Perioperative project in the Pacific – collaboration in action


 

group work

group work

What a wonderful few days we have just had in Suva, Fiji presenting at the workshop on implementing the Pacific Perioperative Practice Bundle (PPPB). We have been working with our colleagues within the organisation, Strengthening Specialised Clinical Services in the Pacific (SSCSiP) developing six infection prevention standards which formed the bundle, together with audit tools for each standard. The workshop was aimed at assisting our Pacific perioperative nursing colleagues implement the bundle within their own workplaces.

SSCSiP’s project coordinator, Mabel Hazelman Taoi and her team did a wonderful job coordinating the workshop and all the travel and accommodation for the twenty participants – no mean feat when you see where they all came from. You will need to get the map out to locate all fourteen countries of the Pacific region represented – Cook Islands, Fiji, Kiribati, FS Micronesia, Marshall Islands, Nauru, Niue, Palau, Samoa, Solomon Islands, Tonga, Tokelau, Tuvalu and Vanuatu. Some of the participants had travelled for a couple of days with many connecting flights via places such as Honolulu and Auckland! Nothing like our 4 hours direct flight from Sydney!

book signing

book signing

webinar with Jed Duff in Sydney

webinar with Jed Duff in Sydney

We had two and half days with our colleagues working through key elements of the standards and strategies for implementation. Each participant received a copy of the 2nd edition of the perioperative text book, Perioperative Nursing: An Introduction. Our fingers were well and truly crossed that technology would work and with the assistance of ACORN’s Education Officer, Dr Paula Foran, we arranged a live webinar with Dr Jed Duff (ACORN President) back in Sydney. He gave a great presentation on putting knowledge into action with excellent practical information on implementing change. It is one thing to have a bundle of standards, it’s quite another to implement them and we spent a lot of time looking and enablers and barriers to implementing change in the workplace based on Jed’s presentation. Another key element to the bundle were the audit tools and for many of our colleagues this was new territory for them. We were able to practice undertaking audits using the tools by carrying out observations in the local operating theatre, around the hospital and by watching videos.

location, location!

location, location!

One additional topic discussed was the formation of a professional association to connect all the perioperative nurses within the Pacific, encouraging sharing of ideas and progress on implementation. We tapped into the experiences of Phyllis Davis who was instrumental in assisting the perioperative nurses of Papua New Guinea form of their association. Another live webinar with Sydney based Phyllis got the ball rolling and served to inspire the group to the next step.

During our workshop we learnt more about the environments that our colleagues work in and the challenges they face in implementing the standards. Some of them work in large units and some come from small facilities with only one operating theatre and minimal staff. It wasn’t all work and we had a lot of fun along the way, including a night out with the group at a local Chinese restaurant.

a night out with the group - note Vane's NSW OTA shirt!

a night out with the group – note Vane’s NSW OTA shirt!

Mabel receiving one of our gifts

Mabel receiving one of our gifts

Unfortunately we were not in Fiji to join in the celebrations for their victorious, gold medal winning 7s rugby team! That would have been an experience judging by the obvious excitement still bubbling amongst the local population. We left Suva exhausted after a full on couple of days, but feeling very satisfied that we had provided the group with lots of information, strategies and encouragement for the next step of their journey. A journey that will bring a consistency to the standards of perioperative nursing practice to their workplace and ultimately a safer environment for their patients.

lovely necklaces and a Fiji banner as gifts

lovely necklaces and a Fiji banner as gifts

We have already had lots of emails from the group who have already organised meetings with their hospital administration to report on the workshop and submit implementation plans. So lots of positive steps are happening already.

We hope to see a few of the group at the South Pacific Nurses Forum to be held in Honiara, Solomon Islands in early November where Sally and Mabel will present a paper on the PPPB Project.

Lister, Carbolic Acid & Alcohol– have we come full circle?

I recently received my annual Nurses’ League Journal from my training hospital, Kings College Hospital, London – the same one featured in one of my previous blogs on the TV show, ’24 hours in Emergency’. The League is essentially the ‘old girls’ association which we joined on completion of our training. The journal is full of news of us ‘old girls’, the reunions that have taken place and general news of the hospital’s activities. The journal usually features an aspect of the hospital’s history, a South London institution since the early 1800s. In this edition, the story of the eminent 19th century surgeon, Joseph Lister was featured. He is widely regarded as transforming surgery into a practice governed by science due to his pioneering work on antisepsis.

Joseph Lister

Joseph Lister

Why am I telling you all this? Well, at the time I was reading about Lister in the journal, I was also editing the chapter on asepsis and infection prevention for the forthcoming second edition of ‘Perioperative Nursing: An Introductory Text’, due for release in May 2016 at the ACORN Conference in Hobart. I was interested to read about Lister’s infection control practices in 1867 and how they contrast with our present day practice. He, like many of his contemporaries, were appalled and puzzled by the high rates of surgical site infections (SSI) which often led to post op death.
It was the work of French chemist of Louis Pasteur’s that influenced Lister’s thinking about what might cause infection. Pasteur had postulated that fermentation of wine and milk was due to bacteria found floating in the air and not just the air itself that caused infection, as had been traditional thinking. Armed with this light bulb moment, Lister’s next step was to experiment with a variety of antiseptic agents which he thought might kill the bacteria that infected surgical wounds. He settled on carbolic acid (phenol) after hearing about its success in cleaning up the city’s stinking sewers. He introduced it into his operating theatre at the Glasgow Royal Infirmary, Scotland, which must have been a most uncomfortable place to work as he sprayed carbolic acid over the operative field (and all the assistants) continuously during surgery and soaked dressings in the solution. His breakthrough moment came when treating a compound tibial fracture in an 11 year old boy, James Greenlees using dressings soaked in carbolic acid. After a few days there was no evidence of the usual infection that blighted such procedures and James made a full recovery.

Lister spraying carbolic acid during surgery

Lister spraying carbolic acid during surgery

Lister continued this type of wound dressing on other surgical patients and his post-operative infection rates dropped dramatically. If Lister had access to the internet, news of this dramatic breakthrough in infection prevention would have spread like wildfire and perhaps been accepted a little sooner, but it was two years before he published a number of articles about his work in the Lancet medical journal. Even then his results were viewed with a degree of scepticism, by many colleagues, particularly in London and it would be another 20 years of further experimentation before the medical profession accepted Lister’s theory and practical application of antisepsis.
Lister carried out much of his research at my old training hospital, King’s College, where he was appointed Chief of Surgery in 1877 and confronted many of his fiercest critics. The hospital had prohibited open surgery into joints due to the high risk of infection, but Lister believing in his antisepsis methods bucked the system (after all he was the boss!), forging ahead with his work, which eventually paid off, laying the foundations for our modern understanding of antisepsis and ultimately aseptic technique.

operating theatre at Kings College Hospital, London

operating theatre at Kings College Hospital, London

Even though we have come a long way since Lister in our understanding of antisepsis and infection prevention, SSIs are still of great concern in the 21st century. Hand washing continues to be a vital strategy in the fight to reduce the risk of infection and what struck me about surgery in Lister’s era, the late 19th century was the use of alcohol as a hand hygiene product. Three to five minutes pre-operative cleansing of the hands using 90% ethanol was common practice amongst surgeons of that era. The efficacy of alcohol to kill microorganisms on the skin has therefore been known for sometime and with the recent introduction of alcohol based surgical scrub solutions (ABSS) in many Australian operating theatres, it feels like we are back to the future!
Moving to ABSS will require a change of culture in our operating theatres – the ritual of the surgical scrub is one which many instrument nurses may be somewhat reluctant to give up – that five minutes or so at the sink was good thinking time when you could gather your thoughts and prepare yourself mentally for the procedure ahead. Replacing that with a 90 second rub with alcohol based product will not come easy to some! For the surgeons too, it is a big change, although having witnessed some surgeons undertake what passes for a surgical scrub by a momentary waving of hands under running water, an application of alcohol will at least kill a few bugs!

Alcohol based surgical scrub

Alcohol based surgical scrub

Many of you have perhaps already been involved in trialling the variety of ABSS products that medical companies are now clamouring the sell us. It’s big business for them! What’s important is to ensure that we make choices based on available evidence of the efficacy of the products and not the hard sell and promises of the company reps. There are many different products on the market –some containing differing percentages of alcohol and those that combine alcohol with other antimicrobial products eg chlorhexidine. Which one to choose? Don’t be afraid to ask the reps for research evidence to back up their claims, but it’s also important to do your own independent research – there is plenty out there and World Health Organisation has some good resources too.
It seems we have come a full circle in the 150 years since Lister first laid the foundations of infection prevention with the introduction of ABSS in the 21st century. It will become one more strategy we can use to reduce the risk of SSIs that continue to be a cause of morbidity and mortality in our hospitals.
Let us know if you are using ABSS in your workplace and how this new procedure is being received.
Bye for now
Menna