Public defence in Caring Science: Maria Qvistgaard
Title: Safeguarding from Surgical Site Infections: A mutual responsibility between the patient, caregiver and perioperative healthcare leaders.
Subject: Caring Science
Faculty: Faculty of Health and Life Sciences
Date: Friday December 10 2021 at 10.15 am
Place: Room N1008V (IKEA-salen), building N, Växjö
External reviewer: Docent Pelle Gustafson, Patientförsäkringen LÖF
Examining committee: Professor Gudrun Rudolfsson, University West
Docent Jan Fohlman, Region Kronoberg
Docent Lena Nordgren, Uppsala University
Chairperson: Professor Marie Oscarsson, Department of Health and Caring Sciences, Linnaeus University
Main supervisor: Docent Sofia Almerud Österberg, Department of Health and Caring Sciences, Linnaeus University
Examiner: Professor Marie Oscarsson, Department of Health and Caring Sciences, Linnaeus University
Spikning: Friday November 19 2021 at 10.00 am, The University Library, Växjö
Abstract
Maria Qvistgaard (2021) SAFEGUARDING FROM SURGICAL SITE INFECTIONS: A mutual responsibility between the patient, caregiver and perioperative healthcare leaders. Linnaeus University Dissertations no. Written in English with a summary in Swedish.
Aim: The overall aim of this thesis is to describe and explore preventive measures and risks for surgical site infections.
Methods: Study I, a registry based and observational design study, includes 35 056 cases analysed for risks for reoperation caused by periprosthetic joint infection after elective total hip arthroplasty. Data are analysed with Cox regression. Study II is a hypothesis testing study and uses an experimental design. Comparative statistics were used to compare contamination of agar plates after 15 hours for two conditions: single drape covering or double drape covering. Study III, an interview study that uses a reflective lifeworld research methodology, includes 15 operating room nurses who were interviewed regarding the phenomenon of intraoperative prevention of surgical site infections. Study IV, also an interview study, includes 14 orthopaedic patients who were interviewed regarding their experience with at-home preoperative skin disinfection. Data were analysed using manifest content analysis according to Graneheim and Lundman.
Results: Study I shows an increased risk of reoperation caused by periprosthetic joint infection after planned total hip arthroplasty for age, male sex, morbidity (ASA class III-IV), obesity, lateral approach to the hip, general anaesthesia, and prolonged operative time. Study II shows reduced contamination of agar plates after 15 hours storage with double drape covering compared to single drape covering. Study III shows that prevention of surgical site infections is a struggle against an invisible and delayed threat. Another key finding is the importance of operating room nurses legitimacy and collaboration within the operating team to prevent surgical site infections. Study IV describes the patients’ experiences with at-home preoperative skin disinfection. The result points out obstacles with the procedure and the importance of identifying those patients who are not suitable for self-care regarding this preventive measure.
Conclusion: Safeguarding from surgical site infections is a mutual responsibility of the patient, caregivers, and perioperative healthcare leaders. Therefore, this complex phenomenon is difficult to assess. Prevention of surgical site infections needs to be a collaborative effort involving patient, caregivers, and perioperative healthcare leaders. The high-risk care of performing surgery requires confident and safe professionals in each position. Well-functioning teamwork and collaboration are key factors for ensuring stability inside the operating room and providing conditions for safe care.
Keywords: Operating Room, Perioperative care, Prevention, Qualitative content analysis, Reflective lifeworld research, Surgical site infection, Operating Room nurse, Teamwork.