Assessment of knowledge and implementation of practice of sterile nursing techniques in operating halls

Surgical Site Infections (SSI) 1 are skin and subcutaneous tissue infections occurring (superficial infections), muscle and fascia’s (deep surgical infections) and of organs, during or after surgical interventions. SSI’s account for up to 17% of all Healthcare Associated Infections (HAI’s) 2 and 38% of the nosocomial infections in surgical patients. Each surgical infection consequently in average requires additional seven to ten days of postoperative hospital care and a two to eleven fold higher death risk, compared to surgical patients who have not developed an infection. HAI’s are infections that patients contract while receiving treatment for medical or surgical conditions, that exhibit within 48h of admission, or occur after 30 days, or 1 year after implantation of foreign bodies, in rare cases may occur after many years (CJD). According to the WHO annually, over 1.4 million people worldwide suffer from complications of healthcare acquired infections. Aim of research: This research aims to assess the level of knowledge and daily practice of sterile techniques by nursing staff in surgical theaters and the role of surgical theatre nurses on implementation of aseptic methods during surgical interventions and their awareness of how non-compliance to these techniques directly affects surgical patients. Methods: This paper is prospective, controlled and quantitative thesis. The study was conducted at University and Clinical Centre of Kosova (UCCK) 3 , Pristina, encompassing up to 80 OT nurses working in: Cardiac, Thoracic, Abdominal, Vascular and Neurosurgery units of Orthopedics, Gynecology and Emergency Clinics. Personal and professional data such as: Gender, age, education, work experience, trainings, hand washing techniques, surgical cap and mask use, sterile gloves placement, use of sterile overalls, instrument table preparation, sterile cover insulation, maintenance and accountability of instruments, consumables and sutures before, during and after procedures, movement inside and around the sterile area, operating room temperature and humidity, were assessed. The results were derived from a questionnaire comprised of two types of data: general nurse data as well as the professional and education /trainings received from verbal contact with the nurse and the professional part where the data that were identified during the process observation of indicators for the implementation of sterile nursing techniques during surgical intervention. Outcomes: Responsiveness to the assessment was at level of 100%, dominating age group was of 30-39 years old (42.5%); education wise most of the nurses 56% had secondary education and the highest work experience was 11-20 years: 49%, whereas 56.26% of respondents claimed that they have had no any kind previous training as surgical nurses. Female nurses dominates 79.9% in this field. 86% of the respondents proved correct placement of the surgical mask, whilst 87% correctly placed surgical caps and 94% correctly did wear in correct manner surgical. Correct surgical hands washing was observed in 45.56% of the cases and 96% did appropriately prepare surgical table. Aseptic rules in patient preparation were followed in 81% case but 60% did not put on correctly sterile gloves 60%, correct movement around the sterile area exhibited 66% of respondents and most of them 86% maintained aseptic methods when dealing with instruments, consumables and sutures. Counting of instruments happened in 52%, whereas counting of gauzes used and expendable material happened in 85% of the cases. Operation table sterility was ensured in 97% whereas stretching and bending in non-sterile areas was observed in 95%. Knowledge about desired operating room temperature observed in 87% whilst 84% presented lack of knowledge about the permissible humidity levels. Conclusion: Operating theatre nurses working in UCCK need adequate surgical trainings and higher (university and postgraduate) levels of education. Refresher courses on 1-3 years basis, to refresh or update their knowledge. Improve the conditions of the operating theatres, by making the necessary and adequate renovations, but as well as appropriate staffing of the OT should be considered. Routine infection screenings (staff and surface swabs) and making sure that OT’s meet requirements in regards to ventilation, humidity and asepsis. Know-how and expertise on sterile techniques transfer should be ensured through appropriate planned trainings in addition to the “in the house” trainings provided by senior nurses to the newly employed ones. In some cases, staff replacement has been foreseen as the most appropriate improvement measure