A CRITICAL ASSESSMENT OF HEALTHCARE WORKERS ATTITUDE AND PRACTICES OF ASEPTIC TECHNIQUES IN PRIMARY HEALTHCARE CENTERS IN KADUNA STATE

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Antiseptic techniques date all the way back to prehistoric times, according to an old document. Ancient Chinese, Persians, and Egyptians developed methods for water cleanliness and wound antisepsis.

The ancient Greeks and Romans restored fresh liquid and wine using silver vessels. Settlers in Australia utilized silverware, while pioneers in the American west infused drinking water with silver and copper coins for the same reason (Lois, 2013).

In the nineteenth century, the current idea of asepsis developed. Ignazsemmelweis (2012) demonstrated that hand washing before to delivery decreased puerperal fever in a Vienna lying-in hospital ward.

After Louis Pasteur demonstrated that microorganisms caused deterioration and could be transferred by the air, he put the booths in flasks with long shaped necks and noticed that no microorganisms developed in the flasks after boiling them. Then Joseph Lister started soaking his surgical dressings in carbolic acid (phenol) after hearing that carbolic acid had been used to treat sewage in Carlise and that the treated fields were now parasite-free, resulting in a remarkable drop in the frequency of post-operative infections (Mokhoro, 2012).

Joseph Lister pioneered the use of carbolic acid as an antiseptic, significantly reducing surgical infection rates, particularly in 1870, when it saved the lives of a large number of Prussian troops. However, several nations, like as England and America, remained opposed to his germ hypothesis.

On October 26, 1877, Lister was given the chance to execute a simple knee surgery (wiring a broken kneecap, which included the purposeful conversion of a simple fracture to a complex fracture), which often ended in widespread infection and death.

The success of this operation compelled people to accept that this technique significantly increased the safety of surgical procedures. His focus on preventive medicine culminated in the establishment of the institution in 1981. This is only one of the many reasons Joseph Lister is often referred to as the "father of antiseptic surgery" (Elana, 2012).

Additionally, Pittet (2012) noted that Lawson Tait transitioned from antisepsis to asepsis by establishing concepts and iconic legislation that have remained in force until the present day. He also credited Ernst Von Bergmann with inventing the autoclave, a device used to steam sterilize surgical tools under pressure. He also highlighted how, in the medieval times, Arabian doctors employed mercury chloride to avoid sepsis in wounds by introducing hypochlorite and iodine as remedies for open wounds in 1825 and 1839, respectively.

1.2 Statement of Problem

The operating room complex environment, including nursing personnel, may contribute to nosocomial infection transmission; hence, (DeLaune and Ladner 2008) claim that nosocomial infections may be transmitted to patients by nursing personnel who do not practice or follow sterile technique standards.

It is essential to pay close attention to the establishment and maintenance of a safe and appropriate therapeutic operating room complex environment in order to avoid the development of nosocomial infections when the patient's skin integrity is compromised during surgery.

The skin is the body's biggest and most vital organ, and its functional components include the epithelium and connective tissue.

Additionally, the skin's epidermal layer contains structures such as sweat and sebaceous glands, hair, and nails. The cutaneous layer is composed of two distinct layers, the epidermis and the dermis. When a wound forms, the skin and its constituents get engaged in the healing process, restoring the skin's integrity (Mulder, 2012). Intact skin is critical for infection and disease prevention because it is the body's first line of defense against infection, promotes overall health, and provides natural biochemical, mechanical, and anatomic protection (Fortunato, 2009).

The majority of wound infections are caused by bacteria found in the patient's skin, mucous membranes, or hollow viscera. When the skin or mucous membranes are incised, the exposed tissues are susceptible to endogenous flora infection (Mangram, 2009). Any intrusive operation that compromises the body's natural defenses, such as the skin or mucous membranes, or when handling equipment that will enter a typically sterile region, requires the adoption of an aseptic technique (Xavier, 2009).

Additionally, infection may occur as a result of the usual colonization of the patient's skin or as a result of bacteria in the operating room's air. This is why specialized air conditioners are required to minimize infection risk. Bacteria that cause infections, such as wound infections, are introduced into the wound during surgery and may not manifest themselves for weeks thereafter (Fry and Fry, 2007).

In the operating room, it is critical to identify the degree of contamination of the surgical wound in order to evaluate whether the nosocomial infection was brought into the operating room complex, since a clean site may become contaminated due to the kind of wound, pathological findings, anatomical position, or a breach in the aseptic technique (Fortunato, 2009).

Patients have a right to be safeguarded against avoidable infections, and health care professionals have a responsibility to preserve their patients' well-being (King 2008).

An aseptic technique should be employed throughout any intrusive surgery that circumvents the body's natural defenses, such as the skin and mucous membranes, or while handling equipment used in these procedures, such as intravenous cannulas and urine catheters.

While maintaining sterility is challenging, it is critical to avoid contamination of sterile equipment. Contamination may occur as a result of improper aseptic practices. Asepsis may be maintained with the proper attitude and a high degree of practice.

It is noticed that when the requirement for aseptic technique is great, a nurse's attitude toward hand washing compliance deteriorates.

There are two important problems that have been identified as influencing the degree of aseptic technique practice. The first is that locations with a high intravenous treatment burden, such as operating rooms and critical care units, often display the worst aseptic technique practice.

For example, hand cleaning is often found to be inadequate, intravenous ports are frequently left unclean, and syringes are frequently reused after being put on the patient's bed linen.

Second, the incorrect attitude included being a chief nursing officer rather than a sister nurse; being male; working in an intensive care unit (ICU); working weekdays rather than weekends; wearing gowns and gloves; performing high-risk cross-contamination activities; and having numerous opportunities for hand hygiene per hour of patient care.

All of these factors have an attitude on health care personnel' attitudes about aseptic technique. (Didier, 2013). Despite health professionals' educational backgrounds and training, and despite ongoing attempts to promote the use of aseptic methods, it seems that many health workers do not use them. This might be as a result of an incorrect attitude, insufficient knowledge, or anything else. The researcher proposes to conduct study on the attitudes and practices of health attitude professionals towards aseptic methods based on this submission.

1.3 Objectives Of The Study

The overall aim of this study is to assess of healthcare workers attitude and practices of aseptic techniques in primary healthcare centers in Kaduna State. Hence, the study will be channeled to the following specific objectives;

1.        Ascertain the extent of health workers knowledge of aseptic practices techniques.

2.        Asses the level of healthcare workers knowledge on benefits of aseptic technique.

3.        Determine whether health workers have a positive attitude towards aseptic techniques.

4.        Identify the factors affecting the practice of aseptic techniques by health workers.

1.4 Research Questions

The study will be guided by the following questions;

1)        What is the level of health workers’ knowledge of aseptic practices techniques?

2)        What is the level of healthcare workers knowledge on benefits of aseptic technique?

3)        Does health workers have a positive attitude towards aseptic techniques?

4)        What are the factors affecting the practice of aseptic techniques by health workers?

1.5 Significance Of The Study

This study will be useful in correcting nurses’ attitude towards aseptic techniques and also to improve the practice of aseptic technique among health workers. The information provided will help nursing administrators in knowing area to address as continued education and seminars are organized for the nurses.

The result of this study will assist in nursing education as it provides information to guide the development of nursing curriculum and training courses related to attitude and practice of aseptic techniques.

This study will help the government to understand that practise of aseptic technique is of utmost importance hence the need to be involved in the provision of protective devices for all health workers

The important of the study to the nation is that it will help to reduce the high rate of cross infection from resulting into increased mortality rate. The significance of the study is that it will serve as a basis for further study to include all the doctors, nursing personnel and nursing students.

1.6 Scope Of The Study

This study is structured to generally assess of healthcare workers attitude and practices of aseptic techniques in primary healthcare centers in Kaduna State. However, the study will further asses healthcare workers knowledge on benefits of aseptic technique,  ascertain the extent of health workers knowledge of aseptic practices techniques, determine whether health workers have a positive attitude towards aseptic techniques, and identify the factors affecting the practice of aseptic techniques by health workers. The respondents for this study will be obtained from two(2) selected primary health care centers in Kaduna State.

1.7 Limitation Of The Study

Like in every human endeavour, the researcher encountered slight constraints while carrying out the study. Insufficient funds tend to impede the efficiency of the researcher in sourcing for the relevant materials, literature, or information and in the process of data collection, which is why the researcher resorted to a limited choice of sample size. More so, the researcher simultaneously engaged in this study with other academic work. As a result, the amount of time spent on research will be reduced.

1.8 Definition Of The Study

Clinical environment: A clinical environment is a location where nursing practice takes place which includes direct patient care ranging from preventative care to chronic care to end of life care (Warshawsky & Havens 2011).

Hospital-acquired infections (HAIs) Hospital-acquired infections formerly called nosocomial infections is defined as infections acquired in the hospital within 48 to 72 hours of hospitalization that were neither present nor incubating upon admission. Infections that present within 10 days after hospital discharge are considered as HAIs (Collins 2008:1).

Aseptic Technique as a set of specific practices and procedures performed under carefully controlled conditions with the goal of reducing microorganism and to protect patient from infection.

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