Sarah Gakstatter

Nursing Informatics 2015

Research Question Assignment
1.) Research Question: In surgical patients, does operating room staffs repeated entering and exiting of the operating suite during
surgery increase the risk of surgical site infection compared to staff staying in the suite during surgery?
P:
I:
C:
O:

surgical patients
OR staff repeated entering and exiting of operating suite
OR staff staying in the operating suite
increased risk of surgical site infection

2.) Why I developed it: I developed this question because of a personal experience. During one of my clinical rotations in the OR, I
overheard two nurses exasperation over a colleague who repeatedly would enter and leave the surgical suite. They commented on the
need to keep the doors closed. The only reason I could think of for why this might be was infection control, and I was curious as to if
this was true or not.
3.) Evaluations of 3 Scholarly Articles:
Worksheet 3.1 Evaluation Flowchart and Checklist (page 2)

Your evaluation: Source #1

Having filled in the flowchart, what conclusion have you reached? Is this a good source for your research
project?
I conclude that this source is reliable and suitable in answering my research question.

Does the author or organization have the proper experience and qualifications to provide this

information? Yes

 If written by an organization, is the organization well known and trusted? N/A

Does the organization have a positive (altruistic) purpose in providing this information? N/A
Does the source contain a bibliography or other references to show the source of the information? Yes
Has this source been through a formal publication process? Yes Has it been edited or reviewed?
Yes

Does the site contain any bias? No If so, can you find a way to balance the bias with information

from other sources? N/A Finally, is it up to date? Yes Is this important for your topic? Yes
Summary (What is your overall evaluation, based on the checklist and your flowchart? Is this a suitable
source for your academic research? What evidence supports your decision?)
This is a suitable source for my research question. It is Level I evidence, providing a systematic review of
clinical trials and current evidence-based clinical practice guidelines about what features and practices
instituted in operating rooms are effective in reducing the risk of surgical site infection development. As
applicable to my question, it discusses that current evidence-based practice is to reduce the movement of
people in and out of the operating suite since studies have shown that increased movement increases and
facilitates the spread of microorganisms within the operating suite.
For further evidence of the reliability of this source, the journal this article was published in is developed by
doctors in the Department of Health Sciences in the University of Genoa, Italy, and the authors are doctors with
over 20 years experience in their respective fields. All have been trained in and are experienced in performing
clinical research. Articles published in the journal are peer-reviewed and edited before deemed credible and
acceptable for publication. The source contains an extensive bibliography and is up-to-date (it was published
within the last 3 years in 2013). I did not detect any bias in this source. It seemed to me to be a
straightforward presentation and summary of current evidence.

Source information:
Title:
Operating theatre quality and prevention of surgical site infections
Author (if listed):
Anna Maria Spagnolo, G. Ottira, Daniela Amicizia, Fernanda Perdelli, and Maria Luisa Cristina

Organization (if provided):

Department of Health Sciences, University of Genoa, Italy
URL (if provided):
http://www.jpmh.org/index.php/jpmh
Other information useful for finding this source again or for citing it later:
Title of Journal: Journal of Preventive Medicine and Hygiene
Date of Publication: September 2013
Volume number: 54 Issue number: 3 Pages: 131-137

Worksheet 3.1 Evaluation Flowchart and Checklist (page 2)

Your evaluation: Source #2

Having filled in the flowchart, what conclusion have you reached? Is this a good source for your research
project?
I have concluded that this is a reliable source, and it is applicable to my research question.

Does the author or organization have the proper experience and qualifications to provide this

information? Yes
If written by an organization, is the organization well known and trusted? N/A
Does the organization have a positive (altruistic) purpose in providing this information? N/A
Does the source contain a bibliography or other references to show the source of the information? Yes
Has this source been through a formal publication process? Yes Has it been edited or reviewed?
Yes

Does the site contain any bias?

No If so, can you find a way to balance the bias with information
from other sources? N/A Finally, is it up to date? Yes Is this important for your topic? Yes

Summary (What is your overall evaluation, based on the checklist and your flowchart? Is this a suitable
source for your academic research? What evidence supports your decision?)

My overall evaluation is that this is a reliable source, and it is suitable for my research question. This source is
Level III evidence a controlled trial designed to determine how movement of people in and out of the
operating room during surgery influences the amount of microorganisms present in the air around the surgical
wounds. This was done by collecting air samples using an air scanner with a sterilized hose and filter attached
to the end that extended to the air close to the wound area. This is applicable to my research question since
the study was designed to see how people entering and exiting the operating room during surgery affects the
risk for surgical site infection. For a limitation to my research question, I would need more evidence to base an
answer to my research question on this article since this article presents the results of only one clinical trial.
For evidence of the credibility of the source, the study was deemed ethical by the ethics committee at the
university in which the study was performed. All samples and equipment were managed using strict aseptic
technique, and samples that were accidentally contaminated were excluded from the study. All other potential
causes of contamination were controlled following normal standards of practice. The authors are doctors and
doctoral nurses who have been trained in and have experience in conducting research studies. The source
contains a bibliography and has been peer reviewed and edited before publication. I did not detect any bias in
this source, and it is up-to-date (it was published in 2012). The source also noted the ways potential risks for
bias in the study were managed.

Source information:
Title:
Traffic flow in the operating room: An explorative and descriptive study on air quality during orthopedic
trauma implant surgery
Author (if listed):
Anette Erichsen Andersson, Ingrid Bergh, Jn Karlsson, Bengt I. Eriksson, and Kerstin Nilsson
Organization (if provided):
N/A
URL (if provided):
http://www.ajicjournal.org/
Other information useful for finding this source again or for citing it later:
Title of Journal: American Journal of Infection Control
Date of publication: October 2012

Volume Number: 40 Issue number: 8

Doi: 10.1016/j.ajic.2011.09.015

Pages: 750-755

Worksheet 3.1 Evaluation Flowchart and Checklist (page 2)

Your evaluation: Source #3

Having filled in the flowchart, what conclusion have you reached? Is this a good source for your research
project?
I have concluded that this is a reliable source and that it is applicable to my research question.

Does the author or organization have the proper experience and qualifications to provide this

information? Yes
If written by an organization, is the organization well known and trusted? N/A
Does the organization have a positive (altruistic) purpose in providing this information? N/A
Does the source contain a bibliography or other references to show the source of the information? Yes
Has this source been through a formal publication process? Yes Has it been edited or reviewed?
Yes

Does the site contain any bias? No If so, can you find a way to balance the bias with information

from other sources? N/A Finally, is it up to date? Yes Is this important for your topic? Yes
Summary (What is your overall evaluation, based on the checklist and your flowchart? Is this a suitable
source for your academic research? What evidence supports your decision?)
This is a credible source that is also applicable to my research question. It is Level I evidence a systematic
review of relevant controlled trials and current evidence-based practice dealing with factors that contribute to
surgical site infections. It is relevant to my research question in that one of the factors it reviewed was
movement in and out of the operating room.

For evidence of the reliability of the source, the authors are doctors practicing at the University of Philadelphia
who have training in and experience in performing research. It has an extensive bibliography, and has been
edited and peer-reviewed before publication. This source does not seem to contain bias. Like the previous
systematic review discussed, it seems to be a straightforward presentation and summary of current evidence.
However, it is noted in the article that several of the authors have association with or hold stock in several
medical organizations or companies related to the subject of this article, in case this could be thought to
influence the presentation of the material in the article by these authors. This source is also up-to-date (it was
published in 2012).

Source information:
Title:
Contributing factors to surgical site infections
Author (if listed):
James S. Harrop, John C. Styliaras, Yinn Cher Ooi, Kristen E. Radcliff, Alexander R. Vaccaro, and
Chengyuan Wu
Organization (if provided):
N/A
URL (if provided):
http://www.jaaos.org/
Other information useful for finding this source again or for citing it later:
Journal Title: Journal of the American Academy of Orthopaedic Surgeons
Date of Publication: February 2012
Volume number: 20 Issue number: 2 Pages: 94-101
Doi: 10.5435/JAAOS-20-02-094

4.) Summary of Findings:

The systematic reviews determined that movement of operating room personnel in and out of the surgical suite is a risk factor for
development of surgical site infections. In particular, the systematic review entitled, Operating Theatre Quality and Prevention of
Surgical Site Infections, noted that movement of operating staff in and out of the operating room has been successively shown to
cause increased dispersion of common surgical site infection causative microorganisms within the operating suite. The controlled
study (source #2) found that as the number of times people entered and exited the surgical suite increased, the amount of
microorganisms collected on the filter by the surgical wound also increased. In operating suites where movement in and out of the
suite was less, the amount of microorganisms on the filter was also less. These sources do answer my question since they show that
increased entering and exiting of operating suites during surgery does increase the risk for surgical site infections. So, trying to reduce
this movement is part of infection control as I had thought. Reducing movement in and out of the operating suite during surgery
would affect patient care by reducing the risk of development of surgical site infections in surgical patients. Recommendations for
application of this finding to practice would include methods to decrease the number of times operating room personnel enter and exit
the operating suite such as: increased preoperative planning to ensure all needed equipment is present in the surgical suite before
surgery and brought into the suite opening the door as few times as possible; surgical team members could also plan to enter and exit
the surgical suite at the same time when possible to reduce movement in and out; staff other than the surgical team should also be
prevented from entering the surgical suite; if other staff members need to be reached during surgery, using the telephone in the
operating room can reduce the need to enter and exit the suite. I feel that these sources have adequately answered my question, and I
do not need to do further research.