A Proposal on the Role of Nurses on the Prevention of Surgical Site Infection
CHAPTER ONE
Objectives of study
- To examine the level of nurses’ knowledge regarding prevention of SSI
- To examine the role of nurses regarding prevention of SSI
- To examine the relationship between nurses’ knowledge and practice regarding prevention of SSI
CHAPTER ONE
LITERATURE REVIEW
Conceptual Review
Surgical Site Infection
Intact skin is the patient’s first line of defense against bacterial invasion. A surgical incision is un-intentional breech of this defense mechanism, after which the surgical wound can be contaminated by bacteria from multiple sources (Fry & Fry, 2007). Surgical site infection (SSI) refers to an infection that occurs within 30 days of the operation, if no implant is left in place or within one year of operation, if an implant is left in place and the infection appears to be related to the operation. SSIs are divided into three types, depending on the depth of infection penetrating into the surgical wound: superficial incisional infection, deep incision infection, and organ/space infection (Florman & Nichols, 2007; Gray & Hawn, 2007; Mangram et al., 1999; Pear, 2007).
SSIs are the most common type of nosocomial infection among surgical patients and are commonly caused by the patients’ own flora and by health care providers (Florman & Nichols, 2007). According to the National Nasocomial Infection Surveillance (NNIS) system of the Centre for Disease Control and Prevention (CDC), SSI accounted for 14% to 16% of all nosocomial infections and was the most common nosocomial infections among surgical patients, and accounted for 38% of such infection (Mangram et al., 1999).
Incidence of SSI
SSI is a world wide clinical problem. In developed countries, approximately 5,000,000 patients developed an SSI during the 44 million inpatients surgical procedures performed annually and rate of SSI was 2% to 5% in the USA (Anderson et al., 2008; Nichols, 2004). In the UK, a study was conducted with caesarean section patients found the incidence of SSI was 2.9% (Ward, Charlett, Fagan, & Crawshaw, 2003). In Sweden, a study reported that the overall SSI rate was 6.4% in orthopedic and thoracic surgical patients (Gunningberg et al., 2008). In 2002, a one-month prospective national multi-cancer surveillance study was conducted in general and gynecology units of 48 Italian hospitals.
CHAPTER THREE
Theoretical Framework
This study was guided by the health belief model (HBM). This model explains the relationship between individual’s beliefs and health behaviours. This theory has been used as a planning tool for promoting adherence with preventive health behaviours and health care recommendations Nutbeam & Harris, (2004).
The HBM has six constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self efficacy. Glanz, et.al, (2008). When nurses recognize that they are susceptible to the risk of HAIs and that they will suffer from serious consequences, they will be interested in conforming to standard precautions in order to prevent themselves from acquiring hospital acquired infections. Further, if they receive supportive cues to action such as posters, enough training to build their self efficacy and the belief that SPs will reduce the risk of getting infected, and that those actions outweigh the costs and barriers, they will be ready to comply.
the human system. Contextual stimuli are all other stimuli present in the situation that contribute to the effect of the focal stimulus and a residual stimulus is an environmental factor within or outside the human system with unclear effects.
The assumptions of the developing theory are: (a) SSI is a breach in the integrity of human beings with regard to the basic need of protection, so it represents a compromised adaptation level and an ineffective adaptive response; (b) Risk factors increases the likelihood of developing a disease or injury and can be semantically aligned to the concept of stimuli, by both theoretical conjectures or statistical measures of association; (c) Risk factors can be classified as contextual or residual stimuli according to the measure of association and statistical significance.
CHAPTER THREE
RESEARCH METHODOLOGY
Research Design
The descriptive correlational study will be conducted to obtain information on knowledge and practices of nurses regarding prevention of SSI at Calabar Medical Hospital (CMCH) in Cross River and also to examine the relationship between these variables.
Population and Setting
One of the largest government acute care centre and teaching hospital in Cross River, Nigeria was conveniently selected to be a target setting for the study. Cross River is located in the south geographical zone of Nigeria. The CMCH is located in the town of Cross River. There are more than one thousand patients getting admitted per day in this hospital. The total number of nurses is 300 nurses, out of which 138 nurses are working in the surgical wards. There were 13 surgical wards covering general surgery, orthopedics, ENT (ear, nose, and throat), eye, gynecology, and labour (postpartum and caesarian section). Nurses who were working in these wards were recruited, if they held a minimum of diploma degree in nursing and had at least six months of experience in surgical related wards.
Sample Size
The sample size of the study was calculated by using power analysis (Cohen, 1988). In this study, the sample size was estimated for an acceptable level of significance, an expected power of (-) and estimated population effect size of .24 (P) that was calculated from the previous study (Vij et al., 2001). This previous study examined the relationship between knowledge and practice of nurses regarding infection control measure. Correlation of these two variables was r =.24. The maximum number of subjects was 132 to achieve a significant level of .05 and power .80. However, a total of 125 surgical nurses were working in surgical wards and they met the inclusion criteria. Thus, in this study all 125 nurses were approached. Only 120 surgical nurses willingly participated to comprise the sample.
CHAPTER FOUR
Data Analysis
Data will be analyzed using computer software. The analysis will include descriptive and inferential statistics to answer the research questions. Demographic characteristics, the knowledge transformed scores regarding prevention of SSI, and the practices transformed scores regarding prevention of SSI were analyzed using frequency, mean, standard deviation (SD), and range. The levels of knowledge and practice regarding prevention of SSI will be categorized and described. The relationship between knowledge and practice regarding the prevention of SSI will be analyzed by using Pearson product-moment correlation. The assumptions of normality and linearity of these two variables will be tested.
REFERENCES
- Adams, S. A., Mattheews, C. E., Ebbeling, C. B., Moore, C. Q., Cunninghan, J. E., Fulton, J., et al. (2005). The effect of social desirability and social approval on self-report of physical activities. American Journal of Epiodemiology, 161, 389-398.
- Akyol, A. D. (2007). Hand hygiene among nurses in Turkey: Opinions and practices.
- Journal of Clinical Nursing, 16, 431 437.
- Allcock, N. (1996). Factors affecting the assessment of postoperative pain: A literature review. Journal of Advanced Nursing, 24, 1144-1151.
- Anderson, D. J., Kaye, K. S., Classen, D., Arias, K. M., Podgorny, K., Burstin, H., et al. (2008). Strategies to prevent surgical site infection in acute care hospital. Infection Control & Hospital Epidemiology, 29, S51-S61.
- Angele, M. K., & Faist, E. (2002). Clinical review: Immunodepression in the surgical patient and increased susceptibility to infection. Critical Care, 6, 298-305.
- Gottrup, F., Melling, A., & Hollander, D. (2005). World wide wounds: An overview of surgical site infection; etiology, incidence and risk factors. European Wound Management Association (EWMA), 5, 11-15.
- Gray, S. H., & Hawn, M. T. (2007). Prevention of surgical site infection. Journal of Hospital Physician, 1, 41-51.
- Gunningberg, L., Persson, C., Akerfeldt, T., Strdsberg, M., & Swenne, C. (2008). Pre and postoperative nutritional status and predictors for surgical wound infection in elective orthopaedic and thoracic patients. The European Journal of Clinical Nutrition and Metabolism, 3, 93-101.
