Effectiveness of Nursing Practice Guidelines for prevention infection in Patients with Open Long Bone Fractures.

Abstract

      This study aimed to examine the outcomes of implementing nursing practice guidelines for the prevention of infections in patients with open fractures of long bones. A quasi-experimental, one-group pre-test/post-test design was employed. The study was conducted across three wards within the Department of Orthopedics: the male orthopedic ward (5th floor), the female orthopedic ward (4th floor), and the male orthopedic ward (3rd floor). The participants consisted of patients admitted to the Department of Orthopedics at Udon Thani Hospital with open fractures of long bones. Data collection took place from June 2026 to September 2026.

      The study found that the nurses who implemented the clinical practice guidelines had a mean age of 35.96 years (S.D. = 8.06 years). The majority (63.0%) were professional nurses at the "proficient" (experienced/specialized) level, and 40.7% had over 10 years of experience working in the orthopedic surgery department. A statistically significant difference (p-value = 0.014) was observed between the nurses' pre- and post-implementation knowledge assessment scores (at a significance level of 0.05). Nurses reported a high level of satisfaction with the guidelines, with a mean score of 74.48 (S.D. = 0.75). The patients had a mean age of 44.23 years (S.D. = 18.09 years), and the majority (83.33%) were male. Regarding the incidence of infections and complications, there was one case (3.33%) that resulted in a below-knee amputation; this patient had an open fracture of both bones of the lower leg (classified as type 3C) accompanied by a vascular injury, with a delay of over 6 hours before undergoing surgical debridement, and required a 38-day hospital stay. The median length of hospital stay was 7.50 days (range: 2–38 days), and the readmission rate was 0%.