Abstract

Asepsis is the absence of infectious material or infection. Aseptic techniques are procedures performed under sterile conditions to protect the patient from infections. This study was aimed at, assessing aseptic techniques and its effect on patient recovery health in the Buea Regional Hospital, South West Region Cameroon.

The main objective was to examine the effect of aseptic techniques on patients recovery  in the  operating theatre, surgical ward and maternity ward of Buea Regional Hospital and follow up to see that the patients were free from morbidity and or mortality.

It was a cross sectional study and sampling technique was random sampling. A sample size of 75 nurses and 35 doctors (110) were used for the research and data collected using structured questionnaire; analysed using frequency distribution tables and simple percentage.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Asepsis is the absence of infectious material or infection (Perry et al., 2014). Aseptic technique is any procedure performed under sterile conditions which protects the patient from the impact of associated health care infections (delayed recovery, longer hospitalization, increased pain and increased morbidity), (Ayliffe, 2000). Surgical aseptic technique is a method employed to maintain asepsis (the absence of pathogenic micro-organisms that cause disease).

Surgical asepsis is the absence of all microorganisms within any type of invasive procedure. Sterile technique is a set of specific practices and procedures performed to make equipment and areas free from all microorganisms and to maintain that sterility according to CDC, 2010 Centre for Disease Control surgical asepsis and sterile technique are commonly used interchangeably, but they mean different things (Kennedy, 2013).

Principles of sterile technique help control and prevent infection, prevent the transmission of all microorganisms in a given area, and include all techniques that are practiced to maintain sterility. Sterile technique is most commonly practiced in operating rooms, labor and delivery rooms, and special procedures or diagnostic areas.

It is also used when performing a sterile procedure at the bedside, such as inserting devices into sterile areas of the body or cavities (e.g., insertion of chest tube, central venous line, or indwelling urinary catheter). In health care, sterile technique is always used when the integrity of the skin is accessed, impaired, or broken (e.g., burns or surgical incisions). Sterile technique includes the use of sterile equipment, sterile gowns, and gloves (Flores, 2008).

In an operating room, all members of the surgical team have to demonstrate good aseptic technique practice as asepsis cannot be compromised for the care giver’s convenience sake.  Medical procedure rooms should be laid out according to guidelines, including regulations concerning filtering and airflow. Members of the surgical team wash their hands and arms with germicidal solution (e.g. an iodine solution such as betadine), and also wear sterile gloves and gowns. Staff members’ hair is covered and surgical masks worn.

The modern concept of asepsis evolved in the 19th century. Ignaz Semmelweis showed that hand washing prior to delivery reduced puerperal fever. After the suggestion by Louis Pasteur, Joseph Lister, 1st Baron Lister introduced the use of carbolic acid as an antiseptic, and in doing so, reduced surgical infection rates. Lawson Tait went from antisepsis to asepsis, introducing principles and the iconic statutes that have remained valid to this day.

Bergmann (1875) introduced the autoclave, a device used for the practice of the sterilization of surgical instruments. Aseptic techniques were first widely adopted in the late 19th century. Prior to this, the importance of sterilizing an area was known, and antiseptics were used to clean locations, tools, and equipment that needed to be sterile, such as when performing surgery.

While antisepsis is concerned with the removal of microorganisms immediately before, during, and after surgery or other work, asepsis is concerned with the maintenance of sterile conditions through good hygiene procedures Hartley (2005). While antisepsis is concerned with the removal of microorganisms immediately before, during, and after surgery or other work, asepsis is concerned with the maintenance of sterile conditions through good hygiene procedures (Rowley et al., 2010).

In the mid-19th century, Louis Pasteur performed several experiments demonstrating the validity of the germ theory and disproving the widely accepted idea of spontaneous generation. Around this time, the development of anesthetics allowed surgeons to perform longer, more complex surgeries on patients, which also largely increased the risk of infection.

In the 1840s, the Hungarian surgeon Ignaz Semmelweis noted that on maternity wards where doctors who also worked in other areas of the hospital were present, the mortality rates were significantly higher than on those wards that were operated by midwives only. He introduced hand washing procedures in these wards. The number of deaths due to infection in these maternity wards dropped drastically following the implementation of this rule. Similarly, having noted the poor condition of hospitals where soldiers were placed during the Crimean war, Florence Nightingale collected extensive data regarding the number and cause of death of these soldiers over a two year period and it was found that a majority of deaths at these hospitals were entirely preventable through aseptic techniques, and the changes she implemented saved many lives during this period Hartley (2005).

Antiseptic surgery was largely pioneered by Joseph Lister in (1860) when he used phenol (known at the time as carbolic acid) as a disinfectant. He would sterilize the operating theatre and surgical tools with phenol, and even soak bandages in the substance before dressing wounds. Although this was effective, he failed to recognize the importance of asepsis at the time.

Robert Koch, through his work with anthrax and tuberculosis, demonstrated that particular diseases were the result of the presence of specific microorganisms within the body, and so strongly reinforced the work of Louis Pasteur and the idea of asepsis.

This led the medical community to stop relying solely on antiseptic techniques and emphasize asepsis as well. They also began to realize the downsides to the use of disinfectants, including the fact that they were highly poisonous, and their entry into a wound was often severely damaging Flores (2008).

In the later decades of the 19th and early 20th centuries, sterilized surgical gowns and gloves became more commonplace. In 1890 William Stewart Halstead requested that the Goodyear Rubber Company make a pair of thin rubber gloves, with the intention that they protect his hands and those of his nurses from the caustic effects of the phenol disinfectant that was still being used. It became clear that disinfecting the gloves in this way and adhering to aseptic techniques in the operating theatre was a superior method. Autoclaves were also used to disinfect the gloves and gowns. It was not until the 1960s that the first commercially available pre-sterilized gloves were manufactured by the Ansell Company (Pellowe, 2007)

1.2 Statement   of   Problem

It is estimated that 4.5 to 5.7 billion people are affected with SSI per year due to lack of aseptic technique practices in hospitals (Infection Control and Hospital Epidemiology, 2017). Approximately 9% of Indian hospital patients acquire    health care associated infections especially post-operative infections and as a result 5000-15,000 die every year.

National surveillance service 2002 conducted a survey for healthcare workers in UK reported 2,351 cases of wound infection. Out of these, 44% of infections occur due to lack of knowledge on aseptic procedures, 29% due to lack of time and 28% due to shortage of staffs.  Infections are a major source of morbidity and cause of mortality during the postoperative phase for patients (Pronovost et al., 2006). Wound infections are the second most commonly encountered type of nosocomial, hospital-acquired, infection in the United States (Nichols, 2007).

Knowing the fact that wound infection may be induced, by not practicing enough infection control measures and sterile techniques in the operating theatre, it is essential to implement infection control principles and apply sterile technique principles. Hospital acquired infections (HAI) related to  poor compliance with aseptic techniques is an important public health problem Aruscavage (2013) published on the Semester-It is therefore against this backdrop the researcher writes on the Problems of Aseptic techniques and its effects on  patient recovery at the Buea regional hospital.

Infections after surgery can cause; pain, poor wound healing, need for further treatment, longer hospital stay time, and increased health care costs. Postoperative infections may cause severe problems including: failure of the surgery, surgical complications, sepsis, organ failure, and even death. Some of this infection can be prevented by giving; antibiotics prophylaxes, making sure the patient is in the best condition possible before the surgery; using an antiseptic solution to “prep” the area around the surgical incision; maintaining sterility (no bacteria or other organisms, such as viruses or parasites) of the surgical area (also called the “surgical field”) and operating tools; and having operating room staff wear clean scrub clothes, hats, and masks.

Some of the risk factors for postoperative infection include: diabetes, obesity, age, emergency operations and obvious contamination (with debris, pus, stool, or other substances) of the injury or the surgical area (Loveday et al., 2014).

1.3 Objectives of the Study

1.3.1 General objective

The main objective was to examine the effect of aseptic techniques on patients’ recovery in the  operating theatre, surgical ward and maternity ward of Buea Regional Hospital and follow up to see that the patient is free from morbidity and or mortality.

1.3.2 Specific Objectives

1. To assess knowledge on personal protective equipment in Buea Regional Hospital
2. To evaluate knowledge on sterilization in the Buea Regional Hospital
3. Compare the use of different disinfectants and their impact on patient health

1.4 Research Questions

1.4.1 Main Research Question

What is the effect of aseptic techniques on patients’ recovery in the operating theatre, surgical ward and maternity ward at Buea regional hospital?

1.4.2 Specific Research Question

1. To what extent does the assessment of knowledge on personal protective equipment affect aseptic techniques in Buea Regional Hospital?
2. Does sterilization of equipment and the ward affect asepsis in Buea Regional Hospital?
3. Do different disinfectants affect patient’s health when used?