Factors Militating Against The Practice Of Aseptic Technique At The Ward Level
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Factors Militating Against The Practice Of Aseptic Technique At The Ward Level
ABSTRACT
Background: Nurses are more likely to acquire and transmit Health Care Acquired Infections (HCAI) when providing nursing care; consequently, prevention strategies are an important component of core nursing care.
Factors that discourage nurses from using aseptic techniques in infection control during burn therapy play an important role in reducing morbidity and mortality, as well as the expense of burn wound management at the individual and ward levels.
As a result, HCAI is the most severe consequence of burns, with sepsis being the leading cause of death. Adherence to YSH’s standard operating procedures for burns therapy, which use aseptic techniques, helps to avoid infection transmission.
The purpose of this study was to identify factors that work against the use of aseptic technique among nurses in the management of burns patients at YSH.
Methods: A cross-sectional descriptive study methodology was used to obtain a sample size of 59 nurses working in the burns ward at YSH. Data were collected using a self-administered questionnaire and a standardised observational checklist.
Data was coded and analysed with SPSS version 21, which used descriptive statistics such as median, mean, and frequency distributions, as well as chi-square analysis for categorical data. The link between the independent variables and the primary dependent variable was determined using logistic regression modelling.
Results: 42.9% of participants did not correctly wash their hands before, during, and after the dressing operation, whereas 88.1% had good knowledge of aseptic technique; nonetheless, 14.6% of individuals practiced aseptic technique throughout the procedure, whilst 85.4% did not.
There was a statistically significant relationship between barriers to aseptic technique and appropriate water supply in the taps and soap at P=0.038 (OR=4.5). 70.7% of the rooms did not have standard operating procedures in place to avoid infection.
31.6% of the rooms contained segregation posters. 54.8% of nurses identified barriers to aseptic technique implementation that impeded knowledge application to practice.
Conclusion: Nurses working in burns specialised units have acceptable understanding of aseptic technique and play an important role in the prevention of sepsis during burns patient management, however their adherence is fair in practice.
Recommendations: These findings suggest that nurses in specialised wards should be re-trained on aseptic technique procedures by the institution, and that institutional policies be made available to the respective ward departments, in addition to adequate logistics on supplies and equipment. Aseptic technique surveillance should be improved from the managerial to the ward level to maintain the Standard Operating Procedures.
Chapter one
INTRODUCTION
1.1 Background information.
Patients with severe burns may die as a result of complications like septicaemia. Burns wound infection (BWI) is the most common nosocomial infection in burn units. Healthcare-associated infection is the most devastating complication of burns, and sepsis is the leading cause of death (Church et al, 2006).
Other burn wound complications include pain, discomfort, annoyance, and impairment (Odabas A.B, et al. 2009). Wound management may also result in financial losses.
Noncompliance with aseptic procedures would increase morbidity and mortality (McRobert & Stiles, 2014), raising the expense of burn wound treatment at both the individual and national levels.
As social scientists agree, there is no national culture, and therefore no national burn management culture or guidelines. Each burn unit has its own burn management culture that is influenced by a variety of circumstances, necessitating the necessity for unit-based studies. In social studies, transferability and generalisation of findings are not suggested from trend analysis.
The number of patients burned each year is disturbing (Andrews E.A. 2015). Globally, fire-related injuries are responsible for 265 000 deaths per year, with the vast majority occurring in low- and middle-income nations.
According to the World Health Organisation (WHO, 2002), South East Asia had the most recorded deaths (57%), followed by Africa (12, 2%), and low and middle regions in the Eastern Mediterranean (11%).
According to the WHO (2008), the annual incidence of fire-related injuries requiring medical attention was 10.9 million worldwide, with South East Asia (5.9 million) being the most afflicted region, followed by Africa (1.75 million) and the Eastern Mediterranean (1.55 million). Burns appear to be most prevalent in underdeveloped nations with limited access to health care and resources (Andrews E.A. 2015).
This study was conducted in Nigeria, a developing country, specifically in Yobe, Nigeria’s capital city. Yobe, like many other developing countries, is characterised by urban migration, poverty, and the growth of slums. These urban characteristics contribute to and are associated with overcrowding and the risk of burns (Rode & Rogers 2011).
Advances in research over the years have significantly improved burn outcomes, as seen with the use of antiseptics in the 1960s, increased use of occlusive dressings and early surgery in the 1970s, and topical antimicrobial agents in the 1990s (Demling & DeSanti, 2001).
Despite these developments, some institutions continue to use out-of-date treatments and practices, such as Silver Sulphadiazine (SSD) cream as the standard of care.
Newer research demonstrates that the disadvantages of SSD outweigh the benefits (Opasanon, Muangman, & Mamiviriyachote, 2010; Muangman, Pundee, Opasanon, et al., 2010; Caruso, Foster, Blome-Eberwein, et al., 2006; Varas, O’Keeffe, Namias, et al., 2005).
The majority of research in the care of burn wounds focusses on surgical management, with no study focussing on nursing management. Burns are currently managed by nurses, however their clinical methods differ significantly.
There are no standards or recommendations in place to influence nursing practice, thus not all patients benefit from evidence-based burn wound treatment techniques.
Several research have been undertaken on surgical burn wound management. Emphasis has been placed on operations in the Burn Unit, which are typically required. This study sought to evaluate aseptic practices used by nurses in burn therapy. Nurses are required to be skilled in wound management, which is taught as part of the undergraduate general nursing curriculum (Bruce, Klopper & Mellish, 2011: 176).
Furthermore, knowledge serves as the foundation for making informed decisions as well as the framework for developing and maintaining competence (Benbow, 1992). Nurses are consequently responsible for being knowledgeable about burn wound treatment guidelines.
Severe and poorly controlled burn infections can cause paralytic ileus, shock, compartment syndrome, and acute renal failure, among other complications (Brunner and Suddarth 2010).
Chronic infections can result in septicaemia or bone infections, which can lead to mortality. Sepsis-related encephalopathy increases morbidity and mortality, particularly in patients (Maramattom, 2007).
Financial constraints, a lack of resources, guidelines, healthcare professionals, and patient characteristics all affect burns care on the African continent (Albertyn R, Numanoglu A., & Rode H., 2014). The significance of aseptic technique measures in relation to other elements must be identified and reinforced.
Nigeria has shown significant improvements in medical practice (Elamenya et al. 2015). Notable efforts have been made to maintain aseptic conditions in surgical wards. However, the prevalence of would infection is growing.
Wound infection management remains a concern in surgical regions, with burns patients being particularly vulnerable to infection (Coban Y.K 2012). Sepsis and multiorgan failure are the top causes of burns death (William F.N 2009). As a result, burns care focusses primarily on prevention and management.
Some research has been conducted at YSH on antibiotic sensitivity patterns (Kinyua, 2013) and pain treatment (Kiplangat, 2013). Aseptic technique is determined by a variety of factors, including changing attitudes.
Age, causes of burns, and the presence of co-morbid conditions were found to be factors determining the duration of stay of burns patients (Lelei L.K, et al, 2011).
Aseptic technique in wound management studies should be conducted on a regular basis in many hospitals, including the same wards, to generate more knowledge.
1.2 Problem Statement
Burn wound infections, if not properly examined and managed, can cause long-term disability, increased morbidity, and mortality. The role of aseptic procedures as infection control measures in connection to other aspects must be identified and reinforced in order to improve patient care.
To minimise injuries following a catastrophic accident, intensive care provided by specialised specialists is essential. This is difficult to execute in a developing nation with few specialised burns facilities and skilled burns professionals (Chalya et al, 2011).
The rate of burns wound infection in YSH was 18.7% in a total of 347 patients, with risk factors predisposing to infection ranging from age to the extent of burns surface area, different modes of management, and their effectiveness (Wanjeri, 2013).
Infections cause the patient more pain and lengthen their stay in the hospital. To avoid infection, the surroundings surrounding the incision should be clean (Almas et al, 2011). As a result, the purpose of this study was to evaluate aseptic technique in burns wound management among nurses.
1.3 Research Questions.
What is the clinical evidence for aseptic technique practice in burns wound treatment among YSH nurses?
What are the obstacles preventing nurses at the ward level in YSH from using aseptic techniques?
1.4 Objectives.
To analyse factors militating against the practice of factors militating against the practice of aseptic technique among nurses in the management of burns patients at the ward level in Yobe State Specialist Hospital
Specific Objective
To evaluate the practice of proper hand washing technique before, during and after procedure among nurses in the management of burns patients at the ward level in Yobe state speciality hospital.
To examine adherence to standard wound dressing method among nurses in the management of burns patients at the ward level in Yobe State Specialist Hospital.
To evaluate the practice of effective waste segregation among nurses during the management of burns patients at the ward level in Yobe State Specialist Hospital.
To identify the factors that influence the practice of factors that impede the practice of aseptic technique among nurses at the ward level in Yobe State Specialist Hospital.
1.5 Significance of the Study
Burn wound infection was the most common infection in burn units. Such injuries may be severe, necessitating critical care and/or surgical surgery.
Burns frequently lead to wounds. A wound can occur as a result of purposeful or inadvertent skin disruption (Giacometti et al, 2000). Good wound management is critical in preventing healthcare-associated infections.
Many of these cases result in premature deaths. The infection rate of burn wounds at YNH was 23.6% (22/93 patients), and the entire study found a high correlation between burn wound infection and mortality in YSH (Ngugi, 2013).
Adherence to aseptic method lowers hospital-acquired infection in burns patients (WHO 2012). The purpose of this study was to analyse aseptic technique practice in connection to the occurrence of burns wound infection in YSH, with the goal of reducing the prevalence of burns wound infections and supporting preventive intervention approaches.
1.6 Scope.
The majority of wounds at YSH (59.3%) are burn wounds, with 22.7% being accident-related wounds. The majority of wound cases were detected in burns wards (56%), with the remainder in burns unit (24.7%) wards.
Wound patients at YSH are treated in the general burns ward or burns unit. This study did not focus on a specific ward, but rather collected samples from all wards containing burn victims.
1.7 Limitations.
Sample size: The population under study supplied a small sample size (59), although statistical tests require a bigger sample size to assure a representation of the population and to be considered representative of the group of persons to whom results will be generalised.
Due to a lack of previous research studies on this topic in YSH, the literature review search was limited to studies conducted both within and outside the hospital on relevant topics.
Participants’ bias may occur when they realise they are being observed, altering the data to be collected. To reduce observational bias, the researcher will observe each participant three times on separate patients while doing the identical procedure on various days.
The semester’s time limits limit the amount of time expected to prepare the proposal and publish the results.
1.8 Operational Definition
The aseptic technique is a way for preventing microorganism infection. It entails adopting the toughest regulations and utilising what is known about infection prevention to minimise the chances of an illness (Kristeen Cherney and Rachel Nall 2015).
A burn is a damage to the skin or other organic tissue that is primarily the result of thermal or other acute stress. It happens when some or all of the cells in the skin or other tissue are killed by hot liquids (scalds), hot solids (contact burns), flames (flame burns), radiation, radioactivity, electricity, friction or chemicals, cold or frost bite.
Burn wound management refers to the treatment of burn wounds. Management begins with an examination of a burn wound’s size, depth, and placement. Following assessment, the wound is cleaned and dressings are put based on the depth of the burn wound (Demling & DeSanti, 2004).
A burns unit is an organised medical system that provides entire care to the wounded patient (British Burn Association, 2002).
Competence is defined as knowledge, skill (behaviour), attitude (interpersonal), and values; it is the deliberate application of judgement based on knowledge and understanding (Bruce, Klopper, & Mellish, 2011: 176).
Evidence-based wound management involves the merging of best scientific evidence, clinical skill, and patient values (Sackett, Straus, Richardson, et al., 2000).
Healthcare-related infection (nasocomial infection): an infection connected with healthcare in any context. The infection may be acquired while undergoing treatment for another condition.
(National Infection Prevention and Control Guidelines for Healthcare Services in Nigeria, 2010)
Health is a condition of total physical, mental, and social well-being, not just the absence of disease or disability. (WHO, 2003)
Management is the specialised treatment of a sickness or condition (Oxford English Dictionary 2014).
Methodological assumptions influence the nature of the research process, including the most appropriate approach to adopt (Mouton, 1996: 124). This study’s methodological assumptions include evidence-based research, the scientific process, and ethical research.
Morbidity refers to an individual’s disease state or the prevalence of illness in a population.
Mortality refers to the state of being mortal, or the frequency of death (number of deaths) in a community.
A nurse is someone who is registered with the NCN to practise nursing or midwifery (SANC, 1984: Nursing Act, 2005) and does so for a living (Searle et al., 2009:50).
Nursing is a caring profession practiced by a person registered with the South African Nursing Council who supports, cares for, and treats a health care user to achieve or maintain health where possible; and cares for a health care user so that he or she lives in comfort and dignity until death (SANC, 1984).
The nursing process is a systematic problem-solving method that identifies, prevents, and treats real or potential health problems while also promoting wellness (Chabeli, 2007).
Wound healing is the process of restoring injured tissues by replacing dead tissue with viable tissue. A closed wound dressing is one that does not communicate directly with the atmosphere.
Wounds are bodily injuries induced by physical causes that interrupt the natural continuity of the skin structure.
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