CHAPTER ONE

GENERAL INTRODUCTION

1.1 Background of the Study

An ancient record shows that antiseptic techniques date far back into history. The ancient Chinese, Persians and Egyptians had methods for water sanitation and antisepsis for wounds.

The ancient Greeks and Romans used silver vessels to restore fresh liquid and wine, settlers in the Australian use silver ware and pioneers of the American west put silver and copper coins in drinking water for the same purpose (Lois, 2013).

The modern concept of asepsis evolved in the 19^th century. Ignazsemmelweis showed that washing the hands prior to delivery reduced puerperal fever in the ward of vienna’s lying-in hospital.

After the suggestion Louis Pasteur, who proved that microorganism caused spoilage and could be transported via the air, placing booth in flasks with long shaped necks, after boiling the booths, observed that no microorganisms grew in the flask,

Then Joseph Lister began soaking his surgical dressings in carbolic acid (phenol) because he heard that carbolic acid has been used to treat sewage in Carlise and the fields that had been treated were now free of parasitic causing diseases, leading to a dramatic decrease in the number of post operational infections (Mokhoro, 2012).

 Joseph Lister introduced the use of carbolic acid as an antiseptic and reduced surgical infection rates especially in 1870 when it saved the lives of many Prussian soldiers. Some countries like England and America were still in opposition to his germ theory though.

The turning point for Lister came on October 26, 1877 when he had the opportunity to perform a simple knee operation (wiring a fracture kneecap, which entailed deliberate conversion of simple fractured into a compound fracture), which often resulted in generalised infection and death.

The success of this operation forced people to accept that this method greatly added to the safety of operative surgery.

The culmination of his emphasis on the principle of preventative medicine was the opening of the institute in 1981. These are a few of the reasons why Joseph Lister is often referred to as the ‘father of antiseptic surgery’ (Elana, 2012).

Furthermore, Pittet (2012) stated that Lawson Tait went from antisepsis to asepsis by introducing principles and the iconic statutes that have remained valid to this day.

He also identified Ernst Von Bergmann as the person who introduced the autoclave, a device used for practice of steam sterilization of surgical instruments under pressure.

He equally explained how the Arabian physicians in the middle ages used Mercury chloride to prevent sepsis in wounds by introducing hypochlorite and iodine as a treatment for open wounds in 1825 and 1839 respectively.

1.2 Statement of Problem

The operating room complex environment, including the nursing personnel, may play a role in the transmission of nosocomial infections; and therefore (DeLaune and Ladner 2008) state that nosocomial infections may be transmitted to the patient by the nursing personnel who fail to practise or carry out the sterile technique principles.

It is necessary to give careful attention to the creation and maintenance of a safe and acceptable therapeutic operating room complex environment in order to prevent the potential development of nosocomial infections, because the integrity of the patient’s skin is compromised during a surgical procedure.

The body’s largest and most important organ is the skin and its functional components are the cutaneous layer that includes the epithelium and the connective tissue.

The skin also includes structures in the cutaneous layer, such as the sweat and the sebaceous glands, hair and nails.

The cutaneous layer consists of two main layers which are known as the epidermis and the dermis. When a wound occurs, the skin and its components become involved in the healing process in other to restore the integrity of the skin (Mulder, 2012)

The intact skin plays an important role in the prevention of infection or disease because it is part of the body’s first line of defence against infection, involves good health and entails natural biochemical, mechanical as well as anatomic protection (Fortunato, 2009).

The source of pathogens for most wound infections is the endogenous flora of the patient’s skin, mucous membranes or hollow viscera. When the skin or mucous membranes are incised, the exposed tissues are at risk for contamination with endogenous flora (Mangram, 2009)).

An aseptic technique must be used during any invasive procedure which breaches the body’s natural defences, for example the skin, mucous membranes, or when one is handling equipment which will enter a normally sterile area (Xavier, 2009).

Infection may also occur from the normal colonisation of the patient’s skin or it may enter the wound from dispersed bacteria in the air of the operating room, hence the rationale for using specialised air-conditioners to reduce potential infection.

Bacteria that are responsible for infections, such as wound infections, are introduced into the wound at the time of the surgical procedure and may only be noticed weeks after the surgical procedure (Fry and Fry, 2007:802).

In the practical situation, within the operating room, it is important to classify the degree of contamination of the surgical wound in order to determine whether the nosocomial infection was introduced within the operating room complex, because a clean site may become contaminated depending on the type of wound, the pathological findings, the anatomical location or a break in the aseptic technique (Fortunato, 2009).

Patients have a right to be protected from preventable infection and nurses have a duty to safeguard the wellbeing of their patients (King 2008).

An aseptic technique should be implemented during any invasive procedure that bypasses the body’s natural defences, e.g. the skin and mucous membranes, or when handling equipment such as intravenous cannula and urinary catheters that have been used during these procedures.

Whilst it is difficult to maintain sterility, it is important to prevent contamination of sterile equipment. Poor aseptic techniques can lead to contamination. By having the right attitude and high level of practice asepsis can be maintained.

It is observed that a nurses’ attitude towards hand washing compliance worsened when the demand for aseptic technique was high.

There are two significant problems that are found to influence the level of practice of aseptic technique which include poor practice areas with high intravenous therapy workloads, such as theatres and intensive care units, often seemed to demonstrate the poorest aseptic practice.

For instance, hand washing is often found to be poor, intravenous ports are often not cleaned and syringes are often re-used after being placed on the patient’s bed linen.

Secondly, the wrong attitude, included being a chief nursing officer rather that a sister nurse, being male; working in an intensive care unit (ICU); working during weekdays rather than weekends; wearing gowns and gloves; performing activities with high risk for cross infection; and having many opportunities for hand hygiene per hour of patient care.

All these affect the attitude nurses have towards aseptic technique. (Didier 2013)

Despite nurses educational background and training and continuous efforts made in the promotion of the practice of aseptic techniques, many nurses seems not to be performing it.

This may be probably due to wrong attitude, inadequate knowledge and so on. It’s based on this submission that the researcher intends to carry out a research on the attitude and practice of nurses towards aseptic techniques.

1.3 Objective

The aim of the study is to assess the attitude of nurses carrying out aseptic techniques

1.4 Research Questions

1.4.1 Main research question

 What is the attitude of nurses towards aseptic technique practice?

1.4.2 Specific research question

What is the level nurse’s knowledge on aseptic technique?

What knowledge do nurses have on the importance of aseptic technique?

What are the challenges faced by nurses in the practice of aseptic technique?

1.5 Objectives of the Study

The main objective of this research is: To investigate the nurse’s attitude towards aseptic technique practices

1.5.1 Specific objective

To asses nurses knowledge on aseptic technique

To assess nurses knowledge on the importance of aseptic technics

To assess the challenges faced in the practice of aseptic technics

1.6 Significance of the Study

This study will be useful in correcting nurses’ attitude towards aseptic techniques and also to improve the practice of aseptic technique among nurses. The information provided will help nursing administrators in knowing area to address as continued education and seminars are organized for the nurses. 

The result of this study will assist in nursing education as it provides information to guide the development of nursing curriculum and training courses related to attitude and practice of aseptic techniques.

This study will help the government to understand that practise of aseptic technique is of utmost importance hence the need to be involved in the provision of protective devices for all nurses

The important of the study to the nation is that it will help to reduce the high rate of cross infection from resulting into increased mortality rate. The significance of the study is that it will serve as a basis for further study to include all the doctors, nursing personnel and nursing students.

1.7 Scope of Study    

This study is to be carried out among nurses at the Bamenda regional hospital and other hospitals in Bamenda . The nurses used were nurses from male surgical ward, female surgical ward, male medical ward, female medical ward, children ward, theatre and labour ward.

1.8 Operational Definitions of Terms

1. Aseptic techniques:  process or procedure used to achieve asepsis to prevent the transfer of potentially pathogenic micro-organisms to a susceptible site that may result in the development of infection (Wilson, 2019).

2. Practice: It is a complex, dynamic and experiential activities that are embodied in and transformed through individual performances and grounded in ethical aim of doing good for others (Dalton and Higgs, 2014).

3. Nurses: are people who provide services essential to or helpful in the promotion of health, prevention of illness, care of physically ill, mentally ill, disabled people of all ages, maintenance and restoration of health and well being (ICN, 1987).

4. Cross infection: is a type of infection that is normally transmitted between individuals who are infected with different microorganisms ( Kristencherney, 2017).

5. Attitude: is the disposition or state of mind, a settled way of thinking or feeling that affects an individual’s behaviour (Dixon et al, 2015).