer with artificial intelligence, iThermonitor (WT705, Raiing Medical, Beijing, China), and to ascertain its feasibility for perioperative continuous body temperature monitoring in surgical...

Predictors of In-Hospital Mortality in Surgical Wards: A Multivariable Retrospective Cohort Analysis of 2,800,069 Hospitalizations

BackgroundIdentifying prognostic factors that are predictive of in-hospital mortality for patients in surgical units may help in identifying high-risk patients and developing an approach to reduce mortality. This study analyzed mortality predictors based on outcomes obtained from a national database of adult patients.Materials and methodsThis retrospective study design collected data obtained from the National Health Fund in Poland comprised of 2,800,069 hospitalizations of adult patients in surgical wards during one calendar year. Predictors of mortality which were analyzed included: the patient’s gender and age, diagnosis-related group category assigned to the hospitalization, length of the hospitalization, hospital type, admission type, and day of admission.ResultsThe overall mortality rate was 0.8%, and the highest rate was seen in trauma admissions (24.5%). There was an exponential growth in mortality with respect to the patient’s age, and male gender was associated with a higher risk of death. Compared to elective admissions, the mortality was 6.9-fold and 15.69-fold greater for urgent and emergency admissions (p < 0.0001), respectively. Weekend or bank holiday admissions were associated with a higher risk of death than working day admissions. The “weekend” effect appears to begin on Friday. The highest mortality was observed in less than 1 day emergency cases and with a hospital stay longer than 61 days in any type of admission.ConclusionAge, male gender, emergency admission, and admission on the weekend or a bank holiday are factors associated with greater mortality in surgical units.

Exploring rural patients' understanding of the types, risk factors and measures to prevent healthcare-associated infections in Australia.

In Australia, there are approximately 165,000 healthcare-associated infections (HAIs) per year. Improving patient knowledge on HAIs and actively involving them in infection prevention is essential. This study assessed patient knowledge on types of and risk factors for HAIs and their perceptions of HAI information provision and hospital infection control practices in rural New South Wales, Australia. Medical and surgical ward patients in three rural hospitals completed a questionnaire between February and March 2019. Open ended responses were grouped under categories, decided upon by two researchers, one of which is an infection prevention and control nurse. Descriptive analysis was completed. A total of 153 patients completed the survey. Most (n=126, 82%) participants were previously aware of HAIs, with common sources of education/information being family/friends (n=55, 36%), television (n=28, 18%), newspapers (n=27, 18%), and previous experience of a HAI (n=20, 13%). Satisfaction with infection control measures and hospital cleanliness was high. Over half (n=83, 54%) of participants thought they received too little information on HAIs, and only 35% (n=21) of those that had surgery reported receiving information. Participants suggested that more education for the general public (n=117, 76%) and patients (n=110, 72%) in both written form and verbally from hospital staff, and education outside of the hospital in various mediums, could help reduce the risk and rates of HAI. Awareness of HAIs amongst respondents was high, however, education appeared to be lacking. More can be done to inform patient, family and general public education programs in rural and regional Australian hospitals.

Multinodular goitre: a clinicopathological study from Kerala

Background: Multinodular goiter (MNG) occurs due to repeated hyperstimulation of thyroid gland due to iodine deficiency, goitrogens, antithyroid drugs and genetic defects. MNG can have different complications which include treacheal compression, retrosternal extension, malignancy and secondary thyrotoxicosis. The aim of the work was to study the clinical features and histopathology of MN in patients admitted for thyroidectomy in surgical wards of a tertiary care hospital in north Kerala.Methods: A prospective hospital based observational study in the patients in surgical wards of a tertiary care hospital in north Kerala from April 2011 to March 2012. The clinical data of patients who are subjected to thyroidectomy for MNG (clinical and fine needle aspiration cytology diagnosis) were included in this study. Patients undergoing completion thyroidectomy for recurrence or malignancy were excluded from this study.Results: MNG is more common in females. Female to male ratio 24:1 Majority are in the age group of 30-50 years (64%) with a mean age of 41 years. 38% (38 cases) had pressure symptoms in the form of dysphagia or dyspnea. Secondary thyrotoxicosis seen in 17% (17 cases). Fine needle aspiration cytology (FNAC) is not an error-proof investigation in MNG. 14 % of our patients had malignancy inspite of being reported as benign in FNAC. Among the malignancies papillary carcinoma thyroid was found to be most common accounting for 12% of cases (12/100) followed by follicular carcinoma.Conclusions: FNAC is not an error proof investigation in MNG. Incidental thyroid cancer in MNG is about 14 % with papillary carcinoma thyroid being the commonest.

Clinical deterioration and hospital‐acquired complications in adult patients with isolation precautions for infection control: A systematic review

To review and synthesize literature examining clinical deterioration and hospital-acquired complications in adult patients with isolation precautions for infection control. Isolation precautions are a common infection prevention and control strategy which may have impact on safety and quality of care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines guided this systematic review, which was registered with PROSPERO [CRD42019131573]. A search of Medline, Embase, and Cumulative Index to Nursing and Allied Health Literature was conducted for studies published in English up to 5 April 2019. Risk of bias was determined using Critical Appraisal Skills Program tools. Quality appraisal was performed using the Grades of Recommendation, Assessment, Development, and Evaluation approach. The primary outcomes of interest were clinical deterioration events and hospital-acquired complications. In-hospital death and hospital length of stay were secondary outcomes. Data were synthesized using a narrative approach. The search yielded 785 citations after removal of duplicates, of which, six studies were relevant. Certainty of evidence for outcomes of interest was low to very low. There is no strong evidence that adult medical and surgical ward patients in isolation precautions for infection control are more or less likely to experience clinical deterioration or hospital-acquired complications. What problem did the study address? Are patients in isolation precautions more likely to experience clinical deterioration or hospital-acquired complications than non-isolated patients? What were the main findings? There is no strong evidence that clinical deterioration and hospital-acquired complications are more likely to occur to patients in isolation precautions for infection control. This research is of relevance to acute care nurses.

Effectiveness of a daytime rapid response system in hospitalized surgical ward patients.

BackgroundClinical deteriorations during hospitalization are often preventable with a rapid response system (RRS). We aimed to investigate the effectiveness of a daytime RRS for surgical hospitalized patients.MethodsA retrospective cohort study was conducted in 20 general surgical wards at a 1,779-bed University hospital from August 2013 to July 2017 (August 2013 to July 2015, pre-RRS-period; August 2015 to July 2017, post-RRS-period). The primary outcome was incidence of cardiopulmonary arrest (CPA) when the RRS was operating. The secondary outcomes were the incidence of total and preventable cardiopulmonary arrest, in-hospital mortality, the percentage of “do not resuscitate” orders, and the survival of discharged CPA patients.ResultsThe relative risk (RR) of CPA per 1,000 admissions during RRS operational hours (weekdays from 7 AM to 7 PM) in the post-RRS-period compared to the pre-RRS-period was 0.53 (95% confidence interval [CI], 0.25 to 1.13; P=0.099) and the RR of total CPA regardless of RRS operating hours was 0.76 (95% CI, 0.46 to 1.28; P=0.301). The preventable CPA after RRS implementation was significantly lower than that before RRS implementation (RR, 0.31; 95% CI, 0.11 to 0.88; P=0.028). There were no statistical differences in in-hospital mortality and the survival rate of patients with in-hospital cardiac arrest. Do-not-resuscitate decisions significantly increased during after RRS implementation periods compared to pre-RRS periods (RR, 1.91; 95% CI, 1.40 to 2.59; P<0.001).ConclusionsThe day-time implementation of the RRS did not significantly reduce the rate of CPA whereas the system effectively reduced the rate of preventable CPA during periods when the system was operating.

Contribution of intravenous medication to water and sodium intake in upper and lower gastrointestinal surgical patients.

The quantitative importance of prescribed intravenous (IV) medication to water and sodium intake in routine clinical practice is undocumented, with uncertain influence on clinical outcomes. The present study aimed to redress this issue in surgical patients with gastrointestinal problems. The prescription and administration of IV medication and fluids were retrospectively reviewed for water and sodium over 24-h periods in 86 patients in upper and lower gastrointestinal surgical wards in two teaching hospitals. Changes over 5 y were assessed in the same two wards using the same methodology. Among 90.7% of patients prescribed IV medication, the median intake was 272 mL water/d (range, 40-2687 mL water/d) and 27 mmol sodium/d (range, 2-420 mmol sodium/d), with no significant difference between hospitals or ward type. In 28.2% of patients receiving any infusates, the only source of water and sodium was IV medication, and in 14.3% of patients, the medication provided more sodium than other infusates. Antibiotic agents and paracetamol accounted for 58.3% of water and 52.3% of sodium in IV medication. Historic data of IV medicine-related water and sodium intake did not differ significantly from current data. The literature suggests that clinical outcomes can be modulated by variations in water and sodium intake well within the range provided by IV medication. IV medicine prescriptions, particularly antibiotic agents and paracetamol, can make substantial and clinically relevant contributions to daily water and sodium intake. These contributions have persisted over time and should be considered during routine assessments of fluid balance and interventions aiming to improve clinical outcomes.

Clinical Effectiveness of the Elder-Friendly Approaches to the Surgical Environment Initiative in Emergency General Surgery

Older adults, especially those with frailty, have a higher risk for complications and death after emergency surgery. Acute Care for the Elderly models have been successful in medical wards, but little evidence is available for patients in surgical wards. To develop and assess the effect of an Elder-Friendly Approaches to the Surgical Environment (EASE) model in an emergency surgical setting. This prospective, nonrandomized, controlled before-and-after study included patients 65 years or older who presented to the emergency general surgery service of 2 tertiary care hospitals in Alberta, Canada. Transfers from other medical services, patients undergoing elective surgery or with trauma, and nursing home residents were excluded. Of 6795 patients screened, a total of 684 (544 in the nonintervention group and 140 in the intervention group) were included. Data were collected from April 14, 2014, to March 28, 2017, and analyzed from November 16, 2018, through May 30, 2019. Integration of a geriatric assessment team, optimization of evidence-based elder-friendly practices, promotion of patient-oriented rehabilitation, and early discharge planning. Proportion of participants experiencing a major complication or death (composite) in the hospital, Comprehensive Complication Index, length of hospital stay, and proportion of participants who required an alternative level of care on discharge. Covariate-adjusted, within-site change scores were computed, and the overall between-site, preintervention-postintervention difference-in-differences (DID) were analyzed. A total of 684 patients were included in the analysis (mean [SD] age, 76.0 [7.6] years; 327 women [47.8%] and 357 men [52.2%]), of whom 139 (20.3%) were frail. At the intervention site, in-hospital major complications or death decreased by 19% (51 of 153 [33.3%] vs 19 of 140 [13.6%]; P < .001; DID P = .06), and mean (SE) Comprehensive Complication Index decreased by 12.2 (2.5) points (P < .001; DID P < .001). Median length of stay decreased by 3 days (10 [interquartile range (IQR), 6-17] days to 7 [IQR, 5-14] days; P = .001; DID P = .61), and fewer patients required an alternative level of care at discharge (61 of 153 [39.9%] vs 29 of 140 [20.7%]; P < .001; DID P = .11). To our knowledge, this is the first study to examine clinical outcomes associated with a novel elder-friendly surgical care delivery redesign. The findings suggest the clinical effectiveness of such an approach by reducing major complications or death, decreasing hospital stays, and returning patients to their home residence. ClinicalTrials.gov Identifier: NCT02233153.

&lt;p&gt;Serum Concentration of Vancomycin Is a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Septic Patients in Clinical and Surgical Wards&lt;/p&gt;

Introduction and AimThere have been few studies to evaluate the monitoring of plasmatic concentrations of vancomycin in septic patients and their association with acute kidney injury (AKI) and death. This study aimed to evaluate the prevalence of adequate, subtherapeutic, and toxic serum concentrations of vancomycin in hospitalized septic patients and to associate the adequacy of therapeutic monitoring with clinical outcomes.MethodologyThis was a cohort-unicentric study that evaluated septic patients aged >18 years using vancomycin admitted to clinical and surgical wards of a Brazilian university center from August 2016 to July 2017 in a daily and uninterrupted way. We excluded patients with AKI prior to the introduction of vancomycin or with AKI development <48 hours after use, patients with AKI of other etiologies, stage V chronic kidney disease, and pregnant women.ResultsWe evaluated 225 patients, and 135 were included. Evaluation of serum concentration of vancomycin was realized in 94.1%, and of those, 59.3% presented toxic concentrations. The prevalence of AKI was 27.4% and happened on average on the ninth day of vancomycin usage. Between the fourth and sixth days, vancomycin serum concentration of >21.5 mg/L was a predictor of AKI, with area under the curve of 0.803 (95% CI 0.62–0.98, p=0.005), preceding the diagnosis of AKI by at least 3 days. Of these patients, 20.7% died, and serum concentrations of vancomycin between the fourth and sixth days were identified as risk factors associated with negative outcomes.ConclusionSerum concentration of vancomycin is an excellent predictor of AKI in patients admitted to wards, preceding the diagnosis of AKI by at least 72 hours. Toxic concentrations of vancomycin are associated with AKI, and AKI was a risk factor for death. Also, serum concentration of vancomycin >21.5 mg/L was the only variable associated with death in the Cox model.

Proper use of surgical antibiotic prophylaxis for prevention of surgical site infections: Pre-operative timing and duration of prophylaxis

Background: Surgical site infection (SSI) is an infection that occurs at or near a surgical incision within 30 days of surgery or within 1 year if an implant is left in place. They are the most common nosocomial infections in surgical patients, accounting for approximately 500,000 infections annually. The cost of care for patients with SSIs is nearly three-fold higher than that for surgical patients without the infections. Aim and Objective: The main objectives for conducting current study are to know incidence of SSI, to check proper use of surgical antibiotic prophylaxis and prepare data for health-care improvement. Materials and Methods: The study was observational, prospective in nature and conducted after getting institutional ethical clearance. All post-operative patients in surgical wards that fulfill the inclusion criteria were included in the study over the period of 2 months. Data were collected in questionnaire Google forms by both direct interview and referring indoor files. Result: Total 198 patients were included and evaluated. Total six patients were not given any antibiotic. Incidence of SSI was 7.57% in total 198 patients. Most of the cases were from general surgery, followed by orthopedic, gynecology, and obstetrics. Total 124 patients were given antibiotics for

Prevalence of ICU and surgical ward patients with systemic inflammatory response syndrome in Alhada Armed Forces Hospital, Taif, Saudi Arabia

Prevalence of ICU and surgical ward patients with systemic inflammatory response syndrome in Alhada Armed Forces Hospital, Taif, Saudi Arabia

Qualitative research of working experience in the management mode of distributed daytime surgery nurse

Objective To briefly describe the work experience of nurses under the decentralized day Operation management mode, and explore Improvement Strategies, so as to provide reference for the better construction of day surgical nursing team. Methods Using phenomenological qualitative research method, Semi-structured interviews were conducted with 15 nurses, and the interview data were analyzed by using Colaizzi′s 7-Step analysis method. Results After analysis, the theme: the development of decentralized day surgery management mode has certain necessity, there are various kinds of diseases, complicated medical advice, strong fluidity, the characteristics of emotional agitation, nurses are faced with the lack of professional knowledge, poor health education, medical care and doctor-patient communication errors, gap between nurses′ performance expectation and actual existence, and bed vacancy increases the psychological burden of nurses. Conclusions Optimize the process and management system for patients in day surgical wards, ensure smooth communication between doctors, patients and nurses, pay attention to the mental health of nurses and patients, improve the nurse pay management system, and improve nurse training and education system. These can effectively help decentralized day surgical ward nurses to carry out their work better. Key words: Nurses; Dispersion type; Day surgery management; Work experience; Qualitative research

Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients

Failure to rescue causes significant morbidity and mortality in the surgical population. Human error is often the underlying cause of failure to rescue. Human error can be reduced by the use of cognitive aids. To test the effectiveness of cognitive aids on adherence to best practice in the management of deteriorating postoperative surgical ward patients. Randomized clinical trial in a simulation setting. Surgical teams consisted of 1 surgeon and 2 nurses from a surgical ward from 4 different hospitals in Amsterdam, the Netherlands. Data were analyzed between February 2, 2017, and December 18, 2018. The teams were randomized to manage 3 simulated deteriorating patient scenarios with or without the use of cognitive aids. The primary outcome of the study was failure to adhere to best practice, expressed as the percentage of omitted critical management steps. The secondary outcome of the study was the perceived usability of the cognitive aids. Of the total participants, 93 were women and 51 were men. Twenty-five surgical teams performed 75 patient scenarios with cognitive aids, and 25 teams performed 75 patient scenarios without cognitive aids. Using the cognitive aids resulted in a reduction of omitted critical management steps from 33% to 10%, which is a 70% (P < .001) reduction. This effect remained significant (odds ratio, 0.63; 95% CI, -0.228 to -0.061; P = .001) in a multivariate analysis. Overall usability (scale of 0-10) of the cognitive aids was scored at a median of 8.7 (interquartile range, 8-9). Failure to comply with best practice management of postoperative complications is associated with worse outcomes. In this simulation study, adherence to best practice in the management of postoperative complications improves significantly by the use of cognitive aids. Cognitive aids for deteriorating surgical patients therefore have the potential to reduce failure to rescue and improve patient outcome. ClinicalTrials.gov identifier: NCT03812861.