AN ASSESSMENT OF NURSES’ KNOWLEDGE AND PRACTICES IN THE PREVENTION OF SURGICAL SITE INFECTIONS

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Nurses constitute an indispensable part of the global healthcare workforce, and their expertise and clinical practices significantly influence infection control outcomes, thereby impacting the quality of care delivered to patients. According to Sadia (2017), surgical site infections (SSIs) typically manifest within 48 hours of hospital admission or may arise post-discharge. Inadequate infection prevention practices are a major contributor to avoidable morbidity and mortality, particularly in low-resource settings, where SSIs remain a leading cause of preventable complications. Surgical site infections present a major concern for healthcare systems worldwide. Radu (2022) noted that SSIs generally develop in patients who have been hospitalized for at least 48 hours. The adoption of clinical best practices—such as the appropriate administration of prophylactic antibiotics, preoperative hair removal using clippers, maintenance of optimal blood glucose levels before and after surgery, and prevention of intraoperative hypothermia—has been recognised as essential in mitigating the risk of SSIs (Wick, 2020). One particularly vital component of SSI prevention is the timely and judicious use of antimicrobial prophylaxis, which is a globally accepted quality indicator for perioperative care (Humphreys, 2018). Several studies have demonstrated a notable reduction in SSI incidence following increased awareness and engagement of healthcare professionals in infection control practices (Nanjaiah, 2019). However, Mahmud et al. (2021) found that insufficient knowledge among nurses correlates strongly with poor adherence to established infection control guidelines, especially in surgical settings. Ibrahim et al. (2022) emphasized the need for nurses to possess a comprehensive understanding of SSI pathogenesis, risk factors, and evidence-based prevention strategies in order to effectively mitigate the occurrence of infections. Supporting this view, Babatunde (2024) argued that knowledge deficits directly contribute to lapses in infection prevention and increase patient vulnerability to SSIs. Moreover, Inyene (2023) highlighted that awareness alone is inadequate; translating knowledge into consistent clinical practice is essential for effective infection control. This requires adherence to established protocols, including hand hygiene, correct use of personal protective equipment (PPE), and strict aseptic techniques. Consistent implementation of these practices is crucial in minimizing infection risks and fostering a safer surgical environment. In Nigeria, where healthcare systems face significant challenges—such as resource constraints, overburdened facilities, and limited access to infection control materials—evaluating nurses' knowledge and practices related to SSI prevention is of paramount importance. Identifying existing knowledge gaps and behavioural shortcomings among nurses can inform the development of targeted educational and operational interventions aimed at strengthening infection control practices. Consequently, this study aims to investigate the level of knowledge and the extent of practical adherence among Nigerian nurses with regard to the prevention of surgical site infections. 1.2 Statement of the Problem Nurses, being integral to patient care and clinical safety, are central to implementing infection prevention measures. Despite this critical role, many nurses receive inadequate training in infection control specific to surgical environments. Even though hand hygiene is widely recognised as the most effective method for reducing SSIs, its routine practice remains suboptimal. In addition to increasing morbidity and mortality, SSIs impose a significant financial burden on healthcare systems in low-income countries such as Nigeria (Hendrickx & Winters, 2022). A particularly pressing issue in Nigeria is the limited understanding of the extent to which nurses are adequately prepared to prevent SSIs through evidence-based practices. Access to infection control supplies and training is often inconsistent, further hampering the ability of nursing staff to effectively implement prevention strategies. According to Aliu (2022), discrepancies in training quality and ongoing professional development contribute to varying levels of competence among nurses, leading to inconsistent application of preventive measures. Despite the existence of guidelines and protocols, many nurses still lack adequate familiarity with current evidence-based practices for SSI prevention. Insufficient knowledge of the causes, risk factors, and prophylactic interventions for SSIs can lead to poor infection management and increased risks for surgical patients. Research by Famakinwa (2022) revealed that, while nurses often possess a reasonable degree of theoretical knowledge about SSI prevention, challenges persist in the practical application of this knowledge. The gap between knowledge and clinical implementation remains a significant barrier to effective infection control. This challenge is not unique. As Fadeyi (2017) observed in a study at Obafemi Awolowo University Teaching Hospital, nurses exhibited high levels of awareness regarding SSIs but demonstrated negative attitudes toward consistent preventive practices. This suggests that knowledge alone does not necessarily translate into appropriate behaviour. Possessing knowledge is only impactful when it fosters positive attitudes that motivate consistent application in daily clinical practice. Thus, it becomes evident that awareness must be accompanied by the right disposition to achieve meaningful behaviour change. The goal of this study is therefore to evaluate both the depth of knowledge and the degree of compliance among Nigerian nurses with established protocols for preventing surgical site infections. 1.3 Objectives of the study The primary objective of this study is to assessNurses’ Knowledge and Practices in the Prevention of Surgical Site Infections. Specific objectives of this study are to: i.To investigate the awareness level of nurses regarding surgical site infections. ii.To assess the level of knowledge of Nurses on the risk factors associated with surgical site infections. iii.To assess the current knowledge of nurses regarding the prevention of surgical site infections. iv.To assess Nurses practices   regarding the prevention of surgical site infections. 1.4 Research Questions The following research questions which are in line with the objectives of this study will be answered in this study: i.What is the awareness level of nurses regarding surgical site infections? ii.What is the level of knowledge of Nurses on the risk factors associated with surgical site infections? iii.What is the current knowledge of nurses regarding the prevention of surgical site infections? iv.What are Nurses practices   regarding the prevention of surgical site infections. 1.5 Research Hypotheses To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.: Ho: The current knowledge of nurses regarding the prevention of surgical site infections is low. Ha: The current knowledge of nurses regarding the prevention of surgical site infections is high. 1.6 Significance of the study The study will provide a fundamental reference point for healthcare providers, surgical patients, policymakers, students, and scholars. Hospitals can decrease healthcare expenses related with treating surgical site infections (SSIs) by enhancing nurses' knowledge and practices. These circumstances have financial consequences for healthcare facilities and can lead to overall reductions in costs. More so, nurses have a crucial role in providing direct patient care, particularly in the perioperative environment. It is essential to adhere to best practices for infection prevention in order to uphold high standards of care. Analyzing their expertise and methods can reveal deficiencies and areas that need improvement, guaranteeing that care standards are achieved and elevated.  For nursing education, identifying deficiencies in nurses' knowledge and practice can provide valuable insights for the creation of focused educational programs and training initiatives. This can guarantee that nurses are well-informed about the most recent evidence-based procedures and guidelines for preventing surgical site infections (SSIs). Nurses have a crucial role in providing patients with information and guidance on postoperative care. Enhancing the knowledge and skills of nurses can result in more efficient patient education, enabling patients to comprehend their responsibility in infection prevention and enhancing compliance with postoperative care guidelines.  Empirically, conducting research on the knowledge and behaviors of nurses can offer useful insights for the development or revision of hospital policies and protocols pertaining to infection control. This guarantees the implementation of the most efficient techniques to avoid Surgical Site Infections (SSIs). Healthcare organizations can enhance infection prevention measures and overall patient care by investigating and addressing the factors that influence nurses' actions and implementing quality improvement efforts. Furthermore, upcoming scholars will utilize it as a thorough examination of the current academic literature. Hence, individuals with a profound enthusiasm for this field of research can depend on this work as a reliable and thoroughly evaluated source of information. 1.7 Scope of the study Broadly, this study focus is to assess Nurses’ Knowledge and Practices in the Prevention of Surgical Site Infections. Specifically, this study seeks to assess the level of knowledge of Nurses on the risk factors associated with surgical site infections and assess the current knowledge of nurses regarding the prevention of surgical site infections.  Further, this study will focus on assessing the level of knowledge of Nurses on the use of asepsis and it also seeks to explore barriers that hinder nurses from fully implementing recommended practices for surgical site infections prevention. The study is carried out in Nigeria. 1.8 Limitations of the study Like in any human attempt, the researchers encountered several small limits during the investigation. The primary constraint was the dearth of comprehensive literature on the topic, given the scarcity of data pertaining to Nurses' knowledge and practice towards prevention of surgical site infection. Therefore, a substantial investment of time and effort was required to identify the suitable materials, books, or information and to collect data.  Moreover, this study is limited by its diminutive sample size and restricted geographical range, concentrating just on Nigeria. Hence, the findings of this study cannot be extrapolated, thereby necessitating additional research. More so, the researcher's restraints were predominantly attributable to financial limitations, as they are a student without a means of revenue to support themselves. The research location's high transportation costs, impacted by current inflation in Nigeria, made it difficult to afford transportation fees. In addition, the researcher encountered a time limitation as a result of the necessity to do this research while simultaneously meeting the responsibilities of attending lectures and engaging in other educational pursuits. 1.9 Definition of terms Surgical site infections: This infection occurs beneath the incision area in muscle and the tissues surrounding the muscles. Organ or space SSI. This type of infection can be in any area of the body other than skin, muscle, and surrounding tissue that was involved in the surgery. This includes a body organ or a space between organs Nosocomial infections: Nosocomial infections are infections patients acquire while admitted to a health-care facility and generally develop 48 hours or later after admission. These infections can lead to serious problems like sepsis and even death. Asepsis: Asepsis is a condition in which no living disease-causing microorganisms are present. Asepsis covers all those procedures designed to reduce the risk of bacterial, fungal or viral contamination, using sterile instruments, sterile draping and the gloved 'no touch' technique.