International Journal of Health Sciences and Research

www.ijhsr.org ISSN: 2249-9571

Original Research Article

The Practice of Aseptic Techniques on Surgical Wound Dressing By Health

Care Professionals
Dhanasundari. G1, Dr. Malarvizhi. S2, Dr. Rebecca Samson3, Amirtha Santhi. S4, Dr. Ravichandran. K5
1
M.Sc. (N), New Delhi
2
Professor, Assistant Registrar, HOD - Department of Medical Surgical Nursing, College of Nursing,
Pondicherry Institute of Medical Sciences, Puducherry
3
Professor, Dean, College of Nursing, Pondicherry Institute of Medical Sciences, Puducherry
4
Assistant Professor, College of Nursing, Pondicherry Institute of Medical Sciences, Puducherry
5
Biostatistician, Department of Biostatistics, Pondicherry Institute of Medical Sciences, Puducherry
Corresponding Author: Dr. Malarvizhi. S

ABSTRACT

Asepsis is freedom from infection or prevention of contact with microorganisms. Aseptic technique is
a set of practices and procedures performed under controlled conditions with the goal of reducing
contamination by pathogens. Surgical aseptic procedures are used to keep the objects or areas sterile
or completely free from microorganisms. The effectiveness of infection control practices depends on
health care professionals conscientious and consistency in using effective aseptic technique.
Objectives: 1.To assess the practice of aseptic techniques on surgical wound dressing among medical
interns and staff nurses. 2. To identify the factors influencing the standard of practice followed in
aseptic techniques on surgical wound dressing among medical interns and staff nurses. Descriptive
design was used in this study. The study was conducted in the General surgical wards. Purposive
sampling method was used to select the samples. Totally 15 medical interns and 15 staff nurses were
included. Medical interns and staff nurses were observed using different checklist for aseptic
techniques on surgical wound dressing. After completing the observation, study variables and
influencing factors for aseptic techniques on surgical wound dressing were collected. According to the
level of practice on surgical wound dressing by following aseptic techniques, 13 (87%) of the medical
interns followed moderately adequate practice and among staff nurses nine (60%) of them followed
moderately adequate and six (40%) of the participants followed adequate practice. By implementing
surgical wound dressing checklist in respective wards the surgical wound infection can be prevented
and also the health care professionals will have better practice related to surgical wound dressing.

Key words: aseptic techniques, surgical wound dressing, health care professionals, surgical wound
infection.

INTRODUCTION the introduction of foreign objects to the

The human skin is the outer covering wound’s surface. Thus, wound
of the body. In humans, the integumentary contamination occurs endogenously through
system is the largest organ. [1] Normal skin the patient’s own flora, or exogenously
microflora includes Staphylococcus, whereby microbes are introduced through
Streptococcus, Acinetobacter, Peptococcus, external sources, such as the health care
and yeast. Intact skin may be contaminated professional hands. [2]
with up to 103 microbes per gram of tissue Patients with sepsis often require
without any effect on tissue healing. care in the intensive care unit, with broad
Contamination can also occur as a result of spectrum intravenous antibiotic. Once the

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Dhanasundari. G et.al. The Practice of Aseptic Techniques on Surgical Wound Dressing By Health Care
Professionals

infection is identified, antibiotics may be MATERIALS AND METHODS

given according to the specific causative Non-experimental descriptive study
organism. Mortality associated with sepsis was conducted in the general surgical wards
can be as high as 60% if there are other of a tertiary care teaching hospital at
medical problems involved. Among the Pondicherry. This study was approved by
three forms of sepsis such as uncomplicated the Institutional review board of College of
sepsis, severe sepsis and septic shock, Nursing, Pondicherry Institute of Medical
severe sepsis carries a mortality of 30% to Sciences. In this study the participants were
35% and septic shock carries a mortality of the medical interns and staff nurses who
50%. [3] perform surgical wound dressing in general
Surgical site infections are the surgical wards at Pondicherry Institute of
second most common nosocomial (hospital- Medical Sciences. In this study 30 health
acquired) infection and are responsible for care professionals participated i.e. 15
longer hospital stays and increased costs to medical interns and 15 staff nurses.
the patient and hospital. Approximately Purposive sampling method was adopted.
80% of these wounds use some form of For this study the list of medical interns who
closure product: sutures, staples, and tapes. are posted in the general surgical ward was
Many employ hemostasis products, and use obtained from the department of general
fabric bandages and surgical dressings. A surgical and for the staff nurse from nursing
recent survey was conducted in India to office.
estimate the prevalence rate of chronic Criteria for sample selection
wounds; it was 4.5 per 1000 population. [4] Inclusion Criteria
Surgical wounds account for the vast  Medical interns and staff nurses who are
majority of skin injuries. A Study estimated doing surgical wound dressing.
that over 234 million major surgical  Both male and female medical interns
procedures are performed all over the world and staff nurses.
every year. [5] In the US each year 750,000 Exclusion Criteria
gall bladder surgeries, 20 million hernia  Health care professionals who are doing
surgeries, 100,000 to 120,000 radical dressing on infected surgical wound.
prostatectomy surgeries, one million Total of 15 medical interns and 15 staff
cholecystectomies, 150,000 gastric bypass nurses were selected using purposive
surgeries were performed. [6] So it is sampling method. Group consent was
considered that use of aseptic techniques is obtained from the participants and the
necessary for creating a healthy observer’s identity was not revealed
environment in health care setting. throughout the study.
Objectives Instruments used:
1. To assess the practice of aseptic There are 4 types of tools used in this study
techniques on surgical wound dressing and they are as follows:
among medical interns and staff nurses. 1. Tool I - Observational Checklist for
2. To identify the factors influencing the aseptic techniques on surgical wound
standard of practice followed in aseptic dressing by Medical Interns.
techniques on surgical wound dressing 2. Tool II - Observational Checklist for
among medical interns and staff nurses. aseptic techniques on surgical wound
3. To find out the association between the dressing by Staff Nurses.
level of practice on aseptic techniques 3. Tool III – Self administered questionnaire
with study variable of medical interns, for medical interns
staff nurses and their study clients. 4. Tool IV- Self administered questionnaire
for staff nurses.
Formal administrative permission
was obtained from Institutional Review

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Dhanasundari. G et.al. The Practice of Aseptic Techniques on Surgical Wound Dressing By Health Care
Professionals

Board (IRB No. 1601 dated 03.05.2016), RESULTS

and concerned authorities. The nature and Section A: Distribution of Medical
purpose of the study was explained to the Interns and staff nurses according to
medical interns by Dean UG medical study variables.
college and head of general surgery Table – 1 : Distribution of medical interns according to study
variables. n = 15
department and for the staff nurses the study S. No. Study variables Frequency Percentage
was explained by Nursing Superintendent in I Medical Interns
1. Age (in year)
the group and the group consent (verbal 21 – 22 6 40
consent) was obtained for the observation of 23 – 24 9 60
2. Gender
practice on surgical wound dressing. 15 Male 8 53
medical interns and 15 staff nurses were Female 7 47
selected using purposive sampling 3. Area of work
Male surgical ward 9 60
technique. Female surgical ward 6 40
The data collection was done in
September and October 2016. Each medical Table 1 revealed that nine (60%) of the
intern was observed for 23 steps on practice medical interns were in the age group of 23-
of aseptic techniques on surgical wound 24 years, six (40%) of them were in the age
dressing using observational checklist. group of 21-22 years. With regard to gender
Researcher used participative and non eight (53%) of them were males and seven
participative observational technique to (47%) of them were females. Nine (60%) of
observe the level of practice for aseptic them performed surgical dressing in the
techniques on surgical wound dressing by male surgical ward and six (40%) in female
medical interns. If the step was correctly surgical ward.
performed one score was given and zero
score for the steps that were not followed. Table 2 : Distribution of staff nurses according to study
variables n=15
Each staff nurse was observed for 24 steps
S. No Study Variables Frequency Percentage
on practice of aseptic techniques on surgical I Staff Nurses
wound dressing using observational 1. Age (in years)
20 – 23 6 40
checklist and same scoring procedure was 24 – 26 9 60
followed. Researcher used non participative 2. Gender
observational technique to observe the staff Male 1 7
Female 14 93
nurses practice on surgical wound dressing. 3. Educational Qualification
Participant information sheet was B.Sc nursing 14 93
GNM 1 7
provided and written consent was obtained 4. Experience
from medical interns and staff nurses before < 1 yrs 1 7
collecting information on self administered 1- 3 yrs 10 67
> 3- 5 yrs 4 27
questionnaire. Study variables and 5. Area of work
contributing factors that hinder the practice Male surgical ward 11 73
Female surgical ward 4 27
of aseptic techniques on surgical wound 6. Formal In-service Training received
dressing were obtained from medical interns Yes 2 13
No 13 87
and staff nurses using self administered
questionnaires. The researcher identity was
not revealed throughout the observation. Table 2 revealed that nine (60%) of them
The collected data was analyzed to find out were in the age group of 24 – 26 years. With
the practice of aseptic techniques on regard to gender 14 (93%) of them were
surgical wound dressing among health care females, with regard to educational
professionals. qualification 14 (93%) of them had
completed B.Sc. nursing degree. Among 15
staff nurses 10 (67%) had clinical
experience between 1-3 yrs, 11 (73%) were

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Dhanasundari. G et.al. The Practice of Aseptic Techniques on Surgical Wound Dressing By Health Care
Professionals

working in male surgical ward. With regard medical interns, one (7%) participant had
to formal in service training on aseptic inadequate practice, majority 13 (87%) of
training or infection control measures 13 them had moderately adequate practice and
(87%) of them did not have any formal one (7%) had adequate practice.
training on aseptic techniques or infection n = 15

control measures. LEVEL OF PRACTICE

Section B: Level of practice by medical Adequate (85.1 -
interns and staff nurses on surgical 100%)
wound dressing Moderately Adequate
n = 15 (60.1 - 85 %)

Fig. 2: Percentage distribution of staff nurses according to the

level of practice on surgical wound dressing.

Figure 2 shows the level of practice of

aseptic techniques on surgical wound
dressing by staff nurses. Majority Nine
Fig. 1: Percentage distribution of medical interns according to
the level of practice on surgical wound dressing.
(60%) of the staff nurses had moderately
adequate practice and Six (40%) of them
Figure 1 shows the level of practice of had adequate practice.
aseptic techniques on surgical wound
dressing by medical interns. Among 15

Section C: Distribution of factors influencing the practice of aseptic techniques on

surgical wound dressing by staff nurses.
Table 3 (a): Frequency and percentage distribution of staff nurses according to the factors influencing the practice before the
surgical wound dressing. n = 15
S. BEFORE THE PROCEDURE Steps Yes No Influencing
No factor
(no.) (%) (no.) (%) A B C D
1. I explain the procedure to the patient. 15 100 - - - - - -
2. I provide privacy. 15 100 - - - - - -
3. Place the patient in a comfortable position that provides easy access to the 13 87 2 13 - 2 - -
wound.
4. Arrange all the equipments such as dressing trolley with needed articles, waste 15 100 - - - - - -
bin near to the patient bed side
5. Checked the expiry date on the sterile dressing pack and solutions used for 14 93 1 7 - 1 - -
cleaning the wound.
6. Placed the unsterile objects separate from the sterile field. 11 73 4 27 - 1 - 3
7. Place sterile dressing tray on a clean and dry trolley. 14 93 1 7 - 1 - -
8. Place waterproof pad under the wound site. 14 93 1 7 - - - 1
9. Switch off the fan near the patient bed side. - - 15 100 6 4 5 -
10. Remove rings/ bracelets/ wrist watch before hand washing. 10 67 5 33 - 2 3 -
11. Wash hands with soap and water for 40-60 seconds and dried the hands / hand 33 - 2 3 -
rubbed with alcohol based solution for 20-30 seconds before the procedure. 10 67 5
12. Wear face mask throughout the procedure. 13 87 2 13 - - 2 -
A- Patient/Physician request, B - No time, C- Negligence, D- Inadequate materials

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Dhanasundari. G et.al. The Practice of Aseptic Techniques on Surgical Wound Dressing By Health Care
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Table 3 (a) revealed the influencing factors listed by staff nurses such as the patients/
physician requested not to switch off the fan, forgot and no time, unavailability of
equipments, not necessary to follow few steps.

Table 3 (b): Frequency and percentage distribution of staff nurses according to the factors influencing the practice during the
surgical wound dressing. n = 15
S. DURING THE PROCEDURE Steps Yes No Influencing
No factor
(no.) (%) (no.) (%) A B C D
1. Open the glove pack without touching the inside of the wrapper. 15 100 - - - - - -
2. Open the outer layer of the sterile dressing pack and ensure it didn’t touch any 15 100 - - - - - -
surface other than trolley.
3. Hold the cleaning solution bottle approximately 6 inches above sterile bowl 11 73 4 27 - 3 1 -
while pouring the solution.
4. Keep the sterile pack dry without becoming wet while pouring solution 13 87 2 13 - 1 1 -
5. Drop the sterile articles gently to the sterile field without touching any articles. 14 93 1 7 - - 1 -
6. Do not touch the sterile dressing tray / articles using bare hands. 14 93 1 7 - 1 - -
A- Patient/Physician request, B - No time, C- Negligence, D- Inadequate materials.

Table 3 (b) shows the influencing factors listed by staff nurses such as no time and not
necessary to follow few steps.

Table 3 (c): Frequency and percentage distribution of staff nurses according to the factors influencing the practice after the surgical
wound dressing. n = 15
S. AFTER THE PROCEDURE Steps Yes No Influencing
No factor
(no.) (%) (no.) (%) A B C D
1. Place the patient in a comfortable position 15 100 - - - - - -
2. Remove used dressing tray and remaining equipments from patient side 15 100 - - - - - -
immediately after the dressing.
3. Dispose soiled dressing in yellow bin and gloves and tubings in red bin 14 93 1 7 - - - 1
4. Wash reusable articles to be sent for sterilization. 15 100 - - - - - -
Wash hands with soap and water for 40-60 seconds and dried the hands/ hand
5. rubbed with alcohol based solution for 20-30 seconds after the procedure. 10 67 5 33 - 5 - -
Document the date and time of the procedure, nature of the wound and
6. drainage, solutions used and patient condition. 14 93 1 7 - 1 - -
A- Patient/Physician request, B - No time, C- Negligence, D- Inadequate materials

Table 3 (c) revealed the influencing factors listed by staff nurses such as no time to do hand
wash and documentation after the procedure and no adequate bin to dispose the soiled
dressing.

SECTION D: ASSOCIATION BETWEEN THE LEVEL OF PRACTICE ON

ASEPTIC TECHNIQUES WITH SELECTED STUDY VARIABLES.
Section D (I): Association between the level of practice on aseptic techniques with study
variable of medical interns and study clients.
Table 4: Association between the level of practice on aseptic techniques with study variable of medical interns and their study
clients. n = 15
Level of Practice
S.No Study Variables Inadequate Moderately adequate Adequate Fisher’s Exact Test
(0-60%) (60-85%) (>85%)
I Medical Interns
1. Gender
a) Male 0 7 1 1.892
b) Female 1 6 0 NS
II Study Clients
2. Surgery
Minor 0 11 1 3.660
Major 1 2 0 NS
3. Number of post operative days
a) 0 - 10 days 0 7 1 1.893
b) 11 - 20 days 1 6 0 NS
NS – Not significant

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Fisher’s Exact test was used to find out the association between the level of practice on
aseptic techniques with study variable of medical interns and study subjects. Table 4 revealed
that there is no statistically significant association between the level of practice on aseptic
techniques with gender of medical interns, surgery and number of post operative days of
study clients.

Section D (II): Association between the level of practice on aseptic techniques with
selected study variables of staff nurses and study clients.
Table 5: Association between the level of practice on aseptic techniques with selected study variables of staff nurses and study
clients. n = 15
Level of Practice
S. No Study Variables Moderately adequate Adequate Fisher’s Exact Test
(60-85%) (>85%)
I Staff Nurses
1. Age ( in years)
a) 20– 23 5 1 0.287
b) 24 - 26 4 5 NS
2. Experience ( in month)
a) 1- 24 months 5 1 0.287
b) 25 - 48 months 4 5 NS
3. Area of work
a) Male surgical ward 6 5 0.604
b) Female surgical ward 3 1 NS
II Study Clients
4. Surgery
Minor 6 5 0.604
Major 3 1 NS
5. Number of post operative days
a) 0 - 10 days 0.467
b) 11 - 20 days 0 8 NS
1 6
NS – Not significant

Fisher’s Exact test was used to find out the adequate practice and Six (40%) of them
association between the level of practice on had adequate practice. Among 15 medical
aseptic techniques with selected study interns, one (7%) participant had inadequate
variables and study subjects. Table 5 practice, majority 13 (87%) of them had
revealed that there is no statistically moderately adequate practice and one (7%)
significant association between the practice had adequate practice. Nurses and doctors
on aseptic techniques with age, experience who perform surgical dressing need to
and area of work of staff nurses, surgery and follow asepsis to prevent the surgical site
number of post operative days of study infections. A study was conducted on
clients. prevention of post-operative wound
infection in accordance with evidence based
DISCUSSION practice. The study includes staff nurses and
Surgical site infections are caused by facilitators from the female surgery ward.
not following proper aseptic technique. A The skill of doing procedure systematically
prospective study was conducted on Post in the pre test was only 58.57% but the
Surgical Wound Infections in a Tertiary posttest shows improvement that is 100%.
Care Hospital in Kanchipuram among 30 Therefore there was significant
patients. All the pus swabs were processed improvement in developing evidence based
and identified as per standard methods of skill of doing procedure. [8]
identification. The rate of surgical site In this present study the staff nurses
infections in this study was 8.3%. The rate reported that they do not have time to follow
of surgical site infections was higher all the steps of the procedure in emergency,
(73.3%) in emergency surgeries than the forgot to do some steps, unavailability of
elective surgeries. [7] In the present study equipments and need not to follow few steps
Nine (60%) staff nurses had moderately in the procedure. A descriptive study was

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conducted to explore the Cypriots surgical- University, Chennai. A total of 100 staff
oncology nurse’s perceptions on nurses have been taken from the selected
postoperative wound management and to hospital. A very highly significant (t=31.74,
identify factors involved in decision-making p<0.05) difference was observed between
on this topic. The absence of nurse’s up-to- the pre-test and post-test knowledge scores
date knowledge and the absence of wound of staff nurses in the areas of aseptic wound
care guidelines appear to negatively dressing practices. [12] A descriptive study
influence the postoperative wound care was conducted to assess wound dressing
decision-making. Furthermore, the performances among nursing personnel in
influencing role of the doctors in deciding three surgical wards of Olabisi On Shagamu
how to manage postoperative wounds is one Ogun State Nigeria. Nurses have a very
of the factors that nurses identified as a good performance of concepts/principles of
negative influence to their autonomy. sterile technique in the performance of the
Workload was identified as a major factor procedure. Significant difference was found
that influences the quality of postoperative between length of clinical experience and
wound care and maximizes the occupational practice of wound dressing. [13] So frequent
risks in nurse’s area of practice. [9] A training is needed for the nurses to follow
descriptive study was conducted on the aseptic techniques and prevent the
Knowledge, Attitude and Practice regarding surgical site wound infections.
Universal Precautions among nursing
personnel. The study was conducted in the CONCLUSION
Government Multi-Specialty Hospital The present study assessed the
Sector 16 Chandigarh in 2006 and 2007. In practice of aseptic techniques on surgical
the practice score 38.7% of subjects wound dressing by health care professionals
reported the universal precautions to be time in general surgical wards. The practice was
consuming whereas 26% of them did not observed by using observational checklist
take it as time consuming while at the same and self administered questionnaire. The
time 21.3% of the total subjects did not current study revealed that majority of the
attempt the question. [10] A descriptive study medical interns and staff nurses had
was conducted to assess the knowledge and moderately adequate level of practice of
practices of aseptic techniques applied in aseptic techniques on surgical wound
nursing practice among staff nurse working dressing. Therefore the study concluded that
in selected hospital, Ahmednagar. Finding there is a need for continuous education and
revealed that overall knowledge mean score reinforcement of aseptic techniques on
was 11.56 ± 2.37 which is 57.80 % of the surgical wound dressing among health care
total score. It interprets that the staff nurses professionals to improve their practice.
had good level of knowledge of aseptic
techniques applied in nursing practice. It ACKNOWLEDGEMENTS
interprets that the staff nurses maintain very We would like to thank the Management and
good practices of aseptic techniques applied Members of Institutional Review Board,
in nursing practice. However overall College of Nursing, Pondicherry Institute of
Medical Sciences for granting us permission to
practices mean score for no was 4.97 ± 3.12 conduct the study. We also thank all the study
which is 24.60%. It is essential to raise participants for spending their valuable time to
awareness about aseptic techniques in answer the questions.
providing nursing care to patients. [11]
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How to cite this article: Dhanasundari. G, Malarvizhi. S, Samson R et.al. The practice of aseptic
techniques on surgical wound dressing by health care professionals. Int J Health Sci Res. 2018;
8(12):81-88.

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