Intraoperative aseptic practices in orthopaedic operations
Pitko, Ninamari (2023)
Pitko, Ninamari
2023
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https://urn.fi/URN:NBN:fi:amk-2023060116874
https://urn.fi/URN:NBN:fi:amk-2023060116874
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The objectives of the research were to monitor the aseptic practices carried out by operating room nurses and doctors in orthopaedic operations focusing on aseptic behaviour and preparations of the personnel during sterile field establishment and maintenance phases of the surgeries, and to evaluate the practices carried out compared to existing international and national guidelines and evidence-based recommendations.
Previous study findings indicate that existing recommendations on aseptic and sterile technique are always not fully adhered to and that there are improvement areas in the aseptic practices of operating room personnel during surgery. The adherence to aseptic practices in intraoperative settings is essential within all team members to minimize and control microbes from contaminating the surgical field and its surroundings, but also to protect the personnel from being transmitted with antibiotic resistant microbes. Surgical site infections after orthopaedic operations where foreign body fixation materials are used have long-term effects and high costs. This study evaluated the actualized aseptic practices during sterile field establishment and maintenance phases in five operating room units within one organization in Finland. The study was implemented as a local small-scale observational clinical aseptic practice quality improvement study with statistical data analysis. The research aimed to compare the practices in action to existing evidence-based guidelines and recommendations using criteria-based evaluation. Data collection was done with the constructed tool in which foci of observation were divided to seven main themes: Availability of hand hygiene products, hand hygiene realisation, preparations of the patient, establishment of sterile field, preparations of sterile personnel, aseptic behaviour and maintenance of sterile field. A descriptive analysis of the research data was conducted using SPSS-software.
Results show high adherence to most evaluated categories, but also that there are areas of improvement in sterile field establishment and maintenance, and aseptic behaviour during surgery. The hand hygiene enabling products were properly available in 74.7% of observed operations and hand hygiene realisation of the team was 91% of operations. Timely antibiotic prophylaxis of 60 minutes before incision or tourniquet inflation was managed in 97.7% of operations. Establishment of sterile field was adherent in 89,5% of operations. Preparations of the sterile team members were highly adhered to: Sterile surgical attire was used according to guideline in all operations, and double gloves and protective eyewear were used adherently in 95.5% of operations. Aseptic behaviour during
surgery was adherent in most of the operations (90.7%), but it appeared that doors were often open during surgery: The average number of door openings during surgery was six. The number of door openings and joint replacement surgeries were noticed to have a statistically significant association. Surgery duration did not seem to have a statistically significant association with aseptic behaviour or sterile field maintenance, but an operation with a duration of more than 45 minutes was noticed to require more door openings than a surgery with shorter duration: The average number of door openings in longer operations was eight. Maintenance of sterile areas was adherent in 76.9% of all operations, where eye contact and visible distance to sterile fields were kept in 81.6% of operations when moving near sterile fields, and back was not turned to sterile areas by sterile team members in 69.4% of observed cases.
Aseptic practices are teamwork that are affected by actions of all individuals in the operating room. Previous research findings indicate that aseptic practice training and implementation of guidelines are considered insufficient by OR staff and lack of adherence was discovered in some observed criteria. Based on study results, to enable adequate infection control and prevention in intraoperative settings, implementation of regular multidisciplinary education, policy development and monitoring of aseptic practices were recommended.
Previous study findings indicate that existing recommendations on aseptic and sterile technique are always not fully adhered to and that there are improvement areas in the aseptic practices of operating room personnel during surgery. The adherence to aseptic practices in intraoperative settings is essential within all team members to minimize and control microbes from contaminating the surgical field and its surroundings, but also to protect the personnel from being transmitted with antibiotic resistant microbes. Surgical site infections after orthopaedic operations where foreign body fixation materials are used have long-term effects and high costs. This study evaluated the actualized aseptic practices during sterile field establishment and maintenance phases in five operating room units within one organization in Finland. The study was implemented as a local small-scale observational clinical aseptic practice quality improvement study with statistical data analysis. The research aimed to compare the practices in action to existing evidence-based guidelines and recommendations using criteria-based evaluation. Data collection was done with the constructed tool in which foci of observation were divided to seven main themes: Availability of hand hygiene products, hand hygiene realisation, preparations of the patient, establishment of sterile field, preparations of sterile personnel, aseptic behaviour and maintenance of sterile field. A descriptive analysis of the research data was conducted using SPSS-software.
Results show high adherence to most evaluated categories, but also that there are areas of improvement in sterile field establishment and maintenance, and aseptic behaviour during surgery. The hand hygiene enabling products were properly available in 74.7% of observed operations and hand hygiene realisation of the team was 91% of operations. Timely antibiotic prophylaxis of 60 minutes before incision or tourniquet inflation was managed in 97.7% of operations. Establishment of sterile field was adherent in 89,5% of operations. Preparations of the sterile team members were highly adhered to: Sterile surgical attire was used according to guideline in all operations, and double gloves and protective eyewear were used adherently in 95.5% of operations. Aseptic behaviour during
surgery was adherent in most of the operations (90.7%), but it appeared that doors were often open during surgery: The average number of door openings during surgery was six. The number of door openings and joint replacement surgeries were noticed to have a statistically significant association. Surgery duration did not seem to have a statistically significant association with aseptic behaviour or sterile field maintenance, but an operation with a duration of more than 45 minutes was noticed to require more door openings than a surgery with shorter duration: The average number of door openings in longer operations was eight. Maintenance of sterile areas was adherent in 76.9% of all operations, where eye contact and visible distance to sterile fields were kept in 81.6% of operations when moving near sterile fields, and back was not turned to sterile areas by sterile team members in 69.4% of observed cases.
Aseptic practices are teamwork that are affected by actions of all individuals in the operating room. Previous research findings indicate that aseptic practice training and implementation of guidelines are considered insufficient by OR staff and lack of adherence was discovered in some observed criteria. Based on study results, to enable adequate infection control and prevention in intraoperative settings, implementation of regular multidisciplinary education, policy development and monitoring of aseptic practices were recommended.