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Disposable surgical face masks for preventing surgical wound infection in clean surgery.

BACKGROUND: Surgical face masks were originally developed to contain and filter droplets of microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient. However there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound. OBJECTIVES: To identify and review all randomised controlled trials evaluating disposable surgical face masks worn by the surgical team during clean surgery to prevent post-operative surgical wound infection. SEARCH STRATEGY: All relevant publications about disposable surgical face masks were sought through the Specialised Trials Register of the Cochrane Wounds Group (March 2001). Manufacturers and distributors of disposable surgical masks as well as professional organisations including the National Association of Theatre Nurses and the American Operating Room Nurses Association were contacted for details of unpublished and ongoing studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-randomised controlled trials comparing the use of disposable surgical masks with the use of no mask were included. DATA COLLECTION AND ANALYSIS: Data were extracted independently by AL and PE. MAIN RESULTS: Two randomised controlled trials were included involving a total of 1453 patients. In a small trial there was a trend towards masks being associated with fewer infections, whereas in a large trial there was no difference in infection rates between the masked and unmasked group. Neither trial accounted for cluster randomisation in the analysis. REVIEWER'S CONCLUSIONS: From the limited results it is unclear whether wearing surgical face masks results in any harm or benefit to the patient undergoing clean surgery.

Disposable Equipment↗

Hand washing awareness: a community health initiative.

Handwashing, so simple but forgotten in this busy, hectic, modern world. As perioperative nurses, handwashing is part of our everyday routine. The Ottawa Regional Operating Room Nurses Association brought this important message to the community through our "Back to Basics Health Awareness" Campaign described herein.

Communicable Disease Control↗

Foucault could have been an operating room nurse.

BACKGROUND: Operating room nursing is an under-researched area of nursing practice. The stereotypical image of operating room nursing is one of task- and technically-orientated aspects of practice, where nurses work in a medical model and are dominated by constraints from outside their sphere of influence. This paper explores the possibility of understanding operating room nursing in a different way. AIM: Using the work of Michel Foucault to analyse the work of operating room nursing, this paper argues the relevance of the framework for a more in-depth analysis of this specialty area of practice. CONTENT: The concepts of power, discipline and subjectivity are used to demonstrate how operating room nursing is constructed as a discipline and how operating room nurses act to govern and construct the specialty. Exemplars are drawn from extensive professional experience, from guidelines of professional operating room nursing associations, as well as published texts. The focus is predominantly on the regulation of space and time to maintain the integrity of the sterile surgical field and issues of management, as well as the use of the ethical concept of the 'surgical conscience'. CONCLUSIONS: This form of analysis provides a level and depth of inquiry that has rarely been undertaken in operating room nursing. As such, it has the potential to provide a much needed, different view of operation room nursing that can only help to strengthen its professional foundations and development.

Ethics↗

Initial validation of the perioperative nursing data set in Finland.

PURPOSE: To explore the relevance of the Perioperative Nursing Data Set (PNDS) in Finland. METHODS: A three-round Delphi technique (10 participants) and content analysis of 134 articles from the Journal of the Finnish Operating Room Nurses Association. FINDINGS: All the PNDS outcomes, 86% of the diagnoses, and 87% of the interventions were found to be relevant. The Delphi panel suggested, and content analysis revealed, 6 new outcomes, 43 new diagnoses, and 11 new interventions. Consensus was achieved on 77%. The phrases used in perioperative articles corresponded with those of PNDS 56%-78% of the time. CONCLUSIONS: PNDS can be used to describe perioperative nursing in Finland. Further conceptualization and validation are needed before using the data set in perioperative practice. IMPLICATIONS FOR PRACTICE: Although PNDS cannot be implemented in Finland as is, it is a valid structure for further development of the terminology, contents, methods, and practice of Finnish perioperative documentation.

Documentation↗

Liquid sterilization versus high level disinfection in the urologic office.

OBJECTIVES: Systems are available for liquid sterilization (LS) and high level disinfection (HLD) of flexible cystoscopes. Guidelines from the Association of Operating Room Nurses and the Association for Professionals in Infection Control and Epidemiology recommend HLD for urologic endoscopic equipment. We examine these methods emphasizing costs, performance of procedure, and maintenance. METHODS: The process of LS using the Steris System 1 Processor (SSP1) was studied from June 1993 to June 1994. The Voluntary Hospital Association (VHA) Plus Glutaraldehyde HLD system was evaluated from July 1994 to July 1995. Costs are those incurred by the Ochsner Department of Urology over these same periods. RESULTS: Purchase of the SSP1 system proved costly: $16,200 for purchase; $8645 for accessories, service contract, and training seminars; and $5800 for unit installation. Two gallons of glutaraldehyde including the disinfection container cost $15.60. Since government regulation requires less than 0.2 ppm airborne glutaraldehyde concentration, some facilities may need to install ventilation systems. There were no clinical differences between the two systems. Yearly operating expenses in our department for SSP1 was $6037 compared to $445 for HLD. Mean length of time to process was 35 minutes per use for SSP1 and 20 minutes for HLD. Repair of seven cystoscopes during the SSP1 period cost $11,500. No repairs were required for the cystoscopes used during the HLD period. CONCLUSIONS: Outpatient flexible cystoscopy was performed an average of 988 times per year during the study period. Major cost savings were incurred with institution of the HLD system and no endoscope repairs were necessary. There were no clinical differences between the two systems.

Costs and Cost Analysis↗

Disposable surgical face masks: a systematic review.

UNLABELLED: Surgical face masks were originally developed to contain and filter droplets of microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient. However, there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound. Surgical face masks have recently been advocated as a protective barrier between the surgical team and the patient, but the role of the surgical face mask as an effective measure in preventing surgical wound infections is questionable. The aim of the systematic review is to identify and review all randomised controlled trials evaluating disposable surgical face masks worn by the surgical team during clean surgery to prevent postoperative surgical wound infection. All relevant publications about disposable surgical face masks were sought through the Specialised Trials Register of the Cochrane Wounds Group (March 2001). Manufacturers and distributors of disposable surgical masks as well as professional organisations including the National Association of Theatre Nurses and the Association of Operating Room Nurses were contacted for details of unpublished and ongoing studies. Randomised controlled trials (RCTs) and quasi-randomised controlled trials comparing the use of disposable surgical masks with the use of no mask were included. MAIN RESULTS: Two randomised controlled trials were included involving a total of 1453 patients. In a small trial there was a trend towards masks being associated with fewer infections, whereas in a large trial there was no difference in infection rates between the masked and unmasked group. Neither trial accounted for cluster randomisation in the analysis. REVIEWERS' CONCLUSIONS: From the limited results it is unclear whether wearing surgical face masks results in any harm or benefit to the patient undergoing clean surgery.

Antisepsis↗