http://www.inosr.

net/inosr-experimental-sciences/
Kyakimwa
INOSR Experimental Sciences 11(1):34-66,2023.
©INOSR PUBLICATIONS
International Network Organization for Scientific Research ISSN:2705-1692
Surgical Site Infection prevention among Nursing Staff at Kampala
International University Teaching Hospital Bushenyi, Uganda

Kyakimwa Naume

School of Nursing Science Kampala International University-Western Campus, Uganda.

ABSTRACT
Surgical site infections (SSIs) are infections related to an operative procedure that occurs at
or near the surgical incision within 30 days after the surgery. The incidence of SSI Varies
from hospital to hospital in different countries with developed countries having lower
incidences ranging from 2% to 6.4%, and developing countries with higher incidence
ranging from 5.5% to 25%. The aim of this study was to assess knowledge and practices
regarding surgical site infection prevention among Nursing Staff at Kampala International
University Teaching Hospital Bushenyi, Uganda. This was across sectional descriptive study
and quantitative in nature. The main objective of this study was to examine the level of
knowledge and practices regarding surgical site infection prevention among nursing staff
at Kampala international university teaching hospital. It involved 33 respondents who were
conveniently selected to participate in the sturdy. Results from this study indicated that an
average of 16(48.5%) respondents had adequate knowledge on SSI infection prevention
while an average of 17(51.5%) respondents had inadequate knowledge on SSI prevention.
The study revealed that there was no positive relationship between knowledge and practice
regarding surgical site infection prevention since respondents were found to have slightly
higher knowledge but with less practice of the recommended precautions about surgical
site infection prevention. In conclusion, basing on the findings of this sturdy, nurses have
low level of knowledge about prevention of infection of surgical sites. The areas that
registered extremely poor knowledge were areas of wound assessment, pre-operative
showering, timing and importance of preoperative prophylactic antibiotics and correct
diagnosis of surgical site infection. This study also concludes that the level of practices of
the recommended precautions as far as prevention of infection of surgical sites was low
among nursing staff at KIU-TH. The areas that registered extremely poor practice included
use of masks during wound care procedures, nutritional assessment (BMI) for surgical
patients, and administration of preoperative prophylactic antibiotics, pre-operative shaving
and use of separate sterile pressing pack for every patient during wound care.
Keywords: Surgical site infections, developing countries, surgical incision, prophylactic
antibiotics.
INTRODUCTION
Surgical site infections (SSIs) are from hospital to hospital in different
infections related to an operative countries with developed countries
procedure that occurs at or near the having lower incidences ranging from 2%
surgical incision within 30 days after the to 6.4%, [1] and developing countries with
surgery, [1]. higher incidence ranging from 5.5% to
Humaun et al [2] defined SSIs as 25% [3].
infections that occur after the operation There are patient related (intrinsic)
within 30 days if no implants or within factors including; age extremities, poor
one year if there is an implant. SSIs are nutritional status, metabolic diseases,
one of the nosocomial in which an smoking, obesity, hypoxia, immune
infection occurs after an invasive suppression and length of pre-operative
procedure. The incidence of SSI Varies stay that increase the risk of developing

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SSI. The extrinsic factors that influence
the risk of SSI include, application of skin
antiseptics, preoperative shaving,
antibiotic prophylaxis, preoperative skin
pre-operative skin preparation,
inadequate sterilization of instruments,
surgical drains, surgical hand scrub and
dressing techniques, [4, 5,6,7,8,9].
SSIs contribute substantially to surgical
morbidity and mortality, leading to
increased duration of postoperative
hospital stay, higher rates of hospital
readmission, impaired health outcomes
and increased costs. In 2009, in the USA,
it was estimated that a SSI extended the
length of hospital stay by 9·7 days on
average [6,10,11,12,13,14,15].
Sepsis is a common diagnosis, a frequent
cause of hospitalization, and a leading
cause of death in the United States [8].
Becoming familiar with sepsis is essential
for nurses in all settings [16,17,18,19].
Approximately 24% of patients who
develop severe sepsis or septic shock will
do so on a medical-surgical unit [8].
Sepsis was the principal reason for
hospitalization in 836,000 hospital stays
and the secondary diagnosis in an
additional 829,500 hospital stays in 2009
[9]. Levit, et al; [10] tracked sepsis data
from 1997 to 2006, noting that sepsis as a
principal diagnosis increased 48%. The
rate of hospitalization for sepsis as a
primary or secondary diagnosis rose
to70% from 2000 to 2008 [11]. Between
1997 and 2008, hospital stays for
septicemia increased by 91% (Healthcare
Cost and Utilization Project [HCUP], 2010).
It is estimated that 1.4 million people
worldwide are suffering from HAI.
Approximately 2 million patients develop
HAI and nearly 90,000 of these patients
are estimated to die annually, which ranks
HAI as the fifth leading cause of death in
the United States of America (USA)
[12,20,21,22,23,24].
Accordingly, among the HCWs, nurses
have a critical role to play in prevention
efforts and they are an important
population to study their level of
knowledge, and practices regarding SSIs
prevention. However, up to date these
issues have received only limited
attention and obtaining information may
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be useful for developing programs to
increase compliance, [13,25,26,27].
Problem statement
It is estimated that SSI develop in 2% to
5% of the more than 30 million patients
who undergo surgical procedures
representing 14% to 16% of all HAIs
annually in US. These infections account
3% of all surgical mortality and lead to
increased re admission, increased length
of hospital stays and higher medical
costs, [14,28,29,30,31,32,33].
In the past 20 years, the overall incidence
of HCAIs has increased by 36 percent. The
substantial human suffering and financial
burden of the infections is staggering.5-
10 percent of patients acquire one or
more infections and 15-40% of patients
are affected by Hospital acquired
infections (HAI) [15, 28,29,30,31,32,33].
WHO [16] estimated the burden of SSI in
developing world where sub-Saharan
Africa falls at 29%, Europe at 17%and USA
at 20% of all patients undergoing surgical
procedures. In East Africa, Tanzania leads
the region with the burden of SSI
estimated to be at 26% of all patients
undergoing surgical procedures
In Uganda Literature about SSI is still
scarce and the true incidence and cost per
patient is unknown. However, research
done at Mbarara regional referral hospital
in south western Uganda to determine the
incidence of SSIs on surgical wards in
2016, put post-operative incidence
density at 16.4 % [17].
At Kampala international university
teaching hospital, unpublished hospital
records indicate that, for every 10patients
undergoing surgical procedures, 5 suffer
post-operative SSI and the situation is
worse with patients undergoing
orthopedic surgeries where about 8 out of
10 suffer SSI leading to long duration of
hospital stay and the very increased
medical costs.
Nurses are directly involved in the
assessment of patients at risk for
developing SSI and in the treatment of
patients with it and can, therefore, affect
outcomes for critically ill patients [18]. It
is from this back ground that the
researcher derives the interest to carry
out this study about knowledge and
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practice among nursing staffs regarding
SSI prevention.
Aim of the study
The purpose of this study was to examine
the level of knowledge and practices
regarding surgical site infection
prevention among nursing staff at
Kampala international university teaching
hospital
Specific objectives
1. Assessment of the level of nurses’
knowledge on surgical site
infection prevention
2. Examine the practices of nurses
regarding SSI prevention
Research questions
1. What is the level of nurses’
knowledge on SSI prevention?
2. What are the practices of nurses on
SSI infection prevention?
METHODOLOGY
Study design and rationale
The study was a descriptive cross-
sectional of quantitative in nature. This
design was used because; it is cheap in
terms of resources like time and money
since data collected once.
Study setting and rationale
The study was conducted at Kampala
international university teaching hospital
(KIU-TH), found in ishaka municipality,
Bushenyi district KIU-TH is private not for
profit institution which was founded in
2004 and it serves as a teaching hospital
for KIU medical school. It’s located
approximately 395 km North West of
Kampala capital, 45 km north of Mbarara
along the Mbarara Fort portal high way.
The hospital has a capacity of about 300
beds and serves also as a referral hospital
for the entire greater Bushenyi region.
The researcher intends to carry out this
because of its convenience in terms of
accessibility but also the observation
made by the researcher about the burden
of the problem necessitated that the
study be carried out at this site
Study population
The sturdy involved nursing staff of all
cadres at KIU-TH
Sample size determination
The sample size will be determined using
[21]
Justification of the study
Despite being largely preventable, SSI
continues to represent about fifth of all
health care associated infections [19].
Despite many advances in infection
control practices, including improved
operating room ventilation, sterilization
methods, barriers, surgical technique, and
antimicrobial prophylaxis, SSIs still cause
a substantial amount of morbidity and
mortality among hospitalized patients.
The increase of transmissible infections,
not only in health care institutions but
also in the home, is an issue of great
societal concern, [20]. The findings of the
study will therefore help in policy
formulation at ministry level and
implementation in hospitals as well as for
reference purposes by future researchers.
n=z2pq/r2
Where:
n is the sample size desired
Z is the degree of accuracy, 95% which is
1.96
P is Proportion of KIU staffs that are
nurses working in surgical units ie
50(0.05)
Q=1-p
By substitution in the above formula=33.
Therefore, the study used a sample size
of 33 nurses working in surgical units
Sampling procedure (methods)
The research respondents were selected
using convenient method of sampling
since the entire can nursing staff not be
on duty at same time
Inclusion criteria
The nursing staffs that were on duty and
voluntarily consented to participate in the
study at the time of data collection
Exclusion criteria
The staff who were not nursing
professionals
Nursing staff that did not consent to
participate in the sturdy on voluntary
basis
Independent variable
Knowledge of nurses about SSIs
prevention
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Dependent variable statistics were used. Association between
Practices of nurses regarding SSIs dependent and independent variables
prevention were assessed and presented using tables,
Research instruments graphs, and pie charts.
Data was collected using an approved Ethical considerations
structured questionnaire which consisted The researcher sought approval of the
of both open and close ended questions. proposal from the supervisor before
The questionnaire was divided into 3 handing it in to the school of nursing
parts ie the demographic characteristics, research coordinator for further scrutiny
knowledge of nurses about surgical site and approval. Thereafter, the proposal
infection prevention and practices of was submitted to Kampala international
nurses on surgical site infection university research and ethics committee
prevention. for review, approval, and granting
Data collection procedures permission to proceed with data
After the sampling process, the researcher collection. The researcher also requested
distributed the questionnaires to the for letters of introduction to hospital
consented respondents who were administration in order to be allowed
required to fill them. collect data from hospital nursing staff
Data management and this was granted.
Data collected was edited before leaving Confidentiality was maintained to the
the area, to ensure completeness and if best of the researcher’s ability and no
any blank spaces found, they we refilled name was required on the questionnaires
there and then. and the information generated was only
Data processing and analysis used for academic purposes.
Data entry, coding, and analysis were Participant autonomy was respected by
performed using SPSS version 20 software giving them full information and allowing
package. To explain the study population them to freely decide whether to
in relation to relevant variables, participate or not.
frequencies, percentages, and summary
RESULTS

Social demographic characteristics

Table 1: shows the age distribution among respondents (n=33)
Age range of respondents Frequency(n) Percentage (%)
18-30 16 48.5
31-40 13 39.4
41 and above 4 12.1
Total 33 100

Table 1 shows that majority of the years of age while only 4 (12.1%) were of
respondents16 (48.5%) fell in the age age 41 and above.
range 18-30 years, 13 (39.4%) were 31-40

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Figure 1: sex of respondents

Majority of the respondents 21 (63.6) were females and 12 (36.4%) were male

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Figure 2: Distribution of the respondent’s level of education

From figure2 above, the majority of the and the smallest proportion of
respondents 15 (45.5) are certificate respondents 5 (15.2%) are graduates of
holders, followed by diploma, 13 (39.4%) nursing.

Table 2: shows distribution of respondents according to years spent in service

(experience)
n=33
Number of years respondents Frequency(n) Percentage (%)
have spent in service
Less than 1 year 5 15.2
1-5 years 16 48.5
6-10 years 7 21.2
11 years 5 15.2
Total 33 100

From table 2 above the majority of and 11 years and above had the least
respondents16 (48.5) had worked for 1-5 number of respondents, 5(15.2%)
years, followed by those who had served respectively.
6-10 years, 7(21.2) while less than 1 year

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Figure3: Shows the distribution of respondents according to religion (n=33)

From figure 3 above, it is evident that Catholics 8 (24.2%) with the least being
most of the respondents 17 (51.5%) were seventh day Adventists 3 (9.1).
Anglicans by faith followed by Roman

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KNOWLEDGE ON PREVENTION OF SURGICAL SITE INFECTION

FIGURE 4: Respondents’ responses regarding the best preoperative shaving method

(n=33)

Respondents were given alternatives to thought shaving with a razor blade is the
choose which one is the best method of best followed by clipping shaving 9
preoperative shaving. From figure 4 (27.3%) and the least 4(12.1) chose
above, most of the respondents 20(60.6%) depilatory shaving.

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Figure5: respondent’s responses regarding best time for pre-operative hair removal
(n=33)

Respondents were asked to choose from
the alternatives which one was the best
time for preoperative hair removal. An
equal proportion 13(39.4%) selected
shaving immediately before surgery and
another 13(39.4%) chose shaving in the
morning on the day of surgery, with least
number respondents 7(21.2%) choosing
shaving one night pre-operative.

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n=45

Figure 6: Participant’s responses regarding the best agent for preoperative skin
preparation

From figure 6 above, most 15(45.5%) of 10 (30.3%) who thought that chlorhexidine
the respondents thought that alcohol is the best and finally 8(24.2%) of the
based solutions are the best for pre- respondents thought that povidone iodine
operative skin preparation, followed by is the best.

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Figure 7: Participants responses regarding the purpose of pre-operative skin

preparation (N=45).

From figure 7 above most 19 (57.6%) of helps prevent to inhibit fungi growth
the respondents thought that while 6(18.2%) correctly thought it
preoperative skin preparation helps inhibits or prevents bacterial growth.
inhibit viral growth, 8(24.2%) thought it

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Figure 8: Participants responses regarding surgical site disinfection before the

operation(n=33)

Participants were asked how they would majority 21(63.2%) of respondents would
disinfect a surgical site before the use broad spectrum antiseptics, 8(24.2%)
operation. From the figure above, would use savlon solution and 4(24.2%).

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Figure 9: Participants’ choices regarding what is true about prophylactic antibiotics

Respondents were asked to choose from prophylactic antibiotics are important in

the alternatives what is true regarding prevention surgical site infection while
prophylactic antibiotics and from the 5(15.2%) of the respondents indicated that
figure above, overwhelming majority24 prophylactic antibiotics are not important
(72.7%) of the respondent indicated that in prevention of surgical site infection.

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Figure 10: Participants responses regarding the appropriate time to administer

prophylactic antibiotic before surgery

From the figure above, most 22(66.7) of before surgery while only 8(24.2%) would
the respondents would consider giving a give the prophylactic antibiotic 2 hours
prophylactic antibiotic 30-60 minutes before surgery.

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Figure 11: Participants responses about the importance of preoperative showering

Participants were asked about the promotes comfort of the patient while
importance of preoperative showering. 4(12.2%) said it prevents bacterial growth
Most 24(72.7%) said it reduces skin on the skin.
microbial infection 5(15.2%) said it

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Figure 12: Participant responses on malnutrition affect the immunity of a patient

undergoing surgery

Participants were asked to choose from immunity to prevent infection while

alternative what is correct regarding 3(9.1%) said that the patients have normal
malnutrition Among surgical patients, and immune response to prevent the
majority 27 (81.8%) correctly said that infections.
these patients have compromised

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Figure13: Participant responses about what level of blood sugar that is appropriate for
normal white blood cell function.

Majority19(57.58%) of the respondents thought blood sugar level should be

thought blood sugar less or equal to higher than 200mgdl to enhance white
110mg/dl is appropriate while 6(18.2) blood cell functioning.

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Figure 14: Participants responses regarding the correct method of hand washing.

From the figure above, most 17(51.5%) of a towel, 10 (30.3%) would wet hands,
the respondents would wet their hands, apply soap and rinse and 6 (18.2) would
apply antiseptic agent, rinse and dry with wet hands, rinse and dry.

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Figure15: Participants responses regarding the benefits of wound dressing

Most 20(60.6%) of the respondents that absorb exudates while 6(18.2%) said
wound dressing absorbs exudates, wound dressing reduces pain.
7(21.2%) said wound dressing doesn’t

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Figure 16: Respondents responses about when they would change a wound dressing

From figure 15 above, most 20(60.6%) of while 8(24.2%) would only change the
the respondents would only change the dressings whenever the surgeons order
wound dressings whenever they are them to do so.
performing wound dressing procedures

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Figure 17: Participants responses regarding how they would choose addressing
solution

Most 16 (48.5%) of the respondents would depending on the wound size, and
chooses a dressing solution basing on the 10(21.2) would base on the depth of the
wound characteristics while 10(30.3%) wound.
would choose the dressing solution

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Figure 18: participant responses regarding the correct diagnosis of surgical site
infection

Participant were also giving alternative
statements and were require to choose
one that was correct regarding the
diagnosis of surgical site infection. From
figure 17 above, majority 26 (78.8%) of
the respondents, would diagnose SSI
when the patient has fever with 3 day
after surgery, 4(12%) would only diagnose
SSI when the in cisional culture is
negative and 3(9.1%), know that it occurs
with 30 days after surgery.

PRACTICES OF NURSES REGARDING SURGICAL SITE INFECTION PREVENTION

Table3: Participant’s responses about use of alcohol and chlorhexidine gluconate for
preoperative skin preparation.
N=33
Participants response Frequency(n) Percentage (%)
Never practice 0 0
Seldom practice 3 9.1%
Sometimes practice 6 18.2
Always practice 24 72.7%
Total 33 100

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Table 4: Participants responses regarding the practice of hand washing during wound
care procedures

N=33
Participants response Frequency(n) Percentage (%)
Never practice 0 o
Seldom practice 2 6.1
Sometimes practice 10 30.3
Always practice 21 63.6
Total 33 100

Figure19: Participants responses about practice of washing hands before wearing

sterile gloves during wound dressing.

Participants were asked about their before wearing sterile gloves,12 (36.4%)
practice regarding use of surgical gloves sometimes wash hands before putting on
and hand washing; from figure 18 above, sterile gloves,2(6.1%) seldom practice
majority18 (54.5&) always wash hands and1(3%) never practice so.

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TABLE 5: Participants responses regarding performance of pre-operative shaving right
before surgery.
Participants response Frequency(n) Percentage (%)
Never practice 5 15.2
Seldom practice 8 24.5
Sometimes practice 18 54.5
Always practice 2 6.1
Total 33 100

Majority 18(54.2%) of the respondents sometimes perform pre-operative shaving right

before surgery.

Table 6: Participant’s responses about administration of prophylactic antibiotics one

hour before surgery
Participants response Frequency(n) Percentage (%)
Never practice 2 6.1%
Seldom practice 3 9.1%
Sometimes practice 24 72.7
Always practice 4 12.1
Total 33 100

From table 7 above, most 24(72.7%) only 3(9.1%) seldom practice, 2(6.1%) never
administer prophylactic antibiotic one practice and only 4(12.1) always practice.
hour before surgery on some occasions,

Figure 20: Participants responses on whether they advise the patients to take a shower
6-12 hours before surgery (N=33).

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Almost half,16(48.5%) of the respondents there was no participant 0(0%) who always
advises patients to take shower 6-12 advises patients to take a shower 6-12
hours before surgery on rare hours before surgery.
occasions,10(30.3%) never do so, while

Figure 21: Participants responses on BMI assessment before and after surgery

From figure 20 above more than half 18 surgery while only 1(3.0%) of the
(54.5%) of the respondents never assess respondents always assess the patients
their patients BMI before and after BMI before and after surgery.

Table 7: Participant’s responses regarding to whether they always use sterile materials
for wound dressing

Participants response Frequency(n) Percentage (%)

Never practice 2 6.1
Seldom practice 2 6.1
Sometimes practice 15 45.5
Always practice 14 42.4
Total 33 100

From table 7 above, it is evident that 14(42.4%) who always use sterile
majority15 (45.5%) sometimes uses sterile materials in wound dressing.
materials in wound care, followed by

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Table 8: Participants responses on use aseptic technique (nontouch method) during
wound dressing
Participants response Frequency(n) Percentage (%)
Never practice 1 3
Seldom practice 1 3
Sometimes practice 26 78.8
Always practice 5 15.2
Total 33 100

From table9 above, only 5(15.2%) of the 26(78.8%) use aseptic technique some
participants always use aseptic technique times.
during wound dressing while majority

Figure 22: Participants responses on isolation of surgical infected patients from non-
infected ones

Respondents were asked whether they majority24 (72.7%) do so sometimes while

have a practice of isolating surgical only5(15.2%) always separate infected
infected patients from non-infected ones; patients from non-infected.
from the figure above it is evident that

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Figure 23: Participants responses on use of face masks during wound dressing

From the figure 22 above, majority masks on rare occasions and only 1(3.0%)
13(39.4%) said the never use masks always use masks during wound dressing.
during wound dressing, 11(33.3%) use

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Figure 24: Participants responses on disinfection of dressing trolley before wound

dressing

Most 16(48.5%) of the respondents wound dressing,2 (6.1%) admit to have

disinfect dressing trolley before wound never disinfected dressing trolley before
dressing sometimes while 11(33.3%) wound dressing.
always disinfect dressing trolley before

Table 9: Participants responses on appropriate waste disposal after wound dressing

Response Frequency(n) Percentage

Never practiced 0 0

Seldom practice 0 0
Sometimes practice 05 15.2

Always practice 28 84.8

Total 33 100

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From table 10 above, it is well shown that the respondents always appropriately
an overwhelming majority 28 (84.8%) of dispose wastes after wound dressing.

Table 10: participant’s responses on use of separate sterile dressing packs for each
patient during wound dressing

Response Frequency(n) Percentage (%)

Never practiced 8 24.2
Seldom practice 7 21.2
Sometimes practice 14 42.4
Always practice 4 12.1

Total 33 100

8(24.2%) of the respondents have never
used separate dressing packs for each
patient while performing wound dressing,
14 (42.4%) do so some times while only
DISCUSSION
Demographic characteristics
Majority of the respondents16 (48.5%) fell
in the age range 18-30 years, 13 (39.4%)
were 31-40 years of age while only 4
(12.1%) were of age 41 and above. This is
perhaps because Uganda has one of the
youngest populations in the world and
the even in the work force, it is expected
that most of the workers are younger and
this is also shown with the above finding
where only 4(12.1%) of the respondents
were above 41 years of age. The
researcher was unable to find literature
that classifies Ugandan work force in this
case nurses by age.
In this study majority of the respondents
21 (63.6) were females and 12 (36.4%)
were male. This is because, traditionally,
nursing id regarded as profession of
females and so most of the time females
are readily available to take up nursing
jobs compared to their male counter
parts. The researcher was unable to
access records from the Uganda Nurses
and Midwives council for comparison
purposes to see which gender dominates
the Nursing profession.
On the level of qualification, most of the
respondents were 15(45.5%) were
certificate holders, followed by diploma
13(39.4%), 5(15.2%) and none of the
respondents had a master’s degree. This
4(12.1%) always use separate sterile
dressing packs for each patient during
wound dressing.
could be due to the fact that there many
trainings institution awarding certificates
than diploma and bachelors, entry
requirements for certificates are low and
so the numbers are more. But also, it is
important to note at this point that in
Uganda salary is determined by ones level
of education and so this implies that
certificate holders offer cheap labour than
diploma and bachelor holders hence
organization hire more of them in order
to maximize profits and this probably
explains why they dominated in this
study. There is no literature available for
comparison with this finding
In this study most 16(48.5%) of the
respondents had an experience in service
of 1-5 years, 7(21.2%) had worked for 6-10
years and 5(15.2%) had worked for over
11 years. If we are to go by the number of
years spent in service to translate into
experience in service delivery, then this
study reveals that most of the
respondents were less experienced.
Most 17(51.5%) of the respondents in this
study were Anglican by faith, followed by
Roman Catholics 8(24.2%), and 3(9.1%)
were seventh Adventists. This also
portrays the national picture because the
major religions in Uganda are catholic and
Anglican. There is no data showing

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categorization of nurses according to
their religions.
Knowledge of nurses on prevention of
surgical site infection
Results from this study indicated that
9(27.3%) knew the recommended method
of shaving while 24(72.7%) did not know
the recommended method of hair removal
before surgery;13 (39.39%) correctly on
the best time pre-operative
shaving(immediately before surgery)
while 20(60.61%) did not know the
recommended time for pre-operative hair
removal;15(45.5%) of the respondents
said alcohol based solutions are the best
for pre-operative skin preparation
while18(54.5%) did not know;6(18.1%) of
the respondents knew the importance of
pre-operative skin preparation while
27(81.82%) did not know;24(72.3%) said
that preoperative prophylactic antibiotics
are important in prevention of SSI. These
agree with [22] “40 % to 60% of the SSI
would be preventable with properly
administered prophylactic pre-operative
antibiotics; while 9(27.27%) thought pre-
operative antibiotics are not important in
prevention of SSI; 22(66.7%) Knew when to
give prophylactic pre-operative
antibiotics, “timing of the antibiotic is
considered critical for effective antibiotic
prophylaxisis” [23] while 11(33.3%) did
not know; 27(81.8%) knew the importance
of pre-operative showering while 6(18.2%)
did not know; 17(51.5%) knew the correct
procedure of hand washing while
16(48.5%) did not know the correct
procedure of hand washing; 20(60.6%)
knew the importance of wound dressing
while 13(39.4%) did not know the
importance of wound dressing;20(60.6%)
would correctly judge when to change the
wound dressings while 13(39.4%)would
not;16(48.5%) of the respondents would
objectively based on the wound
characteristics choose addressing
solution while17(51.5%) would not; which
agrees with [22] who stated “appropriate
dressing materials should be selected
according to the wound characteristics”
only 3(9.09%) would correctly diagnose
SSI while 30(90.9%) would not correctly
diagnose SSI. From the above results, an
63
average of 16(48.5%) respondents had
adequate knowledge on SSI infection
prevention while an average of 17(51.5%)
respondents had inadequate knowledge
on SSI prevention. The above findings are
similar to findings of [24] whose study on
knowledge and practices of nurses on SSI
prevention in Bangladesh revealed low
level of knowledge. Humaun, [24] in his
sturdy also asserted that for effective
prevention of surgical site infection,
nurses should have sufficient knowledge
and skills on pre-operative, intra
operative and post-operative care of
surgical patients for better outcome of
the care. However, se this is direct
opposite of the findings of this sturdy.
Practices of nurses regarding surgical
site infection prevention
Approximately 25% infections could be
prevented by nursing personnel by
following proper precautions during
nursing care to surgical patients [25] the
findings from this study revealed
different levels of practices about some of
the precautions taken during wound care
procedures.
On use alcohol-based solution for pre-
operative skin care, majority 24(72.7%)
always use and also there was high
performance of hand washing before and
after procedures at 21(63.6%) of the
respondents.
There was low practice when it came to
pre-operative shaving right before surgery
with an over whelming majority18 (54.5%)
doing so only some times, and only2
(6.1%) always performing.
On administration of pre-operative
prophylactic antibiotics, only 4(12.1%)
always do and majority24 (72.7%) only do
so some times.
When it came to BMI assessment in
surgical patients, level of performance
was extremely poor standing at 1(3.03%)
of the respondents and 18(54.5%) saying
they have never practiced that.
On use of sterile materials during wound
dressing, 14(42.4%) always do and 2(6.1%)
said they have never; 5(15.2%) dress
wounds using non touch technique and
only 5(15.2%) always separate infected
surgical patients from non-infected.
http://www.inosr.net/inosr-experimental-sciences/
When it came to use of masks, the level of
performance was so miserable, 13(39.4%)
of respondents never using masks during
wound dressing and only 1(3.03%) always
using masks.
16(48.5%) of the respondents disinfect
trolleys some times while only11 (33.3%)
always disinfect the dressing trolleys.
This study also found out that there was
no positive relationship between
knowledge and practices which
contradicts the findings of [27] whose
study in India revealed appositive
relationship between the two. This study
also reveals slightly higher knowledge but
low levels of practices regarding infection
CONCLUSION
In conclusion, basing on the findings of
this sturdy, nurses have low level of
knowledge about prevention of infection
of surgical sites. The areas that registered
extremely poor knowledge were areas of
wound assessment, pre-operative
showering, timing and importance of
preoperative prophylactic antibiotics and
correct diagnosis of surgical site
infection.
This sturdy also concludes that the level
of practices of the recommended
precautions as far as prevention of
infection of surgical sites was low among
nursing staff at KIU-TH. The areas that
registered extremely poor practice
included use of masks during wound care
procedures, nutritional assessment (BMI)
for surgical patients, and administration
of preoperative prophylactic antibiotics,
pre-operative shaving and use of separate
sterile pressing pack for every patient
during wound care.
There was no positive relationship
between knowledge and practices. The
Nurse who knew the recommended
precautions regarding surgical site
infection prevention, did not necessarily
practice them.
Recommendations
The Uganda nurses and midwives
examination board that mandated under
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