title: Nurses' practice in preventing postoperative wound infections: an observational study.
abstract: OBJECTIVE
  Surgical site infections (SSIs) are serious postoperative complications that may lead to undesired patient outcomes. Previous research has used survey and chart audit methods to describe wound care practices. However, little research has been published using contemporaneous observations to describe the surgical wound management practices of nurses. The aim of this study was to prospectively describe surgical nurses' postoperative wound care practices and the extent to which observed surgical wound practices aligned with evidence-based guideline recommendations.
  
  
  METHODS
  In this cross-sectional prospective study, we observed a convenience sample of 60 nurses from four surgical units using a specifically developed observational audit tool. Inter-rater reliability for this tool was assessed during the observation period.
  
  
  RESULTS
  Of 60 observed episodes of wound care, post-procedure hand hygiene (n=49, 81.7%) was less evident compared with pre-procedure hand hygiene practice (n=57, 95%). Over one-third of nurses observed did not correctly use clean gloves (n=16, 38.1%) and one in five did not properly use sterile gloves (n=4, 22%). More than half of surgical nurses (n=37, 61.7%) did not educate patients on post-discharge wound management. Fewer than a quarter (n=14, 23.3%) of wound care events were recorded on both wound assessment charts and patients' progress notes. Inter-rater reliability testing indicated good agreement (intra-class correlation coefficient 0.859; 95% CI: 0.771-0.923; p<0.0005).
  
  
  CONCLUSIONS
  Despite surgical wound care guideline recommendations on aseptic technique compliance, patient education, wound assessment and documentation practices, there is a clear gap between recommended and observed wound care practice. This study highlights an area where clinical practice is not reflective of evidence-based recommendations, suggesting that to minimise SSI as an adverse event, practice should be evaluated and strategies incorporating evidence into practice are explored.
authors.affiliation: Clinical Nurse, School of Nursing and Midwifery, Griffith University, Australia; and Gold Coast Hospital and Health Service.
authors.forename: S
authors.initials: S
authors.lastname: Ding
authors.affiliation: Senior Lecturer, School of Nursing and Midwifery, Griffith University, Australia; Gold Coast Hospital and Health Service; and Menzies Health Institute Queensland, Griffith University, Australia.
authors.forename: F
authors.initials: F
authors.lastname: Lin
authors.affiliation: Professor of Acute and Complex Care Nursing, School of Nursing and Midwifery, Griffith University, Australia; Gold Coast Hospital and Health Service; and Menzies Health Institute Queensland, Griffith University, Australia.
authors.forename: A P
authors.initials: AP
authors.lastname: Marshall
authors.affiliation: Professor of Patient Safety, School of Nursing and Midwifery, Griffith University, Australia; Gold Coast Hospital and Health Service; Menzies Health Institute Queensland, Griffith University, Australia; and National Centre for Research Excellence in Nursing, Griffith University, Australia.
authors.forename: B M
authors.initials: BM
authors.lastname: Gillespie
mesh_terms: D000328:Adult; D017575:Gloves, Protective; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D024802:Nurse's Role; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D055815:Young Adult
keywords: aseptic technique; chart audit; clinical practice guidelines; education; observations; surgical wounds