Nurses' practice in preventing postoperative wound infections: an observational study

OBJECTIVE: Surgical site infections (SSIs) are serious postoperative complications that may lead to undesired patient outcomes. Previous research has used survey and chart audit methods to describe wound care practices. However, little research has been published using contemporaneous observations to describe the surgical wound management practices of nurses. The aim of this study was to prospectively describe surgical nurses' postoperative wound care practices and the extent to which observed surgical wound practices aligned with evidence-based guideline recommendations. METHOD: In this cross-sectional prospective study, we observed a convenience sample of 60 nurses from four surgical units using a specifically developed observational audit tool. Inter-rater reliability for this tool was assessed during the observation period. RESULTS: Of 60 observed episodes of wound care, post-procedure hand hygiene (n=49, 81.7%) was less evident compared with pre-procedure hand hygiene practice (n=57, 95%). Over one-third of nurses observed did not correctly use clean gloves (n=16, 38.1%) and one in five did not properly use sterile gloves (n=4, 22%). More than half of surgical nurses (n=37, 61.7%) did not educate patients on post-discharge wound management. Fewer than a quarter (n=14, 23.3%) of wound care events were recorded on both wound assessment charts and patients' progress notes. Inter-rater reliability testing indicated good agreement (intra-class correlation coefficient 0.859; 95% CI: 0.771-0.923; p<0.0005). CONCLUSION: Despite surgical wound care guideline recommendations on aseptic technique compliance, patient education, wound assessment and documentation practices, there is a clear gap between recommended and observed wound care practice. This study highlights an area where clinical practice is not reflective of evidence-based recommendations, suggesting that to minimise SSI as an adverse event, practice should be evaluated and strategies incorporating evidence into practice are explored.