Reduction Of Sharp Injuries In Operation - Myassignmenthelp.Com

Question: Evaluation of the hands-free technique inthe reductionof sharp injuries in operation theatre. Answer: Aims The aim of the proposed study would be to potentially assess the efficiency and usefulness of hands free technique in passing sharp instruments in reducing sharp injuries in operation theatre. Such injuries would include contaminations, percutaneous injuries and glove tears that are due to imporper handling of sharp instruments. The study would conclude whether a better and safer environment can be created with the use of hands free technique when a surgery is undertaken. Introduction Healthcare professionals are often exposed to the risk of harm due to the nature of their duties and tasks they fulfil. Professionals working in operating theatres are at increased risk of suffering such harm that can be detrimental under certain cases. Operating theatre personnel, more specifically the nurses and those taking part in the surgical processes in a direct manner, are usually exposed to various forms of biological material. Numerous pathogens are transmitted through exposure to these biological materials (Berges et al. 2014). The operating theatre have been also known to be the environment within the hospital where there is a considerable concentration of sharp instruments. Sharps refer to the blades, needles, scalpels and other related medical instruments used in healthcare units required for promoting health care work. These can cause injuries through cuts and pricking of skin. An injury due to sharp and related instruments that can penetrate the skin is known as percu taneous injury. Therefore, there is enhanced the risk of percutaneous injuries while coming in contact with sharp objects that are responsible for blood-borne disease contamination. Sharps injury rates are, as indicated by statistics, proportionally higher in perioperative areas when compared to other practice settings. According to Abraham (2016), operation theatre policies that aim at lessening the surgical risk have been pointed out in literature. These policies propose different strategies which when applied can be largely useful for the professionals in minimising injury risk. Measures encompass the use of blunted suture needles, redesigned instruments, safe wok practices, and restriction to use of exposure-prone products. The hands-free technique for the purpose of moving about sharp instruments in the hospital environment has been suggested by many researchers. A number of healthcare scholars have recommended the hands-free technique, involving use of an object, such as a tray, for the elimination of simultaneous handling of sharp instruments. The process includes the indirect transfer of the instruments between two professionals wherein direct contact with the sharp products are minimised to a great extent. Items are put in a designated safe or neutral zone from which retrieval can be done. This can include a part of the container of the surgical field. Although there has been a valuable proposal made regarding the hands-free technique, research in this aspect is limited. The technique makes intuitive sense; however, there is a limited evaluation of its effectiveness (Stringer et al. 2009). Literature review Jagger et al. (2011) highlighted that the prevalence of blood borne pathogen exposure is high among Thailand nurses working in operating rooms. Protecting behaviours are required to address the novel risk factors. Personal accountability must also be there in this regard. Kasatpibal et al. (2016) further added that the operating room is one of the high-risk settings for occupational sharps injuries and exposure to blood borne pathogens. The need to use safety-engineered devices has gained negligible attention in the surgical settings and operating theatres. Stringer, Infante-Rivard and Hanley (2002) had given an emerging concept of hands-free technique in the reduction of operating theatre injuries. This study had concluded that hands-free technique did not give similar results in case of all operations, specifically those that involved substantial loss of blood. Lakbala et al. (2014) had pointed out that sharps injuries in the operating room are a significant topic of research in the domain of healthcare. The research conducted aimed at identifying which group of healthcare professionals sustain needlestick and sharps injuries and the circumstances in which such injuries are suffered. It further explored the actions that can be taken for minimising the risk in response to care procedures. A cross-sectional study was carried out Iran with 215 operating room personnel working in 14 hospitals. 250 respondents filled up the questionnaire and reported that their level of awareness about techniques for injury prevention was poor. The study concluded that there is an urgent need of bringing reforms in the local protocol for reducing sharps injury. Research is of prime importance to indicate which technique is more effective in comparison to others. Aneja, Leung and Marquez-Lara (2016) assessed the hands-free technique for upper extremity limb holding at the time of surgical preparation. As per the researchers, lifting and consecutive holding lower and upper limbs at the time of preparation for particular orthopaedic processes are known for exerting strong forces on the person holding it. This leads to musculoskeletal disorders in the individual. For addressing the challenges at the time of upper extremity procedures, the authors studied a particular hands-free elevation and traction technique in case of preoperative skin preparation. This was done with the help of item available within the operating room. The method was found to be useful specifically for fracture or heavy limbs responsible for imposing a major barrier to lift in a stable position. When implemented practically, the technique reduces the risk to nursing professionals, personnel working in the operation room and caregivers. Williams (2016) studied the factors related the use of hands-free techniques and safety-engineered needles in a healthcare setting. The study explored the current practices among operating room nurses. The researchers state that injuries suffered by nurses due to contaminated needles and other related medical devices, sharp in nature, present serious and hazardous occupational health concerns. This is a cause of major risk of infection due to life-threatening blood borne pathogens like HIV, Hep C and Hep B. injuries in the operating room has increased considerably in the last few years. Previous research had indicated that reduction in sharps-injury in non-surgical settings is due to an increased use of sharps with engineered sharp-injury protections (SESIPs) which include safety-engineered hypodermic needles and hollow-bore. The US Department of Labor, Occupational Safety and Health Administration (OSHA) put forward recommendations regarding the use of work practice controls that el iminate and minimise the exposure to pathogens. There is a pool of evidence that use of a hands-free passing practice might prove to be effectual in eliminating the hand-to-hand passing of contaminated instruments at the time of surgical procedures. The present research was a descriptive correlational study with the help of cross-sectional survey data collection method. The study pointed out that that the use of hands-free technique was limited. Training was required to increase the level of awareness among the professionals and fostering the use of the technique. There is a need for research highlighting the enabling factors and barriers for the utilisation of hands-free technique in settings. Stringer et al. (2006) stated that occupationally contracted blood-borne infections are preventable and protective measures are to be used accordingly for best results. The researchers carried out an in-depth telephone interview for exploring the perception and knowledge of healthcare providers related to use of hands-free technique (HFT). It was found that the majority of the interviewees did not consider use of HFT. They had lack of knowledge about the same and some resisted using it. Stringer et al. (2009) aimed at determining whether the use of hands-free technique (HFT) reduces the rate of percutaneous injury. In addition, it wanted to explore whether a video-based intervention was useful in increasing the use of hands-free technique over time and on immediate basis. This study had found that both HFT and HFT video intervention was useful. However, both the studies had certain limitations that restricted the generalizability of the study results. Linzer and Clarke (2017) opined that an improved safety climate had been associated with better compliance with safety behaviours. Their study assessed on the topic of whether effective management support can be perceived as the most commonly studied safety climate dimension, and whether there was a connection between the greater use of HFT and safety dimension. Operating room nurses took part in questionnaire based surveys. It was concluded that management support was needed to increase use of HFT. Design A research design is the procedure and set of methods that are used for collection and analysis of variables considered in the research problem. All study designs define the type of study along with the data collection and data analysis method. It acts as the framework in case of the research proposal based on which the research is to be carried out in future (Flick 205). In the present case, the proposed study is to be conducted over one-year time frame in any private hospital in the country that would have the use of the hands-free technique included in the hospital policy. Personnel and operations- Operations that would be considered eligible for inclusion into the study would be those that are performed in the same day surgery operation theatres during weekdays and in the main operating theatres during weekdays, 24 hours per day. Full-time nurses are supposed to work in these theatres. The personnel who are perceived to be at risk would be nurses, physicians, physicians assistants, technicians, residents who would provide direct surgical care to the patients. Anaesthetists would not be included in this study. Data collection- An informal consultation would be done with the personnel after the end of each operation. This consultation would be done with the help of unstructured interview process. The nurse would record the degree to which hands-free method is used. The standardised questionnaire is to be used for this purpose. Questions would aim at highlighting the length and type of operation, the amount of blood loss, noise levels at the time of surgery, time of the day when surgery would take place, whether the procedure was emergency or not, and the number of individuals present for 75% of the operations. The nurses would also provide more information on each incident. This would highlight percutaneous injury, a glove tear and a contamination. Data analysis- Data analysis would be done on the basis of all operations for which the researchers can address the research question of whether there was the adequate use of hands-free technique. For carrying out the analysis in a suitable manner, hands-free variable would be designated as a yes/no variable. The operations in which the hands-free technique would be found to be 75% of the time or 100% of the time would be considered to have taken place following the hands-free technique. The operations in which the hands-free technique would be found to be 0%, 25%, 50% of the time would not be considered to have taken place following the hands-free technique. In case of the first set of analysis, glove tears, contaminations and injuries would be considered as the prime indicators of safety and component of the accident range. These are to be classified as incidents. For analysing the accurate and particular impact of handling and passing sharp instruments, a second analysis would be carried out. In this case, the specific definition of incident would be restricted to all contaminations and injuries associated with passing and handling of sharp items and all glove tears. Seven variables, namely surgical speciality, number of personnel in the operating theatre, duration of surgery, shift, blood loss, emergency and noise levels, all known to make a direct influence of the risk of incident would be considered for the analysis. It is to be noted that noise was not included in previous studies as a risk of incident. However, research indicates that there is a relationship between noise and short-term memory loss. Moreover, the analysis would be done with the aim of finding the relationship between the risk of indicators and use of hands-free technique. For making the research process easier, types of operations would be grouped into categories such as general, orthopaedic, cerebrovascular, cardiothoracic operations, and another category. This other category would include ENT, gynaecology, plastic, urology combined. The rationale behind this step would be to gain equal number in each category for constructing a homogenous risk profile. Duration of all the surgeries would be divided into three categories, hour or less, 12 hours, and greater than 2 hours. Moreover, blood loss would be indicated as less than or more than 100 ml. In case of noise level, classification would be done into loud and quite and normal. For shifts, classification would be done into evening and night versus day. Operations would be classified as emergency or non-emergency. The number of personnel present at least 75% of the time would be dichotomised into 15 versus 6 or more. Odds ratio would be used for analysing the relative risks of incidents, both in case of use and non-use of hands-free method. Logistic regression would be utilised for estimating adjusted risk ratios (RR) and for producing 95% confidence interval (CI). The aim would be to do the adjustment in different risk profiles of operation that would have hands free technique and also not have hands free technique. All risk factors under measurement would be included in the regression model. Duration of surgery, type of surgery, and blood loss, are to be included if the p-value associated with the likelihood ratio is less than 0.10 (Stringer et al. 2009). Ethical consideration Ethical considerations for primary research are a valuable aspect that all researchers are to encompass in their studies. The proposed research would abide by the principles of informed consent, respondent confidentiality and data protection. Prior to research, informed content would be taken from the potential participants, which implies that the individuals would agree to take part in the research voluntarily after having understood the aim of the research. The objectives and purpose of the research would be clearly explained to them. Participation would be voluntary, and they would have the option of quitting the research at any point in time. The personal details of the respondents would be kept confidential. Lastly, the data reports would be saved in a safe manner without the reach of third parties (Nieswiadomy and Bailey 2017). Timeline Month 1 Month 2-13 Month 14 Month 15 Month 16 Preparation of research Data collection Data analysis Report generation Dissemination of findings Budget The research would have 8000 dollars. This would include direct and indirect costs, including travel expenses, miscellaneous costs. Dissemination Dissemination of study findings refers to the process of providing research data to the appropriate audience through effective communication. The report generated based on the study findings would be disseminated to reputed hospitals in the country after publish. A well known peer-reviewed journal would be selected for publishing the article so that maximal readers can be reached. The outcomes of the proposed study would be appropriate to the majority of the hospitals in the country. This study would lend weight to the different recommendations put forward by the different healthcare bodies that promote the use of the hands-free technique as a valuable safety measure in all operating rooms (Parahoo 2014). References Abraham, S.P., 2016. Perspectives on surgical patient safety at operation theatre.TNNMC Journal of Medical Surgical Nursing,4(1), pp.25-31. Aneja, A., Leung, P. and Marquez-Lara, A., 2016. Hang Them High: A Hands-Free Technique for Upper Extremity Limb Holding During Surgical Preparation.Orthopaedic Nursing,35(6), pp.377-381. Bergs, J., Hellings, J., Cleemput, I., Simons, P., Zurel, ., Vertriest, S. and Vandijck, D., 2014. Surgical safety checklists: an update.Acta Chirurgica Belgica,114(4), pp.219-224. Flick, U., 2015.Introducing research methodology: A beginner's guide to doing a research project. Sage. Jagger, J., Berguer, R., Phillips, E.K., Parker, G. and Gomaa, A.E., 2011. Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation.AORN journal,93(3), pp.322-330. Kasatpibal, N., Whitney, J.D., Katechanok, S., Ngamsakulrat, S., Malairungsakul, B., Sirikulsathean, P., Nuntawinit, C. and Muangnart, T., 2016. Prevalence and risk factors of needlestick injuries, sharps injuries, and blood and body fluid exposures among operating room nurses in Thailand.American journal of infection control,44(1), pp.85-90. Lakbala, P., Sobhani, G., Lakbala, M., Inaloo, K.D. and Mahmoodi, H., 2014. Sharps injuries in the operating room.Environmental health and preventive medicine,19(5), pp.348-353. Linzer, P.B. and Clarke, S.P., 2017. an Integrative Review of the Hands-free Technique in the Or.AORN journal,106(3), pp.211-218. Nieswiadomy, R.M. and Bailey, C., 2017.Foundations of nursing research. Pearson. Parahoo, K., 2014.Nursing research: principles, process and issues. Palgrave Macmillan. Stringer, B., Haines, A.T., Goldsmith, C.H., Berguer, R. and Blythe, J., 2009. Is use of the hands-free technique during surgery, a safe work practice, associated with safety climate?.American journal of infection control,37(9), pp.766-772. Stringer, B., Haines, T., Goldsmith, C.H., Blythe, J. and Harris, K.A., 2006. Perioperative use of the hands-free technique: a semistructured interview study.AORN journal,84(2), pp.233-248. Stringer, B., Haines, T., Goldsmith, C.H., Blythe, J., Berguer, R., Andersen, J. and De Gara, C.J., 2009. Hands-free technique in the operating room: reduction in body fluid exposure and the value of a training video.Public Health Reports,124(4_suppl1), pp.169-179. Stringer, B., Infante-Rivard, C. and Hanley, J.A., 2002. Effectiveness of the hands-free technique in reducing operating theatre injuries.Occupational and Environmental Medicine,59(10), pp.703-707. Williams, D., 2016.Factors Associated with Use of Safety-Engineered Needles and Hands-Free Techniques: Current Practices among Operating Room Nurses(Doctoral dissertation, Johns Hopkins University).