Effect of an eductional intervention on nurses’ knowledge, compliance and barriers regarding implementation of a surgical site infection prevention bundle at Mzuzu Central Hospital in Malawi

Abstract

ABSTRACT Background Surgical site infections are the second largest category of health care associated infections. Infection prevention care bundles, such as the surgical site infection prevention bundle is a well-known strategy to reduce surgical wound infections amongst hospitalized patients. Despite their potential to reduce surgical wound infections, a lack of understanding and awareness of the surgical site infection prevention bundle amongst nursing staff remains a challenge in sub-Saharan Africa, hence inability to integrate them into clinical practice. Study Aim: To test the effect of an educational intervention on nurses’ knowledge, compliance and barriers regarding implementation of a surgical site infection bundle and associated barriers at Mzuzu Central Hospital in Malawi. Materials and Method: A one group pre-post-test quasi-experimental research design was employed at Mzuzu Central Hospital. A stratified random sampling technique was used to recruit 90 nurses from eight departments dealing with surgical patients. A pre-post-test questionnaire was used for data collection. The study measured three variables, knowledge, compliance and barriers with knowledge being tested three times at three different time points, pretest, immediate pos-test and follow up test at four weeks. Data was analysed using SPSS version 25. Both descriptive and inferential statistics were used to analyse the data. Chi-Square test was used to determine the association between sociodemographic characteristics and knowledge. Repeated measures ANOVA were used statistically determine changes in the average mean scores for a pretest, immediate posttest and a follow-up posttest at four weeks. P-values of 0.05 were set as a cut of point for significant findings. Results: Only 8% of the nurses had adequate knowledge on SSI prevention strategies and only 1% of the participants was aware of the SSI prevention bundle in a pretest assessment. There was however significant improvement in the knowledge level immediately after the education intervention to 97% and 100% during a follow up test at one month after the intervention. The mean scores were compared and the mean was higher for follow up results (M=14.78, SD=1.819), as compared to the immediate post test results (M=12.36, SD=1.691) and the pretest (M=5.96, SD=1.550). The difference in means was statistically significant at 1%. There was also improved compliance ratings also after the intervention compared to before the education session. The mean score before the intervention was 20.09 and increased to 30.00 after the educational intervention. There was a statistically significant difference in nurses’ ratings before and after the intervention with a p-value of 0.0000. The most reported barriers in this study were: unavailability of resources 67(82%), lack of interprofessional collaboration 56(69%), workload 47(57%) and absence of guidance from departmental leaders 45(55%). Conclusion: The findings of this study suggest that providing an education intervention to nurses not only improves their knowledge level, but also improves their compliance to guidelines in practice. The barriers identified in this study highlights critical areas for improvements in healthcare setting to ease guideline compliance and implementation. Key words Barriers, compliance, knowledge, nurses, surgical site infection bundle