EXPLORING CHALLENGES REGARDING THE SURGICAL HAND SCRUBBING, GOWNING AND GLOVING IN THE OPERATING THEATRE OF A HOSPITAL IN SWAZILAND BY THELMA SMANGELE DLAMINI A Dissertation submitted in partial fulfilment of the requirements for the degree of MAGISTER CURATIONIS In the Department of Nursing Science School of Healthcare Sciences Faculty of Health Sciences University of Pretoria Supervisor: Dr C Maree Co- Supervisor: Ms V Bhana January 2015 APPROVAL This research project is the Master’s degree thesis, full dissertation of Thelma Smangele Dlamini in the Department of Nursing, Faculty of Health Sciences University of Pretoria. This work has been approved by the following intellectual ……………………………………… ………………………………………… Supervisor Date …………………………………………………… ………………………………… Internal Examiner Date …………………………………………….………………………………………… External Examiner Date ………………………………………………… …………………………………… Head of Nursing Department Date i ACKNOWLEDGEMENTS I would like to thank the almighty GOD for giving me the strength, courage and sound health, without which this work would not have been completed. Again, I want to extend my sincere and hearty gratitude to all the people who contributed towards the success of this study, especially to: • Dr C. Maree, my supervisor for her guidance, patience, support and encouragement, • Ms V. Bhana, my co supervisor, • The surgical teams and the hospital management who are concerned in this study, • The administration of the hospital where data was collected for granting me permission to conduct the study, • The University of Swaziland, Faculty of Health Sciences for the continuous support, • S. Masuku for her unremitting encouragement and succour, • M. Ndayisicaba, my cousin and friend for her assistance with accommodation, • My colleagues at work for their contribution and support. Finally, my thanks are due to my family both the Dlamini and Mhlongo family, my son, daughter and nephew - their support has always been a source of empowerment “GOD BLESS YOU ALL” ii DECLARATION STUDENT NUMBER: 11293323 I, Thelma Smangele Dlamini, hereby declare that: EXPLORING CHALLENGES REGARGING THE SURGICAL HAND SCRUBBING, GOWNING AND GLOVING PROCEDURE IN THE OPERATING THEATRE OF A HOSPITAL IN SWAZILAND Is my original work, all the sources that I have quoted in this document are indicated and acknowledged by means of complete references and that this work has not been submitted before for any degree or examination at any other academic institution. ………………………………………………… …………………………………… THELMA SMANGELE DLAMINI Date iii ABSTRACT Background of the study The operating theatre is a controlled environment where surgical teams have to adhere strictly to the infection control principles. If infection control principles are not applied correctly or adhered to in the operating theatre, it can lead to contamination and infection of the surgical site. Surgical site infections are the third most common source of nosocomial infections in developing countries. In Swaziland, the incidence of surgical site infections was exceptionally high and a major cause of post-surgical complications as it accounts for about 12-18% of hospital acquired infections in all the regional hospitals. Surgical hand scrubbing is the process of removing as many microorganisms as possible from the hands of the sterile surgical team members before wearing a sterile surgical attire that consist of a sterile gown and sterile gloves. The antiseptics should conform to the agreed standards of infection control and principles of sterile technique to prevent contamination. Multiple factors influence the availability of the needed resources and the implementation of policies in an operating theatre such as the setting where the research was conducted. Aim of the Study The aim of this study was to explore and describe challenges faced by the surgical teams and the hospital management regarding the surgical hand scrubbing, gowning and gloving procedure in the operating theatre of a hospital in Swaziland. Research Objectives The objectives of the study were the following: iv • to explore and describe the challenges experienced by surgical teams regarding surgical hand scrubbing, gowning and gloving procedures in the operating theatre; • to explore and describe the challenges experienced by the hospital management regarding surgical hand scrubbing, gowning and gloving procedures in the operating theatre; and • to make recommendations to address the challenges regarding surgical hand scrubbing, gowning and gloving in the operating theatre of a hospital in Swaziland. Methodology A qualitative design was used. The population for this study was the surgical teams from all the surgical disciplines of the operating theatre and the hospital management which includes the operating theatre nurse managers and the administrative management of the hospital. Data were collected by means of focus group interviews, which were conducted separately for the hospital management and the surgical teams. Data analysis was through qualitative content analysis. Themes and subthemes that merged from the focus groups interviews with relevant literature were used to make recommendations to address the challenges experienced. Results of the Study Seven main themes were identified, which were related to the following: Management; Supplies; Physical Facilities; Equipment; Personnel knowledge, skills and attitude; Maintenance of infection control practices; and Process of surgical hand scrubbing, gowning and gloving. Recommendations Recommendations were made for clinical practice, education and research in order to improve surgical hand scrubbing, gowning and gloving procedure in the operating theatre. v Key Words: Surgical hand scrubbing, surgical teams, gowning, gloving, surgical site infection, hospital management and operating theatre. vi 1 Table of Contents CHAPTER ONE: OVERVIEW OF THE STUDY .............................................................. 1 1.1 INTRODUCTION ..........................................................................................................1 1.1 BACKGROUND AND RATIONALE .............................................................................2 1.3 PROBLEM STATEMENT ..................................................................................................4 1.4 SIGNIFICANCE OF THE STUDY ......................................................................................5 1.5 RESEARCH QUESTION ...................................................................................................5 1.6 AIM AND OBJECTIVES ....................................................................................................6 1.6.1 Research Aim ................................................................................................. 6 1.6.2 Research Objectives ..................................................................................... 6 1.7 CONCEPT CLARIFICATION ............................................................................................7 1.7.1 Surgical Team ................................................................................................ 7 1.7.2 Management ................................................................................................... 7 1.7.3 Surgical Hand Scrubbing .............................................................................. 8 1.7.4 Gowning ......................................................................................................... 8 1.7.5 Gloving ........................................................................................................... 8 1.7.6 Operating Theatre .......................................................................................... 8 1.7.7 Challenges...................................................................................................... 9 1.8 PHILOSOPHICAL ASSUMPTIONS ..................................................................................9 1.8.1 Ontological Assumptions ............................................................................. 9 1.8.2 Epistemological Assumptions .................................................................... 10 1.8.3 Methodological Assumptions ................................................................. 11 1.9 DELINEATION ................................................................................................................11 1.10 QUALITATIVERESEARCH DESIGN ............................................................................12 1.10.1 Explorative Research ................................................................................ 12 1.10.2 Descriptive Research ................................................................................ 12 vii 1.10.3 Contextual Design ..................................................................................... 12 1.10.4 Objective 1: Challenges experienced by surgical teams ....................... 15 1.10.5.Objective 2: Challenges experienced by the hospital management ..... 19 1.10.6 Objective 3: Recommendations to address the challenges ................... 21 1.11 TRUSTWORTHINESS ..................................................................................................21 1.12 ETHICAL CONSIDERATIONS ......................................................................................21 1.13 CONCLUSION ..............................................................................................................22 CHAPTER TWO: LITERATURE REVIEW ...................................................................