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10. THEREZA MUSIRA 11. SILAS LUGEMBE TITTLE Determine the quality of practice on wound care among nurses of ward 11 and 12 at Kibasila Block in Muhimbili National Hospital. TITTLE Determine the quality of practice on wound care among nurses of ward 11 and 12 at Kibasila Block in Muhimbili National Hospital. LIST OF ABBREVIATION SSI – Surgical Site Infection WHO –World Health Organization MNH –Muhimbili National Hospital DEFINITION OF TERMS Wound Is a type of injury which happens relatively quickly in which skin is torn, cut, or punctured. (https://en.m.wikipedia.org) Wound care A process that ensures minimal wound infection by microorganisms.(Wills 2004) Wound healing Is a response to the injury that sets into motion a sequence of events that leads to repair. (https://en.m.wikipedia.org) Infection Is the invasion and multiplication of micro-organism within tissue, which then results in destruction of the tissue (ICNA 2003) Abrasion Superficial wounds in which the topmost layer of the skin is scrapped off. ( Kilongi 2006) CHAPTER ONE
The skin is the body’s largest organ. It measures about 1.5-2 square meters in adult and weighs about 15% of total body weight. It is portal of entry for microorganisms (Roth and James 1999) Between 187 and 281 million surgical procedures are around the world performed each year, equating to one procedure each year for every 25 people (WHO 2009) Acute wounds include surgical incisions and traumatic injuries such as Lacerations, Abrasion, Avulsions, penetrations, or bites and burn injuries. Acute wounds that occur as a result of surgery are closed by approximations of the wound edges, thus heal by primary intention (NICE 2008). These wounds normally proceed through and timely reparative process that culminates in restoration of anatomic and functional integrity (Lazarus et al 1994). Naturally these wounds are at risk of surgical site infections (SSI) defined as Infection up to 30 days after surgery and affect the incision, deep tissue at the operation site or involve organs or body space. Infact SSI account for up to 30% of surgical procedure and occur in up to 14% of hospital acquired infection (NICE 2008). A study conducted in United state found that 1% of 75000 episodes resulted in SSI (de lissovoy et al 2009) SSI’s are associated with significant morbidity and over one third of post operative deaths, atlest in part have been associated to SSI (Astagneau et al 2001). SSI’s can double the length of hospital stay and thus increase the costs of health care, an incovinience to the patient (underson et al 2010, Astagheau et al 2001, de lissovoy et al 2009). Despite the high costs, management of acute wounds remain a crucial problem of nurse’s clinical practice. Appropriate wound care and management during post-operative period will reduce the risk of complication such as SSI and prevent this wound from developing into chronic wound. This study aims to describe quality of practices of nurses towards wound management. 1.2 PROBLEM STATEMENT Surgical site infection are the common infection among surgical patients, but currently the magnitude of this problem has become large to the extent that threatens the future of surgical patients. These surgical site infection normally associates with local nosocomial infections and it has lead to large number of disabilities, morbidity and mortality. The quality of practice on wound it has seen to be a problem among nurses, due to this problem it leads to decrease on the healing process of many wounds and increase the risk of infection. Availability of instrument it is also a major concern to nurses during caring of the wound. This also is important aspect in ensuring quality practice on wound. Aseptic technique adherence among nurses in wound caring is the key aspect towards healing of the wound and decrease risk of infection (Griffiths 2008).
Determine the quality of practice on wound care among nurses of ward 11 and 12 at Kibasila Block in Muhimbili National Hospital. 1.4 RESEARCH QUESTION The research question was to determine the quality of practice on wound care among nurses of ward 11 and 12 at Kibasila block in Muhimbili National Hospital. 1.5 OBJECTIVES GENERAL OBJECTIVE Determine the quality of practice on wound care among nurses of ward 11 and 12 at Kibasila block in Muhimbili National Hospital. SPECIFIC OBJECTIVE
CHAPTER TWO LITERATURE REVIEW Over the past 30 years scientific has revolutionized changes in wound care practice from traditionally held premises of dry to moist wound healing. While the notion of moist interactive wound healing is strongly advocated (AWMA 2010, leaper,Gillepse and Frenick 2012, NICE 2008). Its use in clinical practice remains variable (Drew, Madson, Verdu 2007). The shift to moist healing and the understanding that traditional products (e.g gauze) do little to actively to promote healing have informed contemporaly wound care practices ( Drew, madson,Verdu 2007). The management of acute wounds, whether closed with sutures to heal by primary intention or left open and heal by secondary intention requires selection of particular type of dressing based on objective wound assesments (Drew, Madson, Verdu2007, Nicks et al 2010). There is an increasing number of dressing products containing ant- microbial such as honey, silver and cadexomer iodine available. None the less, there is little empirical evidences support their efficacy in preventing SSI (NICE 2008). The main purpose of wound dressing is to allow appropriate post-operative wound assessment, absorb exudates ease pain and protect newly formed tissue (NICE 2008). Contemporary dressing productes are designed to maintain the moist environment, without causing maceration to the surrounding skin as the dressing can be difficult given the surge in the sophiscation and sheer the volume of materials available and the specificity of the dressing type to the wound. A recent environmental scan revealed that availability of a wide range of dressing products was considered advantageous in wound management because health care professionals were given greater choice and could select the dressing product based on the patient unique set of clinical needs (Gillesple et al 2012). However, despite the wide range, clinicians do not always have the product specific knowledge required to make an informed decision about which dressing is much suitable. Additionally, the availability of the dressing product is largely controlled by hospital inventory and the choice often driven by the surgeon’s preference which may not always reflect current evidence and practice h(Dreas et al 2007, coillespie et al 2012). Several studies have been conducted in a countries with more resources and most of the knowledge is from this environment. The results might not be adaptable to countries with fewer resources. The experience and guidelines from countries with greater resources cannot always be applied to hospitals in countries with fewer resources. Globally the SSI reported from countries with more resources is often below 5%, in Brazil and Mexico the SSI rates are usually between 10% and 15%. An international survey done by WHO in 2008 the SSI rate between 5.2% and 34.4%. There is several explanation for these variations. Besides the quality of the infection prevention measures and the differences in the patient population the use of different methodologies also had an influence. The length of post-operative hospitalization is decreasing in most industrial countries and many countries and many SSI are therefore first apparent only after discharge. Between 12% and 84% of SSI reported are detected after patients were discharged. The post-operative stay is often longer in countries with fewer resources. One could therefore expect the post discharge rate to be lower in countries with fewer resources. However a study from Mexico found that 87.5% of the SSI were apparent after discharge. The inclusion of post discharge surveillance will influence the final SSI rate. In Africa region the SSI rate among Africa as reported by by WHO 2008 is ranging from 16-38.7%. This is due to economic status of most African countries, however strategic has been implemented so as to reduce the risks for SSI In Sub Saharan countries the wound care and management has been of major problem for all % pre, intra and post-operative procedures due to poor facilities according to Joy Oluch Osakwe et al 2010. SSI rates among sub Saharan African countries ranges from 11% -58% depending on age, and type of procedures. Example SSI rate in Tanzania is 26% while the incidence for Uganda is 58.9% the SSI rate in children undergoing surgery operation in Zaria is 23.6%. as reported by Joy Oluch Osakwe et al 2010 and cited from Ameh et al… SSI rate of 14.3% reported in clean incisions, 27.3% in contaminated incision and 60% in dirty incisions. Emergency procedures has a higher rate (25.8%) then elective procedure (20.8%) osifer et al found SSI rate of 11.8% in neonatal surgical operation in Benin city, Ojiyi et al, working in a tertiary hospital, in southeastern Nigeria found SSI rate of 11.0% among patients who had Caeserean sections. In Tanzania as reported by department of Medicine and Diagnostics swiss tropical institute 2006. The SSI was 26% among district hospitals in Tanzania. In Muhimbili National hospital the risk of SSI development is 35.6% as reported by Akoko et al 2012 with wound class, abdominal surgeries, emergency surgeries being factors for developing SSI. Superficial SSI being the most commonly observed type 54.8% also HIV prevalence 16.9% with 5 times of developing SSI. Wound care practices are of paramount importance towards preventing the development of SSI among patients at ward 11 and 12. This study aims to determine the practices among nurses in prevention of developing SSI (Nosocomial Infection) by ensuring a maximum quality provision of care. CHAPTER THREE 3.0 RESEARCH METHODOLOGY 3.1 Research design The study design will be quantitative. 3.2 Study area The study area will be in ward 11 and 12 in Kibasila Block in Muhimbili National Hospital. 3.3 Sampling procedure The sampling procedure is probability sampling 3.4 Sampling technique The sampling technique is simple random. 3.5 Sample size The sample size will be 20 nurses. 3.6 Data collection tools The tools for data collection will be questionnaire. 3.7 Pre-testing Questionnaire will be given among third year student at least six students, to respond to the question and quickly review will be performed to see response of the questions and correction will be done in case of ambiguity and illogical arrangement. 3.8 Data management The questionnaire will be labelled by numbers and will be self-administered, after being filled the questionnaire will be checked whether each is filled completely. Questionnaire will be kept in a way that cannot be destructed and confidentiality will be maintained. APPENDIX NO. 1 QUESTIONAIRE English version questionnaire for health care providers. Tool no. 01 Instruction: No need for writing your name Part I: Demographic data Put a (√) in the box provided for the most preferred answer 1. Age
a).18-35 years [ ] b).35-45 years [ ] c).46 years and above [ ] 2. Gender a). Female [ ] b). Male [ ] Part II: Put a (√) in the box provided for the most preferred answer 5. How many years have you been in service? a). 0-5 years [ ] b). 5-10 years [ ] c). 10 years and above [ ] 4. How many patient have you attended on caring the wound per day? a). 0-5 years [ ] b). 5-15 years [ ] c). 15 years and above [ ] 5. Equipment for wound care are they available? a). Yes [ ] b}. No [ ] 6. If available are they sufficient? a). Yes [ ] b). No [ ] 7. How many times per day do wound dressing done to a patient? a). Once day [ ] b). Twice a day [ ] c). Thrice a day and above [ ] 8. Do you wash your hands before and after caring the wound? a). Yes [ ] b}. No [ ] FAHARASA NAMBA 1 Dodoso la Kiswahili kwa ajili ya wafanyakazi wa afya Maelekezo: Usiandike jina lako katika dodoso hili Sehemu ya kwanza: Taarifa ya watu Weka alama ya (√) katika sanduku kwa jibu lililo sahihi
a). Miaka 18- 35 [ ] b). Miaka 35- 45 [ ] c). Miaka 46 na zaidi [ ] 2. Jinsia a). Kike [ ] b). Kiume [ ] Sehemu ya pili: Weka alama ya (√) katika sanduku kwa jibu lililo sahihi 3. Una mda gani tangu uanze kufanya kazi katika kitengo hiki? a). Miaka 1- 5 [ ] b). Miaka 5- 10 [ ] c). Miaka 10 na zaidi [ ] 4. Unahudumia wagonjwa wangapi wenye vidonda kwa siku? a).Mgonjwa 1- 5 [ ] b). Wagonjwa 5-10 [ ] c). Wagonjwa 10 na zaidi [ ] 5. Vifaa vya kuhudumia vidonda vinapatikana? a). Ndio [ ] b). Hapana [ ] 6. Kama vinapatikana je vinatosha? a). Ndio [ ] b).Hapana [ ] 8. Vidonda kwa wagonjwa husafishwa mara ngapi kwa siku? a). Mara moja [ ] b) Mara mbili [ ] c) Mara tatu na zaidi [ ] 8. Je unaosha mikono kabla na baada ya kuhudumia mgonjwa mwenye vidonda? a). Ndio [ ] b). Hapana [ ] Tool no. 2: CHECKLIST
RESEARCH PROPOSAL BUDGET
APPENDIX NO. 2 CONSENT FORM (English Version) Participant number …………………………………… OBJECTIVE: To determine the quality of practice on wound care among nurse of ward 11 and 12 at Kibasila block in Muhimbili National Hospital”. RESEARCHERS: Group one members BENEFITS: This research will help us to know and understand the quality of practice on wound care among nurse of ward 11 and 12 at Kibasila block in Muhimbili National Hospital”. CONFIDENTIALITY: No participant name is going to be written in this document and no participant is going to be harmed. PARTICIPANT RIGHT: Have right to participate or not. For more information HEAD OF SCHOOL SCHOOL OF NURSING MUHIMBILI P.O.BOX 63003, DAR ES SALAAM. OR 0759 522510(group leader)
I agree [ ] I disagree [ ] ………………………………………… ……………………………………… Participant signature Date …………………………………. ………………………………….. Interviewer signature Date
……………………………… ……………………………… Saini ya mshiriki Tarehe ………………………………. …………………………….. Saini ya mtafiti Tarehe MAP OF THE STUDY AREA CHARTER FOUR RESULTS The study was to determine the quality of practice on would care among Nurses of ward 11 and 12 at Kibasila block in Muhimbili National Hospital. The participants in this study were nurses of kibasila ward 11 and 12, who were 20 in number. Data was collected and analyzed and the findings varied as shown in tables below. Table 1 Respondent’s age distribution(n=20)
Table 2 Respondent’s gender distribution (n=30)
Table 3 Respondent’s year in service (n=20)
Table 4 Respondent’s on patient that they attend per day (n=20)
Table 5 Respondent’s on equipment for wound care if their available (n=20)
Table 6 Respondent’s on equipment if their sufficient (n=20)
Table 7 Response on wound dressing done to a patient per day (n=30)
Table 8 Response on washing hands before and after caring the wound (n=30)
CHAPTER 5 DISCUSSION The study was to determine the quality of practice on would care among Nurses of ward 11 and 12 at Kibasila block in Muhimbili National Hospital. The participants in this study were nurses of kibasila ward 11 and 12, who were 20 in number. In table 1 respondent’s age varies from 18-35 years,35-45 years, and 46 years and above where by majority aged is 18-35 years their 15 which is 75%. In table 2 the results show that majority of respondents were female who were 15 which is 75% while 05 which is 25% of respondents were male. In table 3 results show that 10 students (33.3%) from each class of study were selected randomly. In table 4 results show that majority of respondents attend patient on wound caring per day 6-15 patient are 11, 0-5 patient are 9, and 16 and above none. On the other hand in table 5 results show that availability for wound care equipment’s 20 respondents which is 100% say YES and none say NO. In table 6 results majority witnessed that if equipment’s are sufficient is 15 respondents’ which is 65% say NO, and 5 respondents which is 35% say YES. In table 7 the results show that majority of nurses perform wound dressing twice a day are 18 which is 90% and 2 once a day which is 10% and thrice a day none. In table 8 majority shows that respondents who wash their hand before and after caring wound dressing are 20 and none doesn’t wash their hands. Recommendations
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