NURSES' KNOWLEDGE AND PRACTICE TOWARDS PREVENTION OF SURGICAL SITE INFECTION

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Globally, nurses are considered the essential and fundamental component of every hospital, hence proficiency and methodologies employed by nurses play a vital role in managing infections, consequently enhancing the standard of care delivered to patients. Sadia (2017) assert that SSI, or surgical site infection, typically becomes clinically evident within 48 hours of admission or may occur after the patient has been discharged. Insufficient infection control practices are the main reason for preventable sickness and death in impoverished countries, with SSI being the leading cause. The term "surgical site infections" present a challenge for medical facilities globally. According to Radu (2022), patients get Surgical Site Infections (SSIs) after being hospitalized for a minimum of 48 hours.  The utilisation of quality measures such as antibiotic prophylaxis, hair removal by the use of a clipper, strict regulation of pre- and post-operative glucose levels, and prevention of hypothermia are all acknowledged as crucial quality measures in diminishing infection rates (Wick 2020). The timing of surgical prophylaxis and the optimal utilisation of antimicrobial prophylaxis is a widely accepted measure of quality and a crucial intervention in the prevention of surgical site infections (Humphreys, 2018).

 Several studies have documented a notable decrease in the occurrence of Surgical Site Infections (SSIs) as a result of heightened awareness among healthcare professionals (Nanjaiah  2019). Conversely, the study by Mahmud et al. (2021) revealed that a lack of understanding regarding infection prevention and control was linked to subpar adherence to conventional measures among nurses in surgical wards.As stated by Ibrahim et al. (2022), a comprehensive grasp of the causes, risk factors, and preventive measures for surgical site infections (SSIs) is crucial for nurses to effectively control and manage infections. Babatunde (2024) supports this claim by claiming that deficiencies in knowledge can result in failures in infection prevention practices and a heightened susceptibility to SSIs. This entails being knowledgeable on evidence-based standards and policies for the prevention of surgical site infections (SSIs).

 Inyene (2023) argues that mere awareness of risk factors and management strategies is insufficient; the application of information in practice is crucial for the prevention of SSIs. This entails following established infection control protocols, including practicing proper hand hygiene, correctly utilizing personal protective equipment (PPE), and employing aseptic procedures. Implementing these guidelines consistently decreases the probability of infections and guarantees a more secure surgical setting (Inyene, 2023). Assessing the knowledge and practice of nurses in Nigeria regarding the prevention of surgical site infections (SSI) is crucial due to the country's healthcare facilities facing substantial obstacles such as limited resources and a high number of patients. Assessing the existing knowledge level and identifying areas where there is a lack of practice can help in developing specific interventions to improve infection control efforts. This study aims to evaluate the level of awareness and adherence of Nurses in Nigeria to the prevention of surgical site infections.

1.2 Statement of the problem

It is no doubt that nurses, as essential healthcare providers involved in all aspects of patient care, have a vital role in implementing these practices. However, a significant number of nurses lack sufficient training and education in this particular profession. Despite being the most efficient approach to reduce surgical site infections (SSIs), hand hygiene is not adequately practiced. Not only can SSI cause preventable deaths, but it also puts a financial burden on the healthcare system in underdeveloped countries such as Nigeria (Hendrickx and Winters, 2022).

 Bizzarely in Nigeria, there exists a significant disparity in comprehending the extent to which nurses possess the requisite knowledge and abilities to effectively avert SSIs. Nurses' capacity to properly implement preventative procedures can be hindered by limited access to sufficient resources and infection control supplies. According to Aliu (2022), differences in the extent of training and continuous education among nurses can result in inconsistent implementation of SSI preventive methods. According to Aliu (2022), there may be substantial deficiencies in nurses' understanding of evidence-based recommendations and protocols for preventing surgical site infections (SSI), notwithstanding their availability. Inadequate comprehension of the aetiology, predisposing factors, and prophylactic treatments for surgical site infections (SSIs) can result in inefficient infection management and heightened susceptibility to SSIs among surgical patients.

A study conducted by Famakinwa  (2022) found that nurses possess a considerable level of knowledge on the prevention of Surgical Site Infections (SSIs). An important challenge in preventing harmful health outcomes is the conversion of acquired knowledge into practical actions. This is particularly true for healthcare providers whose professional training exposes them to a comprehensive understanding of crucial health matters. The issue lies in effectively applying this knowledge to take necessary procedures in order to avert adverse health consequences, such as surgical site infections. Having knowledge of what has to be done is distinct from actually doing the actions one is aware of. It is crucial to ensure that the knowledge one possesses is powerful enough to inspire the necessary attitude to maximize the likelihood of turning that knowledge into desirable behaviors. This statement confirms that having knowledge does not always result in taking action. The study's findings support the prior findings of Fadeyi (2017) that also revealed a high level of awareness on SSIs prevention among nurses in Obafemi Awolowo Teaching Hospital, Ile-Ife, Nigeria. The study's findings also revealed a notably unfavorable disposition towards the prevention of SSIs, which is believed to have an impact on actual implementation. As previously mentioned, possessing information does not necessarily result in a positive mindset. 

While knowledge plays a crucial role in influencing one's attitude, it is not certain that acquiring knowledge would automatically result in a positive attitude. The objective of this study is to assess the extent of knowledge and compliance among nurses in Nigeria on the prevention of surgical site infections.

Objectives of the study

The primary objective of this study is to critically evaluate Nurses' knowledge and practice towards prevention of surgical site infection. Specific objectives of this study are to:

To investigate the awareness level of nurses regarding surgical site infections.

To assess the level of knowledge of Nurses on the risk factors associated with surgical site infections.

To assess the current knowledge of nurses regarding the prevention of surgical site infections.

To assess Nurses practices   regarding the prevention of surgical site infections.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What is the awareness level of nurses regarding surgical site infections?

What is the level of knowledge of Nurses on the risk factors associated with surgical site infections?

What is the current knowledge of nurses regarding the prevention of surgical site infections?

What are Nurses practices   regarding the prevention of surgical site infections.

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: The current knowledge of nurses regarding the prevention of surgical site infections is low.

Ha: The current knowledge of nurses regarding the prevention of surgical site infections is high.

1.6 Significance of the study

The study will provide a fundamental reference point for healthcare providers, surgical patients, policymakers, students, and scholars. Hospitals can decrease healthcare expenses related with treating surgical site infections (SSIs) by enhancing nurses' knowledge and practices. These circumstances have financial consequences for healthcare facilities and can lead to overall reductions in costs. More so, nurses have a crucial role in providing direct patient care, particularly in the perioperative environment. It is essential to adhere to best practices for infection prevention in order to uphold high standards of care. Analyzing their expertise and methods can reveal deficiencies and areas that need improvement, guaranteeing that care standards are achieved and elevated. 

For nursing education, identifying deficiencies in nurses' knowledge and practice can provide valuable insights for the creation of focused educational programs and training initiatives. This can guarantee that nurses are well-informed about the most recent evidence-based procedures and guidelines for preventing surgical site infections (SSIs). Nurses have a crucial role in providing patients with information and guidance on postoperative care. Enhancing the knowledge and skills of nurses can result in more efficient patient education, enabling patients to comprehend their responsibility in infection prevention and enhancing compliance with postoperative care guidelines. 

Empirically, conducting research on the knowledge and behaviors of nurses can offer useful insights for the development or revision of hospital policies and protocols pertaining to infection control. This guarantees the implementation of the most efficient techniques to avoid Surgical Site Infections (SSIs). Healthcare organizations can enhance infection prevention measures and overall patient care by investigating and addressing the factors that influence nurses' actions and implementing quality improvement efforts. Furthermore, upcoming scholars will utilize it as a thorough examination of the current academic literature. Hence, individuals with a profound enthusiasm for this field of research can depend on this work as a reliable and thoroughly evaluated source of information.

1.7 Scope of the study

Broadly, this study focus is to critically evaluate Nurses' knowledge and practice towards prevention of surgical site infection in Nigeria. Specifically, this study seeks to assess the level of knowledge of Nurses on the risk factors associated with surgical site infections and assess the current knowledge of nurses regarding the prevention of surgical site infections.  Further, this study will focus on assessing the level of knowledge of Nurses on the use of asepsis and it also seeks to explore barriers that hinder nurses from fully implementing recommended practices for surgical site infections prevention. The study is carried out in Nigeria.

1.8 Limitations of the study

Like in any human attempt, the researchers encountered several small limits during the investigation. The primary constraint was the dearth of comprehensive literature on the topic, given the scarcity of data pertaining to Nurses' knowledge and practice towards prevention of surgical site infection. Therefore, a substantial investment of time and effort was required to identify the suitable materials, books, or information and to collect data. 

Moreover, this study is limited by its diminutive sample size and restricted geographical range, concentrating just on Nigeria. Hence, the findings of this study cannot be extrapolated, thereby necessitating additional research. More so, the researcher's restraints were predominantly attributable to financial limitations, as they are a student without a means of revenue to support themselves. The research location's high transportation costs, impacted by current inflation in Nigeria, made it difficult to afford transportation fees.

In addition, the researcher encountered a time limitation as a result of the necessity to do this research while simultaneously meeting the responsibilities of attending lectures and engaging in other educational pursuits.

1.9 Definition of terms

Surgical site infections: This infection occurs beneath the incision area in muscle and the tissues surrounding the muscles. Organ or space SSI. This type of infection can be in any area of the body other than skin, muscle, and surrounding tissue that was involved in the surgery. This includes a body organ or a space between organs

Nosocomial infections: Nosocomial infections are infections patients acquire while admitted to a health-care facility and generally develop 48 hours or later after admission. These infections can lead to serious problems like sepsis and even death.

Asepsis: Asepsis is a condition in which no living disease-causing microorganisms are present. Asepsis covers all those procedures designed to reduce the risk of bacterial, fungal or viral contamination, using sterile instruments, sterile draping and the gloved 'no touch' technique.