Surgical site infections; stress reduction counseling; hepatitis B vaccination; perioperative blood transfusion

AORN Journal,  June, 2004  by George Allen

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Surgical site infection after hernia repair

British Journal of Surgery January 2004

Surgical site infections (SSIs), particularly those occurring after clean and clean-contaminated procedures, continue to be a cause of great concern in health care settings. In clean procedures, no bacterially colonized area of the body is opened, so it generally is believed that postoperative wound infection occurs because of problems in the surgical environmental or the surgeon's inexperience. The purpose of this study was to determine the incidence and risk factors for SSI after hernia repair. (1)

Patients who underwent groin hernia repair in Scottish hospitals from October 2000 to September 2001 were telephoned 10, 20, and 30 days after surgery and assessed for SSI via a standard interview format. Individuals who reported a problem were referred to a health care worker who assessed whether the wound was infected. In addition, the researchers visited each hospital at three-month intervals to extract data.

Data examined included biographical information, method of repair, use of antibiotic prophylaxis, American Society of Anesthesiologists score, and duration of surgery. Common statistical methods, including univariate analysis and logistic analysis techniques, were used to analyze the data and compare observed differences.

Findings. Complete data were available for 2,665 patients. Surgical site infection was confirmed by a health care worker in 140 patients for an incidence rate of 5.3%. In both the univariate and multivariate analyses, the only factors shown to be significantly related to SSI were administration of antibiotic prophylaxis and short procedure duration. When the duration of the procedure was 55 minutes or less, the incidence of SSI was 5.8% (121 of 2,073 patients). The rate was 3.1% (17 of 544 patients) when the duration of the procedure was more than 55 minutes ([X.sup.2] = 6.699, P = .009). The incidence of SSI was 4.2% (77 of 1,838 patients) when antibiotic prophylaxis was administered and 7.6% (63 of 827 patients) when no prophylaxis was given ([X.sup.2] = 13.47, P = .002).

Clinical implications. This study demonstrated that there is a high rate of SSI after repair of groin hernia, a procedure classified as a clean procedure. Perioperative nurses and managers should be aware of the incidence of SSI in clean and clean-contaminated procedures so that they can develop and implement corrective action plans if the rate begins to increase.

Stress management and health outcomes

Journal of the National Medical Association September 2003

Stress is the wear and tear human bodies experience as they adjust to a continually changing environment. Stress can interfere with physical functioning and body processes, leading to high blood pressure, cardiovascular and heart disease, inflammation, ulcers, allergies, asthma, and migraine headaches. Stress also can be a contributing factor in making existing medical and surgical conditions worse. Stress management techniques, however, are known to improve such conditions. The purpose of this study was to investigate health care providers' training, perceptions, and practices regarding stress and health outcomes. (2)

Physicians and nurses in an outpatient medical clinic serving a predominantly African-American indigent population were given a survey designed to measure their stress counseling practices and level of training in stress management. Common statistical procedures, including multiple linear regression techniques, were used to determine the relationship between the variables.

Findings. The survey was completed by 151 of 210 participants (72%). Nearly haft of the respondents (ie, 42%) reported that they had received no instruction in stress management during their professional training. The majority of respondents (ie, 90%) believed that stress management was very effective or somewhat effective in improving health outcomes. Respondents were significantly more likely to believe that counseling patients about smoking ([X.sup.2] = 62.23, P < .001); nutrition ([X.sup.2] = 66.06, P < .001); or exercise ([X.sup.2] = 66.06, P < .001) was more important than counseling them about stress. The majority of respondents (ie, 66%) reported that they lacked confidence in their ability to counsel patients about stress, and 57% reported that they seldom practiced stress reduction techniques themselves.

Clinical implications. This study revealed that although the majority of providers believed that stress management is effective in improving a patient's health, many providers received no instruction in topics related to stress management and health outcomes during their professional training. Perioperative nurses are ideally situated to effect a positive change on health outcomes through counseling patients about stress. Perioperative managers should provide perioperative nurses with opportunities to learn how to counsel patients regarding stress reduction.

Hepatitis B vaccination schedules