TABLE
OF CONTENTS
Title Page i
Certification ii
Dedication iii
Acknowledgement iv
Table of Content v
List of Table viii
List of Figures ix
Abstract x
CHAPTER
ONE: INTRODUCTION
Background to the Study 1
Statement of Problem 3
Purpose of the Study 4
Objectives of the Study 4
Hypotheses 4
Significance of the Study 5
Scope of the Study 5
Operational Definitions 6
CHAPTER
TWO: LITERATURE REVIEW
Conceptual Review: 8
Asepsis 8
Aseptic Technique 10
Sterile Technique 11
Surgical Aseptic Technique 12
Surgical Hand Scrub 14
Use of Personal Protective Device 15
Maintaining a Sterile Field During Surgery 17
Control and Design for Safer Surgical Procedure 18
Layout of the Operating Theatre 19
Concept of Attitude of Theatre Users Towards Surgical Aseptic Standard 21
Factor that Influence Attitude of Theatre Workers 22
Concept of Compliance to Surgical Aseptic Standard 22
Theoretical Framework Related to the Study 25
Health Belief Model (HBM) 27
Model of the Study 31
Empirical Review 33
Summary of literature review 38
CHAPTER
THREE: RESEARCH METHODS
Research Design 39
Area of the Study 39
Target Population 41
Sample 41
Instrument for Data Collection 43
Validity of Instrument 45
Ethical Considerations 46
Procedure for Data Collection 46
Method of Data Analysis 48
CHAPTER
FOUR: PRESENTATION OF RESULTS
Demographic Characteristics of the
Respondents 49
Research Objective 1: Theatre Workers’
Attitude Towards Various Aspects of Surgical 51
Aseptic Standard Practice
Research Objective 2: Theatre Practice of Surgical Aseptic Standard. 55
Research Objective 3: Test of Hypotheses 61
Ho1- There is no Significant Relationship Between Theatre Users’ Attitude to Wards Standard Aseptic Technique and their Compliance to Surgical Aseptic Standard. 61
Ho2- There is no Significant Variations
in the Practice of Surgical Aseptic 62
Standards Across Tertiary Health Institutions
in Enugu State.
Ho3: There are no Significant
Variations in the Compliance of Theatre Workers to Surgical
Aseptic Standard Practices. 63
CHAPTER FIVE: DISCUSSION OF MAJOR FINDINGS
Discussion of major findings 66
Respondents’ Characteristics 67
Theatre Workers’
Attitude Towards Various Aspects of Surgical Aseptic
Standard Practice 68
Theatre Workers’ Compliance with Surgical Aseptic Standard Practice. 69
Practice of Surgical Hand Scrub 69
Compliance with the Use of Personal Protective Device. 70
Maintenance of Surgical Field During Surgery 70
Relationship Between Theatre Workers’ Attitude Towards Standard Aseptic Technique And Compares of the Practice of Surgical Aseptic Standard Across Tertiary Health Institutions in Enugu State. 71
Summary 73
Recommendations 74
Limitations 75
Suggestion for Further Study 76
References 77
Appendix 82
LIST OF TABLES
Table1: Population Distribution of Theatre Staff and
Sampling Size Proportions 43
Table 2: Demographic Characteristics of the Respondents 50
Table 3: Theatre workers’
attitude towards the practice of surgical hand scrub 52
Table 4: Attitude towards the use of personal;
protective device. 53
Table 5: Attitude towards
maintaining a sterile field during surgery 54
Table 6: Theatre workers
practice of surgical Hand Scrub. 55
Table 7: To assess
theatre workers practice of under listed aspects of surgical aseptic standard in the practice of the use of personal protective device 57
Table
8: To assess theatre workers practice of under listed aspects of surgical
aseptic standard in the practice of the use of personal protective device. 58
Table 9: Maintaining a
Sterile field during Surgery 60
Table 10: Summary of the
tables on surgical aseptic standard practices 61
Table 11: Relationship between theatre workers’ attitude
towards standard aseptic techniques and their compliance to surgical aseptic standard 62
Table 12: Comparison of surgical aseptic standard practices across tertiary institutions in Enugu State. 63
Table 13: Mean comparison of compliance with surgical aseptic standard practices by theatre worker. 64
LIST OF FIGURES
Figure 1:1 The health belief model 27
Figure 2:2 Conceptual model of the study of attitude
and compliance to
Surgical Aseptic Standard. 31
ABSTRACT
Surgical aseptic
technique is the application of those strict principles and procedures aimed at
preventing the invasion of surgical sites by micro organisms. Prevention of
surgical site infection (SSI) has become a priority worldwide. Approximately
50,000 deaths are estimated to occur annually across Europe, as a consequence
of surgical site infection. In some university teaching hospitals in Nigeria,
the rate of SSI ranges from 10 to 20%. This was linked to non compliance with
standard practice due to poor theatre workers’ attitude to work. Compliance to
surgical aseptic standard in this study entails theatre workers’ readiness and
obedience to carry out the correct procedure in the area of surgical hand scrub,
proper use of personal protective device and maintenance of sterile field
during surgery. The purpose of this study is to determine the attitude and
compliance of theatre workers towards the practice of surgical aseptic standard
in tertiary health institutions in Enugu state. The specific objectives were
to: (i) elicit theatre workers’ attitude towards various aspects of surgical
aseptic standard, (ii) determine theatre workers’ practice of surgical aseptic
standard, (iii) determine the relation between attitude and compliance in the
practice of surgical aseptic standard and (iv)compare the practice of standard
aseptic technique across tertiary health institution in Enugu State. The study
adopted a descriptive cross sectional survey design. It was conducted at the
three tertiary health institutions in Enugu State, Nigeria. Using purposive
sampling technique and observing the following inclusion criteria: (a)
participants must be doctors and nurses working in the operating theatre, (b)
must be certified, registered, and licensed to practice in the operating
theatre, (c) must be physically fit to operate or assist during surgery and (d)
willingness to participate in the study. A total of 272 theatre workers were
recruited from the population of 660 theatre worker. Instruments for data collection
were the pre tested, 20 item researcher developed questionnaire on attitude of
theatre workers and 40 item observational checklist. The instruments were
validated by the researcher’s supervisor and two experts in the Department of
Nursing in University of Nigeria Enugu Campus. Reliability of the questionnaire
was established using test retest method at two weeks interval that yielded
Cronbach’s alpha correlation coefficient of 0.88. The observational checklist,
inter rater scores showed high degree of agreement. Data collected were
subjected to descriptive statistics and analysed using Pearson’s Product Moment
Correlation and analysis of variance (ANOVA) at p < 0.05 significant level.
The significant means decision point for attitudinal item is >2.5 and >2
for observational checklist. The perceived attitude of theatre workers to
surgical aseptic technique was positive with overall mean of 3.40 ± 0.81, while SHS had 3.79 ± 0.18, use
of PPD 3.1 ± 0.18, and MSF had 3.43 ± 0.81.Theatre workers’ compliance to
surgical standard practices were as follows: surgeons and peri operative nurses
consistently had higher mean score, for SHS (2.89 ± 0.19, 2.78 ± 0.18), use of
PPD (2.84 ± 0.12, 2.81 ± 0.22) and MSF(2.75 ± 0.20, 2.84 ± 0.19) respectively,
than physician and nurse anesthetists score SHS (2.34 ± 0.45, 2.39 ± 0.40), use
of PPD (2.43 ± 0.35, 2.71 ± 0.31) and MSF (2.29 ± 0.42, 2.61 ± 0.41)
respectively. There were significant relationship (r= 0.86, r= 0.81, r= 083)
between attitude and compliance. There were no significant variations (p>
0.05) in the practices across the three health institutions. Surgeon and
physician anesthetists showed less compliance to the practice of wearing
theatre outfit within the restricted area, with mean score of 1.67 and 1.56 respectively.
CHAPTER
ONE
INTRODUCTION
Background to the Study
Surgical aseptic
technique is the application of those strict principles, practices, and
procedures aimed at preventing the invasion of surgical sites by microorganisms
during intra and post-operative period (Briggs, 2013). This according to
Albany, (2010) is achieved by ensuring that only uncontaminated equipment,
fluid, and items come in contact with the sterile field during clinical
procedures. Albany, (2010) refers to this procedure as Aseptic Non Touch
Technique (ANTT). However, ineffective application of these clinical procedures
and protocols according to Briggs, (2013) usually result to surgical site
infection which in turn gives rise to long periods of hospitalization and high
cost of hospital bill to both patient and hospital
The prevention of
surgical site infection has become a priority worldwide. Approximately 50,000
deaths are estimated to occur annually across Europe as a consequence of
surgical site infection (Jones, 2012). In New York, the national infection
average per 1000 is 2.7% (National Infection Control, 2010). Albany (2010) in a
study in a New York hospital recorded 3.7% infection rate per 1000 in the
surgical intensive care unit. If the infection rate is that high in developed
economies, the situation may be expected to be worse in developing countries
like Nigeria, where challenges to compliance to surgical aseptic standards are
definitely more.(Infection Control Policy (2010) A descriptive study carried
out in the University Hospital Lagos by Afolabi, (2012) showed about 15% to 20%
infection rate in male surgical ward. This was linked to non- compliance due to
poor attitude of theatre workers to surgical aseptic standard in the area of
surgical hand scrub, use of personal protective device and maintenance of
sterile field during surgery observed by Berkeley (20012).
Compliance in this regard implies the
readiness of theatre workers to practice various aspects of surgical aseptic
standard in the area of surgical hand scrub, use of personal protective device
and maintenance of surgical field during surgery. In other word, it involves
willingness of theatre workers to stick firmly in practice to the rules and
principles of standard aseptic technique. Previous studies according to
Ginasekara (2010) have shown that compliance to the surgical aseptic standard
among theatre workers has been generally unstable and increase in compliance
has been difficult to sustain. Nevertheless, He noted that poor attitude is
responsible for substandard practice as far as compliance to the surgical
aseptic practice is concerned. Several reasons for noncompliance have been
identified, including staff attitude and lack of interest to work. Relationship
among theatre users has also been identified as an important factor in
improving compliance (WHO, 2013). Sidon (2011) also stated that the designing
and establishment of a practicable evidence-based surgical aseptic standard
coupled with a positive attitude to work has been known to improve compliance
to surgical aseptic standard practice.
Macleod, (2010) defines attitude as a
predisposition, a tendency or a propensity to respond positively or negatively
to a certain idea, object, person or situation. Attitude is therefore a serious variable in
compliance (Leon, 2011).This is precisely because attitude influences
individual’s choice of action either positively or negatively. A positive
attitude is sure to affect compliance positively with a low rate of surgical
site infection as collateral, while poor attitude is associated with noncompliance
to the protocol and corresponding increase of rate of surgical site infection.
Despite application of the standard aseptic technique
in recent times as required by WHO (2013) coupled with National and
International recommendations for good practice in infection prevention and
control in many health institutions, compliance has been low leading to
surgical site infection. Surgical site infection has remained the third most
common hospital acquired infection responsible for longer hospitalization with
increased cost for both the patient and hospital (Briggs, 2013).
This
study therefore wishes to assess theatre workers’ attitude and compliance
towards various aspects of surgical aseptic standard as practice in the three
Tertiary Health Institutions in Enugu State.
Statement of problem
ATTITUDE AND COMPLIANCE WITH SURGICAL ASEPTIC STANDARD AMONG THEATRE WORKERS IN TERTIARY HEALTH INSTITUTIONS IN ENUGU STATE
