Nurses’ Surgical Site Infection Prevention Practices in Bangladesh

Main Article Content

Humaun Kabir Sickder
Wanchai Lertwathanawilat
Hunsa Sethabouppha
Nongkran Viseskul


                 Nurses play a significant role in providing quality care and in preventing surgical site infection. However, a thorough literature review revealed a lack of empirical studies regarding surgical site infection prevention in Bangladesh.  The objectives of this study were to identify nurses’ practices and their barriers and facilitators for surgical site infection prevention, and to propose direction for improving nurses’ practices for such prevention.  A mixed method design was used, using the Social Ecological Model as a framework.  The quantitative phase of the study was conducted using a questionnaire survey with 233 randomly selected registered nurses who were working in 3 tertiary-level hospitals.  The descriptive qualitative phase was conducted with 22 registered nurses utilizing focus groups, and with 3 nurse administrators utilizing in-depth interviews. The data were analyzed using descriptive statistics for quantitative data and content analysis for qualitative data.
               The findings showed that less than half of the nurses always practiced surgical site infection prevention.  Four barriers were insufficient knowledge, insufficient resources and budget supply, insufficient performance monitoring system, and lack of a surveillance system.  Two facilitators were team willingness and team support of nurses’ practices. Nurses should adhere to surgical site infection preventive practices in aspects of preoperative shaving; prophylactic antibiotic administration; and hand hygiene.  The PEAK Model is proposed for improving nurses’ practices for surgical site infection prevention but requires further testing in Bangladeshi hospitals.

Article Details

How to Cite
Sickder HK, Lertwathanawilat W, Sethabouppha H, Viseskul N. Nurses’ Surgical Site Infection Prevention Practices in Bangladesh. PRIJNR [Internet]. 2017 Jul. 10 [cited 2022 May 19];21(3):244-57. Available from:
Original paper


1. World Health Organization (WHO). WHO guidelines for safe surgery. WHO . 2009; Geneva.

2. Lissovoy GD, Fraemen K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical infection: Incidence and impact on hospital utilization and treatment cost. American Journal of Infection Control. 2009; 37: 387-397.

3. Tanner J, Dumvile JC, Norman G Fortnam M. Surgical hand antisepsis to reduce surgical site infection. Cochrane Database of Systematic Reviews. 2016; 1: doi: 10.1002/1465 1858.CD004288.pub3.

4. World Health Organization (WHO). Global guidelines for the prevention of surgical site infection. WHO. 2016; Geneva.

5. Nur-e-elahi M, Jahan I, Siddiqui O, Ahmed SU, Joarder AI, Faruque S. et al. Wound infection in surgery department in bsmmu: A study of 100 cases. Journal of the Bangladesh Society of Anaesthesiologists. 2011; 24(2): 65-69.

6. Faruquzzaman, Mazumder SK, Haque MJ, Akter SU. Surgical site infections in relation to the timing of shaving among the gastrointestinal emergency patients through the midline incisions. Dinajpur Medical College Journal. 2012; 5: 39-46.

7. Harrington P. Prevention of surgical site infection. Nursing Standard. 2014; 28(48): 50-58.

8. Linda RG. Preventing surgical-site infections. American Nurses Today. 2015; 10(9). Available from https:// 09/ Special-Report-INFECTION_Surgical.pdf

9. Mangram AJ, Horan TC, Pearson ML, Silver L C, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital infection control practices advisory committee. Infection Control & Hospital Epidemiology. 1999; 20: 250-278.

10. National Institute for Health and Clinical Excellence (NICE). Surgical site infection: Prevention and treatment of surgical site infection. UK: NICE 2008, NICE publications.

11. Demir F. A Survey on prevention of surgical infections in operating theaters. Worldviews on Evidence-Based Nursing. 2009; 6(2): 102–113.

12. Zingg W, Holmes A, Dettenkofer M, Goetting T, Secci F, Clack L, et al. Hospital organization, management, and structure for prevention of health-care-associated infection: A systematic review and expert consensus. Lancet Infectious Diseases. 2014. Available from S14 73-3099(14)70854-0

13. Bono SD, Heling G, Borg MA. Organizational culture and its implications for infection prevention and control in healthcare institutions. Journal of Hospital Infection. 2014; 86: 1-6.

14. Weiser TG, Haynes AB, Molina G, Lipsitz ST, Esquivel MM, Uribe-Leitz T, et al. Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. The Lancet. 2015; 385(S11) [Cited 27 April 2015]. Available from https://www.thelancet. com/journals/lancet/ article/PIIS0140-6736(15)60806-6/fulltext

15. Centers for Disease Control and Prevention. CDC/NHSN surgical site infection (SSI) event.2014 [Jan 1 2014]. Available from pscmanual/9 pscssicurrent. pdf

16. Magill SS, Hellinger W, Cohen J, Cohen J, Key R, Bailey C, et al. Prevalence of healthcare-associated infections in acute care hospitals in Jacksonville, Florida. Infect Control & Hospital Epidemiology. 2012; 33(3): 283-291.

17. Bagadasarian N, Schmadeer K E, Kaye KS. The Epidemiology and Clinical Impact of Surgical Site Infections in the Older Adult. Current translational geriatrics and experimental gerontology reports. 2013; 2: 159–166.

18. Smith MA, Dahlen NR. Clinical practice guideline surgical site infection prevention. Orthopaedic Nursing. 2013; 32(5): 242-247.

19. Cahill JL, Shadbolt B, Scarvell JM, Smith PN. Quality of life after infection in total joint replacement. Journal of Orthopaedic Surgery. 2008; 16(1): 58-65.

20. Famakinwa TT, Bello BG, Oyeniran YA, Okhiah O, Nwadke RN. Knowledge and practice of post-operative wound infection prevention among nurses in the surgical unit of a teaching hospital in Nigeria. International Journal of Basic, Applied and Innovative Research. 2014; 3(1): 23 – 28.

21. Teshager FA, Engeda E H, Worku WZ. Knowledge, Practice, and Associated Factors towards Prevention of Surgical Site Infection among Nurses Working in Amhara Regional State Referral Hospitals, Northwest Ethiopia. Surgery Research and Practice. 2015 [30 November 2015]. Available from

22. Labeau S, Witdouck S, Vandijck D, Claes B, Rello J, Vandewoude K, et al. Nurses’ knowledge of evidence-based guidelines for the prevention of surgical site infection. Worldviews on Evidence-Based Nursing. 2010; 7(1): 16–24.

23. Hadley MB, Roques A. Nursing in Bangladesh: Rhetoric and reality. Social Science & Medicine. 2007; 64: 1153-1165.

24. Bronfenbrenner U. Ecological models of human development. In International Encyclopedia of Education (2nd ed.). Oxford: Elsevier; 2008

25. Sarani H, Balouch A, Masinaezhad N, Ebrahimitabs, E. Knowledge, attitude and practice of nurses about standard precautions for hospital-acquired infection in teaching hospitals affiliated to Zabol University of medical sciences (2014). Global Journal of Health Science. 2016; 8(3): 193-198.

26. Dalheim A, Harthug S, Nilsen R, Nortvedt M. Factors influencing the development of evidence-based practice among nurses: A self-report survey. BMC Health Services Research. 2012, 12 (367) [15 October 2012]. Available from https:// 1472-6963/12/367 Sp

27. Israel GD. Determining sample size. 2013. Available from https://edis.ifas.ufl. edu/pdffiles /PD/PD00600.pdf

28. Sickder HK, Sae-Sia W, & Petpichetchian W. Nurses’ knowledge and practice regarding prevention of surgical site infection in Bangladesh. 2010 [Cited 10 April 2010]. Available from https://sv.libarts. proceedings/ Proceedings2/article/ 6pdf/005.pdf

29. Lincoln YS, Guba EG. Naturalistic inquiry. Newbury Park, CA: Sage Publications; 1985

30. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004; 24: 105–112.

31. Anderson DJ, Podgomy K, Berrios-Torres S, Bratzler DW, Dellinger EP. Greene L, et el. Strategies to prevent surgical site infection in acute care hospital. Infection Control & Hospital Epidemiology. 2014; 29: S51-S61.

32. Petrosillo N, Drapeau CMJ. Nicastri E. Martini L, Ippolito G, Moro ML. Surgical site infections in Italian Hospitals: a prospective multicenter study, BMC Infectious Diseases. 2008; 8: doi:10.1186/1471-2334-8-34

33. Adams SA, Mattheews CE, Ebbeling CB, Moore CG, Cunningham JE, Fulto J, Hebert JR. The effect of social desirability and social approval on self-report of physical activities. American Journal of Epidemiology. 2005; 161: 389-398.

34. Marwati1 T, Subiyanto AA., Mardikanto T, Priyambodo, Wibowo M, Qomariyah N. The impact of surgical site infection to the health care cost. International Journal of Public Health Science. 2016; 5(2): 129 -133.

35. Tirivanhu C, Ancia M, Petronella S. Barriers to infection prevention and control (IPC) practice among nurses at Bindura Provincial Hospital, Zimbabwe. Journal of Nursing and Health Science. 2014; 3(1): 69-73.

36. Bonham CA, Sommerfeld D, Willging C, Aarons GA. Organizational factors influencing implementation of evidence-based practices for integrated treatment in behavioral health agencies. 2014[Cited Mar 3 2014]. Available from

37. Du-Plessis MAR. Determining professional nurses’ knowledge on the performance management and development system in Tshwane. Curationis. 2015; 38(1): 1186-1193.

38. Andrea S, Verna B. Good practice guide to performance management for nurses and midwives in Victorian public health services. 2013. Available from file:///C:/Users/ aio/Downloads/Final-guide_April-2013.pdf

39. Sinkowitz-Cochran RL, Burkitt KH, Cuerdon T, Harrison C, Gao S, Obrosky DS, et al. The associations between organizational culture and knowledge, attitudes and practices in multicenter Veterans Affairs quality improvement initiative to prevent methicillin-resistant Staphylococcus aureus. American Journal of Infection Control. 2012; 40:138-143.

40. Griffiths P, Renz A, Hughes J, Rafferty AM. Impact of organization and management factors on infection control in hospitals: A scoping review. Journal of Hospital Infection. 2009; 73: 1-14.

Most read articles by the same author(s)

1 2 > >>