Eye surgery and face masks; low back pain; surgical site infection; choosing antibiotics - Evidence For Practice

AORN Journal,  April, 2003  by George Allen

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Face mask use during eye surgery

British Journal of Ophthalmology, September 2002

Postoperative bacterial endophthalmitis after cataract surgery, although rare (ie, five out of 10,000 patients), is a complication of major concern. (1) It may result in decreased vision or permanent vision loss, and, in some instances, a patient may require enucleation to eradicate a blind and painful eye. This study evaluated whether surgeons' use of face masks during cataract surgery reduced the volume of potentially infective organisms falling on the surgical field.

Two hundred twenty-one consecutive patients undergoing phacoemulsification cataract surgery were assigned randomly to group A (ie, the surgeon wore a face mask throughout the procedure) or group B (ie, the surgeon did not wear a face mask). Blood agar settle plates were placed adjacent to patients' heads in the OR. At the end of the procedure, plates were incubated, and they were read after 48 hours. Colony-forming bacteria were identified and counted.

Findings. Significantly fewer organisms were found on the settle plates from patients in group A (P = .0006). Eighty-four percent of the bacteria grown were Staphylococcus epidermidis, Bacillus, or diphtheroid, which are potential intraocular pathogens. None of the patients developed bacterial endophthalmitis.

Clinical implications. The clinical significance of bacterial organisms falling on the surgical field was not established; however, this study acknowledged that one purpose of wearing a face mask is to prevent bacteria from falling on the surgical field. It suggests that wearing a face mask during all surgical procedures may be important in reducing the potential of patients developing postoperative bacterial infections. Perioperative nurses can use this information to encourage compliance to existing policies in their institutions regarding the use of face masks during surgery.

Low back pain

Journal of Orthopaedic & Sports Physical Therapy, September 2002

Nationally, it is estimated that 80% of adults experience low back pain, and hospitals lead all industries in lost work days caused by low back pain. (2) This study investigated the association among mechanical factors and the occurrence of low back pain. Six hundred participants ages 20 to 65 were recruited randomly from five hospitals and categorized into four groups (ie, asymptomatic men, asymptomatic women, men with low back pain, women with low back pain). Participants further were divided into age groups (ie, ages 20 to 35, ages 36 to 50, ages 51 to 65).

The relative association of 17 characteristics of low back pain was assessed. Characteristics included size of lumbar lordosis; angle of pelvic tilt; length of abdominal muscles, low back extensor muscles, hip flexor muscles, hamstring muscles, hip abductor muscles, gastrocnemius muscles, and the iliotibial band; leg length discrepancy; endurance of erector spinae muscles; foot arch height; and strength of hip flexor, hip extensor, hip abductor, hip adductor, and abdominal muscles. Backward logistic regression analysis was used to determine the degree of association between selected variables and low back pain.

Findings. Endurance of back extensor muscles had the highest association with low back pain. The length of hamstring and back extensor muscles, iliotibial band tightness, and the strength of hip flexor, hip extensor, hip abductor, hip adductor, and abdominal muscles all were found to be significantly associated with low back pain.

Clinical implications. Perioperative nursing managers should understand that low back pain may be associated with muscle weakness. To decrease the incidence of low back pain in personnel, they should consider implementing periodic testing of back extensor muscle endurance as a screening tool.

Reducing surgical site infection

Clinical Infectious Diseases, Aug 15, 2002

Preoperative nasal carriage of Staphylococcus aureus has been identified as a risk factor for development of surgical site infection (SSI). (3) The purpose of this randomized, double-blind study was to determine whether mupirocin nasal ointment used preoperatively was effective in preventing the development of SSI. Patients scheduled for elective orthopedic surgery involving prosthetic implants were assigned randomly to receive mupirocin or a placebo nasal ointment twice daily until the day of surgery. The day before surgery, hair was removed with a depilatory cream, if necessary. Nasal cultures were obtained preoperatively and postoperatively. The development of SSI was determined up to one month after surgery.

Findings. Mupirocin was significantly more effective in eradicating nasal carriage of Staphylococcus aureus than the placebo (83.5% versus 27.8%, P < .05). The SSI rate in both groups was comparable (3.8% in the mupirocin group versus 4.6% in the placebo group). Endogenous Staphylococcus aureus infection, although not statistically significant, was five times less likely to develop in patients in the mupirocin group (relative risk 0.19; 95% confidence interval [CI], 0.02-1.62).