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

English version

Autoři: Rossella Zucco ^aff001; Francesco Lavano ^aff001; Carmelo G. A. Nobile ^aff002; Rosa Papadopoli ^aff001; Aida Bianco ^aff001
Působiště autorů: Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy ^aff001; Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Cosenza, Italy ^aff002
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0222825

Souhrn

Background

The aims of the study were to assess the level of knowledge, the attitudes and the adherence to evidence-based recommendations for surgical site infection (SSI) prevention and to describe any influences that may motivate nurses to adopt evidence-based practices for SSI prevention.

Methods

The present study was a national cross-sectional survey conducted from June to November 2017. For each hospital that agreed to participate, 30 nurses were randomly selected. The questionnaire was aimed at exploring socio-demographic and practice characteristics, knowledge of, attitudes toward, and reported practices regarding evidence-based procedures for SSI prevention.

Results

Out of 55 hospitals that were contacted, 36 agreed to participate (a response rate of 65%). Of the original sample of 1313 nurses, a total of 1305 returned the questionnaire, a response rate of 99.4%. Regarding knowledge, only 53.8% knew that preoperative hair removal, if necessary, should take place shortly before surgery, and 28.9% of the sample did not know the right definition of “bundle”. Over three quarters of participants stated that they always perform hand antisepsis before and after biological sample collection while 9.7% considered that wearing gloves during this practice is sufficient to prevent SSI. Furthermore, 91% of nurses reported that they always performed hand antisepsis before and after invasive procedures.

Conclusion

The study findings highlight the areas that were most lacking in nurses’ training and for which targeted activities are needed. These data could support healthcare managers to implement interventions focused at enabling adherence to effective prevention practices to reduce risk to all patients.

Klíčová slova:

Nurses – Adhesives – Surgical and invasive medical procedures – Questionnaires – Italian people – Medical risk factors – Vascular surgery – Nosocomial infections

Zdroje

1. World Health Organization. Healthcare-associated infections: fact sheet, 2014. Available at: http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf. Accessed 12 February 2019.

2. Magill S, Hellinger W, Cohen J, Kay R, Bailey C, Boland B, et al. Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Florida. Infect Control Hosp Epidemiol. 2012;33:283–91. doi: 10.1086/664048 22314066

3. Graves EJ. National Hospital Discharge Survey. Vital Health Stat 13. 1989:1–60.

4. Agency for Healthcare Research and Quality.Healthcare Cost and Utilization Project—statistics on hospital stays.2013.http://hcupnet.ahrq.gov/. Accessed February 15, 2019.

5. European centre for disease prevention and control surveillance report: point prevalence survey of healthcare-associated infections and antimicrobial use in european hospitals 2011–2012. 2013 ECDC-Stockholm. Avaiable at: http://ecdc.europa.eu/en/publications/Publications/healthcare-associated-infections-antimicrobial-use-PPS.pdf. Accessed March 12, 2018.

6. O'Keeffe AB, Lawrence T, Bojanic S. Oxford craniotomy infections database: a cost analysis of craniotomy infection. Br J Neurosurg. 2012;26:265–9. doi: 10.3109/02688697.2011.626878 22081956

7. Broex EC, van Asselt AD, Bruggeman CA, van Tiel FH. Surgical site infections: how high are the costs? J Hosp Infect. 2009;72:193–201. doi: 10.1016/j.jhin.2009.03.020 19482375

8. Teillant A, Gandra S, Barter D, Morgan DJ, Laxminarayan R. Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modelling study. Lancet Infect Dis. 2015;15:1429–1437. doi: 10.1016/S1473-3099(15)00270-4 26482597

9. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs.Infect Control Hosp Epidemiol. 2011;32(2):101–114. doi: 10.1086/657912 21460463

10. Anderson DJ, Podgorny K, Berríos-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35:605–27. doi: 10.1086/676022 24799638

11. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017;152(8):784–791. doi: 10.1001/jamasurg.2017.0904 28467526

12. National institute for health and clinical excellence (NICE). Surgical site infection: Prevention and treatment of surgical site infection. London: NICE, 2008. http://www.nice.org.uk/nicemedia/pdf/CG74NICEGuideline.pdf. Accessed January 02, 2019.

13. Bratzler DW, Hunt DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis. 2006;43:322–30. doi: 10.1086/505220 16804848

14. Global guidelines on the prevention of surgical site infection. World Health Organization 2016. Avaible at: http://apps.who.int/iris/bitstream/10665/250680/1/9789241549882-eng.pdf. Accessed March12, 2019.

15. Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16:e276–e287. doi: 10.1016/S1473-3099(16)30398-X 27816413

16. Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16:e288–e303. doi: 10.1016/S1473-3099(16)30402-9 27816414

17. Leaper DJ, Tanner J, Kiernan M, Assadian O, Edmiston CE Jr, et al. Surgical site infection: poor compliance with guidelines and care bundles. Int Wound J. 2015;12:357–62. doi: 10.1111/iwj.12243 24612792

18. Labeau SO, Witdouck SS, Vandijck DM, Claes B, Rello J, Vandewoude KH, et al. Executive board of the flemish society for critical care nurses. Nurses' knowledge of evidence-based guidelines for the prevention of surgical site infection. Worldviews Evid Based Nurs. 2010;7:16–24. doi: 10.1111/j.1741-6787.2009.00177.x 19919658

19. Stata Corporation: Stata reference manual. Release 14. College Station TX; 2009.

20. Diener MK, Knebel P, Kieser M, Schüler P, Schiergens TS, Atanassov V, et al. Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: the randomised controlled PROUD trial. Lancet. 2014;384:142–52. doi: 10.1016/S0140-6736(14)60238-5 24718270

21. Thimour-Bergström L, Roman-Emanuel C, Scherstén H, Friberg Ö, Gudbjartsson T, Jeppsson A. Triclosan-coated sutures reduce surgical site infection after open vein harvesting in coronary artery bypass grafting patients: a randomized controlled trial. Eur J Cardiothorac Surg. 2013;44:931–8. doi: 10.1093/ejcts/ezt063 23435526

22. Justinger C, Slotta JE, Ningel S, Gräber S, Kollmar O, Schilling MK, et al. Surgical-site infection after abdominal wall closure with triclosan-impregnated polydioxanone sutures: results of a randomized clinical pathway facilitated trial (NCT00998907). Surgery. 2013;154:589–95. doi: 10.1016/j.surg.2013.04.011 23859304

23. Edmiston C, Daoud FC, Leaper D. Is there an evidence-based argument for embracing an antimicrobial (triclosan)-coated suture technology to reduce the risk for surgical-site infections?: A meta-analysis. Surgery. 2013;154:89–100. doi: 10.1016/j.surg.2013.03.008 23809487

24. Daoud FC, Edmiston CE Jr, Leaper D. Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: robustness to new evidence. Surg Infect (Larchmt). 2014;15:165–81. doi: 10.1089/sur.2013.177 24738988

25. Sessa A, Di Giuseppe G, Albano L, Angelillo IF; Collaborative Working Group. An investigation of nurses' knowledge, attitudes, and practices regarding disinfection procedures in Italy. BMC Infect Dis. 2011;11:148. doi: 10.1186/1471-2334-11-148 21612613

26. Bianco A, Bova F, Nobile CG, Pileggi C, Pavia M; Collaborative Working Group. Healthcare workers and prevention of hepatitis C virus transmission: exploring knowledge, attitudes and evidence-based practices in hemodialysis units in Italy. BMC Infect Dis. 2013;13:76. doi: 10.1186/1471-2334-13-76 23391009

27. Bianco A, Coscarelli P, Nobile CG, Pileggi C, Pavia M. The reduction of risk in central line-associated bloodstream infections: knowledge, attitudes, and evidence-based practices in health care workers. Clin Microbiol Infect. 2012;18:1212–8. doi: 10.1111/j.1469-0691.2011.03735.x

28. Turenne J, Héon M, Aita M, Faessler J, Doddridge C. Educational Intervention for an Evidence-Based Nursing Practice of Skin-to-Skin Contact at Birth. J Perinat Educ. 2016;25:116–28. doi: 10.1891/1058-1243.25.2.116 27445449

29. Owens P, McHugh S, Clarke-Moloney M, Healy D, Fitzpatrick F, McCormick P, et al. Improving surgical site infection prevention practices through a multifaceted educational intervention. Ir Med J. 2015;108:78–81. 25876299

30. WHO Guidelines on hand hygiene in Healthcare. First global patient safety challenge clean care is safer care. Avaiable at: https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf. Accessed February 21, 2019.

31. WHO Glove Use Information Leaflet. Avaiable at: https://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf. Accessed February 20, 2019.

32. Asadollahi M, Arshadi Bostanabad M, Jebraili M, Mahallei M, Seyyed Rasooli A, Abdolalipour M, et al. Nurses' knowledge regarding hand hygiene and its individual and organizational predictors. J Caring Sci. 2015;4:45–53. doi: 10.5681/jcs.2015.005 25821758

33. Giordano M, Squillace L, Pavia M. Appropriateness of Surgical Antibiotic Prophylaxis in Pediatric Patients in Italy. Infect Control Hosp Epidemiol. 2017;38:823–31. doi: 10.1017/ice.2017.79 28580893

34. Napolitano F, Izzo MT, Di Giuseppe G, Angelillo IF, Collaborative Working Group. Frequency of inappropriate medication prescription in hospitalized elderly patients in Italy. PLoS One. 2013;8:e82359. doi: 10.1371/journal.pone.0082359 24349262

35. Hughes JM. Study on the efficacy of nosocomial infection control (SENIC Project): results and implications for the future. Chemotherapy. 1988;34:553–61. doi: 10.1159/000238624 3243099

36. Bianco A, Capano MS, Mascaro V, Pileggi C, Pavia M. Prospective surveillance of healthcare-associated infections and patterns of antimicrobial resistance of pathogens in an Italian intensive care unit. Antimicrob Resist Infect Control. 2018;7:48. doi: 10.1186/s13756-018-0337-x 29636910