CHAPTER ONE

INTRODUCTION

1.1BACKGROUND

Surgical site infections are the most frequent type of preventable hospital acquired infections with a serious and undesirable outcome which is associated with serious morbidity and mortality rate, prolonged hospital stay, readmission, reoperation, and even excess cost (CDC, 2019). A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place it occurs within 30days of the procedure or 365days if there is an implant (Mangram et al .,1999) .They are the leading cause of  health acquired infections(HAI) particularly in developing countries (CDC,2016). Surgical site infections are classified as ; superficial involving the skin only, deep incisional and organ or space surgical site infections (NHSN, 2016) .They are caused by bacteria that get in through the incisions made during surgery the most common of which are staphylococcus, streptococcus, and pseudomonas .Statistics show that incidence of surgical site infection is lower in developed countries where incidence is 2.0 to 6.4% (Anderson et al ., 2008) compared to developing countries where incidence has been estimated at 5.5 to 25% (Lohsiriwatet al., 2009).

Surgical site infections are classified into intrinsic and extrinsic risk factors (Famakinwa et al., 2014) the intrinsic factors include advanced age , malnutrition , metabolic disease , smoking , obesity , hypoxia and  immune suppression while extrinsic factors include pre-operative skin preparations and skin antiseptic ,antibiotic prophylaxis , inadequate sterilization of surgical instruments , surgical drains , surgical hand scrubs and dressing technique . The classical statement of Johan peter frank director of the general hospital in Vienna around 1800 “can there be a greater contradiction than a hospital disease. An evil that one acquires where one hopes to loose one’s own disease? Is very much applicable in this century.

The staff that providesperioperative care for patients is responsible for minimizing surgical complications. The nurses are the most important since they stay with the patients round the clock it is imperative for the surgical nursesto know the basic importance of pre and post-operative wound infection prevention and control by implementing quality measures which include antibiotic prophylaxis hair removal using a clipper, tight control of pre and post -operative glucose levels and avoiding hypothermia. The timing of surgical prophylaxis and appropriate use of antimicrobial prophylaxis is a quality indicator in preventing surgical site infections.

An array of studies reported significant drop in the rate of SSIs associated with increased awareness among healthcare workers (Joyce and Naajaiah,2009 ; Eskander  et al .,2013 )On the other hand , lack of infection  prevention and control awareness was found to be associated with poor practices of standard precautions by surgical ward nurses (Mahmud et al .,2011). It is possible to prevent most of these adverse effects by following recommended and validated actions thus ensuring the patients safety throughout the hospital stay. Among the recommendations adopted to prevent and control surgical site infections, are the standard precautions taken whenever there is risk of contact with patient blood and body fluid, regardless of risk factors or underlying disease which are use of gloves to reduce contamination from microorganisms as well as change of gloves within procedures, use of gowns and mask to avoid contact with patient fluid and prevention of accidents with biological materials.

To provide quality care it is very important for nurses to have good knowledge and practice towards preventing surgical site infections.

1.2 STATEMENT OF THE PROBLEM

Despite modern surgical techniques and use of antibiotic prophylaxis, surgical site infections still remain a burden for patients and the health system .Most often surgical  Patients   end up with post-operative surgical site infections 30 days after surgery or within 365 days if there is an implant.

Statistics show that among 850,000 general surgeries performed in the United States, it was found an overall incidence of SSI (Surgical site infections) equal 1.9%. In Brazil data on incidence of SSI is 1.4 to 38.8% (NHSN, 2016).Surgical site infections have been reported to be the most common cause of health acquired infections accounting to 20% to 25% of nosocomial infections in Ethiopia and generally worldwide (WHO,2011). A  significant number of studies indicate that most nurses lack knowledge on the prevention and risk factors of surgical site infections (Mitchell et al.,2014)

Surgical site infections have the following complications, prolonged hospital stay, substantial morbidity and mortality rates, readmission, reoperation and even excess cost.

This study seeks to assess the  knowledge , preventive measures and factors associated with  surgical site infections at the Nkwen district hospital Bamenda.

1.3 SIGNIFICANCE OF THE STUDY 

This study is aimed at identifying the associated factors and preventive measures of surgical site infections in order to reduce rate of morbidity and mortality of patients .the results of this study will be of importance to the following people

1. Health administrators ; the results of this study will provide a basis for the implementation of health programs to increase awareness  on SSI in the hospital
2. Care providers ;the results of this study will improve the quality of care provided to patients in order to reduce rate of SSI
3. Patients ; the results of this study will help patients to be aware of the risk of SSI and work in collaboration with the nurses to ensure appropriate care and safety
4. Other researchers; the results of this study will add more facts relating to SSI and fill in the knowledge gaps that exist.

1.4 RESEARCH QUESTION

1.4.1 General question

1. What is the knowledge, preventive measures and factors associated with surgical site infections among nurses at the Nkwen district hospital Bamenda?

1.4.2 Specific question

1. What is the knowledge of surgical site infections among nurses at the Nkwen district hospital Bamenda?
2. What are the factors associated with surgical site infections among patients at the nkwen district hospital Bamenda
3. What are the preventive measures of surgical site infections among nurses at the Nkwen district hospital Bamenda?

1.5 RESEARCH OBJECTIVES

1.5.1 General objectives

The purpose of this study is to assess the knowledge , factors associated with surgical site infections and preventive measures among nurses at the Nkwen district hospital Bamenda

1.5.2 Specific objectives

1. To assess the knowledge of nurses on surgical site infections at Nkwen district hospital Bamenda.
2. To determine the factors associated with surgical site infections among patients at the nkwen district hospital Bamenda.
3. To identify the preventive measures of surgical site infections among nurses at the Nkwen district hospital Bamenda.