During surgery, it is apparent that the primary protective layer of the skin is destroyed, thereby exposing the site to infections. An infection occurs once germs manage to make their way into the wound. Generally, intact skin has qualities that prevent this from happening. Therefore, surgical related infections are often noted by nurses who care for patients’ post-surgery. The most common signs of an infection include Erythema surrounding the incision line, drainage, and induration of the incision. Negative pressure can be applied to the surgical wound to reduce the accumulation of the extra fluid. It also helps to alleviate the pain during the process of changing the dressing. Therefore, to prevent infection after a cesarean section or abdominal laparotomy, PICO dressings or negative pressure wound care should be used.
In cesarean section patients, will PICO dressing or negative pressure wound therapy as compared to standard dressing decrease infection rates when applied after surgery?
P: In cesarean section patients,
I: will PICO dressing or negative pressure wound therapy
C: as compared to standard dressing
O: decrease rates of infection
T: when applied after surgery?
The experiences of pain during negative pressure wound therapy (NPWT) were analyzed by Unver et al. (2018) in a descriptive qualitative research study. The study’s findings are significant in nursing as they provided evidence-based information and proven measures to reduce the growing incidences of SSI, specifically in surgical wound healing (Unver et al., 2018).The research study’s objective and purpose were focused on assessing the effects of the NPWT in the prevention of SSI in wound healing, mainly through closure, besides the evaluation of the cost-efficacy of the NPWT approach. The research question was limited on the need to examine the effects of NPWT in the prevention of surgical site infections from wounds that heal through the primary closure approach.
Another study by Huang et al. (2020) researches on the perspectives established in the element of NPWT at home, specifically in patients suffering from chronic wounds, through a qualitative descriptive study. The significance of this research study is fundamental in nursing practice as it helps the procedures used in the prevention and the reduction of the risks of SSIs. This research study’s purpose and objective was to compare the safety and efficiency of the NPWT approach in a standard surgical dressing method or rather a conventional therapy intended at preventing SSIs (Huang et al., 2020). The study sought to address the uncertainties in practice regarding the use of NPWT to reduce the increasing cases of wound dehiscence, hospital admissions, hematoma, and the adverse events related to the prolonged and shortened length of stay in hospitals.
In the study by Huang-Ping et al. (2019), negative pressure after cesarean section is being compared to regular dressing. It is significant to nursing since it presents a comparison on two modes of care delivery for patients post-surgery. The purpose and objective of this study is to find out whether or not preventative negative pressure wound care may help reduce surgical site infection and other wound complications in obese women undergoing cesarean section. The research is based on an analysis of prophylactic negative pressure wound therapy for surgical site infection in obese women undergoing cesarean section.
In the final study by Kawakita et al. (2019), negative pressure dressings are contrasted to conventional dressings after cesarean surgery. It is significant to nursing since it highlights the nature of different options for wound care after surgery. The purpose and objective of the study was to determine whether PICO negative pressure wound care contributed to a decreased risk of the primary outcome in highly obese women who had cesarean sections compared to standard dressings. The research was based on an analysis of whether or not PICO negative pressure wound care is effective compared to other methods.
The four studies identified relate to the PICOT question since they contribute different forms of information on the subject. They are all related to PICO negative pressure wound care and how effective it is as opposed to standard methods. Also, it focuses on patients who have undergone cesarean section.
Method of Study
Unver et al. (2018), in an effort to address the objectives of the research study, conducted a qualitative descriptive research study intended to examine and explore the element of pain experiences during NPWT in postsurgical abdominal wounds. The research, in this case, made use of a descriptive, semi-structured, and qualitative study that involved face-to-face interviews that were conducted in a surgical ward. The use of this approach was advantageous in the sense that the design used face-to-face interviews that causal played a critical role in the collection of reliable data, considered as a vital and most fundamental approach in the collection of empirical evidence in examining the variables entailed in the study (Yahalom, 2020). A challenge that may be exhibited in the use of this model is evident in the fact that the views of the respondents may at times be biased, a factor that may result in the collection of skewed data.
Huang et al. (2020) conducted a qualitative descriptive research study with the intent of collecting qualitative data through the use of semi-structured interviews. A purpose approach of sampling was used. One of the advantages of this research approach is that, to a more significant extent, the approach focused on addressing confounding issues during the study through the direct collection of data from the respondents (Yahalom, 2020). However, it is notable that there are critical drawbacks in a single large and randomized clinical trial that include the rigorousness of the treatment methods that pose a challenge in research. These two articles being reviewed are similar since they employ a qualitative descriptive approach. However, approaches used for data collection are different as one uses a face-to-face interview, while the other uses a semi-structured interview.
Huang-Peng et al. (2017) conducted a systematic search of PubMed, Embase, the Cochrane Library, and clinicaltrials.gov to identify randomized controlled trials (RCTs) comparing NPWT to standard cesarean delivery dressings. The risk ratio was calculated in this investigation using random-effects models. Review manager 5.3 was used to perform the analyses. Although it is easy to obtain data using the systematic review, combining different findings can be challenging as the researchers have carried out their investigations in different ways. Additionally, the length of the initial study, number of participants among other factors can contribute to the challenges in comparing the findings of the studies.
Kawakita et al. (2019) used a retrospective cohort study design to identify all obese pregnant women who had a cesarean delivery. In a retrospective case-control study, the investigator may quickly assess the impact of an intervention on the outcome status. However, there is a limitation in the sense that susceptibility data may be insufficient and that inconsistencies may be experienced.
Although both of these authors are using a quantitative approach, it is clear that their approach is different. Huang-Ping et al. (2019) use a systematic review for data collection, while Kawakita et al. (2019) use patient data previously collected in only one facility.
Results of Study
Unver et al. (2018), as viewed in this study, establish that NPWT remains critical and significant in reducing the risks of SSIs compared to the use of other standard dressing approaches. Close to fourteen research studies raveled low cases of uncertainty in the use of NPWT. On the other hand, Huang et al. (2020) established that the standard approaches of wound care might reduce the risks of SSIs. However, the study showed uncertainties in the use of NPWT in the reduction removal or rather the increase in the risks of wound hematoma, dehiscence, and hospital readmissions.
Huang-Peng et al. (2017) note that when negative pressure wound therapy is used instead of standard dressings, the risk of surgical site infection is greatly decreased. However, there was no difference between the two groups in terms of wound complications or hospital readmissions. Using trial sequence analysis, they were unable to find any evidence to support the current results. Kawakita et al. (2019), on the other hand, note that positive pressure wound care and standard dressings had equal rates of the main outcome in the mismatched group, as did negative pressure wound care and standard dressings. Females who received negative pressure wound care exhibited comparable major outcome rates to females who received conventional dressings once matching was completed.
The implications of these four studies in nursing practice is that the qualitative articles present a guideline for the closure of surgical wounds to minimize infections. However, in Kawakita et al. (2019), it is noted that no main difference exists between the standard and PICO methods. There is no sure way to determine the level of effectiveness of the negative pressure wound care over standard dressings (Holford, 2020). Finally, Huang et al. (2017) show that although negative pressure wound therapy is beneficial in decreasing surgical site infection in obese women after the cesarean section, it is ineffective in reducing overall wound problems or hospital readmissions.
The ethical consideration in the research studies analyzed primarily included a transparency declaration in presenting the collected data, a phenomenon that the researchers observed. In the qualitative studies by Unver et al. (2018) and Huang et al. (2020), the researchers are revealed to have made use of human subjects. Given this, the researchers observed the ethicality of informed consent in ensuring that the researchers provided consent to engage in the research (Yahalom, 2020). On the other hand, the element of confidentiality of the respondent’s data and information was observed in the research studies. Huang-Ping et al. (2019) and Kawakita et al. (2019) made use of available records rather than direct human subjects.
The PICOT study is likely to show that most surgical coverings absorb fluid, keep the wound moist, and insulate the wound surface. It is possible to control wounds using PICO dressings or negative pressure wound therapy, which includes negative pressure support. PICO dressings assist in reducing the duration of a patient’s hospital stay by reducing the risk of infection. As a result of a scholarly review and study selection procedure, evidence from the findings will indicate that negative pressure wound rehabilitation is superior to traditional or advanced moist wound care when it comes to healing time. However, after analyzing the four articles above, it is evident that negative pressure wound care makes it possible for cesarean section wounds to heal faster and have a smaller surface area. Negative pressure wound therapy was shown to be as effective and safe as more traditional wound care treatments.
Proposed Evidence-Based Practice Change
The PICOT question as well as the identified nursing practice problem are interconnected since they all focus on the same patient population and mode of intervention. Therefore, it is clear that the findings from the four articles can be generalized to the patient population in the real world. Hence, it is recommended that the care of patients’ post-surgery should prioritize the use of PICO dressing or negative pressure wound therapy. However, the standard approaches should still be considered when this option is not present.
Holford C. (2020). Negative-pressure wound therapy – does it lower the risk of complications with closed wounds following breast surgery? Expert Review of Medical Devices, 17(10), 1017–1019. Retrieved from https://doi.org/10.1080/17434440.2020.1828058
Huang Y., Hu J., Mao B., Ni P., Shou Y., Hou L., & Xie T. (2020). Perspectives on the Process of Negative Pressure Wound Therapy at Home in Patients With Chronic Wound: A Qualitative Descriptive Study. The International Journal of Lower Extremity Wounds, 153473462094657. https://doi.org/10.1177/1534734620946577
Huang-Ping H., Wen-Zen Z., Jia P., Fang H. (2019). Prophylactic negative pressure wound therapy for surgical site infection in obese women undergoing cesarean section: an evidence synthesis with trial sequential analysis. The Journal of Maternal-Fetal & Neonatal Medicine, 1–8. Retrieved from https://doi.org/10.1080/14767058.2019.1668924
Kawakita T., Iqbal S., Overcash R. (2019). Negative pressure wound therapy system in extremely obese women after cesarean delivery compared with standard dressing. The Journal of Maternal-Fetal & Neonatal Medicine, 34(4), 634–638. Retrieved from https://doi.org/10.1080/14767058.2019.1611774
Unver S., Eyi S., & Ozkan Z. K. (2018). A Descriptive, Qualitative Study to Explore the Pain Experience During Negative Pressure Wound Therapy for Postsurgical Abdominal Wounds. Ostomy Wound Management, 64(11), 38–48. https://doi.org/10.25270/owm.2018.12.3848
Yahalom J. (2020). Toward a methodology of chance: On obstacles to research and their advantages. Qualitative Psychology, 7(2), 153–168. https://doi.org/10.1037/qup0000172