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

THE IMPORTANCE OF BEING NURSE: A KEY-ROLE IN PERIOPERATIVE CARE AND A MISSION OF RESPONSIBILITY quality of results evaluates quality of performance and then

COMPLEXITY OF THE PERFORMANCE IN THE OPERATING THEATRE MULTIDISCIPLINARY ASPECTS SURGICAL OPERATION TECHNOLOGY Copenaghen

FACTORS PREDISPOSING TO ERRORS SHORT VALUE OF ETHICS SHORT PERCEPTION OF THE JURIDICAL POSITION SHORT TECHNICAL SKILLS Copenaghen

NURSES AND CULTURAL HERITAGE PARCELLING OUT OF CULTURE PARCELLING OUT OF CULTURE CONSOLIDATED HABITS ASSIGNMENT RECORD Copenaghen

TECHNOLOGY CLINICAL ENGINEERING DOCTOR PATIENT KEY-ROLE OF THE NURSE REGULATIONS Copenaghen

WHERE ARE WE GOING? (KEY-ROLE IN PERIOPERATIVE CARE) WHO ARE WE? NURSES AND CULTURAL HERITAGE) WHERE ARE WE FROM? (NURSES AND CULTURAL HERITAGE) This is the question Copenaghen

Copenaghen MAIN GUARANTOR OF THE QUALITY CARE AWARE OF HIS ROLE OF RESPONSIBILITY IN HEALTH WORLD CORRECTING WRONG BEHAVIOUR PROVIDING THE CARE BASED ON SCIENTIFIC EVIDENCE (EBN) ADOPTING GUIDELINES KEY-ROLE IN THE PERIOPERATIVE CARE PREVENTION OF THE SURGICAL SITE INFECTIONS

SOMETHING ABOUT SSI* 90% of SSI are contracted in the operating theatre Staff behaviour Importance of prevention *Surgical Site Infection Copenaghen

MEASURES OF DEMONSTRATED EFFECTIVENESS Sterilization Hand washing Closed-circuit vesical catheterization Correct management of cardiovascular catheter s Sterile clothing in the operating theatre Correct management of assisted respiration Copenaghen

NURSING RESEARCH IN OPERATING THEATRE* Senic* Project *Study on the Efficacy of Nosocomial Infection Control Predictability of SSI – Importance of Behaviour Guidelines Guideline for Prevention of Surgical Site Infection, 1999 Linee Guida sulla Profilassi Antimicrobica Perioperatoria nell’Adulto Copenaghen

The adoption of guidelines, protocols and procedures is an attempt at translating scientific knowledge into operational behaviour How scientific is what we usually do? How ethical is what we usually do? Copenaghen

Studio sulla diffusione ed adozione delle Linee Guida per la Prevenzione delle ISC* Salvatore Giampiccolo P.O. “Michele Chiello” Piazza Armerina AUSL 4 Enna *Infezioni del Sito Chirurgico Foreword: dr.ssa Maria Luisa Moro Obiettivo Qualità

Result of my research is the comparison of the specific guideline with the obtained results. I realized that several basic recommendations contained in the guideilnes are not applied. Copenaghen

Doors in the operating theatre 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 Copenaghen

Is the area of surgical cut washed before the Is the area of surgical cut washed before the 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 Copenaghen

Is the antibiotic prophylaxis practised Is the antibiotic prophylaxis practised 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 Copenaghen

Are the carpets, shoe covers and nebulizers, 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 Copenaghen

After contaminated or dirty operations, is the operation theatre closed or subjected to special cleaning? The global national value is 17%, with a fluctuation from a minimum of 0% toa minimum of 30,19% Right answer: never Copenaghen

Do you usually carry out the microbiological sampling of the air and surfaces of the 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 Copenaghen

The value of guidelines To spread the guidelines To check their application To assess the performance of the individual To acquire results Copenaghen

EBNSKILLS TO KNOW TO BE ABLE TO DO DAILY BEHAVIOUR PREFERENCES OF PATIENTS AVAILABLE RESOURCES AUTONOMYRESPONSIBILITY TO PLAN– TO ASSESS = RESULTS Copenaghen

STANDARD TOOLS STANDARD RESULTS? GUIDELINES PROTOCOLS PROCEDURES 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 Copenaghen

… THE WAY TO RUN TEAM GAME CERTAIN RULES ROLES DEFINED ROLES Copenaghen

CAN WE DO BETTER? quoted in Richard Platt, MD, Msc, Progress in Surgical-Site Infection Surveillance Richard Platt, MD, Msc, Richard Platt, MD, Msc, Clinical experience, a large literature identifying risk factors for infection, and surgeons with higher than average infection rates ALL TELL US THAT WE CAN Copenaghen

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BIBLIOGRAPHY Essential PNLG, Antibioticoprofilassi perioperatoria nell’adulto, 2008,, sta su internet 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 – 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 Richard Platt, MD, MSc, Progress In Surgical-Site Infection Surveillance, Infection Control and Hospital Epidemiology, Volume 23 (7) * July 2002, sta su internet Richard Platt, MD, MSc, Gazzetta Ufficiale della Regione Sicilia n° 18 del 20 aprile 2001, CIRCOLARE 27 marzo 2001, n Lotta contro le infezioni ospedaliere Copenaghen

BIBLIOGRAPHY Essential Legge 10 agosto 2000 n° 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 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 n° 42 – Disposizioni in materia di professioni sanitarie. D.M 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 Copenaghen