INTERGRATIVE REVIEW 14 Equipment and Product Safety Introduction Equipment, drugs, and medical supplies have significant impact on quality of patient care and they account for high proportion of health care costs. Hospitals should make informed choices about what to procure in order to meet priority health needs and avoid wasting the limited resources (Chu, Maine, & Trelles, 2015). Procurement is an important part of managing equipment and products, and stock control, effective storage, and maintenance are also significant factors in health services. Many firms have produced information about important drugs, however, there is less information available about essential equipment and medical supplies (Weinshel, et al., 2015). This results in procurement of items which are inappropriate because they are incompatible with existing equipment, technically unsuitable, and spare parts are unavailable. Despite this, there is little information available about these aspects of management of equipment and medical supplies. According to “American Association of Critical-Care Nurses (AACN), there is convincing evidence that unhealthy surgery environment contributes significantly to ineffective care delivery, medical errors, and stress among nurses (Magill, O’Leary, Janelle, & Thompson, 2018). This integrative literature review was executed to find evidence between surgery operation environment and products on patient safety. This paper is intended to be resourceful in management and procurement of equipment and medical products at primary health care level. It includes guiding concepts for care and maintenance, selecting products and equipment, and safe disposal of medical waste. Purpose of research The integrative literature review aim at analyzing pieces of research which have been conducted on surgical environment and product and their effect on patient safety and outcome. Background Although there are various improvement ongoing, the prevalence of healthcare-associated infections (HAIs) remain a risk and cost within hospitals. Unsafe, inappropriate, and negligent surgical products and equipment affect one in ten patients, on average in the US. Despite the advancement in use of surgical techniques and ergonomic improvements in operating rooms, cases of surgical site infections (SSIs) are high and they cause patient mortality and morbidity. Necessarily, there is increased emphasis on prevention of these infections. The risk of error in operating environment is greater. Some of the environmental and products risks include risk of patient falling and risks of infections. In this light, nurses should promote use of evidence-based care to promote patient safety and improve the quality of care. Patient safety is an important element in health care. Within the principles of WHO, patient safety is the reduction of risk of harm or injury associated with health care. Hospitals are focused in creating healthy and safe ...

1. INTERGRATIVE REVIEW
14
Equipment and Product Safety
Introduction
Equipment, drugs, and medical supplies have significant
impact on quality of patient care and they account for high
proportion of health care costs. Hospitals should make informed
choices about what to procure in order to meet priority health
needs and avoid wasting the limited resources (Chu, Maine, &
Trelles, 2015). Procurement is an important part of managing
equipment and products, and stock control, effective storage,
and maintenance are also significant factors in health services.
Many firms have produced information about important drugs,
however, there is less information available about essential
equipment and medical supplies (Weinshel, et al., 2015). This
results in procurement of items which are inappropriate because
they are incompatible with existing equipment, technically
unsuitable, and spare parts are unavailable. Despite this, there is

2. little information available about these aspects of management
of equipment and medical supplies.
According to “American Association of Critical-Care
Nurses (AACN), there is convincing evidence that unhealthy
surgery environment contributes significantly to ineffective care
delivery, medical errors, and stress among nurses (Magill,
O’Leary, Janelle, & Thompson, 2018). This integrative
literature review was executed to find evidence between surgery
operation environment and products on patient safety. This
paper is intended to be resourceful in management and
procurement of equipment and medical products at primary
health care level. It includes guiding concepts for care and
maintenance, selecting products and equipment, and safe
disposal of medical waste.
Purpose of research
The integrative literature review aim at analyzing pieces of
research which have been conducted on surgical environment
and product and their effect on patient safety and outcome.
Background
Although there are various improvement ongoing, the
prevalence of healthcare-associated infections (HAIs) remain a
risk and cost within hospitals. Unsafe, inappropriate, and
negligent surgical products and equipment affect one in ten
patients, on average in the US. Despite the advancement in use
of surgical techniques and ergonomic improvements in
operating rooms, cases of surgical site infections (SSIs) are
high and they cause patient mortality and morbidity.
Necessarily, there is increased emphasis on prevention of these
infections. The risk of error in operating environment is
greater. Some of the environmental and products risks include
risk of patient falling and risks of infections. In this light,
nurses should promote use of evidence-based care to promote
patient safety and improve the quality of care.
Patient safety is an important element in health care. Within the

3. principles of WHO, patient safety is the reduction of risk of
harm or injury associated with health care. Hospitals are
focused in creating healthy and safe environment. A safe
environment is an atmosphere which is free of harm to patient
seeking medical attention. Study by (Chu, Maine, & Trelles,
2015), shows that 6.5% of permanent dysfunctions and 13.6% of
patient deaths in America could be avoided due medical errors.
Error in this case is an action which occurs outside planned or
incorrect use of plan and cause damage to patient, from need for
therapeutic intervention, increase stay in hospital, and even
death. Moreover, environment and products used or not used in
surgical operation have direct damage which has economic
impact such as continued hospital admission.
In order to ensure safety of patient, the WHO recommends
use of quality tools and equipment during and after surgery in
order to prevent surgical complications. Understanding the
interrelationship between nurses and the tools they use is basic
in improving operation and its effect on performance of nurses.
Methods
This study is an integrative review because it facilitates
and enables search for scientific research which involve
publication useful and contributing data on health care. The
diversity of sources of data within this integrative review need
qualitative methods for evaluation. Methods like case study,
content analysis, and meta-synthesis are used to synthesize the
findings. The goal of integrative review is to develop
comprehensive account on the topic. In other words, the
research give a better understanding of the topic by integrating
information and data from many methods and sources. Also, this
study aim at integrating health scenario and to support decision-
making process and improve surgical practice quality.
For the preparation of this integrative review, three stages
were considered and this include (1) development of the
research question, (2) selection of research articles (exclusion
and inclusion criteria), (3) synthesis of knowledge evidenced in

4. the items. The search strategy was designed to get the largest
number of primary sources using different search approach.
The evidence of surgical-related infections was conducted
online from wide publication in Nursing Database, Medical
literature and Retrieval system on line (Medline through Pub
Med), and through Virtual Health Library (VHL). Each
database was selected based on its potential to inform a model
of SSIs. Medline give complete source of biomedical and health
research. The period of search was between 2010 and 2019 and
the keywords used are “surgical room”, “equipment”, “tools”,
and “patient safety”. The research article were selected based
on exclusion and inclusion criteria. In the sample inclusion
criteria, article considered were published between 2010 and
2019 in English language with full texts available in electronic
databases and free guideline.
According to the exclusion criteria, articles not available in
electronic sources were not considered. Also, article which did
not have any content related to the topic of research were
excluded. The inclusion criteria required that data source:
I. Focus on surgical tools and equipment or outcome of new
technology
II. Deal with adoption of therapeutic techniques like CT
scanning techniques.
III. Focus of healthcare delivery.
To support this analysis, the researcher further considered
the titles and abstracted of the articles to refine the journals
highlighting purpose of the review. Second, the researcher did
exhaustive reading in each journal seeking to get the relevant
aspects. After reading, the articles were organized based on data
collection methods. The analysis of the journal was important in
identifying the issues which are relevant in each article. Third,
the article were classified according to the levels of evidence.
Level 1 article have evidence from meta-analysis or systematic
review of randomized control trials. Level II articles have
evidence based on clinical trial done through randomized
control. Level III have clinical trial evidence but not have

5. randomization yet they are well-designed. Level IV of evidence
have articles which have their evidence based on case-control
but they should be well-designed. The last level of evidence is
based on authors’ opinion. There was need for a database to
enter the information gather which include article title, the year
of publication, the result, and development of the research.
Results
Data Evaluation/Reduction
The data sources were coded based on the subjective
analysis of source’s relevance to the aim of the study and rigor
of data setting, size, and methodology. This methodology was
proposed by, who argue that this kind of analysis is best
because of the variability in quality, method, and design of data
sources. In this case, relevance reflects applicability of data
source to the concept in the study while rigor is judgment of
confidence in findings of data source according to study
methodology. The articles methods, population, setting, and
purpose was considered in determining the rigor. 5-point Likert
scale was used to show rigor and score of 5 represented the
highest rigor.
Rigor
Value
Qualitative
quantitative
0
Magazine and newspaper which do not cite for facts
1
Opinions in peer review journals
Study with literature analysis as data input
2
Case studies or focus groups
3
Cross-sectional research and survey
Comparative case study
4
Integrative reviews

6. Observational research with control groups
5
Formal qualitative approach used with grounded theory
Experimental study
Search outcome
The initial research resulted in 128 article, and irrelevant
article excluded. The abstracts and title of 32 articles were read.
The articles were selected based on abstract review and
compared to the exclusion and inclusion criteria. Full texts were
retrieved in cases were there was scanty details in the abstract
and out of the 32 articles, 8 met the inclusion criteria. The rest
of the articles were excluded because they focused on chronic
would instead of surgical wounds, and the article did not
discuss the relationship between equipment and SSIs. The 8
articles included were published between 2010 and 2019 and
many of them were conducted in America. Three of the selected
articles were quantitative studies while the rest are qualitative
studies.
study
Journal
Methodological design
LE
01
Changes in prevalence of health care–associated infections in
US Hospitals.
Randomized clinical trial
I
02
Post cesarean wound infection:
Prevalence, impact, prevention, and management challenges.

7. A meta-analysis
II
03
Cesarean section surgical site infections in sub-Saharan Africa:
a multi-country study from Medecins Sans Frontieres.
World journal of surgery
Analytical study
III
04
Peri-prosthetic joint infection. The Lancet
Descriptive
V
05
Gap analysis of infection control practices in low-and middle-
income countries. Infection control & hospital
epidemiology
Randomized clinical trial
I
06
Effect of laminar airflow ventilation on surgical site infections:
a systematic review and meta-analysis.
A meta-analysis
II
Of the 8 publication which were included in the review, 2
report are on evidence-based guideline on the best approach to
prevent surgical site infection, 1 report on the application of
techniques, and 5 reports on the description of postoperative
wound infections. Overall, 2 RCTS, one guideline, two meta-
analysis, and one, descriptive study were reviewed. The study
characteristics, critical appraisal, data analysis, and synthesis of
the studies are presented in separate cases for each research
question.
Critical appraisal
One of the RCT (Kapadia, et al., 2016) give detailed
patient information, reported on equipment hygiene, and

8. described the adverse reactions. All articles (Zuarez-Easton,
Zafran, Garmi, & Salim, 2017; Magill, O’Leary, Janelle, &
Thompson, 2018)reported the study objectives, main outcome
measures, the patient characteristics, and the estimate of
variability of the research outcome measures. One study
(Weinshel, et al., 2015) was conducted on Africa and may not
represent the treatment which patients review in the US. All
articles (Bischoff, Kubilay, Allegranzi, & Egger, 2017;
Bischoff, Kubilay, Allegranzi, & Egger, 2017; Weinshel, et al.,
2015)were, however, clear about the unplanned data analysis,
all recorded the same time between outcome among groups and
intervention, and two (Magill, O’Leary, Janelle, & Thompson,
2018) gave detailed statistical analyses. One research, did not
perform the statistical analysis and, therefore, it is not show if
the results are statistically important. Compliance was an issues
in two studies in which patient were subjected to unhygienic
equipment.
Data analyses and synthesis
Infection
SSIs were reported in one meta-analysis and this research
suggest there is difference in postoperative infection rates
between the patient undergoing pre-surgical preparation
compared to patient who do not receive the preparation. One
study reported there is no infections in patients who use skin
preparation.
Summary and main results of studies
Authors
Main results
Magill, S. S., O’Leary, E., Janelle, S. J., Thompson, D. L.,
Dumyati, G., Nadle, J
The number of health care-associated infections in 2015 was
lower than those identified in 2011. To continue with this
progress, it is important to prioritize on safely utilizing
equipment and product
Zuarez-Easton, S., Zafran, N., Garmi, G., & Salim, R
Surgical site infection is a very common complication that

9. develops after cesarean section. It has both physical and
emotional consequences to the mother and is a huge financial
burden to the healthcare system. There is an increase in the
global cesarean section rate therefore surgical site infections are
expected to increase. Wound dressing is one of the preventative
strategies that can be utilized in preventing infections. Another
strategy is skin closure
Chu, K., Maine, R., & Trelles, M.
Surgical site infections (SSI) result to post-surgical mortality
and morbidity and can be a key indicator of the quality of the
surgical process. The study concluded that it incidents of SSI
can be reduced through utilizing perioperative antibiotics,
sterilizing equipment and using clean water.
Kapadia, B. H., Berg, R. A., Daley, J. A., Fritz, J., Bhave, A., &
Mont, M. A
Periprosthetic joint infections are a complication that develops
after arthroplasty. The rise in the prevalence of diseases such as
diabetes and obesity has led to an increase of the rate of
periprosthetic joint infections. The preventive measures include
skin decontamination and glycemic control. Surgical
management practices with a great emphasis on equipment and
products have also been refined. This article concludes that
prosthetic joint infection can be efficiently managed with
various great preventive measures and treatment options
Weinshel, K., Dramowski, A., Hajdu, Á., Jacob, S., Khanal, B.,
Zoltán, M
Healthcare-associated infections are greater in low and middle
income nations compared to higher income nations. The study
concluded that adhering to the set infection control practices is
a great way of reducing the rate of health-associated infections.
Other improvement opportunities exist and they include
antibiotic stewardship and utilizing surgical instrument process.
In addition, hand hygiene must be observed while handling
patients.
Bischoff, P., Kubilay, N. Z., Allegranzi, B., Egger, M., &
Gastmeier, P

10. There is no evidence that supports that laminar airflow is more
efficient compared to conventional turbulent ventilation in
reducing the risk of SSIs in abdominal surgery and total hip.
Decision makers and the hospital management should therefore
not consider laminar airflow as an efficient strategy of
decreasing the risk of SSIs. This means that the equipment
should not be put in the operating rooms since this is just a
financial burden to the organization that does not reduce SSIs’s
risk
Conclusion
It is clear that perioperative nurses play important role in
evaluating product safety, environmental concerns, efficiency
and effectiveness, and cost of these factors in relation to patient
care. Well-informed product purchasing and evaluation is an
important way for hospitals to deal with the increase expenses
in environmental moderate reimbursements. However, the most
challenging aspects of purchasing and evaluating products are
balancing quality and cost. Striving towards achieving products
and equipment standardization reduce waste but increase cost
savings. Another challenge of choosing equipment and safety is
keeping up with the ever changing technological advancements
while ensuring needs of stakeholders are considered. To this
end, all hospital departments should be involved in selecting
products which are environmentally friendly and cost effective.
To reconcile these challenges, perioperative nurses can
consult “Association of Perioperative Registered Nurses”
(AORN)’s for product and equipment selection. Some of the
recommendations from this association include:
Recommendation I: There should be a mechanism for product
and equipment selection. The mechanism for product selection
help in consistent selection of reliable and functional products
which promote quality care, safety of patient, cost-effective,
and environmental friendly.
Recommendation II: The perioperative Registered Nurses
should have competency in product selection and evaluation.

11. The healthcare organizations should have educational programs
on specific steps on product and equipment selection, new
environmental conditions, safe care and handling of equipment
and products, governmental regulations, and product
requirements such as repair and reprocessing.
Recommendation III: Hospitals should have quality assurance
improvement process to measure equipment and product
performance. Also, hospital should conduct post-purchase
assessment to ascertain user satisfaction. The evaluation ensure
new products meet expected performance criteria.
References
Bischoff, P., Kubilay, N. Z., Allegranzi, B., & Egger, M.
(2017). Effect of laminar airflow ventilation on surgical site
infections: a systematic review and meta-analysis. The Lancet
Infectious Diseases, 17(5), 553-561.
Chu, K., Maine, R., & Trelles, M. (2015). Cesarean section
surgical site infections in sub- Saharan Africa: a multi-country
study from Medecins Sans Frontieres. World journal of surger,
39(2), 350-355.
Kapadia, B. H., Berg, R. A., Daley, J. A., Fritz, J., Bhave, A., &
Mont, M. A. (2016). Periprosthetic joint infection. The Lancet,
387(10016), 386-394.
Magill, S. S., O’Leary, E., Janelle, S. J., & Thompson, D. L.

12. (2018). Changes in prevalence of health care–associated
infections in US Hospitals. New England Journal of Medicine,
379(18), 1732-1744.
Weinshel, K., Dramowski, A., Hajdu, Á., Jacob, S., Khanal, B.,
& Zoltán, M. (2015). Gap analysis of infection control practices
in low-and middle-income countries. infection control &
hospital epidemiology, 36(10), 1208-1214.
Zuarez-Easton, S., Zafran, N., Garmi, G., & Salim, R. (2017).
Postcesarean wound infection:prevalence, impact, prevention,
and management challenges. International journal of women's
health, 9(81), 1-10.
128 articles
These articles were identified after crossing the descriptors
32 articles
The articles were picked based on title and abstract. However,
some covered Chronic wounds and not surgical wounds
8 articles
This meet the inclusion criteria

13. 1
Running head: EQUIPMENT AND PRODUCT SAFETY
3
EQUIPMENT AND PRODUCT SAFETY
Equipment and Product Safety
Equipment and Product Safety in Perioperative Nursing
People who work in the departments of product and equipment

14. evaluation and purchasing process plays a crucial role in the
healthcare facility as well as ensuring the safety of patients is
protected. Healthcare facility equipment and products are
sourced from different suppliers. Thus, it is a sensitive sector
that requires a well-structured procuring and evaluation process
to reduce the expenses of reimbursements and risks patients are
exposed to when faulty tools are used. Johanna Newman argues
that perioperative nurses should be trained and understands the
process involved when evaluating the safeness of a product,
efficiency, effectiveness, cost, and environmental concern since
they act as patent’s advocate (2015). Therefore, my
perioperative PICO(T) question will be based on surgical site
infections. This is a sensitive unit that requires a physician to
use sterilized products and equipment to maintain proper
handling and patient safety in the operating room. My PICO(T)
question would look as follows:
P- Perioperative patients in the cardiovascular operating room
I- Perioperative temperature management using a warming
blanket
C- Patients receive no treatment to prevent hypothermia
O- Patients with warming blankets will have a decrease in
surgical site infections
T- The study will take place for one year
A recent report released by Johanna Newman (2015) shows that
more than 500,000 surgical site infections are recorded every
year in a general hospital in the U.S., U.S hospital spends an
average of $10 billion on managing hospital-acquired diseases.
14-16% out of the reported cases of hospital-acquired infections
is as a result of surgical site infections. Despite surgical site
infections affecting patient safety and overall health, it also
leads to instances of high mortality rate, ballooning medical
bills, a more extended stay in the facility, as well as frequent
readmissions. The surgical mortality rate of about 3% is seen in
patients who acquire surgical site infections from the surgical
room. Therefore, it can be understood that surgical site
infections is a real problem in our healthcare facilities.

15. References
Johanna Newman CRNA, D. N. A. P. (2015). Surgical Site
Infection and Prevention Guidelines: A Primer for Certifi ed
Registered Nurse Anesthetists. AANA journal, 83(1), 63.
Retrieved from: https://www.aana.com/docs/default-
source/aana-journal-web-documents-1/jcourse6-0215-pp63-
68.pdf?sfvrsn=1ad448b1_6
NUR 440 Peer Review Guidelines and Rubric
Overview: The purpose of peer review is to facilitate quality-
nursing care through best practice discovered in evidence-based
research. According to the
American Nurses Association, “peer review in nursing is the
process by which practicing registered nurses systematically
access, monitor, and make judgments
about the quality of nursing care provided by peers as measured
against professional standards of practice. Peer review implies
that the nursing care delivered
by a group of nurses or an individual nurse is evaluated by
individuals of the same rank or standing according to
established standards of practice.” Peer review
helps not only the author but the reviewer as well through the
development of a critical eye which can then be applied to their
own work.
Prompt
As the reviewer:
When you peer review another’s work, you will critically

16. evaluate and suggest improvements. You will likely read the
abstract once or twice before delving in with
comments and first impressions. Using the checklist below,
identify strengths and areas for improvement, being sure to
address each critical element in your
review.
Peer Review Checklist:
x Aims and objectives: Is the purpose clearly stated?
x Background: Does the author offer background on the subject?
x Methods: Are the methods clearly stated? What type of
method did the author use?
x Results: Are the results valid and reliable?
x Conclusions: Are the conclusions clearly stated and are they
informed by the results?
x Relevance to clinical practice: Does the author state the
relevancy to clinical practice?
x Articulation of response (e.g., citations, grammar, spelling,
syntax, organization)
You will be evaluated on your peer reviews, not the abstract
submitted, using the rubric below.
As the author of the abstract, remember the following:
x Read the review carefully, avoiding any desire to defend your
choices.
x If you are unclear what the reviewer means, ask them to
clarify.
x If you have any questions, feel free to pose them to the
reviewer.
x Take special note of repeated commentary (e.g., grammar,

17. citation, etc.) as this may signify an area for improvement.
x Thank the reviewers for their feedback. If some commentary
was especially helpful, this is useful information for the
reviewer.
x Accept that negative feedback comes with the territory. Your
job is not to make everyone happy but to make your work the
best that it can be.
https://americannursetoday.com/nursing-peer-review-principles-
and-practice/
Guidelines for Submission: You must submit your abstract to
the provided discussion for review by Sunday of the previous
module. When choosing two abstracts
for review, be sure to select peers who have not yet received
feedback. Each of your reviews should be 2–3 paragraphs in
length.
Rubric
Critical Elements Exemplary (100%) Proficient (85%) Needs
Improvement (55%) Not Evident (0%) Value
Analysis Meets “Proficient” criteria and
provides concrete examples on
how abstracts relate to course
concepts and draws on this
knowledge in analysis
Analyzes abstracts in relation to
course concepts and
terminology

18. Briefly analyzes abstracts in
relation to course concepts and
terminology, or analysis
contains gaps
Does not relate abstracts to
course concepts and
terminology
30
Evaluation: Critical
Elements
Meets “Proficient” criteria and
provides concrete examples on
how to improve the
incorporation of critical
elements in the future
Clearly evaluates abstracts for
the inclusion of required critical
elements
Briefly and incompletely
evaluates abstracts for inclusion
of required critical elements
No evaluation of abstracts for
inclusion of required critical
elements
30
Evaluation: Strengths

19. and Weaknesses
Meets “Proficient” criteria and
provides concrete examples for
improvement
Clearly evaluates abstracts for
strengths and weaknesses
Briefly and incompletely
evaluates abstracts for
strengths and weaknesses
Does not evaluate abstracts for
strengths and weaknesses
30
Articulation of
Response
(APA/Mechanics)
Submission is free of errors
related to citations, grammar,
spelling, syntax, and
organization and is presented in
a professional and easy-to-read
format
Submission has no major errors
related to citations, grammar,
spelling, syntax, or organization
Submission has major errors
related to citations, grammar,

20. spelling, syntax, or organization
that negatively impact
readability and articulation of
main ideas
Submission has critical errors
related to citations, grammar,
spelling, syntax, or organization
that obstruct understanding
10
Earned Total 100%