Abstracts

Sepsis is a widespread problem that can create clinical and economic difficulties. The study aimed to assess nursing prevention and implementation of surgical sepsis in the catheterization of patients in the Tubah Health Center.

Specifically, the study sought to access the prevalence of catheterization of patients, assess sepsis prevention practices of nurses in the catheterization of patients and to identify the challenges faced by nurses in the prevention and implementation of surgical sepsis in the catheterization of patients in the Tubah Health Center.

To achieved these objectives, the study sample 30 nurses randomly from the Tubah Health Center using a structured-questionnaires. Collected data were analysed descriptively using SPSS (25.0). Findings revealed that nurses have poor that there is a poor sepsis prevention practice of nurses in the catheterization of patients at the Tubah Health Center as most nurses did not follow the sepsis techniques that must be apply when dealing with a sepsis patients. Most nurses have never attended a training program on sepsis or even try to perform a sepsis procedure.

The results of the study also revealed that there is a perceived lack of essential medications, inadequate staffs, lack of essential medical equipment’s among nurses working at the Tubah Health Center. The study suggested that education and training program should be conducted to improve nurses’ knowledge and practice in some areas using evidence-based practice.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Surgical sepsis, a potentially life-threatening complication involving organ dysfunction due to a body’s response to an infection, remains a significant threat. Catheterization procedures, essential for various medical interventions, unfortunately, pose a major risk factor for surgical sepsis. Nurses play a crucial role in preventing catheter-related infections and subsequent sepsis through proper implementation of preventive measures.

Surgical site infections (SSIs) are wound infections that occur after an operative procedure. A Preventable complication, are costly and associated with poorer patient outcomes, increased mortality, morbidity and reoperation rates (Norman et al. 2017). Globally, millions of individuals are at risk of complications resulting from surgery if correct action and prevention strategies are not applied at the appropriate times. The global burden of surgical site infection is Important worldwide, yet this burden affects low-income countries more with eleven percent of people who undergo surgery being infected.

In Africa, up to 20.0% of women who undergo caesarian section contract a wound infection, compromising their health and their ability to care for their babies (WHO, 2016).  Many interventions are used to reduce the risk of SSI in people undergoing surgery. These interventions can be broadly delivered in three stages: preoperatively, intraoperative and postoperatively (Liu et al. 2018). Surgical site infections are the most common complication following surgery, with reported rates ranging from 5% to 30%.

The attributable morbidity and mortality are significant, with patients who experience SSIs being 60% more likely to spend time in the intensive care unit, 5 times more likely to be readmitted to hospital and twice as likely to die as patients without Surgical site infections. Surgical site infection is a commonly occurring healthcare-associated infection, complicating 2-5% of surgeries in the United States (US). Increased morbidity and mortality are associated with Surgical site infection, ranging from wound discharge associated with superficial skin infection to life-threatening conditions such as severe sepsis. Surgical site infections are responsible for an increased economic burden on healthcare systems, including additional postoperative hospital duration and costs (Korolet al. 2013).

Whereas many risk factors for the development of Surgical site infections are related to patient characteristics that cannot be easily modified, there are a variety of system or hospital factors that can be manipulated. These include improper selection and administration of antibiotic prophylaxis, intraoperative hypothermia and intraoperative hyperglycemia (Eskicioglu et al. 2012). Staphylococcus aureus has long been recognized as one of the most important bacteria that cause wound infections, contributing to more than 20% of all surgical site infections annually (Boonie & Barnard, 2017).

The morbidity and related costs associated with surgical infections are considerable; estimates of prolonged hospitalization vary from 5 to 20 days per infection. Wound dressings applied after wound closure may provide physical support, and protection and absorb exudates (Dumville et al. 2016). Surgical wound irrigation is an intraoperative technique, which may reduce the rate of SSIs through the removal of dead or damaged tissue, metabolic waste, and wound exudate. Irrigation can be undertaken before wound closure or postoperatively.

Intra-cavity lavage is a similar technique used in operations that expose a bodily cavity; such as procedures on the abdominal cavity and during joint replacement surgery (Norman et al. 2017). The intraoperative interventions are largely focused on decontamination of skin using soap and antiseptics; the use of barriers to prevent movement of micro-organisms into incisions; and optimizing the patient’s bodily functions to promote best recovery. Both decontamination and barrier methods can be aimed at people undergoing surgery and operating staff.

Other interventions focused on Surgical site infection prevention may be aimed at the surgical environment and include methods of theatre cleansing and approaches to managing theatre traffic (Liu et al. 2018). The nurse should make sure that the patient’s temperature is maintained above 36 degrees centigrade to be sure that the patient’s homeostasis is maintained. The nurse is supposed to cover the wound at the end of the surgery.

The dressing should be kept in place for 2 days or 48 hours after surgery unless clinical signs indicate, that the dressing acts as a barrier between the wound and the outside environment thereby protecting the wound site from being infected. A gap exists between the best evidence and practice about surgical site infection prevention. Awareness of evidence is the first step in knowledge translation (Eskicioglu et al. 2012).

Nurses play a crucial role in preventing catheter-related infections and subsequent sepsis through proper implementation of preventive measures. By addressing knowledge gaps, implementing standardized protocols, and ensuring adherence through effective strategies, nurses can play a pivotal role in preventing surgical sepsis in patients undergoing catheterization. This not only improves patient safety and outcomes but also contributes to a more efficient and cost-effective healthcare system.

1.2 Statement of the Problem

While the global challenge of surgical sepsis and its link to catheterization is significant, the problem takes on specific dimensions within the context of Cameroonian hospitals. Building on the general statement we discussed earlier, here’s a refined version specific to Cameroon. Despite advancements in healthcare practices, surgical sepsis remains a significant threat in Cameroonian hospitals, with catheterization posing a major risk factor. This presents a critical problem due to the high burden of surgical sepsis which affects numerous patients annually, leading to increased morbidity, mortality, and healthcare costs (Tambe et al., 2019).

Surgical sepsis affects a substantial portion of patients in Cameroon, often with higher morbidity and mortality rates compared to developed countries. This is partly due to factors like limited access to advanced healthcare, underlying health disparities, and inadequate sanitation infrastructure.

According to Tambe et al (2019), resource limitations, including a shortage of trained nurses, inadequate sterile supplies, and inconsistent adherence to best practices, further magnify the risks associated with catheterization procedures in Cameroonian hospitals. Knowledge gaps among nurses regarding optimal infection prevention during catheterization are compounded by cultural factors that may influence catheter care practices and patient hygiene behaviours (Kesah et al., 2013).

No study had ever been carried out in the Tubah Community on surgical sepsis, it’s against this background that the current study seeks to assess nursing prevention and implementation of surgical sepsis in the catheterization of patients in the Tubah Health Center.

1.3 Research Questions

1. What is the prevalence of catheterization of patients at the Tubah Health Center?
2. What are the sepsis prevention practices of nurses in the catheterization of patients at the Tubah Health Center?
3. What were the challenges faced by the nurses in the prevention and implementation of surgical sepsis in the catheterization of patients in the Tubah Health Center?

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