On skin preparation : The Operating Room Nurse Perspective

Background: Surgical site infections (SSIs) present severe risks to patients undergoing surgery, causing suffering, health complications, and financial burdens to society. Orthopaedic patients, especially those undergoing joint procedures, are particularly vulnerable to SSIs due to the use of implants. Preventing SSIs involves collaborative efforts among healthcare teams and includes skin preparation to reduce bacterial colonisation. Effective and patient-safe skin preparation is an important part of the preventive work. Internationally, there are variations in the responsibility for infection control and skin preparation in the operating room (OR). Swedish OR nurses are uniquely educated in infection prevention and hold responsibility for the prevention of SSIs during the perioperative phase. For patient safety it is important to investigate skin preparation from the perspective of OR nurses. This thesis investigate and compares skin preparation practices used by OR nurses from various perspectives, which may identify vulnerabilities in practices and contribute to enhanced patient safety. Â Aim: The overall aim of this thesis was to investigate and compare skin preparation practices as performed by OR nurses to decrease bacterial colonisation and prevent SSIs. Â Â Methods: Four studies with varying designs were conducted. A cross-sectional survey investigated the prevalence, utilization patterns and knowledge of different skin preparation methods. A focus group study, guided by Kreuger & Casey's principles, explored skin preparation practices from the perspective of OR nurses. An integrative review synthesized existing research on SSI prevention prerequisites as seen by OR nurses. Finally, a randomized controlled study compared the efficacy of two skin preparation methods for cleaning and disinfecting around sutured wounds. Â Results: The main findings of this thesis address skin preparation in the perioperative phase at both fundamental and operational levels. On the operational level, the results reveal ...