Evelyn Kang

Use of Negative-Pressure Wound Dressings to Prevent Surgical Site Complications After Primary Hip Arthroplasty A Pilot RCT

Purpose. Negative-pressure wound therapy (NPWT) is increasingly used for primary surgical incisions despite the paucity of evidence. Study objectives were to assess the use of NPWT on surgical sites to prevent infections and other wound complications after elective primary hip arthroplasty and to consider feasibility of a larger trial. Methods. A nonmasked, randomized controlled pilot trial. Patients were recruited preoperatively from the preadmission clinic of an Australian hospital during 2013-2014. Computer-generated randomization was performed with allocation concealed until completion of surgery. The intervention group received NPWT (PICO) while the control group received the standard care hydrocolloid, reinforced with 2 absorbent dressings. Patients were followed for 6 weeks for postoperative complications (infection, length of stay, readmission) and skin complications (bruising, seroma, hematoma, dehiscence). Feasibility end points included numbers recruited, randomized, and followed up; fidelity; and costs. Results. Of 77 people approached, 76 were recruited, and 70 were randomized. Of 35 in the negative-pressure group, 2 received the standard dressing. Attrition at 6 weeks exceeded 10% in both groups. Dressing costs were lower in the control group (

Reducing the risk of surgical site infection using a multidisciplinary approach: an integrative review

3.01/d vs

Correlates of non-technical skills in surgery: a prospective study

38.40/d); SSI incidence was 2/35 in the NPWT and 3/35 in the control group (intention to treat: risk ratio [RR] = 0.67; 95% confidence interval [CI] = 0.12-3.7; P = .65). NPWT patients experienced more postoperative wound complications (RR = 1.6; 95% CI = 1.0-2.5; P = .04). Conclusion. A reduction of 3% in SSI incidence suggests that a definitive trial requires approximately 900 patients per group. Yet there is uncertainty around the benefit of NPWT after elective hip arthroplasty.

Evaluation of a Brief Team Training Intervention in Surgery: A Mixed‐Methods Study

Purpose To identify and describe the strategies and processes used by multidisciplinary teams of health care professionals to reduce surgical site infections (SSIs). Materials and methods An integrative review of the research literature was undertaken. Searches were conducted in April 2015. Following review of the included studies, data were abstracted using summary tables and the methodological quality of each study assessed using the Standards for Quality Improvement Reporting Excellence guidelines by two reviewers. Discrepancies were dealt with through consensus. Inductive content analysis was used to identify and describe the strategies/processes used by multidisciplinary health care teams to prevent SSI. Results and discussion In total, 13 studies met the inclusion criteria. Of these, 12 studies used quantitative methods, while a single study used qualitative interviews. The majority of the studies were conducted in North America. All quantitative studies evaluated multifaceted quality-improvement interventions aimed at preventing SSI in patients undergoing surgery. Across the 13 studies reviewed, the following multidisciplinary team-based approaches were enacted: using a bundled approach, sharing responsibility, and, adhering to best practice. The majority of studies described team collaborations that were circumscribed by role. None of the reviewed studies used strategies that included the input of allied health professionals or patient participation in SSI prevention. Conclusion Patient-centered interventions aimed at increasing patient participation in SSI prevention and evaluating the contributions of allied health professionals in team-based SSI prevention requires future research.

Factors that influence the non-technical skills performance of scrub nurses: a prospective study.

Background Communication and teamwork failures have frequently been identified as the root cause of adverse events and complications in surgery. Few studies have examined contextual factors that influence teams’ non-technical skills (NTS) in surgery. The purpose of this prospective study was to identify and describe correlates of NTS. Methods We assessed NTS of teams and professional role at 2 hospitals using the revised 23-item Non-TECHnical Skills (NOTECHS) and its subscales (communication, situational awareness, team skills, leadership and decision-making). Over 6 months, 2 trained observers evaluated teams’ NTS using a structured form. Interobserver agreement across hospitals ranged from 86% to 95%. Multiple regression models were developed to describe associations between operative time, team membership, miscommunications, interruptions, and total NOTECHS and subscale scores. Results We observed 161 surgical procedures across 8 teams. The total amount of explained variance in NOTECHS and its 5 subscales ranged from 14% (adjusted R2 0.12, p<0.001) to 24% (adjusted R2 0.22, p<0.001). In all models, inverse relationships between the total number of miscommunications and total number of interruptions and teams’ NTS were observed. Conclusions Miscommunications and interruptions impact on team NTS performance.

Surgical team mapping: implications for staff allocation and coordination.

ABSTRACT The aim of this study was to evaluate a brief team training program in relation to teams’ observed nontechnical skills (NTSs) in surgery, teams’ perceptions of safety culture, and the training implementation. We used mixed methods to analyze structured observations of 179 surgeries, semistructured interviews with surgical team members from four selected surgical specialties, and a survey. There were significant (P < .001) improvements in surgical teams’ observed NTSs and in the use of the World Health Organization’s Surgical Safety Checklist after participation in the training program. Nonsignificant results included increased perceived safety climate and decreased perceived teamwork climate. From participant interviews, we identified that production pressure and time constraints were the biggest barriers to implementation and the greatest enabler was the organization’s support for staff education initiatives. Most participants perceived the content of the program to be useful. These results highlight the complexities inherent in the development and evaluation of interdisciplinary patient safety interventions.