Use of technology for self-care in surgical wound infection surveillance: integrative review

Oliveira, Lia Pacheco de; Lucato, Ana Laura Serra; Fernandes, Daiane Rubinato; Vieira, Leticia Genova; Santos, Bruna Nogueira dos; Silveira, Renata Cristina de Campos Pereira

doi:10.1590/0034-7167-2021-0208

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 75 (3) • 2022 • https://doi.org/10.1590/0034-7167-2021-0208 copy

Use of technology for self-care in surgical wound infection surveillance: integrative review

Uso de tecnología para el autocuidado en la vigilancia de infección de la herida quirúrgica: revisión integradora

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to synthesize knowledge about technology for self-care in surgical wound infection surveillance.

Methods:

integrative review conducted in CINAHL, Embase, LILACS, PubMed, Scopus and Web of Science databases with the descriptors “surgical wound infection” and “self-care”, in addition to manual search in the references of the included studies. The selection and evaluation of the methodological quality of the studies and data collection were performed by two independent reviewers; conflicts were resolved by a third reviewer.

Results:

nine primary studies were included, published between 2011 and 2019. Six are cross-sectional, two are randomized clinical trials, and one is a case report. Mobile, text messaging, and imaging applications, computer software, assessments, and data storage capacity stand out.

Conclusions:

the technologies identified for self-care in surgical wound infection surveillance were the creation and use of mHealth and the use of health apps on mobile devices. Effective technologies in surveillance of surgical wound infection that enable rapprochement with the healthcare team, encourage a greater number of surgical wound assessments, enhance self-care actions, and decrease patient anxiety. Technology is also a monitored and recorded form of patient care, one of the main axes of infection surveillance.

Descriptors:
Self Care; Surgical Wound; Public Health Surveillance; Surgical Wound Infection; Technology

Database	Search strategy	Total of identified studies
CINAHL	(“surgical wound infection” OR “surgical wound infections” OR “surgical site infection” OR “surgical site infections” OR “postoperative wound infection” OR “wound infection” OR “wound infection” OR “wound infections” OR “surgical wound” AND “incision care” OR “self care” OR “self care”)	150 studies
EMBASE	(“surgical wound infection” OR “surgical wound infections” OR “surgical site infection” OR “surgical site infections” OR “postoperative wound infection” OR “wound infection” OR “wound infection” OR “wound infections” OR “surgical wound” AND “incision care” OR “self care” OR “self care”)	43 studies
LILACS	(“surgical wound infection” OR “infección de la herida quirúrgica” OR “infecção da ferida cirúrgica” OR “surgical site infection” OR “infección del sitio quirúrgico” OR “infecção do sítio cirúrgico” OR “postoperative wound infection” OR “infección de la herida postoperatoria” OR “infecção pós-operatória da ferida” OR “wound infection” OR “infección de heridas” OR “infecção dos ferimentos” OR “surgical wound” OR “herida quirúrgica” OR “ferida cirúrgica” AND “incision care” OR cuidado de la incisión OR “cuidados de incisão” OR “self care” OR autocuidado)	13 studies
PubMed	(“surgical wound infection”[MeSH Terms] OR “surgical wound infection” [All Fields] OR “surgical wound infections” OR “surgical site infection” OR “surgical site infections” OR “postoperative wound infection” OR “wound infection”[MeSH Terms] OR “wound infection” OR “wound infections” OR “surgical wound”) AND (“incision care” OR “self care”[MeSH Terms] OR “self care”[All Fields])	83 studies
Scopus	(“surgical wound infection” OR “surgical wound infections” OR “surgical site infection” OR “surgical site infections” OR “postoperative wound infection” OR “wound infection” OR “wound infection” OR “wound infections” OR “surgical wound” AND “incision care” OR “self care” OR “self care”)	309 studies
Web of Science	(“surgical wound infection” OR “surgical wound infections” OR “surgical site infection” OR “surgical site infections” OR “postoperative wound infection” OR “wound infection” OR “wound infection” OR “wound infections” OR “surgical wound” AND “incision care” OR “self care” OR “self care”)	26 studies

Reference	Objective	Study design	No. of patients	Technological interventions used	Main results	JBI^* * JBI - Joanna Briggs Institute. Bias Risk
Abelson et al., (2017)(¹⁸18 Abelson JS, Symer M, Peters A, Charlson M, Yeo H. Mobile heath apps and recovery after surgery: what are patients willing to do?. Am J Surg. 2017;214(4):616-22. https://doi.org/10.1016/j.amjsurg.2017.06.009 https://doi.org/10.1016/j.amjsurg.2017.0... ) United states of America	Verify the public’s willingness to engage with mobile health technology in the post-operative environment and identify the specific variables associated with that willingness.	Cross-sectional study	A total of 3,230 individuals were contacted, of whom 1,184 were eligible. Of those eligible, 800 completed the final survey.	mHealth: trackers, fill out daily surveys, send photos, and share updates with selected family and friends.	Of the patients, 80.6% reported greater willingness to wear a tracker on their wrist; 74.3%, fill out a daily survey; 66.3%, send photos; and 59.1%, share updates. Older age was not associated with less willingness to use mHealth. Hispanic ethnicity was associated with lower likelihood of using a tracker on the wrist. Higher education, internet trust, and preexisting smartphone use were all independently associated with willingness to engage with various mHealth components.	Moderate
Avery et al., (2019)(¹⁹19 Avery KNL, Richards HS, Portal A, Reed T, Harding R, Carter R, et al. Developing a real-time electronic symptom monitoring system for patients after discharge following cancer-related surgery. BMC Cancer. 2019;19(1):463. https://doi.org/10.1186/s12885-019-5657-6 https://doi.org/10.1186/s12885-019-5657-... ) England	To describe the development of an ePRO system integrated with a hospital’s electronic health record to improve the detection of complications and adverse effects after discharge from cancer-related surgery (major abdominal surgery).	Cross-sectional study	Among the patients, 59 accessed the ePRO system.	ePRO system	Incorporating ePRO data into clinical practice may bring broader benefits to patients in relation to surgical wound care in cancer-related surgeries and also to the healthcare system by standardizing care practice, streamlining and improving clinical consultations, and optimizing patient-centered care.	Moderate
Chang et al., (2019)(⁹9 Chang H-Y, Hou Y-P, Yeh F-H, Lee S-S. The impact of an mHealth app on knowledge, skills and anxiety about dressing changes: a randomized controlled trial. J Adv Nurs. 2020;76(4):1046-56. https://doi.org/10.1111/jan.14287 https://doi.org/10.1111/jan.14287... )Taiwan	Evaluate the effectiveness of an mHealth app on patients’ or caregivers’ and family members’ knowledge about wound care, dressing change skills, and anxiety.	Randomized Clinical Trial	A total of 70 patients (or family members) were contacted at a 1,500-bed university hospital. They were randomized into an experimental (n = 35) or a control group (n = 35).	mHealth developed on the Android platform	Participants in both groups (intervention and control) showed significant improvement in wound care between pre-test T1 and post-tests T2 and T3, but especially between T1 and T3. They also significantly improved their levels of wound care skills, being higher for the experimental group than for the control group. With regard to wound care anxiety, there was a greater decrease in anxiety in the experimental group than in the control group.	Low
Chen et al., (2020)(²⁰20 Chen Y-W, Hsu J-T, Hung C-C, Wu J-M, Lai F, Kuo S-Y. Surgical wounds assessment system for self-care. IEEE Trans Syst Man Cybern Syst. 2020;50(2):5076-91. https://doi.org/10.1109/TSMC.2018.2856405 https://doi.org/10.1109/TSMC.2018.285640... ) Taiwan	Propose a surgical wound assessment system for self-care.	Cross-sectional study	46 patients	Superpixel (high resolution) image capture tool)	The implementation of this superpixel-cropped imaging tool has enabled surgical wound assessment to be performed as reliably (90% accuracy) as that performed by medical professionals.	High
Holt, Flint, Bowers, (2011)(²⁵25 Holt JE, Flint EP, Bowers MT. Got the picture?: using mobile phone technology to reinforce discharge instructions. Am J Nurs. 2011;111(8):47-51. https://doi.org/10/1097/01.NAJ.0000403363.66929.41 https://doi.org/10/1097/01.NAJ.000040336... ) United States of America	To demonstrate whether using audiovisual technology to support a patient through discharge education can promote adherence to self-care instructions, increase patient autonomy, and reduce poor quality outcomes.	Case report	One patient	Camera and voice recording from the patient’s cell phone	The intervention employed represents an innovative way to use the existing cell phone technology to provide more effective, patient-centered discharge education, resulting in patient compliance with all the processes required for dressing changes, patient satisfaction and autonomy in the self-care process, no infection or other morbidities, and no need for readmission.	Low
Sanger et al., (2014)(²¹21 Sanger PC, Hartzler A, Han SM, Armstrong CAL, Stewart MR, Lordon RJ, et al. Patient perspectives on post-discharge surgical site infections: towards a patient-centered mobile health solution. PLoS One. 2014;9(12):e114016. https://doi.org/10.1371/journal.pone.0114016 https://doi.org/10.1371/journal.pone.011... ) United States of America	Exploring the patient experience of opening an mHealth wound monitoring application as a solution for SSI.	Cross-sectional study	Seventeen eligible patients were identified. Of these, 13 participated and 4 were willing to participate but faced time constraints or had psychiatric illness.	mPOWEr	Three main themes emerged during the interviews regarding patients’ self-care for post-discharge wound complications, which were knowledge for self-care and self-monitoring, efficacy for self-care and wound monitoring at home, and communication with providers. While considering the acceptability, perceived benefits, and potential limitations of an mHealth solution, participants perceived that this solution can address post-discharge challenges by enabling more frequent, comprehensive follow-up, leading to less anxiety and fewer unnecessary visits to the health care facility.	Low
Tofte et al., (2018)(²²22 Tofte JN, Anthony CA, Polgreen PM, Buckwalter JA, Caldwell LS, Fowler TP, et al. Postoperative care via smartphone following carpal tunnel release. J Telemed Telecare. 2020;26(4):223-31. https://doi.org/10.1177/1357633X18807606 https://doi.org/10.1177/1357633X18807606... ) United States of America	To explore the safety, efficacy, and patient convenience of using a new smartphone app for postoperative care after carpal tunnel release.	Cross-sectional study	16 patients	Mobile Application	All patients successfully completed the removal of the dressing. Overall, ten of 16 patients (63%) were able to successfully remove their sutures. Fifteen patients (94%) captured wound photos, although one photo was deemed too blurry for analysis. For the 14 patients who had a clinically adequate wound photo and clinical documentation of symptoms available, the authors classified the wound as ‘uncomplicated’, ‘macerated’, ‘open’ or ‘infected’. With the exception of a single patient with mild wound maceration, no other significant wound complications were identified at the 10- to 14-day postoperative personal visit or during the review of the wound photographs.	Moderate
Yahanda et al., (2019)(²⁴24 Yahanda AT, Marino NE, Barron J, Concepcion A, St John T, Lu K, et al. Patient engagement and cost savings achieved by automated telemonitoring systems designed to prevent and identify surgical site infections after joint replacement. Telemed J E Health. 2019;25(2):143-51. https://doi.org/10.1089/tmj.2017.0325 https://doi.org/10.1089/tmj.2017.0325... ) United States of America	Evaluate the use and patient satisfaction of text and voice telemonitoring interventions to prevent and identify SSI after joint replacement.	Pilot clinical trial	1,392 patients were enrolled in EpxDecol and 1,753 patients in EpxWound.	EpxDecol and EpxWound (text and voice messages)	The proportion of patients who responded daily on ExpDecol was 91% and of those who responded on ExpWound was 77.7%. The response percentage decreased by 5% during each intervention. In final analysis, 88.4% of EpxDecol patients and 67.8% of ExpWound patients responded to 80% of all messages. For a survey of satisfaction with the interventions, a cohort of 1,246 post-intervention patients was used: the average response of how patients rated the care was 9/9, that is, 8/9 for enhanced communication and 5/9 for the number of messages received.	Alto
Anthony et al., (2018)(²³23 Anthony CA, Lawler EA, Ward CM, Lin IC, Shah AS. Use of an automated mobile phone messaging robot in postoperative patient monitoring. Telemed J E Health. 2018;24(1):61-6. https://doi.org/10.1089/tmj.2017.0055 https://doi.org/10.1089/tmj.2017.0055... ) United States of America	To describe a method of communicating with patients postoperatively outside of the traditional healthcare setting, using an automated software and cell phone messaging platform; and to evaluate the first week postoperatively.	Cross-sectional study	47 patients	Automated software and cell phone messaging platform	The trend of pain decreased daily in the first postoperative week, with the highest levels of pain reported in the first 48 hours after surgery. Patients reported an average use of 15.9 tablets of prescribed opioid analgesic. The use of a cell phone messaging software robot allows for effective data collection on postoperative pain and analgesic use.	Low

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[1] Corresponding author: Renata Cristina de Campos Pereira Silveira, E-mail: recris@eerp.usp.br