Transcript Slide 1

The Effect of Perioperative Scrub Person Expertise and Post-operative
Surgical Site Infection
Melissa Bathish, MS, RN, CPNP-PC, Christine Anderson, PhD, RN, AkkeNeel Talsma, PhD, RN
University of Michigan School of Nursing
BACKGROUND/SIGNIFICANCE
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Little is known about the effects of perioperative nursing
expertise on post-operative patient outcomes such as
surgical site infection (SSI).
Many studies have identified relationships between
surgeon expertise, experience, and patient outcomes.
The definition of surgeon expertise entails ‘amount’
(surgical volume) as opposed to ‘length’ of experience..
The purpose of this study is to evaluate one method of
identifying scrub nurse expertise based on deliberate
practice and to examine its effects on the development of
SSI.
RESULTS
Table 1 describes the scrub person sample in this study. Scrub persons spent 51% of their time in the
scrub role. Table 2 describes the patient sample demographics for SSI groups. The overall SSI rate is 6.1%
(n=56). Figure 1 shows the total number of scrub persons per case (M=2.25, SD=.99) with and without SSI.
Figure 2 illustrates the range of expertise in the general surgery cases (M=394:29, SD=9.89). Scrub person
expertise was not found to be a significant predictor of SSI, with or without controlling for patient and
system variables. Table 3 shows logistic regression results of the final model controlling for other factors.
RVU and patient admission status were found to be significant predictors of SSI (p<.01).
Table 2
Table 1
Scrub Person Category
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A cross-sectional, cohort design with descriptive and
predictive analyses was utilized. Case level and staffing
data were obtained via electronic medical records (EMR)
from one university-based medical center (N = 17,518) as
part of a larger study.
A subset (n = 923) of this data merged a random sample of
case level data (general surgery cases) with pre and postoperative patient outcomes data from the medical center’s
participation in the American College of Surgeons National
Surgical Quality Improvement Plan (ACS NSQIP) and was
used in this secondary analysis.
Expertise was operationalized by summing and weighting
the experience of all scrub persons per case in general
surgery in 2008.
Patient
Demographics
SSI
Yes (n=56)
No (n=867)
Age
55.8±15
53.2±16.5
29.7±8.1
29.5±8.9
Frequency
Percent
Registered Nurse
158
71.8%
BMI
Scrub Technicians
62
28.2%
Gender
Total
220
100%
Male
25(44.6%)
327(37.7%)
Female
31(55.4%)
540(62.3%)
Yes
8(14.35%)
85(9.8%)
No
48(85.7%)
782(90.2%)
METHODS
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Figure 1
Table 3
Smoker
Variables
B
S.E.
Wald
df
Sig.
Expertise
RVU
ASA
Admit Status
-.058
.034
.205
-.518
.063
.012
.105
.197
.859
8.482
3.772
6.898
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1
.354
.004
.052
.009
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Figure 2
Exp(B)
95%
Lower
.943
.843
1.034 1.011
1.227 .998
.596
.405
C.I.
Upper
1.067
1.058
1.509
.877
The outcome variable was the development
of SSI (yes/no) within 30 days postoperatively.
Potential confounding variables included
expertise, relative value units (RVU),
American Society of Anesthesiologists (ASA)
physical status, and patient admission status.
These were controlled for using logistic
regression.
CONCLUSIONS
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This study found no statistically significant
association between scrub nurse expertise based
on deliberate practice (surgical volume) and SSI.
Preliminary analysis did show a relationship
between expertise and intra-operative time which
also affects patient outcomes such as SSI.
Further studies are needed to evaluate this method
of identifying expertise with other patient and case
level variables.
A limitation of this study is the sole focus on scrub
person expertise, excluding the impact of the
circulating nurse on patient outcomes.
ACKNOWLEDGMENTS
Funding was provided by the Rackham Spring/Summer
Research Grants Program; sponsored by Professor AkkeNeel
Talsma, University of Michigan School of Nursing. For more
information contact Melissa Bathish, [email protected]