1.0 INTRODUCTION

1.1 BACKGROUND INFORMATION

Surgical site infections (SSIs) are defined as infections occurring up to 30 days after surgery (or up to one year after surgery in patients receiving implants) and affecting either the incision or deep tissue at the operation site. Despite improvements in prevention, SSIs remain a significant clinical problem as they are associated with substantial mortality and morbidity and impose severe demands on healthcare resources. In many SSIs, the responsible pathogens originate from the patient's endogenous flora. The causative pathogens depend on the type of surgery; the most commonly isolated organisms are Staphylococcus aureus,coagulase-negative staphylococci, Enterococcus spp and Escherichia coli[1]

Patients with known nasal carriage of S. aureus should receive intranasal applications of mupirocin 2% ointment with or without a combination of chlorhexadine gluconate body wash. Mechanical bowel preparation alone (without the administration of oral antibiotics) should NOT be used in adult patients undergoing elective colorectal surgery. In patients undergoing any surgical procedure, hair should either NOT be removed or, if absolutely necessary, should only be removed with a clipper. Shaving is strongly discouraged at all times, whether preoperatively or in the operating room.Surgical antibiotic prophylaxis (SAP) should be administered before surgical incision, when indicated.

SAP should be administered within 120 min before incision, while considering the half-life of the antibiotic. Surgical hand preparation should be performed either by scrubbing with a suitable antimicrobial soap and water or using a suitable alcohol-based handrub before donning sterile gloves Alcohol-based antiseptic solutions based on CHG for surgical site skin preparation should be used in patients undergoing surgical procedures. Adult patients undergoing general anaesthesia with endotracheal intubation for surgical procedures should receive 80% fraction of inspired oxygen intraoperatively and, if feasible, in the immediate postoperative period for 2–6 h. Surgical antibiotic prophylaxis administration should not be prolonged after completion of the operation.
Those strong WHO guidelines are required to be known and practiced by all health care workers attending these surgical patients and as we can see their focusing on all angles to ensure lowest occurance rate of surgical site infections.Knowledge and practice of these guidlines is among the initiatives in preventing occurance of surgical site infections.[2]

1.2 PROBLEM STATEMENT.

Surgical site infections (SSIs) have been reported to be one of the most common causes of nosocomial infections; is accounting 20% to 25% of all nosocomial infections worldwide [3]. SSIs have been responsible for the increasing cost; morbidity and mortality related to surgical operations and continue to be a major problem worldwide [4]. Globally, surgical site infection rates have been reported to range from 2.5% to 41.9% [5–11]. In the United States, approximately 2% to 5% of the 16 million patients undergoing surgical procedures each year have postoperative surgical site infections [6].
In Tanzania, surgical site infections are still one of the leading causes of morbidity and mortality among patients undergoing major surgery. Previous studies conducted in a district and a tertiary hospital in Tanzania reported the surgical site infections rate of 24% and 19.4% respectively [7, 8]. Surgical site infection is one of the most common preventable complications following major surgery at Bugando Medical Centre and represents a significant burden in terms of patient morbidity, mortality and hospital costs.

Despite improvements in operating room practices, instrument sterilization methods, better surgical technique and the best efforts of infection prevention strategies, surgical site infections remain a major cause of hospital-acquired infections and rates are increasing globally even in hospitals with most modern facilities and standard protocols of preoperative preparation and antibiotic prophylaxis. Moreover, in developing countries where resources are limited, even basic life-saving operations, such as appendectomies and cesarean sections, are associated with high infection rates and mortality[9,10]

1.3 RATIONALE OF THE STUDY

For prevention of SSIs proper knowledge and practices are required but there is a gap in showing this important factor at BMC and even other hospitals in Tanzania.
1.4 RESEARCH QUESTION:

What is the knowledge and practice regarding prevention of surgical site infections among health care workers at Bugando Medical Centre?

1.5 OBJECTIVES

1.5.1 Broad objective
To assess knowledge and practice regarding prevention of surgical site infections among health care workers.
1.5.2 Specific objectives
To determine awareness of health care workers on the risk factors of surgical site infections
To determine the level of practice regarding prevention of surgical site infections.
To determine the relationship between health care workers knowledge and practice regarding prevention of surgical site infection.