THE IMPORTANCE OF BEING NURSE: A KEY-ROLE IN PERIOPERATIVE CARE AND A MISSION OF RESPONSIBILITY SALVATORE GIAMPICCOLO P.O. “Michele Chiello” Piazza Armerina

THE IMPORTANCE OF BEING NURSE: THE IMPORTANCE OF BEING NURSE: A KEY-ROLE IN PERIOPERATIVE CARE A KEY-ROLE IN PERIOPERATIVE CARE AND A MISSION OF RESPONSIBILITYAND A MISSION OF RESPONSIBILITY

SALVATORE GIAMPICCOLOSALVATORE GIAMPICCOLO

P.O. “Michele Chiello” P.O. “Michele Chiello” Piazza Armerina (EN)Piazza Armerina (EN)

ITALYITALY

THE IMPORTANCE OF BEING THE IMPORTANCE OF BEING NURSE: A KEY-ROLE IN NURSE: A KEY-ROLE IN PERIOPERATIVE CARE AND A PERIOPERATIVE CARE AND A MISSION OF RESPONSIBILITYMISSION OF RESPONSIBILITY

quality of resultsquality of resultsevaluatesevaluates

quality of performancequality of performance

and thenand then

Copenaghen 18/04/2009 [email protected]



KEY-ROLE OF KEY-ROLE OF THE NURSETHE NURSE

REGULATIONS


This is the

question



KEY-ROLE IN THE KEY-ROLE IN THE PERIOPERATIVE CARE PERIOPERATIVE CARE

PREVENTION OF THE PREVENTION OF THE SURGICAL SITE INFECTIONSSURGICAL SITE INFECTIONS

SOMETHING ABOUT SSI*SOMETHING ABOUT SSI*

90% of SSI are contracted in the operating theatre

Staff behaviour

Importance of prevention

*Surgical Site Infection*Surgical Site Infection


MEASURES OF DEMONSTRATED MEASURES OF DEMONSTRATED EFFECTIVENESSEFFECTIVENESS

• Sterilization• Hand washing• Closed-circuit vesical catheterization • Correct management of cardiovascular

catheter s• Sterile clothing in the operating theatre• Correct management of assisted respiration


NURSING RESEARCH IN OPERATING THEATRE*

• Senic* Project *Study on the Efficacy of Nosocomial Infection Control

• Predictability of SSI – Importance of Behaviour

• GuidelinesGuideline for Prevention of Surgical Site Infection, 1999

Linee Guida sulla Profilassi Antimicrobica Perioperatoria nell’Adulto



Studio sulla diffusione ed adozione delle Linee Guida per la Prevenzione delle ISC*

Salvatore GiampiccoloP.O. “Michele Chiello” Piazza Armerina

AUSL 4 Enna**Infezioni del Sito ChirurgicoInfezioni del Sito Chirurgico

Foreword: dr.ssa Maria Luisa MoroForeword: dr.ssa Maria Luisa Moro

Obiettivo Qualità


Doors in the Doors in the operating theatre operating theatre

are:are:

The global national value is 44%, with a fluctuation from a minimun of 22,22% to a maximum of 65,63%

Right answer: always closed


Is the area of surgical cut washed before theIs the area of surgical cut washed before thedisinfection of the operating field?disinfection of the operating field?

The global national value is 49%, with a fluctuation from a minimum of 20,59% to a maximum of 72,73%

Right answer: always


Is the antibiotic prophylaxis practised Is the antibiotic prophylaxis practised before the induction?before the induction?

The global national value is 57%, with a fluctuation from a minimum of 27,27% To a maximum of 76,92%

Right answer: always


Are the carpets, shoe covers and nebulizers, Are the carpets, shoe covers and nebulizers, used to prevent infections?used to prevent infections?

The global national value is 40%, with a fluctuation from a minimun of 5% to maximum of 71,25%

Right answer: never


After contaminated or dirty operations, is the After contaminated or dirty operations, is the operation theatre closed or subjected to special operation theatre closed or subjected to special cleaning?cleaning?

The global national value is 17%, with a fluctuation from a minimum of 0% toa minimum of 30,19%

Right answer: never


Do you usually carry out the microbiological Do you usually carry out the microbiological sampling of the air and surfaces of the sampling of the air and surfaces of the operating theatre?operating theatre?

The global national value is 21%, with a fluctuation from a minimun of 0% to a minimum of 44,34%

Right answer: never


The value of guidelinesThe value of guidelines

• To spread the guidelines

• To check their application

• To assess the performance of the individual

• To acquire results


EBNEBN SKILLSSKILLSTO KNOWTO KNOW

TO BE ABLE TO DOTO BE ABLE TO DO

DAILY BEHAVIOURDAILY BEHAVIOURPREFERENCES OF PREFERENCES OF

PATIENTSPATIENTS

AVAILABLE AVAILABLE RESOURCESRESOURCES

AUTONOMYAUTONOMYRESPONSIBILITYRESPONSIBILITY

TO PLAN– TO ASSESS = RESULTS TO PLAN– TO ASSESS = RESULTS


STANDARD TOOLS

STANDARD RESULTS?

GUIDELINESPROTOCOLSPROCEDURES

BEHAVIOURAL VARIABLE(Tool that can’t be standardized)

VALIDATION OF DEI BEHAVIOUR(to warrant the same quality of performance)

CONSOLIDATED HABITS NEVER SUBJECTED TO VERIFICATION OF SCIENTIFIC VALIDITY BECAUSE THEY WERE NEVER MEASURED WITH INDICATORS



CAN WE DO BETTER?CAN WE DO BETTER?

quoted in quoted in Richard Platt, MD, Msc, Progress in Surgical-Site Infection Surveillance Progress in Surgical-Site Infection Surveillance

Clinical experience, a large literature identifying risk factors for infection, and surgeons with higher than average infection rates

ALL TELL US THAT WE CANALL TELL US THAT WE CAN


http://www.slackinc.com/general/iche/stor0702/7edi.htm


BIBLIOGRAPHY Essential

• PNLG, Antibioticoprofilassi perioperatoria nell’adulto, 2008,, sta su internet www.pnlg.it• Salvatore Giampiccolo, Le Infezioni in chirurgia: teoria e prassi. Studio sulla diffusione ed

adozione delle Linee Guida per la Prevenzione delle Infezioni del Sito Chirurgico, IV Corso per Infermieri di Sala Operatoria , Roma Settembre 2007

• Salvatore Giampiccolo, Protocolli di sala operatoria per prevenire le ISC*, III Corso per Infermieri di Sala Operatoria , Roma Maggio 2006

• S. Giampiccolo, Studio sulla diffusione e l’Adozione delle Linee Guida per la Prevenzione delle Infezioni del Sito Chirurgico, AICO vol 17 n° 4, 2005

• Salvatore Giampiccolo, Ricerca infermieristica in sala operatoria: teoria e prassi, sta in AICO Organo Ufficiale dell’Associazione Infermieri di Camera Operatoria Vol. 17 2005 – Fascicolo 2.

• Salvatore Giampiccolo, Linee Guida sulla Prevenzione delle Infezioni del Sito Chirurgico ( Surgical Site Infection ), sta in Atti del IX Congresso Nazionale AICO, Rimini 25/27 marzo 2004.

• Richard Platt, MD, MSc, Progress In Surgical-Site Infection Surveillance, Infection Control and Hospital Epidemiology, Volume 23 (7) * July 2002, sta su internet

• Gazzetta Ufficiale della Regione Sicilia n° 18 del 20 aprile 2001, CIRCOLARE 27 marzo 2001, n. 1047. Lotta contro le infezioni ospedaliere


http://www.pnlg.it/

http://www.slackinc.com/general/iche/stor0702/7edi.htm

BIBLIOGRAPHY Essential

• Legge 10 agosto 2000 n° 251 - Disciplina delle professioni sanitarie infermieristiche, tecniche, della riabilitazione, della prevenzione, nonché della professione ostetrica.

• Alicia J. Mangram, MD; Teresa C. Horan, MPH, CIC; Michele L. Pearson, MD; Leah Christine Silver, BS; William R. Jarvis, MD; The Hospital Infection Control Practices Advisory Committee, Guideline for Prevention of Surgical Site Infection, 1999

• Regione Piemonte - Assessorato Sanità, Linee Guida Per La Prevenzione Delle Infezioni del Sito Chirurgico, 1999

• Federazione Nazionale Collegi IPASVI - Codice Deontologico, I doveri degli infermieri sono i diritti dei cittadini, maggio 1999.

• Nicolas Troillet (Sion), Sorveglianza Epidemiologica delle Infezioni del Sito Chirurgico: dai Principi alla Pratica, cit. in SWISS NOSO Volume 6, numero 1, Marzo 1999

• Legge 26.02.1999 n° 42 – Disposizioni in materia di professioni sanitarie.• D.M. 14.09.1994 n° 739 – Regolamento concernente l’individuazione della figura e del

relativo profilo professionale dell’infermiere.• Maria Luisa Moro, Epidemiologia, sta in LE INFEZIONI OSPEDALIERE di Antonio Pagano e

Gaetano Privitera, Intramed Comunications, Milano-Roma 1993.


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THE IMPORTANCE OF BEING NURSE: A KEY-ROLE IN PERIOPERATIVE CARE AND A MISSION OF RESPONSIBILITY SALVATORE GIAMPICCOLO P.O. “Michele Chiello” Piazza Armerina