Implementation methods of infection prevention measures in orthopedics and traumatology – a systematic review

Abstract

Background Prevention of hospital-acquired infections, in the clinical field of orthopedics and traumatology especially surgical site infections, is one of the major concerns of patients and physicians alike. Many studies have been conducted proving effective infection prevention measures. The clinical setting, however, requires strategies to transform this knowledge into practice. Question/purpose As part of the HYGArzt-Project (“Proof Of Effectivity And Efficiency Of Implementation Of Infection Prevention (IP) Measures By The Physician Responsible For Infection Prevention Matters In Traumatology/Orthopedics”), the objective of this study was to identify effective implementation strategies for IP (infection prevention) measures in orthopedics and trauma surgery. Methods The systematic review was conducted following PRISMA guidelines. A review protocol was drafted prior to the literature search (not registered). Literature search was performed in MEDLINE, SCOPUS and COCHRANE between January 01, 1950 and June 01, 2019. We searched for all papers dealing with infection and infection control measures in orthopedics and traumatology, which were then scanned for implementation contents. All study designs were considered eligible. Exclusion criteria were language other than English or German and insufficient reporting of implementation methods. Analyzed outcome parameters were study design, patient cohort, infection prevention measure, implementation methods, involved personnel, reported outcome of the studies and study period. Results The literature search resulted in 8414 citations. 13 records were eligible for analysis (all published between 2001 and 2019). Studies were primarily prospective cohort studies featuring various designs and including single IP measures to multi-measure IP bundles. Described methods of implementation were heterogeneous. Main outcome parameters were increase of adherence (iA) to infection prevention (IP) measures or decrease in surgical site infection rate (dSSI%). Positive results were reported in 11 out of 13 studies. Successful implementation methods were building of a multidisciplinary team (considered in 8 out of 11 successful studies [concerning dSSI% in 5 studies, concerning iA in five studies]), standardization of guidelines (considered in 10/11 successful studies [concerning dSSI% in 5 studies, concerning iA in seven studies]), printed or electronic information material (for patient and/or staff; considered in 9/11 successful studies [concerning dSSI% 4/4, concerning iA 5/5]), audits and regular meetings, personal training and other interactive measures as well as regular feedback (considered in 7/11 successful studies each). Personnel most frequently involved were physicians (of those, most frequently surgeons) and nursing professions. Conclusion Although evidence was scarce and quality-inconsistent, we found that adhering to a set of implementation methods focusing on interdisciplinary and interactive /interpersonal work might be an advisable strategy when planning IP improvement interventions in orthopedics and traumatology.

Application of infection control guidelines among nurses working in surgical units: A cross-sectional study in Sudan

“…This is a descriptive study, was conducted aims to identify the application of infection control guideline among nurses working in surgical units, eighty nurses were included in this study, the majority of them are female 79%, their age ranged between 31 -35-year-old, more than half are educated (Bachelor 56%), this finding is supported by studies on infection control guidelinesAlaa et al, 2021). Our study's findings revealed that more than 75% of them have taken courses on infection control and 45% years of experience among participants, this result is supported by two study which found that the courses and training courses are directly related to the enhancement ofSham et al, 2021;Marche et al, 2021;Naghdi et al, 2021). The study shows there are no relation between the gender, age, and knowledge at p-value 0.05, this result is similar to the two studies conducted on infection control guidelines(Biniyam et al, 2018;Geber, 2018).…”

The Implementation of a Complication Avoidance Care Bundle Significantly Reduces Adverse Surgical Outcomes in Orthopedic Trauma Patients

“…These complications are more likely associated with the surgeon’s experience and expertise in performing the operation, as well as the difficulty of the specific procedure itself. Furthermore, the surgeon’s skills are likewise correlated with the time required for performing the surgery—the longer the duration, the higher the risk for SSI [ 19 , 20 , 21 ]. Nevertheless, by systematically analyzing possible reasons for adverse outcomes, case by case, technical aspects can be discussed during an M&M conference in an intercollegial way.…”

Effect of WeChat-Based Health Preaching Combined with an Enhanced Recovery after Surgery Model on Perioperative Limb Motor Function and Complications in Orthopaedic Patients

“…Self-efficacy is a direct manifestation of patients' confidence in rehabilitation and is closely related to patients' level of health knowledge [ 8 ]. Patients with low levels of health knowledge often fail to clearly recognize the positive effect of the ERAS model, and most patients tend to believe that bed rest should be taken after an injury because rest is more conducive to limb recovery, so they have poor subjective motility and nursing compliance and are unwilling to effectively go along with the nursing measures under the ERAS model [ 9 , 10 ]. Providing patients with scientific and efficient health education can improve their health knowledge levels and enhance their rehabilitation self-efficacy, thus improving the outcomes of perioperative nursing under the ERAS model.…”