1

Introduction

Surgical site infections (SSI) are infections that usually develop within 30 to 90 days after surgical interventions and are among the most common complications after surgery. SSI are closely associated with high mortality and morbidity rates and are mostly caused by the transmission of bacteria and other pathogens found in the skin flora to surgical sites. SSI, which is accepted as an important risk factor in terms of patient safety worldwide and in our country, increases mortality and morbidity rates and causes serious economic losses. These infections, which attract attention with an incidence of 15 % to 30 % among healthcare-associated infections, constitute a serious health problem. SSI are classified into three categories as superficial incisional, deep incisional and organ/cavity infections. ^, These infections are considered as an important health problem because they prolong hospital stay and increase treatment costs. In addition, SSI can lead to negative consequences such as pain, discomfort, loss of income and decreased quality of life for patients, and can take place in a spectrum ranging from a simple incision site abscess to life-threatening complex infections. The fact that SSI development increases morbidity and mortality rates and leads to high costs has caused surgical research to focus on this issue. Therefore, it is critical to know the risk factors well and take the necessary precautions to prevent SSI, which is one of the main problems of modern surgery.

Surgical site infections (SSI) are one of the types of infections that occur after surgical intervention and threaten patient safety. These infections are directly related to the surgical procedure and are considered a special subcategory of hospital infections. Preventing SSIs is an area of responsibility that directly affects surgical nurses’ knowledge and practices regarding infection control. Nurses’ competence in infection control with evidence-based practices is critical in reducing the risk of these infections and making a positive contribution to patient health. Continuous updating of surgical nurses’ knowledge and skills for the prevention of SSIs also contributes to reducing overall healthcare costs. The level of knowledge of nurses working in surgical units about SSI plays a vital role in preventing infections in the hospital environment and improving the quality of patient care. In this context, it is of great importance to determine and evaluate the level of knowledge of surgical nurses about SSI. Based on all these data, this study was conducted to evaluate the knowledge levels of nurses working in surgical units about SSI.

2

Material and method

The study was conducted as a descriptive and cross-sectional study to examine the knowledge levels of nurses working in surgical clinics (general surgery, urology, neurosurgery, neurosurgery, cardiovascular surgery, otolaryngology, thoracic surgery, orthopedics, paediatric surgery, plastic surgery) and surgical intensive care units (general surgery, neurosurgery, cardiovascular and reanimation intensive care) about SSI. Statement for Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used for reporting the study.

3

Findings

Demographic data of the participants are analysed in Table 1 . It was found that 78.9 % of the participants were female, 40.1 % were in the 25–34 age range, and 34.5 % had a bachelor’s degree. The working style of 40.1 % of the participants was day+night, 45.8 % had a total working period of 1–10 years, and 39.4 % had a working period of 1–10 years in the surgical clinic. 72.5 % of the participants had received training on SSI in the institution. The mean number of correct answers given by the participants to the questions about SSI was 20±2.4 (min=12, max=24) and the mean number of incorrect answers was 8 ± 2.4 (min=4, max=16) ( Table 1 ).

The distribution of the participants’ answers to the questions related to SSI was analysed ( Table 2 ). When the distribution of responses given by the nurses participating in the study to the Likert items was examined; when the correct answers given by the participants to the questions were evaluated, it was seen that the highest rate of 142 (100 %) participants answered the 7th question correctly, followed by 140 (98.6 %) participants who gave correct answers to questions 18 and 24. When we look at the question with the highest number of incorrect answers, it was found that 124 (87.3 %) people gave incorrect answers to 2 questions, followed by 111 (78.2 %) people who gave incorrect answers to 4 questions ( Table 2 ).

Table 2

Analysis of the distribution of participants’ responses to questions regarding CAE.

Questions	TRUE		Wrong		I don’t know
	n	%	n	%	n	%
1. Hands should be washed before and after contact with the patient.	139	97.9**	3	2.1	0	0
2. Washing hands after aseptic procedures is sufficient, there is no need to wash hands beforehand (IV, urinary, NG catheter insertion, removal, etc.)	18	12.7	124	87.3**	0	0
3. Those who do not want to wash their hands can ensure adequate hand hygiene by rubbing their hands with alcohol-based hand disinfectants.	54	38	84	59.2**	4	2.8
4. Surgical sets can be reused without sterilization if they are properly closed after use.	28	19.7	111	78.2**	3	2.1
5. If the surgical area needs to be cleaned of hair before the surgery, this should be done as close as possible to the surgery time.	90	63.4**	39	27.5	13	9.2
6. Taking a shower before surgery does not affect the risk of postoperative infection.	35	24.6	94	66.2**	13	9.2
7. The nurse should pay attention to the signs and symptoms of surgical site infections after surgery (swelling, redness, discharge, pain and fever).	142	100**	0	0	0	0
8. When providing wound care, attention should be paid to the nature of the wound (clean, clean-contaminated, contaminated, infected).	133	93.7*	9	6.3	0	0
9. The nurse should inform the patient and their relatives about the detection of surgical site infections in the hospital and after discharge.	133	93.7**	7	4.9	2	1.4
10. When signs and symptoms of infection are observed, the infection nurse should be contacted.	119	83.8**	19	13.4	2	1.4
11. The nurse does not need to follow the patient’s culture results; this process is the doctor’s responsibility.	63	44.4	77	54.2**	2	1.4
12. The nurse takes appropriate isolation precautions according to the microorganism grown in the culture results. (contact, close contact, droplet, respiratory)	136	95.8**	6	4.2	0	0
13. If there is a possibility of contact/splash with blood and body fluids of patients, standard precautions should be applied. (gloves, apron, mask and glasses)	134	94.4**	8	5.6	0	0
14. Patients who will undergo surgery must clean their hair before the surgery.	112	78.9	29	20.4**	1	0.7
15. The most suitable method for cleaning the hair is to clean the hair with a shaving machine.	99	69.7**	33	23.2	10	7
16. Taking a shower before surgery to remove visible dirt from the environment is a precaution to reduce the risk of post-operative infection.	129	90.8**	7	4.9	6	4.2
17. The preoperative preparation and postoperative care of the patient is the responsibility of the nurse.	138	97.2**	4	2.8	0	0
18. When performing wound care, hands should be disinfected and wound dressing should be done by wearing sterile gloves.	140	98.6**	2	1.4	0	0
Serous discharge from the wound during dressing is a sign of infection.	95	66.9	38	26.8**	9	6.3
20. Placing a perneus drain in the wound area after surgery does not pose a risk of infection.	24	16.9	102	71.8**	16	11.3
21. Perneus drains are a suitable method for draining the discharge from the wound site.	110	77.5	25	17.6**	7	4.9
22. Monitoring and recording of drains is not a matter that concerns the nurse, it is the responsibility of the doctor.	40	28.2	100	70.4**	2	1.4
23. Green suits worn in the operating room are heavily infected with microorganisms, so these suits should not be worn in the ward.	138	97.2**	2	1.4	2	1.4
24. The operating room door should be kept closed to prevent unnecessary entries and exits and to eliminate the risk of infection.	140	98.6**	1	0.7	1	0.7
25. In clean wounds with no signs of infection, there is no need to dress after the first 48 h, the wound is left open and allowed to heal that way.	50	35.2**	78	54.9	14	9.9
26. If the wound is dirty, the surrounding area should be cleaned with alcohol and the wound itself should be cleaned with povidone iodine.	74	52.1	65	45.8**	3	2.1
27. Post-discharge patient education should be given to the patient and family by nurses.	131	92.3**	9	6.3	2	1.4
28. Infections that occur after discharge are not included in the hospital infection group; they are considered as infections caused by the patient himself.	78	54.9	57	40.1**	7	4.9

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