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Background: Surgical site infections are commonly occuring within healthcare, especially in Africa. Good hygiene is the most effective way in which to reduce and prevent infection, compliance however is often low or insufficient. Aim: The Aim of the study was to observe intraoperative compliance to basic hand hygiene in the operating theatre, the secondary aim was to investigate the surgical teams views on patient safety by using a survey on patient safety culture. Method: The design is a quantitative observational study. Through participant observation information was gathered on compliance to basic intraoperative hygiene routines in operating theatres in Mozambique. Operating personnel were then asked to complete a survey on patient safety culture. Result: None of the work elements were performed in complete compliance to WHO’s guidelines at all times. The operating theatre personnel’s views on Patient Safety Culture showed the highest percentage of positive responses was the dimensions “Teamwork Within Hospital Units” and “Organisational Learning- Continous improvement”. The dimensions with the least positive response was “Nonpunitive Response To Error” and “Staffing”. When comparing compliance to basic hygiene and the results of the patient safety culture survey a medium relation was found, where the staff who gave the most positive response to the survey also complied better to the WHO’s hygiene guidelines. Conclusions: Compliance to basic hygiene during the intraoperative phase in the operating theatre in Mozambique, Maputo was often insufficient. There was a medium strong relation between the staffs views on patient safety and their compliance to basic hygiene. This implies that working with the staff’s attitudes concerning patient safety could improve hygiene compliance resulting in reduced number of surgical site infections.

<p><strong>Introduktion:</strong> Svårigheter för vårdgivarna att hålla vårdgarantin var utgångspunkten för Sveriges Kommuner och Landsting (SKL) och Västra Götalandsregionen när de startade Genombrottsprojektet, ”Bättre flyt i opererande verksamheter”, det första som endast omfattade opererande verksamheter. Femton team från operationsavdelningar från hela landet deltog. Projektet pågick under år 2008. Alla team skulle uppnå resultatmålen att minst 90 % av patienterna opererades på första utlovade operationsdag och att 100 % av operationerna skulle starta på utsatt tid. Dessutom formulerade teamen egna processmål och balanserade mål. <strong>Syftet</strong> med studien var att beskriva teamdeltagarnas uppfattningar om att arbeta med genombrottsmetoden i opererande verksamheter. <strong>Metod:</strong> En totalundersökning där samtliga teamdeltagare i projektet (n=95) fick en webbenkät omfattande områdena resultat- och processmål, din arbetsplats, resultat och reflektioner. <strong>Resultat: </strong>Enkäten besvarades av 55</p><p>(58 %) teamdeltagare. Trettien redovisade att de nådde sina resultatmål under projekttiden. Processmålet operationsstart på utsatt tid nåddes helt eller delvis av 45 teamdeltagare och 32 lyckades minska bytestiderna. Tjugoen teamdeltagare uppgav att flera patienter per dag kunde opereras och 14 redovisade att de höll vårdgarantin efter projekttiden. De flesta teamdeltagarna ansåg att förankringen av projektet i personalgruppen fungerade bra, liksom stödet från handledarna. Att få tillräckligt med tid för möten, bemanningen på avdelningen och ledningens engagemang fungerade sämre. Avsaknad av ledningens stöd ledde till minskad motivation för förbättringsarbete.<strong> </strong>Teamdeltagarna ansåg vidare att Genombrottsmetoden var strukturerad och pedagogisk. Den gav helhetssyn på processer och reducerade dubbelarbete. Arbetsmiljön blev bättre. <strong>Konklusion:</strong> Teamdeltagarna ansåg att Genombrottsmetoden är användbar för att förbättra patientflödet och vårdkvaliteten på en operationsavdelning.</p> / <p><strong>Introduction:</strong> Difficulties for the caregivers to keep the national health care guarantee was the starting point for the Swedish Association of Local Authorities and Regions (SALAR) and The Västra Götaland Region when they started the project “Better flow in operating theatres”, based on the Breakthrough Series Model. Fifteen teams from operating theatres from the whole country participated. The project went on in 2008. All teams should achieve the result goals that at least 90 % of the patients should be operated on the day they were promised and 100 % of the operations should start in right time. In addition process goals and balanced goals were formulated by the teams. <strong>Purpose: </strong>The purpose of the study was to describe the team participants’ opinions about working with the Breakthrough Series Model in operating theatres. <strong>Method</strong>: All team participants (n=95) in the project received a<strong> </strong>questionnaire consisting of result- and process goals, your working place, results and reflections.</p><p><strong>Results: </strong>Fifty-five (58 %) of the team participants answered the questionnaire. Thirty-one of them achieved their result goals during the project time. Forty-five of the team participants achieved the process goal “operation start in right time” and 32 succeeded in decreasing turnover time. Twenty one of the team participants described that throughput increased and 14 were able to keep the national health care guarantee after the project time.  Most of the team participants considered that the support from the staff worked well, as well as the support from the supervisors. On the other hand there was not enough time for meetings, not enough staffing and the management commitment was not so good. The motivation for improvement work decreased due to lack of management support. The team participants considered the Breakthrough Series Model as systematic and educational. They also attained a comprehensive view of processes and reduced their work load. The work environment became better. <strong>Conclusion: </strong>The team<strong> </strong>participants thought that the Break through Series Model is a useful method for improving patient throughput and quality of care in an operating theatre.</p>

Introduktion: Svårigheter för vårdgivarna att hålla vårdgarantin var utgångspunkten för Sveriges Kommuner och Landsting (SKL) och Västra Götalandsregionen när de startade Genombrottsprojektet, ”Bättre flyt i opererande verksamheter”, det första som endast omfattade opererande verksamheter. Femton team från operationsavdelningar från hela landet deltog. Projektet pågick under år 2008. Alla team skulle uppnå resultatmålen att minst 90 % av patienterna opererades på första utlovade operationsdag och att 100 % av operationerna skulle starta på utsatt tid. Dessutom formulerade teamen egna processmål och balanserade mål. Syftet med studien var att beskriva teamdeltagarnas uppfattningar om att arbeta med genombrottsmetoden i opererande verksamheter. Metod: En totalundersökning där samtliga teamdeltagare i projektet (n=95) fick en webbenkät omfattande områdena resultat- och processmål, din arbetsplats, resultat och reflektioner. Resultat: Enkäten besvarades av 55 (58 %) teamdeltagare. Trettien redovisade att de nådde sina resultatmål under projekttiden. Processmålet operationsstart på utsatt tid nåddes helt eller delvis av 45 teamdeltagare och 32 lyckades minska bytestiderna. Tjugoen teamdeltagare uppgav att flera patienter per dag kunde opereras och 14 redovisade att de höll vårdgarantin efter projekttiden. De flesta teamdeltagarna ansåg att förankringen av projektet i personalgruppen fungerade bra, liksom stödet från handledarna. Att få tillräckligt med tid för möten, bemanningen på avdelningen och ledningens engagemang fungerade sämre. Avsaknad av ledningens stöd ledde till minskad motivation för förbättringsarbete. Teamdeltagarna ansåg vidare att Genombrottsmetoden var strukturerad och pedagogisk. Den gav helhetssyn på processer och reducerade dubbelarbete. Arbetsmiljön blev bättre. Konklusion: Teamdeltagarna ansåg att Genombrottsmetoden är användbar för att förbättra patientflödet och vårdkvaliteten på en operationsavdelning. / Introduction: Difficulties for the caregivers to keep the national health care guarantee was the starting point for the Swedish Association of Local Authorities and Regions (SALAR) and The Västra Götaland Region when they started the project “Better flow in operating theatres”, based on the Breakthrough Series Model. Fifteen teams from operating theatres from the whole country participated. The project went on in 2008. All teams should achieve the result goals that at least 90 % of the patients should be operated on the day they were promised and 100 % of the operations should start in right time. In addition process goals and balanced goals were formulated by the teams. Purpose: The purpose of the study was to describe the team participants’ opinions about working with the Breakthrough Series Model in operating theatres. Method: All team participants (n=95) in the project received a questionnaire consisting of result- and process goals, your working place, results and reflections. Results: Fifty-five (58 %) of the team participants answered the questionnaire. Thirty-one of them achieved their result goals during the project time. Forty-five of the team participants achieved the process goal “operation start in right time” and 32 succeeded in decreasing turnover time. Twenty one of the team participants described that throughput increased and 14 were able to keep the national health care guarantee after the project time.  Most of the team participants considered that the support from the staff worked well, as well as the support from the supervisors. On the other hand there was not enough time for meetings, not enough staffing and the management commitment was not so good. The motivation for improvement work decreased due to lack of management support. The team participants considered the Breakthrough Series Model as systematic and educational. They also attained a comprehensive view of processes and reduced their work load. The work environment became better. Conclusion: The team participants thought that the Break through Series Model is a useful method for improving patient throughput and quality of care in an operating theatre.

Nursing students in South Africa are exposed to various clinical environments as part of the prescribed curriculum (SANC, 2008). These clinical environments not only positively or negatively influence nursing students but also greatly influence their decisions regarding future specialization. This relationship between the influence of the clinical environment and the decision to apply at a specific hospital was established by Andrews et al. (2005:147), but little is known about how it affects the decision of nursing students to specialize in a specific area. According to the South African Nursing Council‟s statistical data, an additional qualification in operational theatre is one of the least qualifications applied for (SANC, 2012b). This indicates that not many nursing students choose, for example, the theatre as a specialization area when their studies are completed. In light of this evidence, this study aimed to explore the influence that the clinical environment has on the decision of nursing students to specialize in a specific area. An explorative and descriptive design, which is qualitative in nature, was followed to conduct this study. The data collection was conducted in two phases. Phase one: Nursing students‟ experiences after exposure to theatre as a clinical environment were explored by means of reflective essays. Data was analysed according to the principles of Tesch as described in Creswell (1994:154). Meetings between the researcher and an experienced co-coder resulted in consensus regarding the findings. Three main themes and eleven sub themes were identified and provided clarity on the influence of the clinical environment on nursing students. Phase two, consisting of two focus group discussions facilitated by an expert in focus group facilitation, was completed to validate the findings from the reflective essay. This data was transcribed, analysed and the findings validated by the existing data from phase one. Conclusions drawn from this study were that the clinical environment does influence the students‟ decision to specialize in operating theatre, but many choose not to specialize in theatre due to personal preferences. / MCur, North-West University, Potchefstroom Campus, 2014

Nursing students in South Africa are exposed to various clinical environments as part of the prescribed curriculum (SANC, 2008). These clinical environments not only positively or negatively influence nursing students but also greatly influence their decisions regarding future specialization. This relationship between the influence of the clinical environment and the decision to apply at a specific hospital was established by Andrews et al. (2005:147), but little is known about how it affects the decision of nursing students to specialize in a specific area. According to the South African Nursing Council‟s statistical data, an additional qualification in operational theatre is one of the least qualifications applied for (SANC, 2012b). This indicates that not many nursing students choose, for example, the theatre as a specialization area when their studies are completed. In light of this evidence, this study aimed to explore the influence that the clinical environment has on the decision of nursing students to specialize in a specific area. An explorative and descriptive design, which is qualitative in nature, was followed to conduct this study. The data collection was conducted in two phases. Phase one: Nursing students‟ experiences after exposure to theatre as a clinical environment were explored by means of reflective essays. Data was analysed according to the principles of Tesch as described in Creswell (1994:154). Meetings between the researcher and an experienced co-coder resulted in consensus regarding the findings. Three main themes and eleven sub themes were identified and provided clarity on the influence of the clinical environment on nursing students. Phase two, consisting of two focus group discussions facilitated by an expert in focus group facilitation, was completed to validate the findings from the reflective essay. This data was transcribed, analysed and the findings validated by the existing data from phase one. Conclusions drawn from this study were that the clinical environment does influence the students‟ decision to specialize in operating theatre, but many choose not to specialize in theatre due to personal preferences. / MCur, North-West University, Potchefstroom Campus, 2014

There is an increase in HIV/AIDS and other blood borne diseases. Health care workers are often exposed to blood and body fluids and thus prone to blood borne infections. Preventative measures can be taken to prevent health workers from contracting these diseases. However, health care workers need to stringently apply these measures. Universal precautions against blood borne infections include diligent hygiene practices, such as hand washing and drying, appropriate handling and disposal of sharp objects, prevention of needle stick or sharp injuries, appropriate handling of patient care equipment and soiled linen, environmental cleaning and spills management, appropriate handling of waste as well as protective clothing such as gloves, gowns, aprons, masks and protective eyewear. This study is aimed at investigating compliance with universal precautions in operating theatres in Northern KwaZulu–Natal as well as perceptions of registered nurses working in these operating theatres regarding factors influencing compliance in order to contribute to measures to limit the risk of infection to patients and health care workers. A sequential explanatory design, mixed–method (quantitative and qualitative) was used to explore the use of universal precautions in operating theatres in the Northern Kwa–Zulu Natal. In the first phase, the sample consisted of practices in operating theatres of six hospitals and one regional hospital in area 3 of Kwa–Zulu Natal. The adapted structured checklist based on an established document developed by the MASA Committee for Science and Education (1995) was pilot tested. The collected data was statistically analysed and interpreted with the help of a statistician using SPSS. The results of Phase 1 were used as a base for the Phase 2 questions. Three focus group interviews were conducted with professional nurses who were observed during Phase 1 at the selected hospitals. Findings from quantitative data show that although health care workers take precautions to prevent infections, they do not attain full compliance to universal precautions. The qualitative data indicated that the reasons for non–compliance amongst others were the lack of knowledge of universal precautions, communication factors, resources, including maintenance of equipment, lack of supplies and shortage of human resources and attitudes of health care workers. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2012.

Bakgrund: : Vårdrelaterade infektioner är kostsamma för vården och orsakar lidande förpatienten. Operationspersonal har en viktig uppgift att förebygga smittspridning och följahygienrutiner. Dessa är bland andra att använda rätt arbetskläder, arbeta aseptiskt och enligtbasala hygienrutiner samt att bibehålla steriliteten. Syfte: Syftet med studien var att observeraföljsamheten till aseptik och basala hygienrutiner på operationssal vid allmänkirurgiskt ingreppvid två sjukhus i Mellansverige. Metod: Studien var en observationsstudie med kvantitativansats. Observationerna genomfördes utifrån ett observationsprotokoll. Ingreppen somobserverades var av allmänkirurgisk karaktär och totalt tio observationer utfördes.Yrkeskategorier som ingår i operationsteamet observerades i olika arbetsmoment, såsomarbetskläder, insättning av PVK, preoperativ huddesinfektion och steril drapering. Följsamhetentill de olika momenten beräknades i procent. Resultat: Totalt tio observationer genomfördes. Dearbetsmoment som hade bäst följsamhet var arbetskläder, insättning av PVK, preoperativhuddesinfektion och steril drapering. I alla arbetsmoment som observerades var handdesinfektionden underkategori som hade sämst följsamhet. Slutsats: I samtliga av de sex arbetsmoment somobserverades i studien fanns brister gällande följsamhet till aseptik och basala hygienrutiner trotsatt vissa moment, såsom preoperativ huddesinfektion och steril drapering av operationsområdet,hade hög följsamhet. / Background: Hospital acquired infections are costly for health care and causes distress for thepatient. Operational staff have an important role in preventing the spread of infection and followhygiene procedures. These include using the proper work clothes, work aseptically and accordingto basic hygiene and to maintain sterility. Aim: The aim of the study was to observe adherence toaseptic technique and basic hygiene procedures in the operating theater for general surgery attwo hospitals in central Sweden. Method: The study was an observational study withquantitative approach. The observations were carried out on the basis of an observation protocol.The surgical intervention that were observed was of a general surgical nature and a total of tenobservations were performed. Professional categories included in the operating team wereobserved in different tasks, such as work clothes, insertion of PVK, preoperative skindisinfection and sterile draping. Adherence to the various elements was calculated in percent.Result: A total of ten observations were made. The observed tasks that had the best adherencewere working clothes, insertion of PVK, preoperative skin disinfection and sterile draping. Handdisinfection was the subcategory that had the lowest adherence of all observed tasks.Conclusion: In each of the six tasks that were observed in the study there were deficienciesregarding adherence to aseptic technique and basic hygiene despite some tasks, such aspreoperative skin disinfection and sterile draping of the surgical field, which had high adherence.

There is an increase in HIV/AIDS and other blood borne diseases. Health care workers are often exposed to blood and body fluids and thus prone to blood borne infections. Preventative measures can be taken to prevent health workers from contracting these diseases. However, health care workers need to stringently apply these measures. Universal precautions against blood borne infections include diligent hygiene practices, such as hand washing and drying, appropriate handling and disposal of sharp objects, prevention of needle stick or sharp injuries, appropriate handling of patient care equipment and soiled linen, environmental cleaning and spills management, appropriate handling of waste as well as protective clothing such as gloves, gowns, aprons, masks and protective eyewear. This study is aimed at investigating compliance with universal precautions in operating theatres in Northern KwaZulu–Natal as well as perceptions of registered nurses working in these operating theatres regarding factors influencing compliance in order to contribute to measures to limit the risk of infection to patients and health care workers. A sequential explanatory design, mixed–method (quantitative and qualitative) was used to explore the use of universal precautions in operating theatres in the Northern Kwa–Zulu Natal. In the first phase, the sample consisted of practices in operating theatres of six hospitals and one regional hospital in area 3 of Kwa–Zulu Natal. The adapted structured checklist based on an established document developed by the MASA Committee for Science and Education (1995) was pilot tested. The collected data was statistically analysed and interpreted with the help of a statistician using SPSS. The results of Phase 1 were used as a base for the Phase 2 questions. Three focus group interviews were conducted with professional nurses who were observed during Phase 1 at the selected hospitals. Findings from quantitative data show that although health care workers take precautions to prevent infections, they do not attain full compliance to universal precautions. The qualitative data indicated that the reasons for non–compliance amongst others were the lack of knowledge of universal precautions, communication factors, resources, including maintenance of equipment, lack of supplies and shortage of human resources and attitudes of health care workers. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2012.

Operationssjukvård krävs under natten för att säkerställa vården och hjälpa patienter inom rimlig tid.  Operationssjuksköterskan i operationsteamet arbetar tillsammans med opererande läkare med det kirurgiska tillvägagångssättet, samt ansvarar för patientens perioperativa vård. Syftet med denna intervjustudie var att belysa operationssjuksköterskornas upplevelser av att arbeta nattskift på en operationsavdelning. Halvstrukturerade intervjuer genomfördes med sex operationssjuksköterskor på ett medelstort sjukhus i Sverige, och efter en kvalitativ innehållsanalys av materialet framkom sex kategorier; Nattens ryggrad – teamarbetet, Natten – vårdandets tid, På Natten – alltid redo, Natten blir till dag, Natten – tidens tand samt Nattens charm. Studiens resultat speglade operationssjuksköterskornas upplevelser av att teamarbetet utgjorde grunden för ett patientsäkert arbete under nattskiftet samt att operationssjuksköterskorna fick en förbättrad möjlighet att fokusera på omvårdnaden och kommunikationen med patienten under natten. Det krävdes även konstant handlingsberedskap inför oväntade situationer, och arbetet under natten var under förändring då fler av dagskiftets operationer sköts över till natten. Operationssjuksköterskorna upplevde även att arbetet under natten blev svårare då de blev äldre, men att arbetet under nattskift ändå upplevdes som roligare än dagskiftet. Således kunde det tolkas att nattskiftet hade en inverkan på operationssjuksköterskornas arbete, då arbetet kunde vara fysiskt och psykiskt ansträngande vilket även kunde ha en inverkan på patientsäkerheten. Nattskiftets speciella karaktär och med ett närmare teamarbete resulterande ändå i att arbetet utfördes med kvalitet samt att operationssjuksköterskorna upplevde arbetet som roligare, vilket fick dem att välja att fortsätta arbeta nattskift.