CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND TO THE STUDY

As the patient's advocate, the Perioperative nurses ensure patient safety and provides

holistic care in each phase of the surgical experience.They are in an excellent position as the

primary patient advocate to guide the patient's surgical experience and ensure appropriate

infection prevention practices are implemented. This is mainly to protect patients passing

through the operating room from surgical site infections (SSI) and have a successful

surgical procedure. To achieve this, perioperative nurses are expected to have a proper

knowledge and effectively practicing universally acceptable 'principles of aseptic

techniques'. This will enhance delivering of high quality perioperative care and services

According to Al-Benna (2012), Microbial contamination of operating theaters (OTs) is a major cause of

nosocomial infections (NIs).It is considered to be a risk factor for surgical site infections (SSIs). SSI delays

wound healing, prolongs hospitalization, increases morbidity and the overall costs. The clinical

implication of microbial contamination in OT is enormous on both the patient and the caring surgical

team. (Okon , Osundi, Dibal, Ngbale, et al 2012). Approximately, 10% of all infections can have serious

consequences in terms of increased patient mortality, morbidity and length of hospital stay and overall

costs. However, it can be prevented through adequate application of infection control practices such as

aesptic techniques. Reduction of airborne bacteria in the Operating Theatre by about 13-fold, for

example, would reduce the wound contamination by about 50%. Reduction of microbial contamination

depends primarily on improved cleaning and proper disinfection of Operating Theatre (Okon et al ,

2012).
Infection control and prevention in perioperative settings should assume a greater significance because

of the vulnerability of patients who are already ill or injured, and because surgery, anaesthesia and

immediate postoperative recovery may expose them to invasive procedures, allowing more portals of

entry for infection. There is ample evidence, widely available, to support best practice in all healthcare

settings. The methods are cheap, easy to apply and very effective (Wright 2004, Pratt et al 2007).

Mangram, et al (2009), suggests that adherence to the aseptic technique principles by the sterile

surgical team members, as well as by the unsterile members such as the anesthetist, must be

observed, as it is the foundation of the prevention of nosocomial infection and contamination of

wounds by potentially pathogenic microorganism. If there is non-compliance with any one of the

sterile techniques and principles it may lead to the surgical wound becoming contaminated.

Furthermore, nosocomial infections may be transmitted to the patient by the nursing personnel

who fail to practice or carry out the sterile technique principles.

Preventing surgical site contamination requires the efforts of all surgical team members

especially Perioperative Nurses, to use their theoretical knowledge and experience in aseptic

practices to provide their patients with optimal care resulting in positive surgical outcomes.

Osman, (2010) reiterated that it is the responsibility of each member of the surgical team to

understand the meaning of principles and incorporate them into their everyday practice.

It is therefore pertinent that perioperative nurses should always aimed at high quality care

delivery to patients passing through the operating Theatre and ensure the practice of aseptic

technique is never compromised at any phase of perioperative care. In a recent survey conducted

in two major hospitals in Greece, nurses demonstrated a sound knowledge of the aseptic

principle when questioned but 15.6% of nurses were found to have contaminated their hands

during the procedure, (Michalopoulos A, 2013). In the Philippines, particularly in Samar

Province, there is a dearth of empirical data regarding nurses’ knowledge and extent of practice

of aseptic technique. As a result, it becomes necessary to research on the knowledge and practice

of aseptic techniques among perioperative nurses towards achieving safe surgical procedures in

LUTH, Idi- Arabia, Lagos state.

1.2 STATEMENT OF PROBLEM

Surgical procedures are one of the most effective medical procedures, used in the management of a

wide variety of diseases. Studies, however, indicate that several of the surgical procedures are

complicated by infection, with 5% of all surgical operations carried out in hospitals in developed

countries said to be affected. (de Lissowy, Fraeman, Hutchins et all, 2009) . Allegranzi, Bagheri,

Combesecure et al (2011) stated that the situation in the hospitals of developing countries is believed to

be significantly worse, with the infection rate found in some studies up to 20 times higher than the rates

in developed countries. Although surgical site infections (SSIs) are not associated with a high mortality

rate, they are, however, a significant source of morbidity, emotional stress and financial cost to the

affected patients and health care institutions, Allegranzi et al affirmed.

According to WHO (2012), approximately five million episodes of SSIs occur in the United States every

year, accounting for an average of 7.3 extra days in hospital, and more than 1.6 billion dollars of

additional hospital charges. Studies carried out in several other developed countries show that SSIs

result in an average of 10 extra days of hospital stay, and add an additional £1780 to the patient's

hospitalbill ; even as the infections are directly linked to the death of at least 5000 patients in the UK

alone, in spite of an expenditure of up to a billion pounds. The situation in developing countries such as

Nigeria is known to be significantly worse. Infection control policy has, however, been shown to reduce

the burden of hospital-acquired infections in several health care institutions and has since become a

constant feature in most health facilities in developed countries. Infection control policies may have has
been introduced in some hospitals in Nigeria and other developing countries, but very few studies have

been published on the effectiveness of the policy (Bagher,Allegranz, Syed et all (2011).

In view of this, it becomes necessary to assess the knowledge and practice of aseptic techniques

among perioperative nurses towards safe surgical procedures in Lagos Univermsity Teaching

Hospital (LUTH). This is essential in order to determine the pattern of information that will

further enhanced aseptic techniques thereby preventing avoidable errors and as well as

redeeming the image of nursing profession.

1.3 OBJECTIVES OF THE STUDY

GENERAL OBJECTIVE

The general objective of the study is to assess the knowledge and practice of aseptic

techniques among perioperative nurses towards safe surgical procedures in Lagos University

Teaching Hospital, Idi – Araba, Lagos.

SPECIFIC OBJECTIVES

To assess the knowledge regarding aseptic technique among perioperative nurses in LUTH

To assess the practice regarding aseptic technique among perioperative nurses in LUTH.

 To correlate knowledge and practice regarding aseptic technique among perioperative nurses.

To determine factors affecting the practice of aseptic technique among perioperative nurses in

LUTH

1.4 SIGNIFICANCE OF STUDY

This study aspires to provide information about the level of knowledge and understanding as

well as the attitude of perioperative nurses in Lagos University Teaching Hospital (LUTH)

toward the principle of aseptic technique. Also, it seeks to ascertain the level of readiness of

perioperative nurses' to comform to the changing world of medicine especially in the

perioperative nursing. It equally intend to increase the level of knowledge and understanding of

perioperative nurses which will eventually improve their practice of aseptic techniques in the

perioperative environment. These will prevent avoidable errors, instil confidence and

competence in nurses and promote a good image of

the nursing profession, if achieved. Furthermore, clients of healthcare will benefit immensely as

it will afford them to be more protected during surgical procedures and as well reduce cost of

treatment.

1.5 RESEARCH QUESTIONS / HYPOTHESIS

RESEARCH QUESTION

i. What is the level of knowledge of perioperative nurses in Lagos University Teaching Hospital

(LUTH) about the aseptic techniques?

ii. What is the attitude of perioperative nurses in Lagos University Teaching Hospital (LUTH)

towards aseptic techniques?

iii. What is the level of compliance of perioperative nurses in LUTH towards the practice of

aseptic technique?

iii.What are the factors affecting practice of aseptic technique by perioperative nurses in Lagos

University Teaching Hospital (LUTH)?

HYPOTHESIS I

Null Hypothesis (HO): There is no significant correlation between years of experience of

perioperative nurses and their knowledge of aseptic technique towards safe surgical

procedures in Lagos University Teaching Hospital.

Alternative Hypothesis (HA): There is significant correlation between years of experience of

perioperative nurses and their knowledge of aseptic techniqal towards safe surgical

procedures in Lagos University Teaching Hospital.

HYPOTHESIS II

Null Hypothesis (HO): There is no significant correlation between the level of knowledge

and the practice of aseptic technique by perioperative nurses towards safe surgical procedures

in Lagos University Teaching Hospital

Alternative Hypothesis (HA): There is significant association between the level of

knowledge and the practice of aseptic technique by perioperative nurses in Lagos University

Teaching Hospital towards prevention of surgical site infection.

1.6 SCOPE OF THE STUDY

The scope of this study is on the knowledge and practice of sterile techniques among

perioperative nurses in Lagos University Teaching Hospital towards safe surgical procedures.

This includes perioperative nurses working in:

Modular theatre.

Labour ward theatre.

Guiness eye theatre.

Accident and Emergency theatre.

1.7 LIMITATION OF THE STUDY

This study is limited by:

Time constraints due to the short duration of perioperative nursing programme.

Uncooperativeness from the respondents apparently due to the heavy workload.

Exclusion of nurses from other provinces or zones may limit the generalizability of this

investigation.

Another potential limitation of the investigation is the use of questionnaires to measure the

practices which may result in information bias.

1.8 OPERATIONAL DEFINITION OF TERMS

1.5 RESEARCH QUESTIONS / HYPOTHESIS

RESEARCH QUESTION

What is the level of knowledge of perioperative nurses in Lagos University Teaching Hospital

(LUTH) about the sterile techniques?

What is the practice of perioperative nurses in Lagos University Teaching Hospital (LUTH)

towards sterile techniques?

What are the factors affecting practice of sterile technique by perioperative nurses in Lagos

University Teaching Hospital (LUTH)?

HYPOTHESIS I

Null Hypothesis (HO): There is no significant association between years of experience of

perioperative nurses and their knowledge of sterile technique towards prevention of surgical

site infection in Lagos University Teaching Hospital.

Alternative Hypothesis (HA): There is significant association between years of experience

of perioperative nurses and their knowledge of sterile technique towards prevention of

surgical site infection in Lagos University Teaching Hospital.

HYPOTHESIS II

Null Hypothesis (HO): There is no significant association between the level of knowledge

and the practice of sterile technique by perioperative nurses in Lagos University Teaching

Hospital towards prevention of surgical site infection.

Alternative Hypothesis (HA): There is significant association between the level of

knowledge and the practice of sterile technique by perioperative nurses in Lagos University

Teaching Hospital towards prevention of surgical site infection.

1.6 SCOPE OF THE STUDY

The scope of this study is on the knowledge and practice of sterile techniques among

perioperative nurses in Lagos University Teaching Hospital towards prevention of surgical site

infection. This includes perioperative nurses working in:

Modular theatre.

Labour ward theatre.

Guiness eye theatre.

Accident and Emergency theatre.

1.7 LIMITATION OF THE STUDY

This study is limited by:

Time constraints due to the short duration of the programme.

Uncooperativeness from the respondents apparently due to the heavy workload.

Exclusion of nurses from other provinces may limit the generalizability of this investigation.

Another potential limitation of the investigation is the use of questionnaires to measure the

practices which may result in information bias.

1.8 OPERATIONAL DEFINITION OF TERMS

1.5 RESEARCH QUESTIONS / HYPOTHESIS

RESEARCH QUESTION

What is the level of knowledge of perioperative nurses in Lagos University Teaching Hospital

(LUTH) about the sterile techniques?

What is the practice of perioperative nurses in Lagos University Teaching Hospital (LUTH)

towards sterile techniques?

What are the factors affecting practice of sterile technique by perioperative nurses in Lagos

University Teaching Hospital (LUTH)?

HYPOTHESIS I
 Null Hypothesis (HO): There is no significant association between years of experience of

perioperative nurses and their knowledge of sterile technique towards prevention of surgical

site infection in Lagos University Teaching Hospital.

Alternative Hypothesis (HA): There is significant association between years of experience

of perioperative nurses and their knowledge of sterile technique towards prevention of

surgical site infection in Lagos University Teaching Hospital.

HYPOTHESIS II

Null Hypothesis (HO): There is no significant association between the level of knowledge

and the practice of sterile technique by perioperative nurses in Lagos University Teaching

Hospital towards prevention of surgical site infection.

Alternative Hypothesis (HA): There is significant association between the level of

knowledge and the practice of sterile technique by perioperative nurses in Lagos University

Teaching Hospital towards prevention of surgical site infection.

1.6 SCOPE OF THE STUDY

The scope of this study is on the knowledge and practice of sterile techniques among

perioperative nurses in Lagos University Teaching Hospital towards prevention of surgical site

infection. This includes perioperative nurses working in:

Modular theatre.

Labour ward theatre.

Guiness eye theatre.

Accident and Emergency theatre.

1.7 LIMITATION OF THE STUDY

This study is limited by:

Time constraints due to the short duration of the programme.

Uncooperativeness from the respondents apparently due to the heavy workload.

Exclusion of nurses from other provinces may limit the generalizability of this investigation.

Another potential limitation of the investigation is the use of questionnaires to measure the

practices which may result in information bias.

1.8 OPERATIONAL DEFINITION OF TERMS

Aseptic

Aspsis

Aseptic technique: A set of specific practices

and procedures performed under carefully

controlled conditions with the goal of minimizing

contamination by pathogens.

Infection: Contamination with micro organism.

Contamination: Soiled or infected by microorganism.

Sterile techniques: A process by which contamination with microorganisms is prevented to

maintain sterility throughout surgical procedure.

Surgical procedure: Process of carrying out surgery on patient.

 Sterile: Free from micro organism.

Stockinette: Equipment used on the patient during surgery.

Cuff: Edges of sterile gowns or gloves.

dmpurities

: Reducing the number of

microorganisms to safe levels)

Dissinfect

Practice: The attitude of the perioperatirds prevention of surgical site infection

Knowledge: The awareness of sterile technique.

CHAPTER TWO

LITERATURE REVIEW

2.0 THE CONCEPT OF STERILE TECHNIQUE