Prevention and management of surgical wound infection and the challenges faced by nurses at the Regional Hospital Buea
Department: Nursing
No of Pages: 37
Project Code: NS9
References: Yes
Cost: 5,000XAF
Cameroonian
: $15 for International students
ABSTRACT
Surgical
wound infections threaten the lives of millions of patients each year and
contribute to the spread antibiotic resistance. In low income countries like
Cameroon, the patient has 2-5% chances of developing an infection at the site
of incision and those that get infected are two to three times likely to die as
a result of the infection. Hence, this study seeks to assess the role of the
nurses in the prevention and management of surgical site infection.
This
study was a hospital-based study carried out at the Buea Regional Hospital for
a period of 5weeks. A descriptive cross-sectional study design was used and a
random sampling technique was used to collect data from nurses working in the
theatre, casualty and the surgical units. Data was collected from 30
participants using observational guides and questionnaires which were
self-administered.
The
data was analyzed using SPSS version 16.0 and Microsoft excel 2010 and
presented in charts and tables. Results obtained revealed most nurses practiced
strict aseptic techniques in the prevention and management of SSIs but there
was negligence in the area of speaking over sterile field, closure of doors and
windows before setting, use of sterile drapes to cover equipment after setting
and use of sterile gloves.
Also,
there were challenges such as insufficient dressing materials, heavy work load,
poor patient nutrition and lack of sterile gloves. It is therefore recommended
that there should be enforcement in the supervision of nurses, hospital
administration should ensure adequate supply of equipment and materials and the
number of newly recruited nurses should increase.
CHAPTER ONE
INTRODUCTION
1.1 Background
Surgical
site infections (SSIs) are wound infections that occur after an operative
procedure. A preventable complication, they are costly and associated with
poorer patient outcomes, increased mortality, morbidity and reoperation rates (Norman
et al. 2017). Globally, millions of individuals are at risk of complications
resulting from surgery if correct action and prevention strategies are not
applied at the appropriate times.
The
global burden of surgical site infection is Important worldwide, yet this
burden affects low income countries more with eleven percent of people who
undergo surgery being infected. In Africa, up to twenty percent of women who
undergo caesarian section contract a wound infection, compromising their own
health and their ability to care for their babies (WHO, 2016).
Many
interventions are used with the aim of reducing the risk of SSI in people
undergoing surgery. These interventions can be broadly delivered at three
stages: preoperatively, intraoperatively and postoperatively (Liu et al. 2018).
Surgical site infections (SSIs) are the most common complication following
surgery, with reported rates ranging from 5% to 30%.
The
attributable morbidity and mortality is significant, with patients who
experience SSIs being 60% more likely to spend time in the intensive care unit,
5 times more likely to be readmitted to hospital and twice as likely to die
than patients without SSIs. Surgical site infection (SSI) is a
commonly-occurring healthcare-associated infection, complicating 2-5% of
surgeries in the United States (US)[1].
Increased
morbidity and mortality are associated with SSI, ranging from wound discharge
associated with superficial skin infection to life-threatening conditions such
as severe sepsis[1,2]. SSIs are responsible for an increased economic burden to
healthcare systems, including additional postoperative hospital duration and
costs(Korolet al. 2013).
Whereas
many risk factors for the development of SSIs are related to patient
characteristics that cannot be easily modified, there are a variety of system
or hospital factors that can be manipulated. These include improper selection
and administration of antibiotic prophylaxis, intraoperative hypothermia and
intraoperative hyperglycemia(Eskicioglu et al. 2012).
Staphylococcus aureus
has long been recognized as one of the most important bacteria that
causes wound infections, contributing to more than 20% of all surgical site
infection annually (Boonie & Barnard, 2017).The morbidity and related cost
associated with surgical infections is considerable; estimate of prolong
hospitalization vary from 5to 20 days
per infection.
Wound
dressings applied after wound closure may provide physical support, protection
and absorb exudates (Dumvilleet al. 2016). Surgical wound irrigation is an
intraoperative technique, which may reduce the rate of SSIs through removal of
dead or damaged tissue, metabolic waste, and wound exudate.
Irrigation
can be undertaken prior to wound closure or postoperatively. Intra-cavity
lavage is a similar technique used in operations that expose a bodily cavity;
such as procedures on the abdominal cavity and during joint replacement surgery
(Norman et al. 2017).
The intraoperative interventions are largely focused on decontamination of skin using soap and antiseptics; the use of barriers to prevent movement of micro-organisms into incisions; and optimizing the patient’s own bodily functions to promote best recovery.
Both decontamination and barrier methods
can be aimed at people undergoing surgery and operating staff. Other
interventions focused on SSI prevention may be aimed at the surgical
environment and include methods of theatre cleansing and approaches to managing
theatre traffic (Liu et al. 2018).
The
nurse should make sure that the patients temperature is maintained above 36
degree centigrade to be sure that the patients homeostasis is maintained. The
nurse is supposed to cover the wound at the end of the surgery. The dressing
should be kept in place for 2days or 48hrs after surgery unless clinical signs
indicated, the dressing act as a barrier between the wound and the outside
environment thereby protecting the wound site from being infected.
A
gap exists between the best evidence and practice with regards to surgical site
infection (SSI) prevention. Awareness of evidence is the first step in
knowledge translation(Eskiciogluet al. 2012). The purpose of this study is to
assess the nurse’s role in the prevention and management of surgical wound
infection.
1.2 Statement of the
problem
Surgical
site infections threaten the lives of millions of patients each year and
contribute to the spread of antibiotics resistance. In low income countries
like Cameroon, a patient has 2 to 5% chances of developing an infection at the
site of incision(Shute,2018) and those that get infected are 2 to 3 times
likely to die because of the infection (Dellingeret al 2019).
SSIs
are relatively common; a recent USA study with assessment in 183 hospitals
involving 11,282 patients found that 452 people (4%) developed
hospital-acquired infection; of these, 21.8% were SSIs (Magill 2014) While more
data are available for Western healthcare settings, SSI was identified as the
leading cause of hospital-acquired infection in a systematic review of studies
in low- and middle-income countries (Allegranzi 2010).
SSI
requires the integration of a range of preventive measures before, during, and
after surgery, the prevention of surgical site infection is complex, and hence,
this study is based on assessing the prevention and management of surgical site
infection by nurses at the Regional Hospital Buea.
1.3 Research objectives
1.3.1 Main objective
- The purpose of this study is to determine the role of the nurses in the prevention and management of surgical site infection at the Buea Regional Hospital and the challenges they faced.
1.3.2 Specific objectives
- To evaluate the knowledge of nurses in the prevention of surgical wound infection at the Buea Regional Hospital.
- To evaluate the practice of nurses in the management of surgical wound infection at the Buea Regional Hospital.
- To
identify the challenges faced by nurses in the prevention and management of
surgical wound infection in the Buea Regional Hospital
