12 The National Institute Clinical Effectiveness (NICE) recommends the use of ANTT for changing or removing surgical wound dressings and the use of sterile saline for wound cleansing up to 48 hours after surgery. 13 Non‐touch (of key parts and key sites) is an integral component of ANTT and is the cornerstone of recommended best practices during surgical procedures. “Aseptic non‐touch technique” is a term applied to a set of specific practices used to ensure asepsis and prevent the transfer of potential pathogens to a susceptible site on the body (eg, an open wound or insertion site for an invasive medical device) or to sterile equipment/devices. 2 Indeed, the use of aseptic technique for changing or removing wound dressings is one of the most important components of wound management given that a break in aseptic non‐touch technique (ANTT) potentially causes the introduction of exogenous microbes, thereby contaminating the wound. Given that SSIs are acutely problematic and preventable, it is important that health care professionals caring for wounds exercise strict asepsis in order to minimise their incidence. Each SSI is associated with approximately 7 to 11 additional postoperative hospital days, and patients with SSI have a 2 to 11 times higher risk of death compared with operative patients without an SSI. 6, 7 SSIs are burdensome on individuals, their families, and on the health services. 5 It is estimated that nearly 50% of surgical site infections are preventable by following evidence‐based guidelines. 4 A substantial number of surgical site infections are caused by microorganism contamination during and after invasive clinical procedures through surgically initiated breaks in the skin. The association between microorganisms in the clinical environment and HCAIs is well accepted. 2 However, standardised education for health care professionals performing surgical wound dressings is lacking. Health care professionals caring for patients with surgical wounds need specialist expertise, knowledge, and skills to ensure optimum evidence‐based wound care. 1 Surgical site infections (SSIs) are one of the most common types of HCAI, representing up to 20% of this patient group. It can be used as both an adjunct to an educational programme and as a tool to assess a practitioner's performance of a wound‐dressing procedure in both simulated and clinical practice contexts.Įvery day, approximately 81 000 people acquire a health care‐associated infection (HCAI) in hospitals across Europe. The metric is a tool that identifies the standard to be attained in the performance of acute surgical wound dressings. The final metric has three phases, 31 individual steps, 18 errors, and 27 sentinel errors. The Delphi panel deliberation verified the face and content validity of the metric. The metric was then subjected to a process of cyclical evaluation by a Delphi panel (n = 21) to obtain face and content validity of the metric. The ANTT wound‐dressing observational metric was stress tested for clarity, the ability to be scored, and interrater reliability, calculated during a further phase of video analysis. This facilitated the identification of the discrete component steps, potential errors, and sentinel (serious) errors, which characterise a wound dressing procedure and formed part of the observational metric. Video recordings of acute surgical wound‐dressing procedures performed by nurses in clinical (n = 11) and simulated (n = 3) settings were viewed repeatedly and were iteratively deconstructed by the metric development group. A scoping review of the literature provided a background empirical perspective relating to wound‐dressing procedure performance. A team of clinicians, academics, and researchers came together to develop an observational metric using an iterative six‐stage process, culminating in a Delphi panel meeting. The aim of this study was to develop an observational metric that could be used to assess the performance of a practitioner in completing an acute surgical wound‐dressing procedure using aseptic non‐touch technique (ANTT).
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