Effectiveness of Evidence Based Practice Protocol in Prevention and Control of Pin Site Infection among Orthopedic Patients with External Fixator

Abstract

The term fracture relates to break in the continuity of anatomical structure of bone. The management of fracture is done by emulating the principles of immobilization and splinting. Application of plaster cast or internal fixator or external fixator is a choice of interventions in treating complex skeletal fractures. Furthermore, the advantage of having external fixator is that it provides stability in patients with poor soft tissue integrity. It is found that the most common complication associated with the use of external fixator is Pin Site Infection (PSI). The objectives of the study were to assess the grades of pin site infection among orthopedic patients with external fixator, to assess the knowledge of staff nurses regarding prevention and control of pin site infection, to compare the effectiveness of evidence-based practice protocol in prevention and control of pin site infection, to evaluate the effectiveness of evidence-based practice training programme on prevention and control of pin site infection, to find the association between grades of pin site infection among orthopedic patients with external fixator and selected demographic variables. A quasi-experimental design was adopted. The conceptual framework developed was based on ARCC model. The sample size was calculated using formula considering mean difference and standard deviation. A total of 40 orthopedic patients with external fixator (20 each in experimental and control group) and 20 staff nurses who met inclusion criteria were selected using non-probability purposive sampling technique. Data collection was done using Checketts and Otterburn’s scale for grading of infection, and visual analogue scale to assess pain. Structured knowledge questionnaire was used to assess the knowledge of staff nurses regarding prevention and control of pin site infection, and a clinical assessment record proforma to record the grading. Before starting data collection, ethical clearance was taken, administrative permission to conduct study was taken from Kakasaheb Mhaske Multispeciality Kamgar Hospital, Ahmednagar, Maharashtra, and an informed consent from participants was obtained. The period of data collection started from 07/02/2016 to 20/05/2016. Data analysis was done using SPSS16.0. Both, descriptive and inferential statistics were used in this study. The findings of this study showed that EBP training programme regarding prevention and control of PSI was found to be effective at 5% level, H2 accepted. EBP protocol was found to have no significant difference in comparison to standard care in prevention and control of PSI at 5% level, H1 rejected. The majority (85%) of patients in experimental group had no pain, 15% of patients had mild pain. The majority (75%) of patients in control group had no pain, 15% of population had mild pain, and 10% of population had moderate pain. The most common micro-organism causing PSI was Staphylococcus aureus. The study came up with two imperative conclusions. Firstly, there was no statistically significant difference between EBP protocol and standard care, and secondly, the EBP training programme was statistically significant at  5% level.