2. Title
• Adherence to Surgical Site Infection Prevention Bundle among
Operating room staff of Institute of Liver and Biliary sciences, New
Delhi.
3. Background of the study
• Surgical site infections (SSIs) are important events. They are one of
the most common nosocomial infections, occurring in 2–5% of the
estimated 30 million operations occurring annually.
• In India, total 1,88,82,734 surgeries were carried out during 2019-20
in the public health facilities. Out of them 48,51,788 and 1,40,30,946
were major and minor surgeries respectively. Among operated
surgeries 23,286 people had experience with surgical site infections
during the reference period at national level.
4. Need for the study
• Surgical site infections (SSIs) have become the most common
hospital-acquired infection (HAI) in recent years, accounting for
36.4% of infections reported to the Centers for Disease Control’s
(CDC) National Healthcare Safety Network (NHSN). According to the
NHSN, abdominal surgeries are the most common cause of SSIs
accounting for almost 50% and where liver transplant procedures
possesses the highest risk for SSI.
• The risk of contracting an SSI can be reduced by performing care
according to infection prevention guidelines, but literature shows that
adherence to these guidelines is repeatedly low.
5. Problem Statement
• An Observational study to assess the Adherence to Surgical Site
Infection Prevention Bundle among Operating room staff working at
Surgical Unit of Institute of Liver and Biliary sciences, New Delhi.
6. Objectives of the Study
Primary objective:
• To assess the Adherence to Surgical Site Infection Prevention Bundle
among Operating room staff working at surgical unit of Institute of Liver
and Biliary sciences, New Delhi.
Secondary objective:
• To find the association of adherence to Surgical Site Infection Prevention
Bundle with surgery related parameters among Operating room staff
working at surgical unit of Institute of Liver and Biliary sciences, New
Delhi.
7. Operational definitions
Assess:
• To examine for the purpose of evaluation and/or quality improvement.
(Mosby, 2009)
• In this study, assess refers to the evaluation of adherence to Surgical
Site Infection Prevention Bundle among Operating room staff.
8. Operational definitions
Adherence:
• The degree to which person’s behaviour corresponds with the agreed
recommendations. (WHO, 2003)
• In this study, Adherence refers to the extent to which Operating room staff
follow an agreed defined set of actions related to Surgical Site Infection
Prevention Bundle, which is measured by 48 items Surgical Site Infection
Prevention Checklist subdivided into three domains: 1. Pre-operative
observations, 2. Intra-operative observations, 3. Post-operative observations
which is graded into good adherence (>80%), moderate adherence (60%-
79%) and poor adherence (<60%) as per revised Bloom’s criteria.
10. Operational definitions
Surgical Site Infection Prevention Bundle:
• A set of key evidence-based Interventions for the prevention of
Surgical Site Infections that improve patient care and outcome when
used together. (CDC 2010)
• In this study, Surgical Site Infection Prevention Bundle refers to a set
of Evidence Based Interventions for the prevention of Surgical Site
Infection in order to improve patient care and outcome.
11. Operational definitions
Operating room:
• A set of specially equipped room, usually in a hospital, where surgical
procedures are performed (Collins 2022).
• In this study, Operating room refers to a theatre in the hospital
specially designed and equipped for performing the abdominal
surgeries.
12. Operational definitions
Operating room staff:
• Operating room staff is a team performing specific functions in coordination
with one another to create an atmosphere that best benefit the patient.
(Mosby, 2016)
• In this study, Operating room staff refers to a group of healthcare
professionals working in the Operating room consisting of Surgeons,
Anesthetists, Scrub nurses, Circulating nurses, Operating room technicians,
GDA.
13. Operational definitions
Surgical Unit:
• A unit in the hospital catering patients in the perioperative period.
(Mosby, 2016)
• In this study, it refers to a unit where patients undergoing abdominal
surgeries are admitted during their perioperative period and consist of
Pre-operative room, operating rooms and recovery room.
14. Operational definitions
Surgery related parameters:
• Parameters associated with surgery.
• In this study, Surgery related parameters includes type of surgery, date of
surgery, surgery planned, laparoscopic surgery, duration of surgery (in
hours), surgical site, incision time, closure time, duration, wound
class/grading, presence of drains, blood loss during surgery (in ml), number
of blood product transfused, types of blood products transfused, multiple
procedures done, prosthesis/implants, use of C-arm, use of microscope for
vascular anastomosis, how many people participated in the surgery
(including breaks, shift changes etc.) and number of shift changes.
15. Variables of the study
Research variable:
• Adherence to Surgical Site Infection Prevention Bundle
16. Assumptions
The study assumes that:
• High adherence to Surgical Site Infection Prevention Bundle reduces
Surgical Site Infection (Ann Coloproctol 2021)
• Operating room staff may have varying degree of Adherence (average-poor)
to Surgical Site Infection Prevention Bundle.
• Adherence to Surgical Site Infection Prevention Bundle can be assessed by
Surgical Site Infection Prevention Bundle checklist. (CDC 2022)
17. Hypothesis
The following hypothesis is tested at 0.05 level of significance:
• H1: There is a significant association of Adherence to Surgical Site
Infection Prevention Bundle with Surgery related parameters.
18. Conceptual framework
• The conceptual framework of the study is based on Fishbone Model of
Quality Assurance.
20. Delimitations of the Study
• The study is delimited to the observation of Operating room staff on
adherence to Surgical Site Infection Prevention Bundle at Surgical unit
of ILBS.
21. Materials and methods
Research approach -Quantitative research approach
Research design –Observational cross sectional design
Setting of the study -Surgical unit of ILBS, New Delhi
Population :
Target population-Operating room staff working at surgical unit.
Accessible population-Operating room staff working at surgical unit
of ILBS.
Sampling Technique - Purposive Sampling Technique.
Sample size -Approx. 40-50 (Number of events)
22. Sampling Criteria
Inclusion Criteria
Operating room staff:
• Working in surgical unit.
• Willing to participate.
• Directly involved in surgical procedure performed in Operating room.
Exclusion Criteria
• Operating room staff not present at the time of data collection.
23. Source of Data
• Data has been collected through direct observation based on current
practices related to Surgical Site Infection Prevention performed by
operating room staff.
24. Structured observation schedule
• A methodology in which an event or series of events is observed in its
natural setting and recorded by an independent researcher.
The subjects
• Surgeons, Anaesthetists, Scrub nurses, Circulating nurses, Operating
room technicians, GDA.
The sessions
• There were direct observation sessions depending upon planned posted
surgeries for the day and night. The observation was carried out only
on working days.
25. Structured observation schedule
The duration/frequency of observation
• Each observation last for < 2 hours to > 6 hours depending on the type
of surgery.
• During observation it was ensured that the researcher was not
interfering with surgical procedure and was able to observe closely for
the Adherence to Surgical Site Infection Prevention bundle.
28. Tool for data collection
Tool-1: Subject Datasheet
Tool-2: Surgical Site Infection Prevention Bundle Checklist
29. Tool for data collection
Tool-1: Subject Datasheet
• Structured checklist for assessing demographic variables, clinical
variables and surgery related variables. This comprises with three
sections.
• Section-A: Demographic Datasheet
• Section-B: Clinical Parameter Datasheet
• Section-C: Surgery related Parameters
30. Tool for data collection
Tool-Ⅱ: 1.1 Surgical Site Infection Prevention Bundle Checklist
Surgical Site Infection Prevention Bundle Checklist has three sections.
• Section-A: Pre-operative Observations
• Section-B: Intra-operative Observations
• Section-C: Post-operative Observations
Tool-Ⅱ: 1.2 Additional observations
• Development and Description of the Tool.
31. Tool for data collection
Development and Description of the Tool.
Tool-Ⅰ:
A structured checklist was developed by researcher after extensive
review of literature and further with the discussion of guide to evaluate
the contributing factors leading to surgical site infection for selected
demographic variables, clinical variables and surgery related variables.
It is divided into 3 sections. Section A, Section B and Section C.
32. Tool for data collection
• Section-A: Demographic variables
• A structured 3 items checklist is proposed for the assessment of
demographic profile of the patient. The demographic profile included
are: Age, Gender, History of Substance abuse (History of Smoking,
History of Tobacco, and History of Alcohol).
33. Tool for data collection
• Section-B: Clinical variables
• A structured 11 items checklist is proposed for the assessment of
clinical profile of the patient. The clinical profile included are: BMI,
Diagnosis, Date of admission, Pre-operative Investigations, Use of
Pre-operative antibiotics, Co-morbidities, History of Chemotherapy,
History of Radiotherapy, History of Steroid use, Nutrient-enhanced
nutritional formula, Nutritional status, Duration of pre-operative
hospital stay, Any H/O pre-operative stenting.
34. Tool for data collection
Surgery related variables
• A structured 18 items checklist is proposed for the assessment of selected
surgery related variables which includes:
• Type of surgery, date of surgery, surgery planned, laparoscopic surgery,
duration of surgery (in hours), surgical site, incision time, closure time,
duration, wound class/grading, presence of drains, blood loss during surgery
(in ml), number of blood product transfused, types of blood products
transfused, multiple procedures done, prosthesis/implants, use of c-arm, use
of microscope for vascular anastomosis, how many people participated in
the surgery (including breaks, shift changes etc.) and number of shift
changes.
35. Tool for data collection
Development and Description of the Tool.
Tool-2
• Development: A structured checklist developed by researcher after
extensive review of literature and further with the discussion of guide
to evaluate the adherence to Surgery related parameters.
• Description: Surgical site infection prevention bundle with 48 items
subdivided into 3 domains: section A: Pre-operative observations with
3 items, section B: Intra-operative observations with 23 items and
section C: Post-operative observations with 22 items.
36. Tool for data collection
• It assesses adherence to Surgical Site Infection Prevention Bundle.
• It comprises items with Adherence, Non adherence and Not-applicable
responses.
• The total score ranges from 0-48 points.
• Score for each “Yes” response-1, “No” response-2 and “N/A response-
3.
37. Tool for data collection
• Adherence scores will be calculated by adding the number of
performed criteria. Which is categorization into good adherence
(>80%), moderate adherence (60%-79% and poor adherence (<60%)
based on revised Bloom’s criteria.
• Higher scores indicate better adherence to Surgical Site Infection
Prevention Bundle.
38. Content validity and Reliability
• Content validity of tools for the current study was assessed by CVI
above 0.8, after giving the content to eleven (11) experts.
40. Ethics committee clearance
• Committee clearance has been taken through two processes: Scientific
review committee of ILBS and ethics committee of college of nursing
ILBS, New Delhi.
• After presenting a study proposal in the SRC, proposed suggestions
were incorporated.
• The study proposal submitted for the ethics committee clearance.
• All procedures performed in this study involving human participation
are in accordance with the ethical standards of the institutional ethical
committee as laid down by WHO, ICMR.
41. Data Analysis Method
• Data analysis will be done by descriptive and inferential statistics.
• Descriptive Statistics: Frequency, percentage, mean and standard
deviation
• Inferential Statistics: Chi square, t-test, ANOVA
42. Pilot Study
• A pilot study was done on 07 subjects (considering 10% of total
sample size) to assess the adherence to Surgical Site Infection
Prevention Bundle. Pilot study facilitated to ascertain the feasibility of
the main study prior to the actual data collection which was found
feasible.
43. Data Collection
• The main study was conducted in Operating room of Institute of Liver
and Biliary Sciences. Formal administrative approval was obtained
from ILBS. Sample was selected on the basis of inclusion criteria of
the study. Final data collection was done from 22/05/2023 to
17/06/2023.
• Total 43 surgeries were observed and Convenience sampling technique
was used. Informed consent was taken and patients’ information sheet
was discussed with study participants.
44. Analysis and interpretation
• Data was collected from 43 patients, who got operated at the ILBS
Operating room during data collection period. On the basis of the
Inclusion and Exclusion criteria study participants were selected. Data
was noted, all the data were entered into Microsoft excel sheet for
tabulation. The values were coded and double checked. Statistical
processing was done using Statistical Package for the Social Sciences
(SPSS) version 2.2.
45. Analysis and interpretation
• The categorical data was presented as Frequency and Percentage and
continuous data was presented as Mean and Standard Deviation.
Statistical Methods used in the study based on the objectives of study,
appropriate descriptive and inferential statistics were employed.
46. Analysis and interpretation
Section A
• To describe the demographic profile of patients, descriptive statistics
were applied to calculate the frequency and percentage.
Section B
• To describe the clinical profile of patients, descriptive statistics were
applied to calculate the frequency and percentage.
Section C
• To describe the surgery related parameters of the patients, descriptive
statistics were applied to calculate the frequency and percentage.
47. Organization and Presentation of data
Section II
• To describe the adherence to Surgical Site Infection Prevention
Bundle, descriptive statistics were applied to calculate the mean,
standard deviation and mean percentage.
Section III
• ANOVA was used to evaluate association of adherence to Surgical Site
Infection Prevention Bundle with surgery related parameters.
48. Organization and Presentation of data
• The analysis of data was organized and presented under various
sections.
• The obtained data was entered into excel sheet for tabulation and
statistical processing was done in SPSS V.20. The data is organized
and presented. It includes subsections:
Section I:
Description of sample characteristics
• Section A: Description of demographic variables.
• Section B: Description of clinical variables.
• Section C: Description of surgery related variables.
49. Organization and Presentation of data
Section II:
• Description of adherence to Surgical Site Infection Prevention Bundle.
Section A: Description of demographic variables
• This section described the sample characteristics of patients in terms
of Age, Gender, History of Substance abuse (History of smoking,
History of Tobacco, History of alcohol)
• Data was analysed and presented as frequency and percentage shown
in Table 1.
51. Demographic Characteristics Frequency (f) Percentage %
Age (Years)
< 30 12 27.9
30-39 7 16.27
40-49 9 20.93
> 50 15 34.88
Gender
Male 27 62.79
Female 16 37.2
Other 0 0
Table 1
Frequency and percentage distribution of Patients in terms of their demographic
variables
n=43
52. History of Substance Abuse
History of Smoking
Yes 3 6.97
No 40 93.02
History of Tobacco
Yes 1 2.32
No 42 97.67
History of Alcohol
Yes 0 0
No 43 100
Table 1
Frequency and percentage distribution of Patients in terms of their demographic
variables
n=43
53. Clinical Characteristics Frequency (f) Percentage %
BMI
Underweight: <18.5 5 11.62
Normal Weight: 18.5 - 24.9 15 34.88
Pre-obesity: 25.0-29.9 17 39.53
Obesity class I: 30.0-34.9 6 13.95
Obesity class II: 35.0-39.9 0 0
Obesity class III: >40 0 0
Pre-operative investigation
Fasting Blood Sugar level ( < 99 mg/dl- Normal, 100-125 mg/dl- Prediabetes, > 126- Diabetic)
Normal 2 25
Abnormal 6 75
Table 2
Frequency and percentage distribution of Patients in terms of their clinical
variables
n=43
54. Clinical Characteristics Frequency (f) Percentage %
BMI
Underweight: <18.5 5 11.62
Normal Weight: 18.5 - 24.9 15 34.88
Pre-obesity: 25.0-29.9 17 39.53
Obesity class I: 30.0-34.9 6 13.95
Obesity class II: 35.0-39.9 0 0
Obesity class III: >40 0 0
Table 2
Frequency and percentage distribution of Patients in terms of their clinical
variables
n=43
55. Pre-operative investigation
Fasting Blood Sugar level ( < 99 mg/dl- Normal, 100-125 mg/dl- Prediabetes, >
126- Diabetic)
Normal 2 25
Abnormal 6 75
Not Done 2 4.65
N/A 41 95.34
Serum. Albumin level (3.4-5.4 g/dl)
Normal 32 74.41
Abnormal 2 4.65
Not Done 9 20.93
Table 2
Frequency and percentage distribution of Patients in terms of their clinical
variables
n=43
56. Haemoglobin level (14-18 g/dl- Male, 12-16 g/dl- Female)
Normal 11 25.58
Abnormal 23 53.48
Not Done 9 20.93
HBA1C level ( < 5.7%- Normal, 5.7%- 6.4%- Prediabetes, > 6.5% - Diabetic)
Normal 2 4.65
Abnormal 1 2.32
Not Done 4 9.3
N/A 36 83.72
Table 2
Frequency and percentage distribution of Patients in terms of their
clinical variables
n=43
57. Platelet count level ( 150,000- 450,000 mcL)
Normal 31 72.09
Abnormal 4 9.3
Not Done 8 18.6
Use of Pre-operative antibiotics
Yes 43 100
No 0 0
Table 2
Frequency and percentage distribution of Patients in terms of their clinical
variables
n=43
58. Comorbidities
DM 4 9.3
HTN 5 11.62
COPD 0 0
Obesity 27 62.79
Peripheral vascular Disease 0 0
Other 7 16.27
None
Table 2
Frequency and percentage distribution of Patients in terms of their clinical
variables
n=43
59. History of
Chemotherapy 0 0
Radiotherapy 0 0
Steroid use 0 0
NIL 43 100
Nutrient enhanced nutritional formula
Given 0 0
Not Given 0 0
Not Required 43 100
Table 2
Frequency and percentage distribution of Patients in terms of their clinical
variables
n=43
60. Nutritional status
Sarcopenia 0 0
No Sarcopenia 43 43
Duration of Pre-operative hospital stay (in days)
Same day 14 32.55
1 day 17 39.53
2 days 7 16.27
> 2 days 5 11.62
Table 2
Frequency and percentage distribution of Patients in terms of their clinical
variables
n=43
61. Any H/O Pre-operative stenting
ERCP 1 2.32
PTBD 1 2.32
DJ Stenting 5 11.62
Other 0 0
Table 2
Frequency and percentage distribution of Patients in terms of their clinical
variables
n=43
62. Surgery related variables Frequency (f) Percentage %
Type of surgery
Elective 42 97.67
Emergency 1 2.32
Laparoscopic Surgery
Yes 26 60.46
No 17 39.53
Duration of surgery (in hours)
<2 25 58.13
2-4. 8 18.6
4-6. 3 6.97
> 6 7 16.27
Table 3
Frequency and percentage distribution of Patients in terms of their surgery related
variables
n=43
63. Surgical site
Abdomen 33 76.74
Other 10 23.25
Wound class/ Grading
Clean ( C ) 34 79.06
Clean-Contaminated (CC) 8 18.6
Contaminated (CO) 1 2.32
Dirty (D) 0 0
Table 3
Frequency and percentage distribution of Patients in terms of their surgery related
variables
n=43
64. Presence of Drain
Yes 7 16.27
No 36 83.72
Number of drain
NIL 36 83.72
1 7 19.27
2 0 0
>2 0 0
Table 3
Frequency and percentage distribution of Patients in terms of their surgery related
variables
n=43
65. Area/Site of drain
Abdomen 7 16.27
Other 0 0
Blood loss during surgery (in ml)
Minimal 35 81.39
< 750 5 11.62
750-1500 3 6.97
1500-2000 0 0
> 2000 0 0
N/A 0 0
Table 3
Frequency and percentage distribution of Patients in terms of their surgery related
variables
n=43
66. No of blood products transfused
NIL 43 100
1 0 0
2 0 0
>2 0 0
Types of blood products transfused
Crystalloid 0 0
Colloid 0 0
FFP 0 0
Cryo/Plats 0 0
Re-suspended cell 0 0
Whole blood 0 0
None 43 100
Table 3
Frequency and percentage distribution of Patients in terms of their surgery related
variables
n=43
67. Multiple procedures done
Yes 0 0
No 43 100
Prosthesis/Implant
Yes 0 0
No 43 100
Use of c-arm
Yes 19 44.18
No 24 55.81
Table 3
Frequency and percentage distribution of Patients in terms of their surgery related
variables
n=43
68. Use of microscope for vascular anastomosis
Yes 0 0
No 43 100
Average number of people participated in the surgery
Surgeon 2.39
Scrub Nurse 1
Circulating Nurse 1
Anathesia Provider 1
OR Technician 1
GDA 1
Number of shift changes
NIL 0 0
1 43 100
2 0 0
Table 3
Frequency and percentage distribution of Patients in terms of their surgery related
variables
n=43
69. Adherence as per category of Operating room staff
Frequency (f)
Percentage
% Range Mean SD
Mean
%
Good Practices
(>80%) 43 100
39-48 43.95 2.04
91.56
%
Moderate Practices
(60-80%) 0 0
Poor Practices
(<60%) 0 0
Minimum score:0, Maximum score:48
Table 4
Level of Adherence to Surgical Site Infection Prevention bundle
n=43
70. Domain Minimum-Maximum Range Mean SD Mean % Rank
Pre-
operative
observations 0-3 1 - 3 2.25 0.96 75.00% III
Intra-
operative
observations 0-23 22-23 22.06 0.25 95.91% I
Post-
operative
observations 0-22 16-22 19.62 1.55 89% II
Table 5
Domain wise adherence to Surgical Site Infection Prevention bundle
n= 43
71. Table 5
Domain wise adherence to Surgical Site Infection Prevention bundle
n= 43
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Mean %
75.00
95.91
89
Domainwise adherence to Surgical site Infection Bundle
Pre-operative observations Intra-operative observations Post-operative observations
72. Sl. No Items
Adherence
Non-
adherence
Not-
applicable
Freque
ncy (f)
Percen
tage %
Frequ
ency
(f)
Perce
ntage
%
Frequ
ency
(f)
Perce
ntage
%
1 Part preparation was done using a clipper.
27 62.79 0 0 16 37.2
2 Part was clipped less than 2 hours before the
operation.
27 62.79 0 0 16 37.2
3 Surgical antibiotic prophylaxis was
administered within 60 minutes before incision.
43 100 0 0 0 0
Table 6
Item-wise analysis of Adherence to Surgical Site Infection Prevention Bundle in terms of Pre-
operative observations
n=43
73. Sl. No Items
Adherence
Non-
adherence
Not-
applicable
Frequ
ency
(f)
Perce
ntage
%
Frequ
ency
(f)
Perce
ntage
%
Frequ
ency
(f)
Perc
enta
ge %
1
Surgical hand preparation was
performed using antimicrobial agent
before donning sterile gown and gloves.
43 100 0 0 0 0
2
Rings, wrist-watch, bracelets and
spiritual threads removed before
surgical hand preparation.
43 100 0 0 0 0
3
Sequence of surgical hand scrubbing
was followed by (Surgeon 1)
43 100 0 0 0 0
Sequence of surgical hand scrubbing
Table 7
Item-wise analysis of Adherence to Surgical Site Infection Prevention Bundle in
terms of Intra-operative observations
n =7
77. Sl. No Items
Adherence
Non-
adherence
Not-
applicable
Frequ
ency
(f)
Perce
ntage
%
Freq
uenc
y (f)
Perce
ntage
%
Frequ
ency
(f)
Perce
ntage
%
1
Vitals of the patient was checked and post-
operative normothermia 36ºC or above was
ensured.
43 100 0 0 0 0
2
Post-operative blood glucose level was
monitored and maintained below 200 mg/dl.
2 4.65 0 0 41 95.34
3
Cleaning and decontamination of
environmental surfaces was ensured prior to
surgery following principle of asepsis (Floor,
40 93.02 3 0 0 0
Table 8
Item-wise analysis of Adherence to Surgical Site Infection Prevention Bundle in
terms of Post-operative observations
n=43
78. Sl. No Items
Adherence
Non-
adherence
Not-
applicable
Frequ
ency
(f)
Perce
ntage
%
Freq
uenc
y (f)
Perce
ntage
%
Frequ
ency
(f)
Perce
ntage
%
4
Operating room ventilation with Positive
pressure was ensured (Manometer above 2.5
Pascal )
37 100 6 13.95 0 0
5
Temperature of operating room was maintained
between 21ºC ± 3 ºC
37 86.04 6 13.95 0 0
6
Humidity of operating room was maintained
between 20 % - 60%.
31 72.09 12 27.9 0 0
7
Processing indicators (Indicator tape) placed
outside each package to show whether the
materials within were processed.
43 100 0 0 0 0
79. Sl. No Items
Adherence
Non-
adherence
Not-
applicable
Frequ
ency
(f)
Perce
ntage
%
Freq
uenc
y (f)
Perce
ntage
%
Frequ
ency
(f)
Perce
ntage
%
8
Parametric indicators (chemical indicators)
placed inside each package to demonstrate that
sterilization was effective.
43 100 0 0 0 0
9
Asepsis was maintained during trolley
preparation.
43 100 0 0 0 0
10
Asepsis maintained throughout the surgery at
trolley level
43 100 0 0 0 0
11
Asepsis maintained throughout the surgery at
field level
43 100 0 0 0 0
12
Asepsis maintained throughout the surgery at
while transferring sterile items from package
43 100 0 0 0 0
80. Sl. No Items
Adherence
Non-
adherence
Not-
applicable
Frequ
ency
(f)
Perce
ntage
%
Freq
uenc
y (f)
Perce
ntage
%
Frequ
ency
(f)
Perce
ntage
%
13
Operating room equipments were covered (C-
arm/microscope/ overhead light etc.).
43 100 0 0 0 0
14
Operating room door was closed except as
needed for passage of equipment, personnel
and patient.
30 69.76 13 30.23 0 0
15
Number of staff in the operating room were
kept minimum (4-8 people)
38 88.37 5 11.62 0 0
16
All sponges, instruments, and needles used
during the procedure were counted at table
level
43 100 0 0 0 0
81. Sl. No Items
Adherence
Non-
adherence
Not-
applicable
Frequ
ency
(f)
Perce
ntage
%
Freq
uenc
y (f)
Perce
ntage
%
Frequ
ency
(f)
Perce
ntage
%
17
All sponges, instruments, and needles used
during the procedure were counted at field
level
43 100 0 0 0 0
18
Biomedical waste segregation was ensured and
Waste, sharps discarded in the appropriate
receptacle.
24 55.81 19 44.18 0 0
82. Sl. No Items
Adherence
Non-
adherence
Not-
applicable
Frequ
ency
(f)
Perce
ntage
%
Freq
uenc
y (f)
Percen
tage %
Freque
ncy (f)
Perce
ntage
%
1
Re-dose of Prophylactic antimicrobial
was administered (If duration of
surgery more than 4 hours or if major
blood losses occur (>1.5 L in adults or
25mL/kg in children)
10 100 0 0 0 0
2 Antimicrobial Impregnated sutures
were used (Applicable as per type of
surgery)
0 0 0 0 43 100
3 Quality of water for surgical scrubbing 43 100 0 0 0 0
83. Sl. No Items
Adherence
Non-
adherence
Not-
applicable
Frequ
ency
(f)
Perce
ntage
%
Freq
uenc
y (f)
Percen
tage %
Freque
ncy (f)
Perce
ntage
%
3 Quality of water for surgical scrubbing
was ensured by checking water report
43 100 0 0 0 0
4
Immersion time of (at least 12 minutes)
for reuse period and duration not to
exceed (14 days) were ensured
0 0 0 0 43 100
5
Strip test checked for ensuring the
effective concentration (above or below
the minimum level)
0 0 0 0 43 100
84. Sl. No Items
Adherence
Non-
adherence
Not-
applicable
Freq
uenc
y (f)
Perce
ntage
%
Frequ
ency
(f)
Perce
ntage
%
Freq
uenc
y (f)
Perce
ntage
%
7
Appropriate duration for cleaning of
operating room in between two surgeries
(20 minutes) were ensured
20 46.51 0 0 23 53.48
8 Terminal cleaning, fumigation (infected
case) was ensured appropriately after the
procedure.
0 0 0 0 43 100
85. Sl. No Variables Mean SD F/t P
1 Type of surgery
Elective 43.93 ± 2.08
0.257 0.615
Emergency 45
2 Duration of surgery (in hours)
<2 43.88 ± 1.87
1.216 0.317
2-4. 43.38 ± 2.50
4-6. 46.00 ± 0.00
> 6 44.00 ± 2.44
3 Wound class/ Grading
Clean ( C ) 43.91 ± 2.13 0.065 0.81
Clean-Contaminated (CC) 44.50 ± 1.60 0.68 0.414
Contaminated (CO) 41.00 ± 2.04 2.142 0.151
Dirty (D) -
4 Laparoscopic surgery
Yes 43.65 ± 2.19
1.39 0.24
No 44.41 ± 1.83
86. Hypothesis
• Ho: There is no significance association between Adherence to
Surgical Site Infection Prevention Bundle and Surgery related
parameters at 0.05 level of significance.
• H1: There is significance association between Adherence to Surgical
Site Infection Prevention Bundle and Surgery related parameters at
0.05 level of significance.
87. Difficulties faced during data collection
• The difficulties faced during the data collection was that the data
collection was time consuming to assess the practice of Operating
room staff. The researcher had to be present for the entire duration of
surgery to assess each staff in terms of Adherence to Surgical Site
Infection Prevention Bundle.
Solutions for problem faced during data collection
• Rapport was established with the Operating room staff to gain their
co-operation
88. Solutions for problem faced during data
collection
• Rapport was established with the Operating room staff to gain their
co-operation
