Safeguarding from surgical site infections : A mutual responsibility between the patient, caregiver and the perioperative healthcare leaders

Abstract: Aim: The overall aim of this thesis is to describe and explore preventive measuresand risks for surgical site infections.Methods: Study I, a registry based and observational design study, includes 35 056cases analysed for risks for reoperation caused by periprosthetic joint infection afterelective total hip arthroplasty. Data are analysed with Cox regression. Study II is ahypothesis testing study and uses an experimental design. Comparative statisticswere used to compare contamination of agar plates after 15 hours for twoconditions: single drape covering or double drape covering. Study III, an interviewstudy that uses a reflective lifeworld research methodology, includes 15 operatingroom nurses who were interviewed regarding the phenomenon of intraoperativeprevention of surgical site infections. Study IV, also an interview study, includes 14orthopaedic patients who were interviewed regarding their experience with at-homepreoperative skin disinfection. Data were analysed using manifest content analysisaccording to Graneheim and Lundman.Results: Study I shows an increased risk of reoperation caused by periprostheticjoint infection after planned total hip arthroplasty for age, male sex, morbidity (ASAclass III-IV), obesity, lateral approach to the hip, general anaesthesia, and prolongedoperative time. Study II shows reduced contamination of agar plates after 15 hoursstorage with double drape covering compared to single drape covering. Study IIIshows that prevention of surgical site infections is a struggle against an invisible anddelayed threat. Another key finding is the importance of operating room nurseslegitimacy and collaboration within the operating team to prevent surgical siteinfections. Study IV describes the patients’ experiences with at-home preoperativeskin disinfection. The result points out obstacles with the procedure and theimportance of identifying those patients who are not suitable for self-care regardingthis preventive measureConclusion: Safeguarding from surgical site infections is a mutual responsibility ofthe patient, caregivers, and perioperative healthcare leaders. Therefore, this complexphenomenon is difficult to assess. Prevention of surgical site infections needs to bea collaborative effort involving patient, caregivers, and perioperative healthcareleaders. The high-risk care of performing surgery requires confident and safeprofessionals in each position. Well-functioning teamwork and collaboration arekey factors for ensuring stability inside the operating room and providing conditionsfor safe care.