Postoperative Showering for Clean and Clean-contaminated Wounds: A Prospective, Randomized Controlled Trial.

OBJECTIVE: To evaluate wound infection rates, pain scores, satisfaction with wound care, and wound care costs starting 48 hours after surgery. BACKGROUND: Showering after surgery is a controversial issue for wound care providers and patients. We investigated the benefits and detriments of showering for postoperative wound care. METHODS: Patients undergoing thyroid, lung, inguinal hernia, and face and extremity surgeries with clean or clean-contaminated wounds were included. The patients were randomized to allow showering (shower group) or to keep the wound dry (nonshower group) for postoperative wound care starting 48 hours after surgery. The primary endpoint was the rate of surgical wound infection. The secondary endpoints included the wound pain score, satisfaction with wound care, and cost of wound care. RESULTS: Between May 2013 and March 2014, there were 222 patients randomized to the shower group and 222 to the nonshower group. Two patients in each group were lost to follow-up. There were 4 superficial surgical site infections in the shower group and 6 in the nonshower group (4/220, 1.8% vs 6/220, 2.7%, P = 0.751). Postoperative pain scores were comparable between the 2 groups. Patients in the shower group were more satisfied with their method of wound care, and their wound care costs were lower when compared with the nonshower group. CONCLUSIONS: Clean and clean-contaminated wounds can be safely showered 48 hours after surgery. Postoperative showering does not increase the risk of surgical site complications. It may increase patients' satisfaction and lower the cost of wound care.

[A project to improve the completion rate of discharge-planning services for organ-transplant patients].

BACKGROUND & PROBLEMS: The average score for satisfaction with self-care instructions among transplant patients was 84 out of 100 in a 2010 survey of patient satisfaction with discharge-planning services. This score was significantly below the hospital average of 90. In addition, discharged patients made more frequent telephone inquiries to healthcare providers to ask questions about post-organ-transplantation self-care. A follow-up study targeted a sample of 30 discharged transplantation patients using hospital medical record reviews and telephone inquiries. This survey found a transplant instruction completion rate of 75% during discharge preparation and 69% accuracy among participants in answering self-care knowledge questions. Both figures were lower than expected. PURPOSE: The goal of this project was to increase the instruction completion rate from 75% to 100% and the percentage of correct answers to self-care knowledge questions self-care knowledge from 69% to 95%. RESOLUTIONS: This study integrated all relevant nursing information into a standardized discharge-planning service booklet that was given to inpatients for reference. Furthermore, a self-care checklist was developed and introduced. Finally, a standard procedure for delivering nursing instructions and a regular audit and follow-up monitoring system were established. RESULTS: The nurses' instruction completion rate rose to 100% and the percentage of questions on self-care knowledge correctly answered by patients increased to 98%. CONCLUSIONS: Adopting a patient-centered philosophy of care and a model of interdisciplinary collaboration effectively integrated resources and promotes nursing quality and quality of life for transplant patients. The project effectively improved the completing rate for post-transplant discharge-planning service instructions and enhanced the self-care knowledge of transplant patients.