PREVENTION AND MANAGEMENT OF SURGICAL WOUND INFECTION AND THE CHALLENGES FACED BY NURSES AT THE REGIONAL HOSPITAL BUEA

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 measure before, during and after surgery, the prevention of surgical site infection is complex, 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

1. To evaluate the knowledge of nurses in the prevention of surgical wound infection at the Buea Regional Hospital.
2. To evaluate the practice of nurses in the management of surgical wound infection at the Buea Regional Hospital.
3. To identify the challenges faced by nurses in the prevention and management of surgical wound infection in the Buea Regional Hospital.