الفهرس 
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Abstract
Surgical site infections considered as a complication of the surgical procedure or of the post-operative caring of the surgical site (Qasem & Hweidi, 2017). It is caused by germs that get into the surgical wound. The adverse effects of SSIs present undesirable yet largely preventable outcomes associated with significant patient’s harm, prolonged hospitalization, higher morbidity and mortality, and increased healthcare costs.
Care bundles are a group of evidence-based interventions related to a disease or care process that, when executed together, result in better outcomes than when implemented individually. It includes pre-operative bathing, surgical site preparation, appropriately and timely administration of antibiotics, pre and post-operative glycemic control, normothermia, and wound management.It is important to create awareness for pediatric nurses responsible for providing nursing care to newborns with I.O through the necessary training and education and provides the nurses with the applicable guidelines, evidence, and supplies to execute the implementation of a bundle(WHO, 2018).
So, this study aimed to evaluate the effect of implementing an educational program for nurses about surgical care bundle on surgical site infections control among newborns with intestinal obstruction.This study was conductedat Surgical Neonatal Intensive Care Unit in Alexandria University Children’s Hospital at El-Shatby.
All available pediatric nurses who were responsible for providing care for neonates in SNICU (30 nurses) comprised the study subjects, regardless of their age, qualifications, and years of experience. In addition, a convenient sample of 100 newborns from both sexes undergoing intestinal obstruction surgerywho were receiving care were included in the study subjects. They were divided equally into two equal groups.The first 50 newborns were considered as a control group and received the routine pre and post-operative care in the hospital before program implementation. The second 50 newborns were considered as a study group and were cared for by the nurses after receiving a surgical care bundle program.
Two tools were used to collect the necessary data; the first tool was nurses’ practices regarding surgical care bundle for control of surgical site infections among newborns with intestinal obstruction observational checklist. It was developed by the researcher guided by the evidence-based recommendations for the control of surgical site infections (WHO, 2018). It was used to assess nurses’ practices regarding pre and post-operative nursing measures for the prevention of surgical site infections among newborns with intestinal obstruction.The second tool wasthe post-operative wound assessment tool.This tool was developed by the researcher after a thorough review of the relevant literature (Nasser et al., 2013; Macefield et al., 2017) to assess the surgical wound of the newborns in the study and control groups during their hospitalization. Data collection was carried out over a period of 8 months starting from the beginning of December 2019 to the end ofJuly 2020.
The main findings of this study showed the following:
Characteristics of the studied nurses:
• The age of the studied nurses ranged from 22-45 years old, where the age group from 25 to less than 30 years and the age group from 30 to less than 35 years constituted 23.3% for each. The age group from 35 to less than 40 years and the age group from 40-45 years constituted 13.3% for each with a mean age of 30.50±6.673 years.
• More than half of the studied nurses had secondary nursing school (56.7%), while 26.7% had technicalnursing school and 16.7% of them had a bachelor degrees of nursing.
• Forty percentof the studiednurses had years of experience less than 5 years. The nurses who had years of experience from 5 to less than 10 years and the years of experience from 10-15 years constituted 30% for each with a mean of 7.00±3.818 years.
Nurses’ total percent scores of practices regarding pre and post-operative nursing measures for control of surgical site infections:
• Only 13.3% of the studied nurses had good score of practices regarding the pre-operative bathing before program implementation and the majority of them (83.3%) had good scores of practices after the program.
• With respect to pre and post-operative normothermia, it was foundthat all nurses (100%) had an unsatisfactory scores of practicesbefore program implementation. Moreover, the majority of them (86.7%) had good scores of practices after the program.
• Regarding post-operative wound dressing, it was noticed that slightly less than three-quarters of the studied nurses (73.3%) had good scores of practices before program implementation. The percent increased to most of nurses (96.7%) after the program.
• None of the studied nurses (0.0%) had good scores of practices regarding the total pre-operative nursing measures before program implementation. On other hand, 80.0% of them had good scores of practices after program implementation with a highly statistically significant difference was found between the nurses’ practices before and after program implementation (p=0.000).
• Before program implementation, one-fifth of the studied nurses (20%) had good scores of practices regarding the total post-operative nursing measures. A progress in their practices was obvious where their good scores had reached 86.7% after the program with a highly statistically significant difference was found between the nurses’ practices before and after program implementation (p=0.000).
• None of the studied nurses (0.0%) had good scores of practices regarding the total pre and post-operative nursing measures before program implementation. The percent was improved to the majority of nurses (86.7%) who had good scores of practices after the program with a highly statistically significant difference was found between the nurses’ practices before and after program implementation (p=0.000).
• The mean scores of nurses’ practices concerning the total pre-operative nursing measure was15.20±8.075 before program implementation and was increased to be 46.20±14.970 after the program with a highly statistically significant difference was found between the nurses’ practices before and after the program (p=0.000).
• Concerning the total post-operative nursing practices, it was recognized that the mean scores of nurses’ practices was 33.53±6.301before program implementation and wasincreased to be 51.90±8.691 after the program with a highly statistically significant difference was observed between the nurses’ practices before and after program implementation (p=0.000).
• The mean scores of total pre and post-operative nurses’ practices was48.73±12.616 before program implementation, while it was increased to be 98.10±22.920 after the programwith a highly statistically significant difference between the nurses’ practices before and after the program (p=0.000).
• All nurses (100%)aged less than 30 years had good scores regarding the total pre and post-operative nurses’ practices, while only one-quarter of the nurses (25%) aged 40-45 years had good scores with statistically significant difference was found between the nurses’ practices and their age (p=0.003).
• There were no statistically significant differences between the nurses’ total scores of pre and post-operative practices and their level of education and years of experience.
Socio demographic and medical characteristics of the studied newborns with intestinal obstruction:
• Concerning the age of the studied newborns, it was found that the mean age was 13.66±11.149 days before program implementation and 15.02±9.879 days after the program. It was also found that the males were more affected with IO whereas, nearly two-thirds of newborns (66.0 %) before program implementation and 56.0% of them after the program were males.
• Regarding newborns’diagnosis, it was obvious that the three common diagnoseswere Hirschsprung’s disease, duodenal atresia and imperforated anus (26.0%, 20%and 12.0 % respectively) before program implementation, and 22.0%, 14.0, and 12.0% respectively after the program.
• In respect to the pre-operative period of hospitalization, the present study revealed that slightly less than one-third of newborns (32.0%) performedthe operation on the same day of admission before and after program implementation.
• Before program implementation, slightly less than two-thirds of newborns (64.0%) spent from 5 to less10 days as a post-operative period of hospitalization and more than three-quarters of them (78.0%) spent the same time after the program.
Wound observations of the studied newborns during the days of hospitalization:
• Fever was found among 34.0% of newborns before program implementation and decreased to 14.0% after the program during the fifth day of wound observation with a statistically significant difference was found (p=0.019). During the seventh day of wound observation, fever was declined from 22.0% before program implementation to 4.0% after the program with a statistically significant difference was found (p=0.007).
• Regarding wound exudate, it was obvious that there were statistically significant differences found during the fifth and seventh days before and after program implementation (p=0.038&0.012 respectively).
• Concerning mal-odor as a sign of wound infections, there were statistically significant differences found during the third, fifth, and seventh days before and after program implementation (p=0.022, 0.014&0.002 respectively).
• There were statistically significant differences between redness as a sign of wound infections before and after program implementation during the third, fifth and seventh days of wound observation (p=0.037, 0.027& 0.002 respectively).
• Edema was decreased from 28.0% before program implementation to be 10.0% after the program during the seventh day of wound observation with a statistically significant difference (p=0.022).
• As for sloughy tissue, it was declined from 10.0% before program implementation to 0.0% after the program during the seventh day of wound observation with a statistically significant difference (p=0.022).
• Wound culture was taken from half of the studied newborns (50.0%) before program implementation and was taken from 40.0% of newborns after the program as prescribed by surgical teams.
• Concerning the results of culture, it was found that 60.0% of the newborns had positive culture before program implementation while, 25.0% of them had positive culture after the program with no statistically significant difference.
• With respect to sutures removal, it was noticed that 10.0 % of the studied newborns removed the sutures within 25-30 days after the operation beforeprogram implementation while90.0% of them removed the sutures within 10 days from the operation after the program with statistically significant difference (p=0.045).
• The mean score of sutures removal before program implementation was10.25±5.070 days and decreased to be 8.04±2.010 days after the program with a statistically significant difference (p=0.005).
• Regarding death of newborns after surgery, it was noticed that 8.0% of the studied newborns died before program implementation while, 4.0% of them died after the program with no statistically significant difference.
Intervention’s effect size regarding the nurses’ total pre and post-operative practices’ mean scores before and after the program:
• The mean score of total pre and post-operative nurses’ practices were 48.73±12.616 before program implementation whileit increased to be 98.10±22.920 after the program with a mean change of 49.37, and a large effect size was found (effect size = 0.80).
Relation between wound observations of newborns and intervention’s effect size:
• Concerning wound exudate, severe wound exudate was found among 12.0% of newborns during the third day before program implementation and decreased to 10.0% of newborns during the seventh day after the program with a statistically significant difference (p=0.006).
• Erythema of skin was found among slightly less than one-quarter of newborns(24%)during the third day before program implementation and decreased to 6.0% of newborns during the seventh day after the programwith a statistically significant difference (p=0.012).
• Regarding fever as a sign of wound infections, it was found among 22.0% of newborns during the third day before program implementation and decreased to 4.0% of newborns during the seventh day after program implementation with a statistically significant difference (p=0.007).
• Redness as a sign of wound infections was decreased from 26.0% during the third day before program implementation to 10.0% during the seventh day after program implementation with a statistically significant difference (p=0.037).