Preventing surgical site infection using operating room bundle of care in patients undergoing elective exploratory laparotomy cholecystectomy surgery

Objective:Surgical procedures manifest immense risks to patients.One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection(SSI).Although several effor ts are being under taken to determine the proper means to reduce such complications,there is still a high incidence of SSI worldwide.Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site.This study tested the effectiveness of an operating room(OR)bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery.Methods:A quasi-experimental pretest and posttest design was utilized to determine its effectiveness.The study was composed of 60 par ticipants divided into two groups:30 subjects were selected to receive the OR bundle of care,while the other 30 subjects received the usual care.The groupings were determined through a systematic random sampling technique.The OR bundle of care had three interventions,namely:(1)maintaining perioperative normothermia,(2)no pre-operative surgical site hair removal,and(3)changing gloves before abdominal wall closure.These patients were evaluated using the standard instrument,Bates–Jensen Wound Assessment Tool(BWAT)in the post-intervention phases of the wound healing process,which are as follows:hemostasis,inflammatory,and proliferative phases.To describe the difference in the patients’wound status after implementation of the OR bundle of care in each post-intervention phase,Friedman’s test was used.To describe the difference in the patients’wound status in both groups after implementation of the OR bundle of care,the Mann–Whitney U test was used.Results:The patient’s wound status was lower,indicating a more healing process.Differences between the wound status of the control and the experimental group were observed on the third postoperative day.This indicates that the experimental group’s wound status healed much faster and more effectively than the control group based on the BWAT scoring severity scoring.A significant difference in the patient’s wound status from the hemostasis phase compared with the proliferative phase was observed.Conclusions:The OR bundle of care has been shown to be effective in preventing SSI in patients who had undergone exploratory laparotomy cholecystectomy surgery in the selected hospital,if there is uniform and consistent implementation of the said intervention.

Venous thromboembolism prophylaxis in hospitalized elderly patients： Time to consider a ＇MUST＇ strategy

Venous thromboembolism （VTE） is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute illnesses. Clinical diagnosis of VTE in the elderly patient is particularly difficult and, as such, adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE. Omission of VTE prophylaxis is, however, very common despite continuous education. A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual＇ s risk of VTE. Although pharmacological VTE prophylaxis is effective for most patients, a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate. Mechanical VTE prophylaxis, including calf and thigh compression devices and/or an inferior vena cava filter, are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE. Because pneumatic compression devices and thigh length stockings are virtually risk free, mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients, regardless of their bleeding and VTE risk. Although the cost-effectiveness of this Multimodality Universal STat （＇MUST＇） VTE prophylaxis approach for hospitalized elderly patients remains uncertain, this strategy appears to offer some advantages over the traditional ＇selective and single-modal＇ VTE prophylaxis approach, which often becomes ＇hit or miss＇ or not implemented promptly in many hospitalized elderly patients. A large clustered randomized controlled trial is, however, needed to assess whether early, multimodality, universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.

Timely completion of multiple life-saving interventions for traumatic haemorrhagic shock: a retrospective cohort study

Background:Early control of haemorrhage and optimisation of physiology are guiding principles of resuscitation after injury.Improved outcomes have been previously associated with single,timely interventions.The aim of this study was to assess the association between multiple timely life-saving interventions(LSIs)and outcomes of traumatic haemorrhagic shock patients.Methods:A retrospective cohort study was undertaken of injured patients with haemorrhagic shock who presented to Alfered Emergency&Trauma Centre between July 01,2010 and July 31,2014.LSIs studied included chest decompression,control of external haemorrhage,pelvic binder application,transfusion of red cells and coagulation products and surgical control of bleeding through angio-embolisation or operative intervention.The primary exposure variable was timely initiation of≥50%of the indicated interventions.The association between the primary exposure variable and outcome of death at hospital discharge was adjusted for potential confounders using multivariable logistic regression analysis.The association between total pre-hospital times and pre-hospital care times(time from ambulance at scene to trauma centre),in-hospital mortality and timely initiation of≥50%of the indicated interventions were assessed.Results:Of the 168 patients,54(32.1%)patients had≥50%of indicated LSI completed within the specified time period.Timely delivery of LSI was independently associated with improved survival to hospital discharge(adjusted odds ratio(OR)for in-hospital death 0.17;95%confidence interval(CI)0.03–0.83;p=0.028).This association was independent of patient age,pre-hospital care time,injury severity score,initial serum lactate levels and coagulopathy.Among patients with pre-hospital time of≥2 h,2(3.6%)received timely LSIs.Pre-hospital care times of≥2 h were associated with delayed LSIs and with in-hospital death(unadjusted OR 4.3;95%CI 1.4–13.0).Conclusions:Timely completion of LSI when indicated was completed in a small proportion of patients and reflects previous research demonstrating delayed processes and errors even in advanced trauma systems.Timely delivery of a high proportion of LSIs was associated with improved outcomes among patients presenting with haemorrhagic shock after injury.Provision of LSIs in the pre-hospital phase of trauma care has the potential to improve outcomes.