Surgical site infection not only brings morbidity and mortality to patients, but it also bring substantial financial burden to the hospital and the healthcare system. To minimize the clinical consequences of surgical site infection, it is crucial that all appropriate measures for reduction of surgical site infection should be implemented. Since patient’s skin is a potential source of pathogens, normal skin flora is a common cause of surgical site infections. Preoperative skin disinfection of the surgical site with an antiseptic agent is an effective method to remove the soil and transient organisms from the skin. Currently, there are different skin antiseptics available and the most commonly used agents are povidone iodine and chlorhexidine gluconate. Although povidone iodine has a long-standing recommendation and it is widely used in various surgical procedures, it has several limitations. On the other hand, there is an increasing interest of the use of chlorhexidine in indwelling catheter placement and care, surgical hand scrubbing, as well as wound dressing. In view of this, there is a potential of replacing povidone iodine by chlorhexidine as preoperative skin antiseptic agent. As there is no existing guideline supportingthis innovative movement, this dissertation aimed to review the currently available evidence on preoperative skin preparation and to develop an evidence-based guideline of using chlorhexidine in preoperative skin preparation for reducing surgical site infection in patients undergoing general surgery. Five randomized controlled studies were identified from MEDLINE, CINAHL and PUBMED and evaluated by a critical appraisal tool, the Scottish Intercollegiate Guidelines Network. All studies reported that preoperative skin preparation with chlorhexidine is more effective than the use of povidone iodine in reducing surgical site infection. An evidence-based guideline is developed according to the guideline development process from the Scottish Intercollegiate Guideline Network. Patient characteristics, local clinical setting, organizational infrastructure and staff competency is congruent with the proposed innovation. The new protocol not only can minimize the risk of postoperative surgical site infection but also save costs. The cost-benefit analysis showed that the new protocol can help to save $675,552 to $1,097,772 (HK dollars) in six-month period after implementation. To facilitate a more comprehensive plan in actual implementation of the proposed guideline, stakeholders at administrative, managerial, and operational levels would be invited to take part in the 12-week pilot test. Surgical site infection, staff satisfaction and compliance, as well as cost and benefit ratio of the guideline would be measured in the evaluation plan. The refined guidelines would then be implemented for one year. The effectiveness of the guideline would be determined by reduction in postoperative surgical site infection, increase in staff knowledge and satisfaction, and the overall expenditure. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Submitted in partial compliance with the requirements of the Master’s Degree in Technology: Homoeopathy, Department of Homeopathy, Durban University of Technology, Durban, South Africa, 2016. / Introduction This research study investigated the efficacy of a homoeopathic protocol in the post-surgical wound management of medical male circumcision (MMC) in the KwaZulu-Natal region. The study had 30 male participants from 10 of the 11 district municipalities of the KwaZulu-Natal province. The study consultations took place at the Durban University of Technology Health Sciences Clinic. Aim of the study The aim of the study was to determine the efficacy of a topical application of a homoeopathic protocol using; Calendula officinalis (mother tincture (M.T.)), Hypericum perforatum (M.T.) and Delphinum staphysagria 30CH (orally) as an adjunct to the standard care of the post-surgical effects of circumcision and to assess the wounds post-surgically in terms of time taken to heal and associated signs and symptoms. Methodology The data for this study was collected from 30 male participants who had undergone MMC from various hospitals within KwaZulu-Natal. The participants were aged between 18 to 30 years. All participants underwent a medical examination and were given a pain rating scale and a pain and sleep diary. They were instructed to keep a daily record using the data collection tools mentioned above for the study period of six weeks. Descriptive statistics were employed in the form of tables and graphs. The data analysis methods used in the study are: independent samples t-test and the non-parametric Spearman’s Correlation test. Results Group statistics in relation to ‘time to heal’ showed a statistically significant reduction in the time taken for the group on the homoeopathic protocol. Analysis of ‘time to heal’ by group shows that on average, Group 1 (active group: homoeopathic protocol + standard care) (M = 31.4, SD = 7.49) healed in a significantly shorter time than Group 2 (control group: standard care) (M = 38.6667, SD = 1.99), t (28) = -2.617, p=.014. There was no other statistical significance noted except for the results of the Spearman’s rho, where table 4.8 shows there is a significant positive correlation between average quality sleep until healing and the proportion of days across healing NOT feeling refreshed (rho = .676, p<.0005). / M

Infections are a major cause of morbidity and mortality during the post-operative phase of patients’ recovery. Wound infections are the second most commonly encountered type of nosocomial infection. Because wound infections can be introduced by not applying infection control measures and sterile technique principles in the operating room, the implementation of infection control principles is an imperative. The aim of this study was to explore and describe infection control practices related to the prevention of Surgical site infections in the operating rooms in a public health care sector in the Nelson Mandela Bay Municipality. The findings were compared with practices, as indicated in an evidence-based guideline. The research design was quantitative, explorative, descriptive, comparative-descriptive and contextual in nature. The research sample consisted of all the professional nurses, in the operating room. The data were collected by means of a self-administered questionnaire. Descriptive statistics was used to present the data in the form of tables and graphs. Based on the analysis of the data, some recommendations were made for the implementation of infection control practices, in order to prevent Surgical site infections in the operating room.