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
SURGICAL
OPERATION
TECHNOLOGY
MULTIDISCIPLINARY
ASPECTS
COMPLEXITY OF THE PERFORMANCE IN
THE OPERATING THEATRE
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SHORT
PERCEPTION
OF THE
JURIDICAL
POSITION
SHORT
TECHNICAL
SKILLS
SHORT
VALUE OF
ETHICS
FACTORS PREDISPOSING TO ERRORS
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CONSOLIDATED
HABITS
ASSIGNMENT
RECORD
PARCELLING
OUT OF
CULTURE
NURSES AND CULTURAL HERITAGE
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KEY-ROLE OF
THE NURSE
TECHNOLOGY
CLINICAL
ENGINEERING
DOCTOR
PATIENT
REGULATIONS
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This is
the
question
WHERE ARE WE GOING?
(KEY-ROLE IN PERIOPERATIVE CARE)
WHO ARE
WE?
WHERE ARE WE FROM?
(NURSES AND CULTURAL HERITAGE)
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KEY-ROLE IN THE
PERIOPERATIVE CARE
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
PREVENTION OF THE
SURGICAL SITE INFECTIONS
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SOMETHING ABOUT SSI*
90% of SSI are contracted in the operating theatre
Staff behaviour
Importance of prevention
*Surgical Site Infection
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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
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NURSING RESEARCH IN OPERATING
THEATRE*
• Senic* Project
*Study on the Efficacy of Nosocomial Infection Control
• Predictability of SSI – Importance of Behaviour
• Guidelines
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Guideline for Prevention of Surgical Site
Infection, 1999
Linee Guida sulla Profilassi
Antimicrobica Perioperatoria nell’Adulto
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The adoption of
guidelines, protocols
and procedures is an
attempt at translating
scientific knowledge
into operational
behaviour
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• How scientific is what we
usually do?
• How ethical is what we
usually do?
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Foreword: dr.ssa Maria Luisa Moro
Studio sulla diffusione ed adozione delle
Linee Guida per la Prevenzione delle ISC*
Obiettivo Qualità
Salvatore Giampiccolo
P.O. “Michele Chiello” Piazza Armerina
AUSL 4 Enna
*Infezioni del Sito Chirurgico
Result of my research is
the comparison of the
specific guideline with the
obtained results.
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I realized that several
basic recommendations
contained in the
guideilnes are not applied.
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Doors in the operating theatre are:
Right answer: always closed
The global national value is 44%, with a fluctuation from a
minimun of 22,22% to a maximum of 65,63%
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Is the area of surgical cut washed before the
disinfection of the operating field?
Right answer: always
The global national value is 49%, with
a fluctuation from a minimum of
20,59% to a maximum of 72,73%
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Is the antibiotic prophylaxis practised
before the induction?
Right answer: always
The global national value is 57%, with a fluctuation from a minimum of 27,27%
To a maximum of 76,92%
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Are the carpets, shoe covers and nebulizers,
used to prevent infections?
Right answer: never
The global national value is
40%, with a fluctuation from a
minimun of 5% to maximum of 71,25%
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After contaminated or dirty operations, is the
operation theatre closed or subjected to special
cleaning?
Right answer: never
The global national value is
17%, with a fluctuation from a minimum
of 0% toa minimum of 30,19%
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Do you usually carry out the microbiological
sampling of the air and surfaces of the
operating theatre?
Right answer: never
The global national
value is 21%, with a
fluctuation from a minimun
of 0% to a minimum of 44,34%
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The value of guidelines
• To spread the guidelines
• To check their application
• To assess the performance of the individual
• To acquire results
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EBN
SKILLS
TO KNOW
TO BE ABLE TO DO
DAILY BEHAVIOUR
PREFERENCES OF
PATIENTS
AVAILABLE
RESOURCES
AUTONOMY
RESPONSIBILITY
TO PLAN– TO ASSESS = RESULTS
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GUIDELINES
PROTOCOLS
PROCEDURES
STANDARD TOOLS
STANDARD RESULTS?
CONSOLIDATED HABITS NEVER
SUBJECTED TO VERIFICATION OF SCIENTIFIC
VALIDITY BECAUSE THEY WERE NEVER
MEASURED WITH INDICATORS
BEHAVIOURAL VARIABLE
(Tool that can’t be standardized)
VALIDATION OF DEI BEHAVIOUR
(to warrant the same quality of performance)
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CERTAIN
RULES
DEFINED
ROLES
TEAM
GAME
… THE WAY TO RUN
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CAN WE DO BETTER?
Clinical experience, a large literature identifying
risk factors for infection, and surgeons with
higher than average infection rates
ALL TELL US THAT WE CAN
quoted in Richard Platt, MD, Msc, Progress in Surgical-Site Infection Surveillance
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BIBLIOGRAPHY Essential
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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
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BIBLIOGRAPHY Essential
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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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