PREVENTIVE MEASURES OF OPERATING ROOM
HAZARD TOWARD SURGICAL SAFETY AMONG SURGICAL TEAM MEMBERS AT MODIBBO ADAMA
UNIVERSITY TEACHING HOSPITAL, YOLA
BY
PHILEMON PETER (RN, RPON)
EDITED BY
MAL TUTA MAHMUD AHMED AND MAL NUHU LAWAN
ABSTRACT
The safety of every surgical patient and surgical team members before,
during and after all surgical procedure depends on the standard of preparedness
and guideline followed to ensure the safety. This study was done to assess the
preventive measure of operating room hazard toward surgical safe among surgical
team members in Modibbo Adama University Teaching Hospital Yola. Descriptive
cross-section design was used to carry out this study. A sample of 84 respondents was used to carry
out the study which are the surgical team members of MAUTH, Yola comprising of
Perioperative nurses, surgeons and Anesthesia specialist. Well formulated
structures questionnaire was used for collection of data which was validated by
the project supervisor and other research team in the school to test its reliability,
content in the questionnaire were analyzed using frequency distribution tables,
percentage and Likert scale. Result reveal that operating team members are pose
with hazards of smoke, biological, chemical and organizational hazard in MAUTH,
Yola with Cumulative mean of 4.1, incidence of operating room hazard is more
among patients than in surgical team members with cumulative mean of 3.7, there
is a need to train operating team members on operating room hazard. And that
the reason for not using surgical safety checklist is because of lack of
manpower, lack training, , lack of cooperation among the surgical team
members,, seniority among the surgical team members, negative attitude to
surgical safety checklist, lack of essential equipment.Base on the above
findings, the research recommend that let there be mandatory training on
operating room hazard to all the surgical team members quarterly, committee
should be set to ensure its implementation. Staffs should also be motivated for
using that. This will help improve patient safe and further prevent litigation.
CHAPTER ONE
1.0 INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Surgery has the ability to save lives,
but a number of hazards lying in the Operating room are numerous. Surgeons,
Perioperative nurses, Anesthesiologist, Assistant surgeons and other professionals
working in surgical environment put themselves at risk every day in their
careers. If you work as part of surgical team, its essential that you
familiarize yourself with potential hazards so you can avoid getting injuries
or exposing yourself to other dangers while on the job (Chron Contributor,
2020).
Occupational hazards among operating
team members has been of great concern globally; it is a condition surrounding
working environment that increase the chance of death, or disability of the employee.
The operating room is characterized by multidimensional and complex environment
that make health workers susceptible to occupational hazards and injuries. In
most cases, it results in various forms of disabilities, loss of manpower,
decrease production and of the time inevitable death of workers. Also, the
occupational health hazard is a threat to the quality of health care services
because the health workers and well-being of health workers and their patients
are greatly influenced by the quality of the working environment. It is
shocking to note that the occupational hazard is preventable by directing all
the available tools, science, training, research and educational programs
toward a safe working environment (Olorunfemi etal, 2022).
In recent years, operating room
occupational hazard and safety have become a global occupational public health
issues. Occupational safety and health (O.S.H) programs have traditionally been
concerned with reducing hazardous exposures at work that can lead to work
related injury, illness and disability. The joint committee of international labor
organization (I.L.O) and world health organization (W.H.O) adoption of O.S.H in
1950 has gain a lot of global importance on health and safety at work matters
that relate to general health and well being of working people. The goal of all
occupational health and safety operation is to foster a safe working
environment (Danjuma, 2016).
The delivery of health is complex and
riddle with potential for errors due to human factors, system failure or a
combination of both. Surgery form an important treatment mobility with millions
of surgical procedures performed all over the world. Complications are not
uncommon and occur in 3-16% of all surgical procedures, with permanent
disability or mortality rate ranging between 0.4 -0.8% in all surgical
procedures (Ambulkar, Ranganathan and Savarkar 2018).
Protocol are a common tool for
preventing human errors in complex and high intensity areas of work. It has
been shown to be valuable (checklist or protocol) in various professions such
as aviation and armed services. In 2017, the world health organization (W.H.O.)
launched the “Safe surgery saves lives” global campaign during which it identified
key process in perioperative period that could potentially affect outcome; these
include anesthetic safety practices, avoidance of surgical infraction and poor
communication among team members. The checklist was modified 2009. This helps
reduce complication during perioperative period and the number of communication
failure (Ambulkar, Ranganathan and Savarkar, 2018)
Operating room hazard and surgical
safety is a major problem in the theatre both outside and within Nigeria. This
is what prompts the researcher to study more on preventive measure of operating
room hazards toward surgical safety among surgical team members.
1.2 STATEMENT OF THE PROBLEM
Operating room hazard is a
challenging problem to both the surgical team members and the patient because
the theatre environment is equipped with so many electrical equipment
(Diathermy, suction machine and etc), Anesthetic gases which can exploit,
sharps (blade, sutures, needles etc), smooth floor which can cause harm to both
patient and caregivers. There are also biological hazards from fluids and blood
of patient. Shortage of man power and a times refusal to follow the standard of
care have put so many patient and surgical team members to several harm.
Lebin, Azar & Sharm,(2021) State
that occupational hazards are among the major health problems worldwide, and
there is the probability of accident in all work place, an furthers said that
hospital are one of the vulnerable places in this regard.
W.H.O surgical checklist is a
promising tool to reduce the surgical complications worldwide. The surgeon,
Anesthetist, perioperative nurses and paramedical staff need to work together
to overcome the socio cultural and organizational hurdles to ensure successful implementation
of W.H.O surgical checklist (Divya, Ridhima, and Seran, 2018).
The researcher had observe with
dismay the low interest toward utilizing the W.H.O safety checklist,
consequently, the desire to investigate the preventive measures of Operating
room hazard among practitioners at MAUTH, Yola. In a view to examine safety
measures.
1.3 OBJECTIVE OF THE STUDY
1.3.1 General Objective
The objective of this study is to
generate data required to gain insight on preventive measures of operating room
hazard toward surgical safety among surgical team members at MAUTH, Yola.
1.3.2 Specific Objective
1. To assess the incidence of operating
room hazard among surgical team members of MAUTH, Yola.
2. To identify the preventive measures
of Operating room hazard among surgical team members at MAUTH, Yola.
3. To identify factors that hinders
surgical safety practice among surgical team members at MAUTH, Yola.
1.4 RESEARCH QUESTIONS
1. What is the incidence of operating
room hazard among surgical team members in MAUTH, Yola?
2. What are the preventive measures put
in place to prevent Operating room hazard among surgical team members in MAUTH,
Yola?
4. What are the factors that hinder
surgical safety practice among surgical team members at MAUTH, Yola?
1.5 SIGNIFICANCE OF THE STUDY
To perioperative nursing: It will add
to the existing knowledge on operating room hazard and preventive measure to
render a quality patient care.
To client: The research findings will
help the client to appreciate the service being rendered.
To the future researcher: It will
serve as source of knowledge for future researchers who will identify this
topic of interest and add to the existing knowledge. Findings will reveal
evidence base and factual data to the researcher for proper judgment as to know
why utilizing W.H.O surgical safety checklist which is not been done at MAUTH,
Yola. It will also serve as a source of literature for future researchers.
1.6 SCOPE OF THE STUDY
The study will cover the entire
surgical team members of MAUTH, Yola and will assess the preventive measures of
operating room hazard toward surgical safety among surgical team members.
1.7 OPERATIONAL DEFINATION OF
TERMS
Hazard: Any source of potential
damage, harm or adverse health effects on something or someone.
Surgical Team members: These include
surgeon, surgeon assistant, anesthesiologist/nurse anesthetist, scrub nurse and
circulating nurse.
Preventive measures: Any reasonable
measures taken by any person in response to an incident, to prevent, minimize
or mitigate loss or damage or effect to environmental cleanup.
Operating Room (OR): Were surgical
procedure is being done.
Operating room Hazard: Injury or harm
that affect both patient and surgical team members in the theatre.
CHAPTER TWO
2.0 Literature Review
2.1 CONCEPTUAL REVIEW
2.1.1 Concept of Operating Room Hazard
Right from inception, Operating room environment
is basically a close, isolated, restricted, yet flexible environment charge
with multiple inherent risks for both surgical team and the patient brought for
surgical treatment. The complexity of the surgical working environment is
determined by the various occupational hazards and risk as listed below:
Accidental hazard: Harm caused by
falling object, fall on wet floor, needle pricks, electrical shock from faulty
equipment etc.
Physical Hazard: Exposure to
radiation from X-ray and radisotope sources.
Chemical Hazard: Exposure to
anesthetic drugs and gases, skin problem by frequent use of soap, irritation of
eye and throat, etc.
Biological Hazard: Hepatitis B and C,
HIV, etc
Ergonomic Physical Hazard: Physical
hazard cause by a feeling of responsibility toward patient, fatigue and
muscular pain due to handling of heavy patients and long period of standings.
Organizational Hazard: Exposure to
severe traumatized patients, multiple victims of disaster or catastrophic event
etc (Danjuma, 2016).
2.1.1.1 Accident hazards: Injuries to legs and toes caused by falling objects, e.g.,
medical instruments. Slips, trips, and falls on wet floors, especially during
emergency situations. Stabs and cuts from sharp objects, especially needle-pricks
and cuts by blades. Burns and scalds from hot sterilizing equipment.
Electric shock from
faulty or improperly grounded equipment, or equipment with faulty insulation.
Acute back pain
resulting from awkward body position or overexertion when handling heavy patients.
2.1.1.2 Physical hazards: Exposure to radiation from x-ray and radioisotope sources.
2.1.1.3 Chemical hazards: Exposure to various anesthetic drugs (e.g. N2O,
halothane, ethyl bromide, ethyl chloride, ether, methoxyfluorane, etc.).
Skin defatting, irritation,
and dermatoses because of frequent use of soaps, detergents,
disinfectants, etc.
Irritation of the eyes,
nose, and throat because of exposure to airborne aerosols or contact
with droplets of washing
and cleaning liquids. Chronic poisoning because of long-term exposure to
medications, sterilizing fluids (e.g., glutaraldehyde), anesthetic gases,
etc.
Latex allergy caused by
exposure to natural latex gloves and other latex-containing medical
devices.
2.1.1.4 Biological hazards: Infections due to the exposure to blood, body fluids or
tissue specimens possibly leading to blood-borne diseases such as HIV,
Hepatitis B and Hepatitis C.
Risk of contracting a
nosocomial disease as a result of a prick from a syringe needle (e.g.
infectious hepatitis,
syphilis, malaria, tuberculosis). Possibility of contracting palm and
finger herpes (Herpes Whitlow). Increased hazard of spontaneous miscarriages.
2.1.1.5 Ergonomic,psychosocial and organizational factors:
Fatigue and lower back
pain due to the handling of heavy patients and to longed periods of
work in a standing
posture.
Psychological stress
caused by a feeling of heavy responsibility towards patients.
Stress, strained family
relations, and burnout due to shift and night work, overtime work, and
contact with sick
patients, especially when patients don't recover from the operation.
Problems of
interpersonal relations with surgeons and other members of the operating team.
Exposure to severely
traumatized patients, multiple victims of a disaster or catastrophic event
or severely violent
patients may lead to post-traumatic stress syndrome, (International Hazard
Datasheets on Occupation, 2020).
2.1.1.6 Organizational hazards: Hazards or stressors that cause stress (short- term effects)
and strain (long-term effects). These are the hazards associated with workplace
issues such as workload, lack of control and/or respect, etc. Examples of work
organization hazards include: Workload, demands, Workplace violence, Intensity
and/or pace, Respect (or lack of), Flexibility, Control or say about things,
Social support/relations Sexual harassment (Occupational
Safety and Health Administration, 2018).
2.1.2
Incidence
Health sector is one of the dangerous
lines of work in which occupational health and safety (OHS) are becoming
increasingly important. Healthcare professionals are faced with many
occupational risks while performing their duties. There are also many risk
factors for those who work in operating rooms. These include inconvenient
physical environment, heavy physical work, working in shifts and working in
non-ergonomic positions (Monual & Speizer, 2013 in Gul, 2021). Operating
team members are threatened by stress, mobbing, violence, malnutrition etc. For
example, being in close contact with the patient in the operating room increases
the risk of infection. Surgical team members who are likely to come into
contact with blood and bodily fluids of the patients during their daily
activities at the hospital are in the high risk group for blood-borne diseases .
Thus, researches indicate that surgical team members are mostly faced with
biological and psychological risk factors (Monual & Speizer, 2013 in Gul,
2021). Operating room employees may experience occupational accidents due
to sharp object injuries, contamination with blood and bodily fluids, heavy
lifting, falling, hitting, tripping, slipping, being injured etc ( Lee etal,
2017 in Gul, 2021).
The risks of the operating rooms may
cause a decrease in productivity, economic loss of the institution, increase in
occupational accidents, and putting the people who receive care from healthcare
professionals directly at risk. Therefore, hospitals need to be suitable for
health and safety measures, environmental precautions should be taken, risk
factors should be eliminated or controlled and personal protective equipment
should be paid attention to by performing risk assessment and management (Gul,
2021).
2.1.3 Prevention:
·
Risk
assessments so to see which areas, departments or staff members are the most at
risk. This not only helps target resources and training but means it's simple
to find solutions that address the unique demands and risks of the department
or level of healthcare worker. It has been estimated that around 400,000 sharp
injuries happen each year in the US, with around a quarter of these being
sustained by surgeons. With the amount of sharps that are used as an essential
part of the operating room, it is perhaps no surprise that surgeons are
considered to be the most at-risk staff members.
·
wearing
the right protective clothing and shoes.
·
Reinforces
the importance of sharps safety and
ensuring this stays at the forefront of each healthcare worker's mind until the
needle or scalpel is contained in an appropriate disposal container.
·
Training
of staffs on theater hazards and prevention (ICUMedical, 2015).
·
Maintain
adequate ventilation, temperature through AC
·
Lighting
should be without shadow and glare
·
Wall, ceiling and curtain should have light
green or light blue
·
Provision for soft music which is relaxing for
both patient and OT personnel
·
Operation
table should be adjusted to best working
height
·
Periodical
checking and checking before using of electrical sockets, equipment's and
devices
·
All
electrical equipment's should be properly insulated.
·
Periodic checking of electrical sockets,lines.
·
Anaesthesia machines should be kept away from
source of heat.
·
Implantation
or removal of radioactive elements.
·
Minimum
exposure to fluoroscope , image intensifier and x-ray machine.
·
Unsterile members should leave OT during
procedures.
·
Sterile team members should keep atleast 2m
distance.
·
Gloves
and goggles should be worn while using chemicals
·
Proper
dilution of solution
·
Cleanse
puncture site
·
Report
the incident and seek medical attention promptly following needle injuries
·
Regulation,recommendations,guidelines
and laws should be enforced to prevent disastrous consequences of occupational
hazards.
·
Policies
and procedures should be written reviewed and updated periodically.
·
Protective
attire and safety equipment’s should be made available to the employees
·
Employee
health services should be provided for immunizations, etc (Shaju, 2020).
2.1.4 Surgical Safety
The WHO Surgical Safety Checklist was
developed after extensive consultation aiming to decrease errors and adverse
events, and increase teamwork and communication in surgery. The 19-item
checklist has gone on to show significant reduction in both morbidity and
mortality and is now used by a majority of surgical providers around the world
(W.H.O, 2022).
Fig 1. Model of W.H.O
Surgical safety Checklist
2.2 THEORETICAL FRAME WORK
NIGHTINGALE’S ENVIRONMENTAL THEORY
The Environmental Theory by Florence Nightingale defined Nursing as “the act of
utilizing the environment of the patient to assist him in his recovery.”
It involves the nurse’s initiative to configure environmental settings
appropriate for the gradual restoration of the patient’s health and that
external factors associated with the patient’s surroundings affect the life or
biologic and physiologic processes and his development. Nightingale discussed
the Environmental Theory in her book Notes
on Nursing: What it is, What it is Not. She is considered the first
theorist in nursing and paved the way in the foundation of the nursing
profession we know today.
Nursing: “What
nursing has to do… is to put the patient in the best condition for nature to
act upon him” (Nightingale, 1859/1992). Nightingale stated that nursing “ought
to signify the proper use of fresh air, light, warmth, cleanliness, quiet, and
the proper selection and administration of diet – all at the least expense of
vital power to the patient.” She reflected the art of nursing in her statement
that “the art of nursing, as now practiced, seems to be expressly constituted
to unmake what God had made disease to be, viz., a reparative process.”
Human Beings: Human
beings are not defined by Nightingale specifically. They are defined in
relation to their environment and the impact of the environment upon them.
Environment: Nightingale
stresses the physical environment in her writing. In her theory, Nightingale’s
writings reflect a community health model in which all that surrounds human
beings is considered concerning their health state.
Health: Stated,
that health is the position of which pathology is negative, except for the
observation and experience. Given her definition that the art of nursing is to
“unmake what God had made disease,” then the goal of all nursing activities
should be client health. She believed that nursing should provide care to the
healthy and the ill and discussed health promotion as an activity in which nurses should engage (Gonzalo,
2021).
2.2.1 Conceptual Model of operating room Hazard
Fig.
2
Philemon, (2022): Model of Operating Room Environmental Hazard.
Intra operative injury: Handling of sharp objects with
extreme care; use special safety receptacles to store used hypodermic needles until
disposal. Use safety needles, if available
Air Pollution: Install air conditioning with
effective general ventilation in the operating room to reduce heat stress and remove
odors, gases, and vapors. Provide eye wash bottles or fountains.
Wrong site surgery: Ensure utilization of surgical safety
checklist, pre visit and surgical site marking.
Electrocution: Install ground fault circuit interrupters; call a qualified electrician
to test and repair faulty or suspect equipment. Comply with all safety instructions
regarding the installation and periodic inspection of electrical medical equipment.
Radiation & burns: Wear a radiation dosimeter (badge or
other) when exposed to radiation; comply with all safety instructions to reduce
exposure to a minimum
Fall/slip: Wear shoes designed for nurses, with
non-slip soles.
Infection: Follow established appropriate
infection control precautions assuming blood, body fluids and tissue are
infectious Routinely use barriers (such as gloves, eye protection (goggles or
face shields) and gowns) Wash hands and other exposed skin surfaces after
coming into contact with blood or body fluids
Chemical: Ensure all the solution to be use is
non irritating, non corrosive to skin and long acting to provide and rendered a
good transient Microorganism on skin in active, to promote patients health.
2.2 Application of the theory to the study. Nightingale theory talk about nursing
which surgical team members are part of this aspect, by ensuring they perform a
surgery using appropriate skills required by them to, to ensure patient safety
and allow nature to act upon it.
Environmental care is very relevant
to my research because operating room hazard use to come as a result poor
environment control which according to this theory it says that, care of
patient is centered to his environment which can be either internal or
external. This can control by appropriate environmental hygiene, ensure instrument
and swab count done so that the care rendered will be done to ensure nature
took it place. Clean environment will also prevent the surgical team members
from hazard such as biological, fall or slip, chemical to be use on patient and
scrubbing.
The theory also talks about air which
theatre humidity and control is very essential in the control of hazard such as
smoke and static electricity. Clean air is need to minimize the risk of
infection to both the client and surgical team members, also to prevent the
risk of static electricity.
In the theatre environment we are
faced with different forms of hazards to both patient and surgical team
members, which some are as a result of poor cleanliness of the theatre
environment, poor lighting system, drainage system and in appropriate disposing
of sharps etc.
A healthy environment indeed heals,
as Nightingale stated. Still, the question now is how our environment would
remain healthy amidst the negative effects of the progress of technology and
industrialization.
Since the applicability of some of
the concepts to specific situations today is non-feasible, this theory’s
development is utterly needed to accommodate the changes in the environment
that we currently have. Still, above all this, it is very clear that Nightingale’s
Environmental Theory is superb as a starting point of our profession’s progression
and catalyzed nursing improvement. And in what so ever we do, we should ensure
that the health of patient is put first
2.3 EMPIRICAL REVIEW
2.3.1 Incidence of operating room hazard
Danjuma, Babatunde, Taiwo and
Micheal, (2016) state that Surgical trainees had a greater frequency of
exposure of operating room hazard than attending surgeons, which is attributed
to the nature of residency. Residents spend, on average, 80 hours per week in
the hospital. On the other hand, attendings were less frequently exposed owing
to the fact that they have dedicated operative and clinic days, and thus spend
less time in the Operating Room.
Surgical specialty-dependent exposure patterns were observed among
several sub-specialties. Neurosurgery, Orthopedic surgery, and Urology shared a
higher exposure frequency to radiation while Plastic surgery, Neurosurgery, and
Orthopedic surgery were found to have a greater exposure to methylmethacrylate
(Danjuma, 2016).
According to research conducted on 92
perioperative nurses reports that the prevalence rate of
Errors in surgery – the size of the
problem The WHO have estimated that 234M operations are performed annually
around the globe. A systematic review including over 74 000 patient records
found a median incidence of in-hospital adverse events of 9.2% with
approximately half of those events being operation or drug-related, and 43%
deemed preventable. In England and Wales, the National Reporting and Learning
System (NRLS) reported 10 526 patients died or came to severe harm secondary to
incidents in 2013-2014. Over 3000 of these incidents were related to treatment
or procedure, or implementation of care and ongoing monitoring/review (Woodman,
2016).
Medical errors in the United States.
Other studies suggest that the incidence rate of hospital hazard lies somewhere
between 2.9 % (499/17,192) and 16.6 % (2,353/14,179). Of concern is
that nearly 45 % (7,712/17,192) of adverse events (AE) occur in surgery,
with a median of 43.5 % (interquartile range 39.4 to 49.6 %) of these
considered as avoidable. The incidence of major complications as a result of
surgery is estimated to be between 23.3 % (272/1,177) and 77 %
(112/146) of inpatient surgical procedures (Gillespie etal, 2016).
Research on incidence of operating
room hazards among Nigerian perioperative nurses indicated that (72%) of the
participants have occasionally exposed to daily hazards related to factors at
workplace. Nearly two-third (64%) of the participants affirmed being
occasionally exposed to accidental type of hazards (Danjuma etal, 2016).
Study on incidence of operating room
hazard have reveal that surgical trainees reported frequent exposure to
bloodborne pathogens, radiation, methylmethacrylate, prolonged standing,
patient lifting, surgical smoke, cytotoxic drugs, formaldehyde, and surgical
noise than attending surgeons that was irrespective of formal training,
demonstrating increased vulnerability in the setting of a knowledge gap (Landford,
2021).
2.3.2 Preventive measures of
operating room hazard
The rate of operating room hazards
among Nigerian perioperative nurses is high. This demonstrates a need for more
professional consciousness on the concepts of educational and practical
interventions practices on ways of identifying and preventing different types
of hazards not only among perioperative nurses but also among other similar
professional groups can significantly reduce the risk of hazards exposures (Danjuma,
2016).
Preventable harm occurs daily during
surgery across the world. The WHO checklist was introduced as one means of
reducing harm and improving patient safety in the operating theatre. The
checklist needs to become part of routine surgical culture, even more so in an
emergency or at the end of a long shift when simple tasks are easily forgotten.
With consistent use, team members will become familiar with the checks, less
embarrassed about using them, more time efficient, and break down the barriers
to success. And ultimately, patient harm will be reduced (Woodman,
2016)
Occupational health problems caused
by the risks in the workplace can be reduced and the rates of serious injuries
and damages can be decreased with proper and efficient risk management. Operating
room nurses and other surgical team members should be trained on subjects such as general
environmental pathogens, ergonomics, blood-borne pathogens, protective
equipment, radiation safety, fire safety, general safety, use of hazardous
material (substances), emergency situation management, protection against
airborne diseases, mobile liquefied oxygen, communication and enlightenment on
dangers, medical equipment care and safety of tap water (Gül, 2021).
Primary precautions to reduce
exposure to chemical substances include using materials with low danger
potential, paying attention to the allowed concentrations, frequently
ventilating the environment, hand washing, using personal protective equipment
such as aprons and masks, updating old methods and equipment, measuring and
monitoring samples taken regularly, biological monitoring. In addition to
these, there are many precautions that are customized according to the
characteristics and risks of the chemical substances (Gül, 2021).
All patients should be managed as
Covid-19 patients until the results are confirmed. Risk of Covid-19 should be
considered for general surgery emergencies and personal protective equipment
should be used accordingly. Patients should be transferred to the operating
rooms by service nurses and nurses should wear N95 masks, goggles/face shields,
waterproof aprons and overshoes. Patients should also wear a surgical mask and
transferred to the operating room via the shortest way with least contact with
others (Gül, 2021).
Nurses who are educated on
occupational risks and employee safety can have the ability to define and
control the possible risk factors. Nurses undertake many duties besides patient
care in operating rooms, which are not their essential duties. Excessive
workload and transfer of the duties of other disciplines to nurses leads to the
emergence of an unhappy occupational group which works hard yet does not have
time to practice their own profession. This situation should be prevented and
it should be ensured that nurses do the duties they have been trained for (Danjuma, 2016)
Concordance and productivity of the
team depend on the position and role of each member of the team being defined
and recognized. It also depends on each member having the capability and
possibility to perform their own roles at their best. Therefore, nurses’ roles
should be defined and nurses should be capable of performing those, and roles
of nurses should be known, recognized, accepted and respected by the other
members of the team. In order to establish such an environment, besides
following the law and legislation, employees and employers should accept their
roles that prioritize health and safety, believe that safety would be
maintained in the institution, adopt an appropriate attitude and display social
responsibilities (Danjuma, 2016).
As described above safe working
environment is important for all hospital workers, especially for those who
work in operating rooms. Necessary precautions should be taken and controlled
regularly in order for surgical nurses to perform their duties successfully.
Employees should be informed about work safety precautions and most importantly
push for these precautions. In addition to patient and employee safety in
operating rooms, environmental safety also has an important place.
Environmental risk analysis should be performed by experts in the operating
rooms at regular intervals and risk management should be implemented by the
occupational health and safety committees in the hospital (Danjuma, 2016).
Firstly, training on SSC for all new
surgical staff members was deemed necessary before rotation to the theatre
rooms from other departments. Refresher training for all existing staff was
also suggested as a way to improve adherence to the checklist. Respondents also
suggested that better enforcement of the formal system already put in place by
the Ministry of Health, termed Service Quality Assessment (SQA), could improve
SSC utilisation and accountability in the operating rooms at UTH. This involved
the use of a tool to monitor compliance. However, respondents stated that this
needed to be reinforced with the allocation of specific funds to ensure its
proper application. It was also noted that implementation champions would be
needed to ensure consistency in the use of the SSC. The champions would ensure
that compliance with SSC use is measured and documented, would provide relevant
feedback to the theatre teams and facilitate communication with hospital
management. Additionally, setting up teams to periodically evaluate the SSC
utilisation given monitoring patient safety was also seen as an essential
component of standard surgical practice.
(Munthali etal, 2022).
Primary precautions to reduce
exposure to chemical substances include using materials with low danger
potential, paying attention to the allowed concentrations, frequently
ventilating the environment, hand washing, using personal protective equipment
such as aprons and masks, updating old methods and equipment, measuring and
monitoring samples taken regularly, biological monitoring. In addition to
these, there are many precautions that are customized according to the
characteristics and risks of the chemical substances (Gul, 2021).
Operating room nurses should be
trained on subjects such as general environmental pathogens, ergonomics,
blood-borne pathogens, protective equipment, radiation safety, fire safety,
general safety, use of hazardous material (substances), emergency situation
management, protection against airborne diseases, mobile liquefied oxygen,
communication and enlightenment on dangers, medical equipment care and safety
of tap water (Gul, 2021).
2.3.3 Factors that hinder surgical safety practice
Analysis revealed variability in implementation of the SSC by surgical
teams, which stemmed from lack of senior surgeon ownership of the initiative,
when the Surgical Safety Checklist (SSC) was introduced at University Teaching Hospital
5 years earlier. Low utilisation was also linked to factors such as: negative
attitudes towards it, the hierarchical structure of surgical teams, lack of
support for the SSC among senior surgeons and poor teamwork. Further
determinants included: lack of training opportunities, lack of leadership,
organizational barrier, surgical team inconsistent training, lack of supervision
etc (Munthali etal, 2022).
The study on factors preventing the
utilization of surgical safety checklist consisting of 1440 surgical
procedures, 1299 checklists, and 28 578 items. The mean compliance rate was
90.2% (0, 100). The mean completion rate was 61% (0, 84). 11 barriers to
effective checklist implementation were identified. Their incidence varied
widely across centres. The main barriers were duplication of items within
existing checklists (16/18 centres), poor communication between surgeon and
anaesthetist (10/18), time spent completing the checklist for no perceived
benefit, and lack of understanding and timing of item checks (9/18), ambiguity
(8/18), unaccounted risks (7/18) and a time-honoured hierarchy (6/18) (Fourcade, Louis Blache2, Grenier, Bourgain & Minvielle 2019).
85% of the study participant report lack of retraining opportunities for
staff rotating from other departments or newly hired, as a result, the
checklist was not followed in the operating rooms run by new or rotating staff,
who had a poor understanding of the SSC intended purpose and benefits and Senior
medical and nursing staff who had undergone training rarely shared their
learning or encouraged the use of the SSC among their team members with no
training (Munthali etal, 2022).
Some medical doctors who have been operating
for years without any recorded complications, think that the tool is being
imposed on them by the westerners, and feel it is not important and won’t
utilise the tool (Munthali etal, 2022).
89% of a Study participants indicated that lack of supervision and formal
oversight measure in place, such as a designated person in-charge, to ensure
consistent use of the SSC at University Teaching Hospital operating theatre
departments as one of the factor that is hindering the utilization of WHO
Surgical safety checlist (Munthali etal, 2022).
Study reveal that non-availability of
essential surgical equipment and supplies at the time of an operation had an
indirect, negative impact on the use of the SSC. All participants consistently
indicated that in these instances management of the Operating Theatres was
challenging and a considerable amount of time was spent on searching for and
borrowing resources from other theatre rooms, or sending faulty equipment for
repairs. This delayed the operations and took away some of the actual surgery
time, which could only start when all required resources were present in the
operating room, with a knock-on effect on the surgical list. As a result, in
these instances the surgical teams tried to make up for the lost time by
skipping the SSC (Munthali etal, 2022).
Study have reveal that shortfall of
essential surgical staff such as nurses, anaesthesia providers and support
staff to cover all operating rooms. Participants reported that non-specialised
nurses (non-perioperative) were often allocated to work in the surgical
departments to fill these gaps. They were usually given on-the-job orientation
to be able to work in the operating theatres, but the use of the SSC was not
routinely covered. Inadequate human resources were also reported to contribute
to high workload and fatigue of surgical teams, particularly the ones handling
emergency operating rooms. Respondents stated that these staff shortages,
coupled with lack of protocols to enforce SSC utilisation before every surgical
operation, meant that when clinicians were overwhelmed, they skipped the SSC.
This was also common in instances where the SSC printed out copies were
misplaced. As reported, this in turn resulted in failure to conduct adequate
handovers of cases at the end of shifts, which occasionally led to recording
incomplete medical details about patients undergoing surgery (Munthali etal, 2022).
The absence of standard operating
procedures to guide the work of the surgical teams and an assigned champion to
ensure implementation of the SSC resulted in its 85% inconsistent application. Study
participants also reported 96% excessive influence of individuals whose
behaviour and attitude could either drive or hinder the use of the checklist (Munthali etal, 2022).
Structure of surgical teams and the
surgeon is regarded as having a ‘higher’ central, decision-making role, while
the other team members (anaesthesia providers and perioperative nurses) were
perceived to be in a ‘lower’ subordinate position. If the surgeon leading the
operation did not support its use it will affects SSC utilization. The
hierarchical and surgeon-centred structure of the surgical team played also a
role in the rollout of the initial SSC training offered to UTH surgical staff
in 2015. According to an interviewee, some surgeons (these being perceived as
in a ‘senior or higher’ position) chose not to attend as they did not want to
receive training from a person whom they considered junior to them (at the time
the SSC training was delivered by a nurse) (Munthali etal, 2022).
Study reveal 75% negative attitudes
towards the SSC by some members of the surgical team also affected its utilisation.
Participants reported that some surgeons often ‘rushed’ to proceed with a case, seeing the SSC as an unnecessary
‘delay’. In some instances,
such behaviour and lack of support from senior or ‘perceived higher-level’ team
members made the staff in junior or perceived ‘lower’ positions reluctant to
further suggest using the SSC for subsequent cases. Some senior surgeons who
were supportive of the use of the SSC confirmed the presence of such behaviour
among some of their peers. They acknowledged that such dismissive attitude had
negative consequences for the team dynamics, and ultimately led to lack of a
team approach to and poor utilisation of the SSC (Munthali etal, 2022).
Another reported issue was the
occasional occurrence of ‘intimidating’
behaviours, where some junior or perceived ‘lower position’ staff (such as
anaesthetists) were told that they ‘want
to waste time’ after they had suggested utilisation of the SSC prior to
the operation. This in turn further deteriorated the already poor team dynamics
and reinforced the hierarchical structure (Munthali etal, 2022).
Participants also reported that the
utilisation of the SSC was undermined by the poor work ethics of some of the
team members. One of the issues identified by respondents was the late
reporting for work of 60% of the team, which led to failure to form surgical
teams on time and delayed the start of the operation. To compensate for the
time lost, the surgical teams proceeded with surgery without applying the SSC (Munthali etal, 2022).
According the study conducted by Shapiro, Fernando & Urman, (2014) on Barriers to the implementation of
checklists in the office-based procedural setting shows that Only 50% of offices surveyed use
safety checklists in their practice. Only 34% had checklists or equivalent
protocol for emergencies such as anaphylaxis or failed airway. As many as 23.7%
of respondents indicated that they encountered barriers to implementing
checklists. The top barriers identified in the study were no incentive to use a
checklist (77.8%), no mandate from a local or federal regulatory agency
(44.4%), being too time consuming (33.3%), and lack of training (33.3%).
Reasons identified that would encourage providers to use checklists included a
clear mandate (36.8%) and evidence-based research (26.3%).
CHAPTER THREE
3.0 Research Methodology
3.1 Research Design
The study utilized descriptive cross-section
design to describe the preventive measure of operating room hazard and surgical
safety among surgical safety among surgical team members in Modibbo Adama
University Teaching Hospital, Yola.
3.2 Description Of The Study Area
The Federal Medical Centre (FMC),
Yola, Adamawa State, Nigeria was established through an agreement dated 21st
August 1998 signed between the Federal Ministry of Health, Nigeria and Adamawa
State Government to take over the then Yola Specialist Hospital, Yola, Adamawa
State, Nigeria. Clinical Services commenced on 15th May 1999. However, the then
Civilian Government in the State decided to repossess the Specialist Hospital
so that it could have a secondary healthcare facility in the state capital.
Thus, it was decided that the Centre should be relocated to the present site in
the premises of the School of Nursing and Midwifery, Yola, along Lamido Zubairu
Way, Yola-Town. It is a 330-bed hospital that provides tertiary healthcare
service to people from Adamawa, parts of Taraba, Gombe and Borno states in
addition to those coming from the neighbouring republic of Cameroun. Within the
limits of available resources, the facility has been able to provide a high
standard of healthcare to its teeming clients. In fact, with the ongoing insurgency
in Northeastern Nigeria, all the casualties of our armed forces personnel and
civilians are promptly and adequately catered for in the centre.
The Federal Medical Centre, Yola covers an initial total landmass of 23.84
hectares and in 2016 His excellency the Adamawa state Governor gave them an
additional land of 15.75 hectares from the neighbouring Technical College making
a total of 39.59 hectares.The first Medical Director was Dr. Aminu Muhammad Mai
who administered the Centre from its inception in 1999 to 2007. In 2007, Dr.
Ali Danburam was appointed the Medical Director. His tenure came to an end in
March, 2015 and Professor Auwal took over on 1st April, 2015 to date. The
hospital was upgraded to teaching Hopital President Mohmammadu Bahari in 2022.
3.3 Target Population
The target population of the study
are the surgical team members of Modibbo Adama University teaching Hospital,
Yola which include (Perioperative nurses, surgeons, & anesthesiologist/anesthetist).
The table below show the total number
of the surgical team members
|
S/N
|
NAME
OF SPECIALITY
|
NUMBER
|
|
1
|
Surgeons
|
17
|
|
2
|
Perioperative
nurses
|
64
|
|
3
|
Anesthetist
|
25
|
3.4 Sample Size/Sampling
The sample size were
determined using Taro Yamane Formula.
n
Where
n = sample
N = Total population of the area under study (106)
1 = 1 is constant
e = error limit or margin of error. It’s usually accepted at
5% or 0.05.
n
n
n
n
n = 84
The table below shows the number of
questionnaire to be given per each speciality.
Using the formula
Numbers of
questionnaire
e.g surgeon number of questionnaire
=13
|
S/N
|
NAME OF SPECIALITY
|
NUMBER
|
NUMBER OF QUESTIONNAIRE
|
|
1
|
Surgeons
|
17
|
13
|
|
2
|
Perioperative nurses
|
64
|
51
|
|
3
|
Anesthetist
|
25
|
20
|
|
|
TOTAL
|
106
|
84
|
3.5 Sampling Technique
Proportionate sampling technique was
used to get the sample size and distribute the questionnaire. Where respondent
were meet in their various theatre suits, issued with questionnaire. The researcher
introduces his self and reason for the research, their consent was obtained
verbally to participate in the research.
3.6 Instrument for Date Collection
The researcher used self developed
close ended structured questionnaire that contain four (4) sections A-D.
section A was made up of demographic data of the respondents, section B the
incidence of operating room hazards among surgical team members, section C
Preventive measure of operating room hazard among surgical team members,
section D contain the factors that
hinder the practice of surgical
safety among team members
3.7 Validity of Instrument
The questionnaire was developed by
the researcher and validated by the supervisor and other research experts in
the school to ascertain it standard.
3.8 Reliability of Instrument
A pilot study was done by
administering the 10 copies of the questionnaire to surgical team members were
the data obtained, analyzed and presented to ensure reliability of the instrument
for the research being carryout.
3.9 Data Collection Method
The researcher prepared
questionnaires and distribute them to the respondent after introducing self,
the researcher gave the questionnaires and waited for the respondents to fill
and after that, the questionnaires were collected for analysis.
3.10 Method of Data Analysis
All the data collected, was subjected
to analysis using simple frequency distribution table and simple percentage
analysis.
3.11 Ethical Consideration
The researcher seek inform consent
from the respondents before administering the questionnaire. The researcher
seeks voluntary consent of the respondent without cohesion.
Anonymity of the respondents was also
ensured by the researcher as evidence by non-inclusion of names.
All data was collected from the respondents
was treated confidential. Letter was written by the school which was taken to the study area to abstain
permission and carry out the study.
CHAPTER FOUR
4.0 INTRODUCTION
This chapter deals with the
presentation, analysis and interpretation of data collected through the one
hundred and five copies of questionnaire that were distributed on the respondent.
4.1 Data Presentation and Analysis
SECTION A: Demographic Data
Table 4.1.1
|
S/N ITEM
RESPONSES PERCENTAGE
|
|
1. AGE:
20 - 29 29
34.5%
30 - 39 25 30.0%
40 - 49 24
28.6 %
50 - 59 6
7.1%
60 years and above 0
0%
|
|
TOTAL 84 100%
|
|
Table 4.1.1 above shows
that (29) 34.5% of the respondents are from age 20-29, (25) 30% of the respondents are from age 30
- 39, (24) 28.6% of the respondents are from age 40 to 49, (6) 7.1% of the
respondents are from age 50 - 59 and (0) 0% respondent age 60 years and above.
|
Table 4.1.2
S/N ITEM RESPONSES PERCETAGE
2. DICIPLINE Perioperative Nurse 51
61% Surgeon
13 15% Anesthesia 20 24.0%
TOTAL 84 100%
Table 4.1.2 above shows that 61% (51) of the respondents are
perioperative nurses, 15% (13) of the respondents are surgeons while 24% (20)
of the respondents are Anesthesia specialist.
Table 4.1.3
|
S/N ITEM
RESPONSE
PERCENTAGE
|
3. Years of Experience
1 - 5 years 42 50%
6 –
10years
13 15.5%
11 –
15years 12 14.2%
16 – 20years 17 20.2%
20 years and
above 0 0%
Table of 4.1.3 above shows that 50%
(42) of the respondents are having 1 - 5years of working experience, 15.5% (13)
are having 6 - 10years of working experience, 14.2% (12) are having 11 - 15
years of experience, 20.2% (17) are having 16 – 20 years of experience, while
20years and above have 0%.
Table 4.2 Incidence of operating room hazard
|
S/N
|
Research question
|
SA
|
A
|
UD
|
DA
|
SDA
|
CUMULATIVE MEAN
|
REMARK
|
|
1
|
Operating room environment is basically a close,
isolated, restricted yet flexible environment charge with multiple risk for
both patient and surgical team members
|
55
|
29
|
0
|
0
|
0
|
4.7
|
Strongly agreed
|
|
2
|
Most of the surgical hazard among surgical team
members and patients in MAUTH are: physical, organizational, biological,
Radiation, surgical smoke, chemical hazard etc
|
38
|
32
|
6
|
3
|
5
|
4.1
|
Agreed
|
|
3
|
Incidence of adverse event secondary to non
utilization of W.H.O safety checklist have put so many patient in dangers
such as; operating on wrong patient, wrong site, etc
|
30
|
37
|
13
|
0
|
4
|
4.1
|
Agreed
|
|
4
|
The incidence of operating room hazard is more in
patient than surgical team members
|
19
|
25
|
20
|
17
|
3
|
3.5
|
Agreed
|
|
5
|
The incident of operating room hazard varies
according to specialty among surgical team members
|
14
|
38
|
24
|
8
|
0
|
3.7
|
Agreed
|
Item 1 in table 4.2 shows
a cumulative mean score of (4.7) which means the respondents have strongly
agreed that operating room is a close, isolated, restricted yet flexible
environment charge with multiple risk for both patient and surgical team
members.
Item 2 on table 4.2 shows
a cumulative mean of (4.1) which means majority of the respondents have agreed
that most of the surgical hazard among surgical team members and patients in
Modibbo Adama University Teaching Hospital are physical, organization,
biological, radiation surgical smoke, chemical hazards and etc
Item 3 on table 4.2 above
shows a cumulative mean of (4.1) which means majority of the respondents have
agreed that the incidence of adverse event secondary to non utilization of
W.H.O safety checklist have put so many patients in danger such as operating on
wrong patient, wrong site, etc
Items 4 in table 4.2
above show a cumulative mean of (3.5) which means majority of the respondents
have agreed that the incidence of operating room hazard is more among patient
than surgical team members.
Item 5 on table 4.2 above
shows a cumulative mean of (3.7) which means majority of the respondents agreed
that the incidence of operating room hazard varies according to specialties.
TABLE 4.3: Preventive measures of operating room hazard among surgical
team members
|
S/N
|
Research question
|
SA
|
A
|
UD
|
DA
|
SDA
|
CUMULATIVE MEAN
|
REMARK
|
|
1
|
W.H.O surgical safety checklist is one of the
integral method of reducing operating room hazard and promoting patient
safety.
|
43
|
37
|
0
|
0
|
4
|
4.4
|
Strongly agreed
|
|
2
|
Routine training and retraining of operating team
members on environmental pathogens and risk management will help reduce the
incidence of operating room hazard
|
46
|
33
|
5
|
0
|
0
|
4.5
|
Strongly agreed
|
|
3
|
Using material with low danger will help reduce the
incidence of operating room hazard
|
27
|
44
|
9
|
4
|
0
|
4.1
|
Agreed
|
|
4
|
Proper utilization of PPE among surgical team
members will help reduce the incidence of operating room hazard
|
51
|
33
|
0
|
0
|
0
|
4.6
|
Strongly agreed
|
|
5
|
Creating more awareness on operating room hazard will
help prevent occurrence of operating room hazard
|
23
|
61
|
0
|
0
|
0
|
4.3
|
Strongly agreed
|
|
6
|
Improving the theatre environmental condition will
help prevent operating room hazard
|
35
|
36
|
13
|
0
|
0
|
4.3
|
Strongly agreed
|
|
7
|
Surgical team members with the high knowledge of
operating room hazard have good operating room prevention strategies
|
25
|
49
|
3
|
4
|
1
|
4.0
|
Agreed
|
|
8
|
Allowing every surgical team members to perform
their duties will help make them perform their best which will in turn reduce
operating room hazard
|
15
|
56
|
7
|
1
|
5
|
3.9
|
Agreed
|
|
9
|
Training all surgical team members on Surgical
safety will help reduce prevent operating room hazard
|
42
|
40
|
2
|
0
|
0
|
4.5
|
Strongly agreed
|
|
10
|
Paying special incentive for using Surgical Safety Checklist
|
52
|
20
|
9
|
2
|
2
|
4.4
|
Strongly agreed
|
Item 1 on table 4.3 above
shows a cumulative mean of (4.4) which means majority of the respondents have strongly
agreed that World health organization surgical safety checklist is one of the
integral method of reducing operating room hazard and promoting patient safety.
Item 2 on table 4.3 above
shows a cumulative mean of (4.5) which means majority of the respondents have
agreed that routine training and retraining of operating team members on
environmental pathogens and risk management will help reduce the incidence of
operating room hazard.
Item 3 on table 4.3 above
shows a cumulative mean of (4.1) which means majority of the respondents have
agreed that using material with low danger will help reduce the incidence of
operating room hazard.
Item 4 on table 4.3 above
shows a cumulative mean of (4.6) which means majority of the respondents have
agreed that proper utilization of Personal Protective equipment among surgical
team members will help reduce the incidence of operating room hazard.
Item 5 on table 4.3 above
shows a cumulative mean of (4.3) which means majority of the respondents have
strongly agreed that creating more awareness on operating room hazard will help
prevent occurrence of operating room hazard
Items 6 on table 4.3 above shows a
cumulative means of (4.3) which means majority of the respondents have agreed
that improving the theatre environment condition will help prevent operating
room hazard.
Item 7 on table 4.3 above shows a
cumulative mean of (4.0) which means majority of the respondents have agreed
that surgical team members with high level of knowledge on operating room
hazard have good operating room prevention strategies.
Item 8 on table 4.3 above shows a
cumulative mean of (3.9) which means majority of the respondents have agreed
that allowing every surgical team member to perform their duties will help make
them perform their best which will in turn reduce operating room hazard
Item 9 on table 4.3 above shows a
cumulative mean of 4.5 which signifies that majority of the respondents have
strongly agreed that training all surgical team members on surgical safety will
help reduce operating room hazard.
Items 10 on table 4.3 above shows a
cumulative mean of 4.4 which means majority of respondents have strongly agreed
that paying incentive for using surgical safety check list will help reduce
operating room hazard.
TABLE 4.4 : Factors that hinders surgical safety practice
|
S/N
|
Research question
|
Yes (%)
|
No (%)
|
|
|
The following are contributing factors to non
utilization of W.H.O safety checklist
|
|
|
|
1. Lack
of training
|
76(90%)
|
8(10%)
|
|
2. Lack
of man power
|
63(75%)
|
21(25%)
|
|
3. Lack
of special incentive for using SSC
|
44(52%)
|
40(48%)
|
|
4. Lack
of essential surgical equipment
|
68 (79%)
|
18(21%)
|
|
5. Absence
of standard operation procedure
|
81(96%)
|
3(4%)
|
|
6. Lack
of cooperation among surgical team members
|
69(82%)
|
15(18%)
|
|
7. Negative
attitude to surgical safety checklist
|
73(87%)
|
11(13%)
|
|
8. Seniority
among surgical team members
|
71 (85%)
|
13(15%)
|
|
9. Poor
work ethics
|
81(96%)
|
3(4%)
|
|
10. Delay
in commencement of surgery
|
75(89%)
|
9(11%)
|
Table 4.4 above shows
that 76(90%) of the respondents agreed that lack of training is among the
factors that hinder surgical safety practice 8(10%) said no, 63(75%) said yes
to lack of man power while 21(25) said no,
44(52%) said yes to lack of special incentive and 40(48%) said no,
68(79%0 said yes to lack of essential equipment while 18(21%) said no, 81(96%)
said yes to absence of standard operation procedure while 3(4%) said no, 69(82%)
said yes to lack of cooperation among surgical team members while 15(18%) said
no, 73(87%) said yes to negative attitude to surgical safety checklist while 11
(15%)said no, 71(85%) said yes to seniority among the surgical team members
while 13(15%) said no, 81(96%0 said yes to poor work ethics while 3(4%) said
no, 75(89%) said yes to delay in commencement of surgery while 9(11%) said no.
CHAPTER FIVE
5.0 INTRODUCTION
This chapter discussed the major
finding of the research work with regard to stated objective and research
question equally reflected in this chapter
are implication to nursing, summary conclusion and recommendation,
suggesting further studies and limitation of the study.
5.1 DISCUSSION OF FINDINGS
Findings gotten from the demographic
data shows that majority of the respondents are from the age of 20 to 39years
which shows that FMC are having a good number of youths who are very strong
than can do plenty of work in 24hours, among the respondents, perioperative
nurses are having the highest number in the surgical team members, an majority of
the respondent are only having 1 to 5 years of working experience.
Findings on incidence of operating
room hazard among surgical team members base on data analyzed on table 4.2
reveal that operating room environment is pose with so many risk to both patient
and surgical team members because this is having a cumulative mean of (4.65) and findings also reveal that most of the
operating room hazard among surgical team members in Modibbo Adama University
Teaching hospital Yola are Physical hazards, organizational hazards, radiation
hazards, surgical smoke, and chemical hazards with cumulative mean of (4.1)
showing majority of the respondent have one of the listed hazards during the
course of patient care which agreed with findings of Danjuma, (2016) which said operating room environment is a
close isolated, restricted but yet pose with different hazards such as
radiation, chemicals, biological and etc forms of hazards. Majority of the
respondent also agreed that the incidence of operating hazards varies according
to specialty with cumulative mean of (3.7). findings also shows that the incidents of operating room hazard in Modibbo
Adama University teaching Hospital is more among patients than among the
surgical team members with cumulative mean of (3.7) this agreed with research
by Gillespie etal, (2016) that incidence of operating room hazard is more on
inpatient who had surgical procedure in United State and Danjuma, (2016) that
incidence of operating room hazard is more among Orthopedic and Neurosurgeons.
Findings on prevention of operating
room hazard among surgical team members reveal that using world health
organization surgical safety checklist will help prevent operating room hazard
with cumulative mean of (4.4), Routine training cumulative mean (4.5) and
training all surgical team members on surgical safety checklist with cumulative
mean (4.5) in Modibbo Adama University Teaching Hospital will help prevent
Operating room Hazard, findings also show that improving the working
environment of the theatre with cumulative mean of (4.3), Paying special
incentive for using surgical safety checklist cumulative mean (4.4), proper
utilization of PPE cumulative mean (4.6), creating more awareness on operating
room hazard cumulative mean (4.3), all will help prevent operating room hazard.
These have agreed with study conducted by Woodman, (2016) consistent use of
W.H.O surgical safety checklist will help prevent operating room hazard and
Danjuma, (2016) said nurses who are occupational risk will help control
possible risk factors. And Gul, (2021) said operating room nurses should be
train on general environmental pathogens.
Findings on factors that hinders the
utilization of surgical safety checklist reveal that majority of the
respondents agreed to lack of training, lack of man power, lack of essential
surgical equipments, absence of standard operation procedure, lack of
cooperation among the surgical team members,, seniority among the surgical team
members, negative attitude to surgical safety checklist, lack of essential
equipment, poor work ethics and delay in commencement of surgeries. This have
greed with Munthali etal, and Fourcade, Lous, Blache, Bourgain & Minvielle
research findings that the factors affecting the utilization of W.H.O. surgical
safety checklist are lack of man power, poor work ethics and etc.
5.2
IMPLICATION OF FINDINGS TO NURSING
The study have highlighted lapses in
the practice of surgical team members on operating room hazards and surgical
safety practice among surgical team members in Modibbo Adama University
Teaching Hospital Yola and most of the respondent agreed to not practicing
application of surgical safety checklist in prevention of operating room
hazard. The overall objective of this study is to encourage the utilization of
operating room hazard to promote surgical safety practice among surgical team
members. If this recommendation is used, it will improved the image of perioperative
nursing and surgical team members at large by giving it color to the already
existing responsibility during surgical operation and improving standard of
surgical instrument care and sterilization.
Therefore, it is of paramount
important that the practice of surgical safety checklist to be improved so as
to meet the health need of the patient and general population, to also prevent
litigation of any kind and prevent practice to going into extinction. This
could be achieved through additional studies, trainings, workshops and seminars
and again there is a need for improvement of hospital policies to ensure the
utilization of surgical safety practice among surgical team members.
5.3 LIMITATION OF THE STUDY
The study could not be extended to
other institution in the state following time constraints, financial problem,
time factor in short duration of the training and depth of literature and
empirical review of previous studies.
5.4 CONCLUTION
Majority of the respondents have ones
been exposed to different kinds of operating room hazard, they know the
existence of operating room hazard of which findings even reveal that the
incidence is high among patient than among the surgical team members, which is
a big raise of an alarm that there is a need to start practicing the
utilization of W.H.O Surgical safety checklist in Modibbo Adama University
teaching Hospital Yola and routine staff training and motivation.
5.5 RECOMMENDATION
Ø Government should employ more
technical staffs in MAUTH to ensure the standard of patient care in theatre is
followed by all the specialist involved in patient care.
Ø Modibbo Adama University teaching
hospital should make it a culture by sending the surgical team members to
seminars, workshops or organize a periodic training of all the surgical team
members on environmental pathogens and surgical safety checklist.
Ø The hospital management should make
it a policy that all patient undergoing surgery must have surgical safety
checklist done by all the team before surgery.
Ø The hospital should design a
committee that will evaluate the used of surgical safety checklist after
undergoing a special training on that.
Ø The hospital should design a feedback
from both patient site and surgical patient site condition post operatively so
as to gave a good date and know there challenges and were to improve standard
of care.
5.7 SUGGESTION FOR FURTHER STUDY
Study should be done on
1. To assess the knowledge of operating
room hazards among non surgical team members in Modibbo Adama University
teaching hospital Yola.
2. Assess the Incidence of operating
room hazard in different surgical specialties and among other non surgical team
members.
3. Assess the incidence of post
operative complications on surgical patient
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