Volume 5, Issue 10, October – 2020 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Evaluation of Nurses Knowledges, Practices and

Associated Factors Regarding Prevention of Surgical
Site Infection
Arbëresha Gurguri
Faculty of Public Health
University “Ismail Qemali” Vlorë, Albania

Abstract:- Surgical site infection (SSI) is one of the most  Conclusions:

common types of Healthcare-Associated infection The results suggest that increasing knowledge and
accounting for 14% to 16% of all nosocomial infections focusing on some certain areas of prevention of SSI in
among hospitalized surgical patients. SSI is a significant practice need to be improved ,with a direct impact on
clinical problem associated to post-operative morbidity patient’s life and enhancing health care quality.
,resulting serious consequences in patients’ health ,
prolonged hospital stay and increasing costs. Keywords:- Knowledge, Nurses, Practice, Prevention,
Surgical Site Infection.
 Purpose of the study:
Aimed at assessing level of knowledge of nurses and I. INTRODUCTION
associated factors regarding prevention of SSI in surgical
units of Vlora and Fier Hospital and to determine SSI is one of the most common nosocomial infections
relationship between both variables. in surgical patients. In United State of America Surgical site
infection account for 14%-16% of all health care associated
 Method and Material: infections 1.
A cross-sectional descriptive study included 66
randomly selected nurses who completed an anonymus Surgical site infection (SSI) is defined as an infection
questionnaire regarding surgical site infections during that occurs after an operation within 30 days if no implant or
the period of study .The statistical analysis included the within one year if an implant is inserted into the organ 1.
calculation of averages, frequencies and percentages
while the Chi-Square test was used for the relationship Risk factors associated with the development of SSI
between the variables . To see the relative effect of are Intrinsic and extrinsic factors. Intrinsic factors referred to
independent variables on the dependent variable, advance age, malnutrition, metabolic diseases, smoking,
regression analysis was carried out. obesity, hypoxia, immune suppression, and length of pre-
operative stay2. Extrinsic factors referred to duration and
 Results: application of skin antiseptics, preoperative shaving,
The findings revealed that the majority of nurses antibiotic prophylaxis, pre-operative skin preparation,
(65%) had average knowledge and good practices (46%) inappropriate sterilization of instruments, surgical drains,
regarding the prevention of surgical site infection. There surgical technique, surgical hand scrubs, and dressing
was a significant relationship between the gender of the techniques 2. 25 % of infections can be prevented by nurses
nurses and level of knowledge (p=0.001).Regarding by implementing standard precautionary measures during
nursing practice, there were significant relationships care of the surgical patients. Nurses can help to prevent
between age of nurses and level of practices (p=0.017). surgical site infection, reduces patient costs, economic
One area of their knowledge were at very low level burden and increase patient’s quality of life through their
including understanding prevention of infection for knowledge and recommended practices3.
lengthy operation . Some areas of practices were less
practicing including: advising patients to shower before This study is an attempt to asses knowledge of health
surgery with antimicrobial agents. There were no care professionals about SSI control and their usual practices
statistically significant differences between knowledges in operation theatres/wards to control or prevent them. The
and practice of the respondents in both hospitals while study findings will help the organizations in developing the
there have been observed some important relationships training programs by evaluating the gaps between
between specific questions of knowledge with nurses knowledge and practices of nurses related with prevention of
practices. surgical site infection. Appropriate knowledge and good
practices by the nurses can improve patient care and may
decrease the rate of infection in the hospitals.

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Volume 5, Issue 10, October – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
II. METHODOLOGY receives score 1 and incorrect response will have 0. Those
participants who scored less than 5 points were categorized
The descriptive correlation study was conducted to as “Poor knowledge” , those who scored 6-8 points were
evaluate the level of knowledge and practice of surgical categorized as “Average knowledge” and those who scored
nurses and identify the association between knowledge and 9- 10 points were categorized as “Good knowledge” .
practice regarding prevention of surgical site infection.
Study data were collected from surgical wards of Fieri Nurses’s practices in the prevention of SSIs were
Hospital and Vlora Hospital. Nurses, working in surgical measured by 10 questions in which responses were answered
wards were included in the study. in a 5-point Likert scale (never practiced, rarely practiced
,sometimes practiced, often practiced and always practiced).
Study Design: Cross-sectional descriptive design, was Total score range from 1 to 5. Those participants who scored
carried out in surgical units of Fieri Hospital and Vlora less than 40 points were categorized as “Poor Practice” ,
Regional Hospital for period of October 2018 to March those who scored 41-45 points were categorized as “
2019. Average knowledge “ and those with more than 45 points
were categorized as “Good Practice”.Demographic
Sample of the Study: Non probability sampling was characteristics of all respondents were presented as
conducted .The sample consisted of 66 nurses working in frequencies and percentages.
the surgical units and operating theatre ,who were present
during the study period and who agreed to participate in the Statistical analysis: The data of the study were analyzed by
study. using (SPSS-version.19) program. Frequencies and
Percentages used to describe the study variables. The Chi-
Study Instrument: A questionnaire which was adopted by square test is used for determining the relationships between
Sickder et al 3 consisted from 29 items which include three sociodemographic data and nurses knowledges, practices
parts. First part assessed socio-demographic features of regarding prevention of surgical site infection and to see the
study participants like age, gender, educational qualification, correlation between knowledge and practice scores. A
total work experience, experience in surgical units, regression analysis was carried out to determine the relative
organization, participating in training programs , availability effect of independent variables on the dependent
of infection protocol (IP) guidelines, usage of IP guidelines . variable.Testing the significant association for this study was
Second part consists of questions which assessed used the significant P-value ≤ 0.05.
knowledge of participants regarding prevention of SSI, third
part had questions which assessed various practices III. RESULTS
followed in units and operation theatre and compared with
standard practices according to WHO infection control The characteristics of the respondents in both hospitals
protocols. are presented in Table (1). Table (1) shows that a total of 41
nurses (62.1%) from Fieri hospital and 25 (37.9%) from
The researcher divided collected scores into 3 levels. Vlora hospital were contributed in the study. Most of
The outcome measures of this study were knowledge (good subjects were female (74.2%).and (25.8%) were male
knowledge / average knowledge and poor knowledge) and nurses.
practice (good practice/ average practice and poor practice),
while the independent variables included sociodemographic Nurses’ age ranged between 25 to 45 years.
factors. Respondent qualification represents that most of the subjects
had completed a Master degree(54.5%) followed by (43.9%)
Nurses’s knowledge regarding the prevention of SSIs BSc degree and (1.5%) diploma nurses. According to table
was measured by 10 questions with “Yes” and “No” , in (1) (27.3%) n=18 of subjects have less than 1 year total
which “Yes” is the correct answer and “No” the incorrect work experience and 6-10 year total work experience, n=19
answer. The questions refered to the most important (28.8%) have 1-5 year experience and only n=11(16.7%)
recommendations by the WHO infection prevention and have above 10 year experience.Only 29 (43.9%) of the study
patient safety guideline (presurgical skin preparation, hand participants claim they were trained in the infectious control
hygiene etc.). The correct response for each question program.

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Volume 5, Issue 10, October – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Demographic data
Characteristics Frequency Percentage
Male 17 25.8%
Gender
Female 49 74.2%
<25years 12 18.2%
26-35years 43 65.2%
Age
36-45years 9 13.6%
>45years 2 3.0%
BSN 29 43.9%
Qualification MSN 36 54.5%
Secondary Nursing School 1 1.5%
<1 year 18 27.3%
Total work 1-5 years 19 28.8%
Experience 6-10 years 18 27.3%
>10 years 11 16.7%
<1 year 10 15.2%
Work experience in 1-5 years 37 56.1%
surgical ward 6-10 years 15 22.7%
>10 years 4 6.1%
Attending in training Yes 29 43.9%
programs No 37 56.1%
Availability of IP Yes 31 47.0%
guidelines No 35 53.0%
Usage of IP Yes 20 64.5%
guidelines No 11 35.5%
Fieri Hospital 41 62.1%
Organization
Vlora Hospital 25 37.9%
Table (1): Socio Demographic Characteristics of study sample (n = 66).

Frequency of Correct Percentage of Correct

Questions
Answers Answers
Does pre-operative shaving performed in day before surgery? 66 100%
Does staff existing and reentering the theater affect the incidence of
58 87.9%
surgical site infection?
Are preoperative showers with antiseptics are cost effective in
51 77.3%
preventing surgical site infection?
Does removal of jewelry, artificial nails and nail polish reduces the
46 69.7%
incidence of surgical site infection?
Does the puncture rate of surgical gloves correlate with the incidence
46 69.7%
of surgical site infection?
Does administration of prophylactic antibiotics help in preventing
62 93.9%
surgical site infection?
Does increased pain and discharge from wound site indicate surgical
55 83.3%
site infection?
Does time period of operation have effect developing surgical site
15 22.7%
infection?
Does surgical patients with compromised immune system have more
55 83.3%
chance of developing surgical site infection?
Prolong preoperative hospitalization associated with development of
42 63.6%
surgical site infection?
Table (2) : Knowledge of Nurses Regarding Prevention of Surgical Site Infections.

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Volume 5, Issue 10, October – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Table (2 )shows the responses of the subjects to each Responses of the subjects to another important
of the knowledge question which show that most of the question which refers that time period of operation has effect
nurses have average knowledge about surgical site infection. developing surgical site infection 15 (22.7%) participants
Responses of knowledge of nurses for the best time for pre- were agree about the statement and 51(77.3%) of nurses
operative shaving results that all 66 (100%)were responded knew that preoperative showers with antiseptics are cost
correctly which show that they know about it. Another effective in preventing surgical site infection.
question about staff existing and reentering the theater effect
the incidence of surgical site infection, in which 58 (87.9%) 55(83.3%) of study sample answered the question
nurses responded correctly ,while 46 (69.7 %) replied that increased discharge and pain from wound site indicate
correctly for the question that puncture rate of the surgical surgical site infection correctly and knew that surgical
gloves correlate with the incidence of surgical site infection patients with suppressed immune system were more at risk
,which result that most of the subjects have information of developing surgical site infection Participants of the study
about the significance of wearing gloves during procedure. were asked about the administration of prophylactic
antibiotics in preventing surgical site infection for which
Similarly the response of the subjects to another 62(93.9%) response of the participants were correct while
statement that removal of jewelry, artificial nails and nail 42(63.6%) of participants knew that prolong preoperative
polish reduces the incidence of surgical site infection , which stay is related with development of surgical site infection.
show that most of the participants 46(69.7%) have
knowledge about this question.

Frequency Percentage
Knowledge Level
n %
Low 4 6.06%
Average 43 65.15%
Good 19 28.79%
Table (3) :Description of nurses’ knowledge level regarding prevention of surgical site infection.

The results in the Table (3) shows that the level of total knowledge score of the study participants was 7.52 ±1.32 .
knowledge regarding surgical site infection in this group of 28.79% of participants had good knowledge of surgical site
participants was at average level (65.15%) about the surgical infection prevention followed by low level of knowledge
site infection and its prevention, with minimum score of 5 (6.06%).
and a maximum score of 10 out of 10 items . The mean

Always Often Sometimes Rarely Never

Questions n%
n% n% n% n%

I wash my hands before and after changing wound

57 9
dressing and touching the surgical site
86.4% 13.6% 0 0 0
0% 0% 0%
34 26
I wash my hands before wearing sterile gloves 6 0 0
51.5% 39.4%
9.1% 0% 0%
49 7
I perform pre-operative shaving right before surgery 1 3 6
74.2% 10.6%
1.5% 4.5% 9.1%

I administer pre-operative prophylactic antibiotic 38 18

within one hour before surgery 57.6% 27.3% 5 2 3
7.6% 3% 4.5%

I advice my patient to take pre-operative showering 24 15

with antimicrobial agent 36.4% 22.7% 19 7 1
28.8% 10.6% 1.5%

I use sterilized dressing materials for cleansing 54 12

surgical wound dressing 81.8% 18.2% 0 0 0
0% 0% 0%

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Volume 5, Issue 10, October – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Always Often Sometimes Rarely Never
Questions n%
n% n% n% n%

I use an antiseptic technique during surgical wound

42 16
dressing 8 0 0
63.6% 24.2%
12.1% 0% 0%

55 10 0 1 0
I assess and monitor surgical site condition
83.3% 15.2% 0% 1.5% 0%

I use face mask during cleansing surgical wound 22 18

23 3 0
dressing 33.3% 27.3%
34.8% 4.5% 0%

I separate infected from non-infected cases during

58 8
dressing 0 0 0
87.9% 12.1%
0% 0% 0%
Table (4): Practice of Nurses Regarding Prevention of Surgical Site Infections.

Table (4 )shows the responses of the subjects to each The responses of practice questionnaire with highest
of the practice question which shows that (36.4%) of nurses percentage of nurses “always practice” were : performing
always advised surgical patients about performing pre- hand washing before and after changing dressing and
operating showering with antimicrobial agents and (33.3%) touching the surgical site ( 86.4%), using sterile dressing
of them used always face mask during cleansing surgical materials for performing wound dressing (81.8%), assessing
wound. and monitoring surgical site condition (83.3%) and
separating infected from non-infected materials during
These results indicated that some nurses have poor dressing (87.9%).
practice in these areas.

Frequency Percentage
Practice Level
n %
Low 8 12.12%
Average 27 40.91%
Good 31 46.97%
Table (5): Description of nurses’practice level regarding prevention of surgical site infection.

The results shown in table(5) revealed that of 10 items . The mean practice score of the study
nurses’practice of surgical site infection was at good level participants was 44.68 ±3.47. ( 40.91%) of study participants
(46.97%) about the surgical site infection and its prevention, had average practice and only 12.12% of them had practice
with minimum score of 34 and a maximum score of 50 out at low level towards prevention of surgical site infection.

Knowledge of nurse’s Practice of nurse’s

Demographic Data
P-value P-value
Sex 0.001* 0.153
Age 0.810 0.017*
Organization 0.875 0.567
Qualification 0.661 0.135
Total work Experience 0.758 0.805
Work Experience in surgical ward 0.140 0.796
Attending in training programs 0.696 0.393
Availability of IP guidelines 0.492 0.533
Usage of IP guidelines 0.710 0.243
Table (6): Differences in nurses’ knowledge and practice with respect to selected sociodemographics
Significant at p

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Volume 5, Issue 10, October – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
IV. DISCUSSION The findings of this study are similar to a study which
was done by Joshi7 in India in which nurses‟ practice
The aim of this study was to assess the knowledge and regarding surgical site infection prevention was also at high
practice of nurses and identify factors associated with them level. The results are in the same line to a study which in
regarding prevention of surgical site infections and examine Ethiopia, in which nurses‟ practice were at good level 8. For
the relationships they have. the others item of practice, it was shown that nurses lacked
in some areas of practice where, 1.5% of nurses never
1.Knowledge Regarding Prevention of SSI advised surgical patients about performing pre-operating
The findings highlight ed that total knowledge showering with antimicrobial agents. Another study found
regarding the prevention of SSI was at average level of also some nurses lacked practice in these area.3
knowledge. The majority of the nurses had a Master degree
in nursing (54.5%). (56.1%) of nurses had not been trained
in the infection control training programs. The findings 3.Relationship between Nurses’ knowledge and practice
showed that the working experience in the surgical wards of with demographic variables regarding prevention of
subjects was 1-5 years (56.1%). surgical site infection.
The analysis reveals statistically significant differences
The appropriate timing for removing the hair at the between knowledges of female and male nurses. 90% of
incision site was answered correctly in 100% of nurses . A nurses with good knowledge are women, 75% of nurses with
previous study3 found that only (24.20%)of subjects average knowledge are women and all nurses with low
correctly answered that pre-operative shaving should be knowledges are men. ODDS (good / average) = 2,988
done immediately before the operation. indicates that the probability of having good knowledge in
women is approximately 3 times higher than in men.
The study also revealed that participant’s sex was ODDS(low / average) = 0.0001 indicates that the probability
significantly associated with knowledge regarding of having low knowledge in women is as much as 1/1000 of
prevention of surgical site infection. The results of present men.
study4 agree with they evaluate the knowledge, attitude and
efficacy of nursing staffs in hospital about infections control The analysis showed that there are statistically
they revealed that there a significant relationship between significant differences between nurses practices and
knowledge and gender. A similar study5 has also found that different ages. 63% of nurses with low practice are under 25
the gender is significantly associated with knowledge of SSI years of age, while those with average and good practice are
prevention. in the 26-35 age group (67% and 74%).ODDS (good /
average) = 0.001 indicates that the probability of good
The odd of female nurse’s was almost 3 times higher practices in the age group of up to 45 years is 1/1000 of the
to have good knowledge than males regarding prevention of probability of over 45 years of age in nurses. ODDS (low /
surgical site infections. The possible reasons for this result average) = 4.219 indicates that the probability low practices
might be due to the fact that in this study the proportion of <25 years of age is 4 times higher than those> 45 years old.
females was higher compared to females.
According to a study nurses who were 30 years and
There were no significant difference between above were found being about 2 times more likely to
demographic variables(age, organization, qualification, total practice surgical site infection prevention actives compared
work experience , work experience in surgical ward , to those who were less than 30 years (AOR = 1.79, 95%
attending in training programs, availability of IP guidelines CI)8. Results in this study agree with Kang, et al 9 they
in both hospitals, usage of IP guidelines ) with level of evaluated hospital nurses' knowledge and compliance on
knowledge ‘nurses regarding prevention of surgical site multidrug-resistant organism infection control guideline, in
infections. Korea, they showed that there were significant relationship
between nursing practice and age and the type of units
Another study also revealed that training program did .Correlation analysis showed that there were no statistical
not effect any significant difference in the knowledge level differences between knowledge and practice of nurses.
between control and experimental groups 6. Another study had found no relationships between
knowledge and practice in infection prevention measures 10.
Moreover, this finding is also in agreement with
another study5 where , no significant relationship was found The study concludes that the majority of nurses had
between job position, ward, enrolment in SSI prevention average level of knowledge and good level of practices
program and practice score. (46%) regarding the prevention of surgical site infection.
There were significant relationship between the
2.Practice Regarding Prevention of SSI nurses’knowledge and gender and between nurses’ practice
The findings showed that total practice regarding the and ages at p≥0.05 value. The results and conclusions of the
prevention of SSI was at a good level (46.97%). This study suggest that increasing knowledge and focusing on
indicated that nurses had good nursing practice for the some specific areas of prevention of SSI in practice need
prevention of SSI. improvement ,with a direct impact on patient’s safety and
enhancing health care quality. Hospital institutions should

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Volume 5, Issue 10, October – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
provide for implementation standard guidelines for the
prevention of surgical site infection in the surgical units.

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