Date of Award

11-3-2024

Degree Type

Thesis

Degree Name

Master of Science in Nursing (MScN)

First Advisor

Dr. Salma Rattani

Second Advisor

Ms. Kashmira Nanji

Third Advisor

Ms. Zulekha Saleem

Department

School of Nursing and Midwifery, Pakistan

Abstract

Background: Surgical Site Infection (SSI) is one of the most common postoperative complications that impact patients and the healthcare system in multiple ways. Care bundles are a set of guided interventions merged to provide a systematic approach to ensure compliance in patient care.
Purpose :The study aimed to develop a clinical checklist of SSI preventive measures and evaluate the Healthcare Provider's compliance with the protocol before the intervention and after intervention in the neurosurgery specialty. It also aimed to assess whether the compliance rate affects the number of SSIs.
Method: A Quasi-experimental pre-post intervention study design was used. Data was collected retrospectively from the medical records of neurosurgical patients at a tertiary care hospital in Karachi, Pakistan. A SSI bundle checklist was prepared based on the American College of Surgeon (ACS) National Surgical Quality Improvement Program (NSQIP) best practice guidelines. Nine guided interventions were evaluated before and after bundle intervention, prophylaxis antibiotic use and its administration, glycaemic control pre and post-surgery, smoking cession, antibiotic discontinuation after 24 hours of surgery, maintenance of normothermia preoperative and intraoperative, and wound education. Study intervention was performed through the Training of Trainers (ToT) iv approach. This research was approved by the University Ethical Review Committee (2024-9696-28527). The data was analysed using descriptive and inferential statistics.
Findings: A total of 195 patients' medical records were reviewed of which 103 were in the pre-intervention group and 92 in the post-intervention group. Three prevention bundle components were statistically significant after the bundle education and training session that were administration of antibiotics within 1 hour of incision (57.3% vs 71.7%, P= 0.036), monitoring intraoperative temperature (76.7% vs 93.5%, P= 0.001), and wound care teaching (78.6% vs 91.3%, P=0.007). Moreover, the proportion of SSI declined in the post-intervention group (13% vs 7
Conclusion: The better compliance rate to the ‗SSI bundle checklist‘ led to a reduction in the number of SSIs in the post-intervention group. The IOWA model served as a guiding framework for the study to implement an evidence-based practice. The study recommended incorporating this checklist in a medical document to further emphasize complete adherence in other components too.

First Page

1

Last Page

75

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