Evidence-Based Practice involves using the most current and best evidence to make decisions about the care provided to a patient. It “allow for synthesis of knowledge needed for interventions and practice including development of the following: Guidelines; Standards; Protocols; and Policies” (Kastner, 2012). One of the main goals when providing care for a patient is hygiene for infection control. It is important to keep the area clean for the patient and make sure to thoroughly prepare hands to eliminate the possible spread of bacteria or microorganisms from the hands to the patient during surgery. As tedious as it may feel at the time, it is important that individuals in the health care field always keep the patient’s safety in mind. The last thing a hospital wants is for a patient to acquire an infection that could have been easily preventable. To do this, it is imperative for staff to know how to prevent the spread of bacteria in the hospital setting (Gunter, 2004). Surgeries are performed every day for all kinds of conditions. Patient safety is one of the most important aspects of nursing, especially in the surgery setting. With all the potential ways a surgery can go wrong, infection can pose a huge risk to the patient. The Centers for Disease Control state that roughly 99,000 patients die from hospital acquired infections per year (http://patientcarelink.org/improving-patient-care/healthcare-acquired-infections-hais/). Current practices today include how to maintain a sterile field and even how to properly don gloves. Both impact the spread of bacteria and compromise sterility, but what about nail length or the effect of nail polish on the fingernails? This question leads to my PICOT statement: In OR nurses doing a five-minute scrub, what are the differences in the presence and types of microbes found on natural polished nails, nails without any polish and nail beds of artificial nails at the time of surgery?
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The research for this particular question should help to understand the potential dangers of the different types of microorganisms on the hands of OR nurses in surgery related to differences in polished nails or nail length. Knowing these different types can help facilities
drastically decrease the chances of patients getting infections in the surgery setting by using appropriate policies to guide employees on their nail care. I initially looked up “bacteria that lives on nail beds”. I knew for my statement I was going to need research articles pertaining to infection control, hand hygiene practices, different types of microorganisms on your hands or nail beds, and even surgery procedures that may decrease infection, whether it pertained to different surgical preparation solutions or the length of time hands are scrubbed before surgery.
The first articles read regarded the removal of nail polish or rings to prevent surgical infection. The populations studied were surgical scrub teams. Studies focused on their hands and infection site. The aim was to look at the different amounts of bacteria on hands during surgery to see if nail polish could possibly influence incidence of infection. Taylor 2014 studied participants that included nurses who had unpolished nails, freshly applied nail polish (less than 2 days old) or old nail polish (more than 4 days) for the study. The number of bacteria cultured from each of the groups was compared next. The trial was continuous, it was not stopped and participants remained in the same group throughout: freshly applied nail polish, absence of nail polish or individuals with cracked nail polish. The different participants were: surgeons, anesthetists, surgeon’s assistants, scrub nurses, operating department practioners and scrubbed observers. There were both male and female participants in the study. The group which had no fingernail polish showed the least ties to infections post-surgery because it was found that chipped nail polish harbors bacteria. Although the number of infections increased, the group with freshly applied and non-chipped nail polish did not significantly change the amount (Taylor, 2014).
The second study regarded nail hygiene in preparation for surgery. Walaszek 2018 took 182 participants who were all healthcare workers. Researchers wanted to examine the colonization of different bacteria under longer nails along with the varnish coating if any. Results found that longer nail length and presence of UV cured nail polish made hand hygiene ineffective for getting rid of microorganisms (Walaszek, 2018). The evidence is strong enough to support that a removal of nail polish is the best option when trying to decrease the number of surgical infections. The results show how to decrease infection in surgery and how to prevent complications in the hospital or other healthcare facilities by changing scrubbing procedures and implementing policies on nail length and nail polish (Savage, 2013). Healthcare facilities should work towards improving patient care in all settings, but this is not the best technique to figure out what works best for pre-surgery checklists. Do people have to get nasty infections before realizing there is a problem in nail polish or nail length? For better patient outcomes, policies in facilities should just prevent the negative outcomes before they even happen.
This PICOT statement revolves around the question regarding whether there are differences in the presence and types of microbes found on natural polished nails and nail beds of artificial nails during the time of surgery. A few articles studied MRSA and Pseudomonas aeruginosa and how they can be acquired during healthcare procedures through the hands. It is important to examine the medical approaches to infection control and how people are able to acquire these microorganisms through surgery with the hands. The aim of these studies was to improve medical management of asepsis to keep it pathogenic bacteria from surgical patients. In these qualitative studies, researchers stated that they wanted to focus on an individual’s lived experience and how to can search for a deeper understanding that people give meaning to discussion, reflection and interaction by their experiences. Because the researchers wanted to focus on an individual’s lived experience, it is believed these studies were set up appropriate for the goal. They looked into the participant’s experience and how is transformed the way they lived. There were personal interviews with participants so researchers were able to learn how it was acquired, what has been done for the outcome, and a general study of MRSA and Pseudomonas as well (Tam, 2006). In order to study a person’s personal experience with these bacteria, you need to find participants who had either. It would not have been appropriate if participants could not share an experience because they would have no effect on the outcome of the study. Researchers collected the data because they wanted information about infection care, control and prevention. The kill studies were examined to figure out the relationship between the microbe and antimicrobial agents used to decrease bacterial growth. It was found that infectious disease is still a problem in the healthcare environment because researchers found that there needs to be better procedures for preventing or taking care of microbes for patients in the surgery setting (Price, 2018). Healthcare officials should be able to control microbe growth instead of spreading it. Because the research centered around preventing and controlling infection, one can conclude that the research is valuable to the community. Education is a huge key in teaching patients, so this study can be used to help others protect themselves and prevent problems whether they happen in the healthcare environment or in their own environments (Pittet, 2006).
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The next articles read compared different infection control practices healthcare facilities have today to the methods that were used years ago. The medical field is constantly advancing so that practice can become better and better. There were studies done on the efficacy of different surgical preparation solutions used prior to surgery. I used different studies in order to gather different data on different solutions. One trial was done in order to determine the effectiveness of 3 commonly used surgical preparation solutions in eliminating bacteria from the skin prior to surgery. Decontamination of the skin is a part of standard care before any surgical procedure so this research was done to find the best surgical preparation solution that would decrease infection and possible complications. In the first study, there were 240 patients who were all undergoing clean, elective, soft tissue hand surgery. There were 3 groups that were categorized by the type of surgical preparation solutions that were used to eliminate bacteria from the skin before surgery. Each participant was important to the study because the researchers needed a large sample size in order to get more accurate results on which surgical preparation study was most effective prior to surgery. However, the researchers state in the article that they would like to continue the research with an even larger study sample next time. Betadine and DuraPrep were found to be more effective than ChloraPrep for the elimination of bacteria from the skin prior to incision in surgeries. The study stated that researchers “did not find a significant difference of at least 20% between Betadine and DuraPrep” because, as stated earlier, they would need a larger study to detect smaller differences in efficiency between the 2 different surgical preparation solutions. Researchers did not go into the study knowing which of the three surgical preparation solutions they would be testing would be the “best” in decreasing post-operative infection. All three surgical preparation solutions are effective in eliminating microorganisms, but this study was simply to see which solution did best in aiding to limit post operation infections in patients (). As for the second study, researchers tested effectiveness of commercial alcohol-based waterless solution and alcohol-based water aided scrub solutions with brush-based iodine solution in surgery. Research showed that a brush-based iodine solution performed better than either iodine solutions (Gupta, 2006). Results from both studies are important because infection can lead to poor long-term patient outcomes with significant morbidity or even morbidity. No surgical preparation solution is meant to harm patients but doing this study could help show healthcare facilities which surgical preparation solution would be the most helpful in preventing infection in their facilities. Policies constantly change once new data is discovered in order to make surgery safer for patients. The studies tell which two solutions are superior, but it was not mentioned in the study how cost effective each solution may be. Because of this, it is uncertain about the price of one effective solution being more cost efficient for a facility. If one surgical preparation was much more expensive, hospitals would opt to spend less money unless there was a much more significant difference in the effectiveness.
Interventions can include improving awareness with education, providing unit level protocols and procedures in the hospital, and hospital wide programs. I do think that hand washing is the simplest way to prevent infection. Each patient room has a sink, soap, and even hand sanitizer so nurses should utilize these resources moving in and out of patient rooms. It is probably the most important method to control the transmission of pathogen, as well as the most cost effective (Burton, 2011). With everything we know about bacteria or hospital acquired infections, we can keep improving our techniques and the way we help our patients. Patient safety is a huge priority and it is your responsibility to take all the necessary steps to ensure their safety while under your care. When a nurse cares, it is beneficial for both the patient and nurse. From these results, nurses can care for patients by putting patient needs before their own desires by choosing to go with natural, unpolished nails. In practice, there are patient rights with medication. For example, right patient, drug, route, dose, and time. Studying surgical preparation solutions and microorganisms on the hands of healthcare workers with polished or unpolished nails can help develop patient “rights” for procedures. Such as right preparation solution, right nail length, and right polish habit.
- Burton, M. (2011). The effect of handwashing with water or soap on bacteria; contamination of hands. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037063/
- Gunter, K. (2004). Epidemiologic background of hang hygiene and evaluation of the most important agents for scrubs and rubs. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC523567/
- Gupta, C. (2006). Comparison of two alcohol-based surgical scrub solutions with an iodine-based scrub brush for presurgical antiseptic effectiveness in a community hospital. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16979793
- Kastner, M. (2012). What is the most appropriate knowledge synthesis method to conduct a review? Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477082/
- Pittet, Didier. (2006). Evidence-based model for hand transmission during patient care and the role of improved practices. Retrieved from https://www.sciencedirect.com/science/article/pii/S1473309906706004
- Price, P. (2018). The bacteriology of normal skin; study of the bacterial flora and the disinfectant action of mechanical cleansing. Retrieved from https://www.jstor.org/stable/30088420?seq=1#page_scan_tab_contents
- Savage, J. (2013). An update on modifiable factors to reduce the risk of surgical site infections. Retrieved from https://www.sciencedirect.com/science/article/pii/S1529943013004051
- Tam, V. (2006). Kill studies to determine pharmacodynamics. Retrieved from https://academic.oup.com/jac/article/55/5/699/691304.
- Taylor, R. (2014). Removal of nail polish and finger rings to prevent surgical infection. Retrieved from https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003325.pub3/epdf/full
- Walaszek, M. (2018). Nail microbial colonization following hand disinfection. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29969690