Surgical Skeletal Pin Site Infection Control: Translating Evidence, Implementing Change

2.50
Hdl Handle:
http://hdl.handle.net/10755/601715
Category:
Full-text
Format:
Text-based Document
Type:
Poster
Title:
Surgical Skeletal Pin Site Infection Control: Translating Evidence, Implementing Change
Author(s):
Agbowu, Ruth; Poinsett, Beth; Michelfelder, MaryAnn; Mijares, Estrella
Lead Author STTI Affiliation:
Nu Eta
Author Details:
Ruth Agbowu, BSN, RN,'CMSRN, CBN, PCCN, nursingresearch@mac.com; Beth Poinsett, RN,'ONC; MaryAnn Michelfelder, RN; Estrella Mijares, RN,'CCRN
Abstract:
Session presented on Friday, July 24, 2015: Poster Presentation EBP Initiative' Surgical Skeletal Pin Site Infection Control: Translating Evidence ~ Implementing Change' In an attempt to describe the process to translate research and best practices into a change in policy, this abstract focuses on reducing (SSI) surgical site infection for orthopaedic patients with external fixators. It will identify sucesses and challenges encountered during implementation of new policy and procedures related to reduction of skeletal pin sites. Positive patient outcomes are achieved through identification and implementation of evidence-based prevention measures pertaining to Surgical Site Infection (SSIs) to provide orthopaedic nurses with the knowledge base needed to effectively deliver high quality, continuity of care among patients undergoing surgery of the musculoskeletal system. The target audience is any professional interested in implementing surgical skin site infection protocols to provide positive patient outcomes. Skeletal pins or wires are inserted into the bone through skin incisions. Some pins and wires penetrate through the bone and exit on the other side of the extremity; other pins penetrate just into the bone. When pins or wires are attached to a rigid external frame, an external-fixator system is created. The assumption has been that the open wound around the pin is a potential portal for entry of bacteria into the pin tract. Skeletal pins located in soft tissue area are at greater risk for infection. Skeletal pins could be sited into the cranium, pelvis and upper or lower extremities.' ARMC does not currently have a policy and procedure pertaining to skeletal pin care. ARMC orthopedic surgeons have an order set that provides 2 options for cleansing solutions: 100% peroxide & 50% peroxide-50%sterile water solutions. There is wound research (2002) (in vivo and in vitro) showing that hydrogen peroxide and Betadine at certain concentrations may be cytotoxic to osteoblasts and damaging to healthy tissue. Chlorhexidine has been proven to be more effective in preventing SSIs when compared to iodine-based solutions (Digison, 2007) Chlorhexidine 2 mg/mL solution is considered to be the most effective cleansing solution for skeletal pin site care (Holmes & Brown, 2005). Recent guidelines from the Orthopedic Nursing Society (2013) support change in pin care cleansing solutions from peroxide to chlorhexidine. With hybrid (EMR) electronic medical record systems, change in ordersets for pin site care involve new policy and procedure implementation: supported by input from Orthopedic Surgeons, Nursing, Pharmacy, Purchasing and Clinical Informatics. This abstract chronicles the process to undergo implementing change in best practice in skeletal pin site care; highlighting the' efforts of the professionals involved in this endeavor. Positive patient outcomes in surgical skin site infection prevention is the measurable goal. References Holmes, S. & Brown, S. (2005). Skeletal pin site care: National Association of Orthopaedic Nursing guidelines for orthopaedic nursing. Orthopaedic Nursing, 24(2), 99-107 Lethaby A, Temple J, Santy-Tomlinson J. Pin site care for preventing infections associated with external bone fixators and pins. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD004551. DOI: 10.1002/14651858.CD004551.pub3. Kaysinger, K. K., Nicholson, N. C., Ramp, W. K., & Kellam, J. F. (1995). Toxic effects of wound irrigation solutions on cultured tibae and osteoblasts. Journal of Orthopaedic Trauma, 9(4), 303'311. Rabenberg, V. S., Ingersoll, C. D., Sandrey, M. A., & Johnson, M. T. (2002). The bactericidal and cytotoxic effects of antimicrobial wound cleansers. Journal of Athletic Training, 37(1), 51'54. Smith, M & Dahlen, N. (2013). Clinical Practice Guideline Surgical Site Infection Prevention. Orthopaedic Nursing, 32(5), 242-248.'
Keywords:
(SSI); Skeletal; Pin-Care
MeSH:
Evidence-Based Practice
CINAHL Headings:
Infection�Control�; Pin Site Care
Repository Posting Date:
17-Mar-2016
Date of Publication:
17-Mar-2016 ; 17-Mar-2016
Other Identifiers:
INRC15PST1
Conference Date:
2015
Conference Name:
26th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
San Juan, Puerto Rico
Description:
Research Congress 2015 Theme: Question Locally, Engage Regionally, Apply Globally. Held at the Puerto Rico Convention Center.

Full metadata record

DC FieldValue Language
dc.language.isoenen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePosteren
dc.titleSurgical Skeletal Pin Site Infection Control: Translating Evidence, Implementing Changeen
dc.contributor.authorAgbowu, Ruthen
dc.contributor.authorPoinsett, Bethen
dc.contributor.authorMichelfelder, MaryAnnen
dc.contributor.authorMijares, Estrellaen
dc.contributor.departmentNu Etaen
dc.author.detailsRuth Agbowu, BSN, RN,'CMSRN, CBN, PCCN, nursingresearch@mac.com; Beth Poinsett, RN,'ONC; MaryAnn Michelfelder, RN; Estrella Mijares, RN,'CCRNen
dc.identifier.urihttp://hdl.handle.net/10755/601715-
dc.description.abstractSession presented on Friday, July 24, 2015: Poster Presentation EBP Initiative' Surgical Skeletal Pin Site Infection Control: Translating Evidence ~ Implementing Change' In an attempt to describe the process to translate research and best practices into a change in policy, this abstract focuses on reducing (SSI) surgical site infection for orthopaedic patients with external fixators. It will identify sucesses and challenges encountered during implementation of new policy and procedures related to reduction of skeletal pin sites. Positive patient outcomes are achieved through identification and implementation of evidence-based prevention measures pertaining to Surgical Site Infection (SSIs) to provide orthopaedic nurses with the knowledge base needed to effectively deliver high quality, continuity of care among patients undergoing surgery of the musculoskeletal system. The target audience is any professional interested in implementing surgical skin site infection protocols to provide positive patient outcomes. Skeletal pins or wires are inserted into the bone through skin incisions. Some pins and wires penetrate through the bone and exit on the other side of the extremity; other pins penetrate just into the bone. When pins or wires are attached to a rigid external frame, an external-fixator system is created. The assumption has been that the open wound around the pin is a potential portal for entry of bacteria into the pin tract. Skeletal pins located in soft tissue area are at greater risk for infection. Skeletal pins could be sited into the cranium, pelvis and upper or lower extremities.' ARMC does not currently have a policy and procedure pertaining to skeletal pin care. ARMC orthopedic surgeons have an order set that provides 2 options for cleansing solutions: 100% peroxide & 50% peroxide-50%sterile water solutions. There is wound research (2002) (in vivo and in vitro) showing that hydrogen peroxide and Betadine at certain concentrations may be cytotoxic to osteoblasts and damaging to healthy tissue. Chlorhexidine has been proven to be more effective in preventing SSIs when compared to iodine-based solutions (Digison, 2007) Chlorhexidine 2 mg/mL solution is considered to be the most effective cleansing solution for skeletal pin site care (Holmes & Brown, 2005). Recent guidelines from the Orthopedic Nursing Society (2013) support change in pin care cleansing solutions from peroxide to chlorhexidine. With hybrid (EMR) electronic medical record systems, change in ordersets for pin site care involve new policy and procedure implementation: supported by input from Orthopedic Surgeons, Nursing, Pharmacy, Purchasing and Clinical Informatics. This abstract chronicles the process to undergo implementing change in best practice in skeletal pin site care; highlighting the' efforts of the professionals involved in this endeavor. Positive patient outcomes in surgical skin site infection prevention is the measurable goal. References Holmes, S. & Brown, S. (2005). Skeletal pin site care: National Association of Orthopaedic Nursing guidelines for orthopaedic nursing. Orthopaedic Nursing, 24(2), 99-107 Lethaby A, Temple J, Santy-Tomlinson J. Pin site care for preventing infections associated with external bone fixators and pins. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD004551. DOI: 10.1002/14651858.CD004551.pub3. Kaysinger, K. K., Nicholson, N. C., Ramp, W. K., & Kellam, J. F. (1995). Toxic effects of wound irrigation solutions on cultured tibae and osteoblasts. Journal of Orthopaedic Trauma, 9(4), 303'311. Rabenberg, V. S., Ingersoll, C. D., Sandrey, M. A., & Johnson, M. T. (2002). The bactericidal and cytotoxic effects of antimicrobial wound cleansers. Journal of Athletic Training, 37(1), 51'54. Smith, M & Dahlen, N. (2013). Clinical Practice Guideline Surgical Site Infection Prevention. Orthopaedic Nursing, 32(5), 242-248.'en
dc.subject(SSI)en
dc.subjectSkeletalen
dc.subjectPin-Careen
dc.subject.meshEvidence-Based Practiceen
dc.subject.cinahlInfection�Control�en
dc.subject.cinahlPin Site Careen
dc.date.available2016-03-17T12:53:35Zen
dc.date.issued2016-03-17-
dc.date.issued2016-03-17en
dc.date.accessioned2016-03-17T12:53:35Zen
dc.conference.date2015en
dc.conference.name26th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen
dc.conference.locationSan Juan, Puerto Ricoen
dc.descriptionResearch Congress 2015 Theme: Question Locally, Engage Regionally, Apply Globally. Held at the Puerto Rico Convention Center.en
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