CHAPTER ONE

INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Aseptic technique is a procedure used by medical staff to prevent the spread of
infection. The goal of aseptic technique is to reach asepsis which means an environment that
is free of harmful microorganisms (Berry, 2008). Brian and Whitney (2009) define aseptic
technique as a method designed to prevent contamination from microorganisms. It involves
applying the strictest rules and utilizing what is known about infection prevention to
minimize the risk of experiencing an infection. According to Kendra (2008), aseptic
technique is employed to maximise and maintain sepsis, the absence of pathogenic organisms
in the clinical setting. The goals of aseptic technique are to protect the patient from infection
and to prevent the spread of pathogens. Aseptic technique aims to prevent pathogenic
organisms, in sufficient quantity from causing infection, from being introduced to susceptible
body sites by the hands of staff, surfaces or equipments.
Each healthcare setting has its own set of practices for achieving asepsis. Aseptic techniques
are important in preventing hospital acquired infection which will lead to morbidity and
mortality as well as additional costs due to prolonged hospitalization. In the last couple of
decades, refusal to practice aseptic technique has led to nosocomial infection being reported
as a serious public health threat in most hospital in Africa, it is therefore imperative to
examine the attitude of nurses towards adhering to basic safety precautions especially aseptic
technique. Despite all the nurses efforts, infection remains an unwanted side effect of
healthcare, often causing serious harm to patients. The statement of Johan Peter Frank,
director of the general hospital in Vienna around 1800 an hospital acquired infection is an
evil that one acquires where one hopes to lose ones own disease the biggest problem is not
the lack of effective techniques and evidenced based guidelines, but the fact that health care
workers practice these measures insufficiently. Improving this negligent attitude of healthcare
workers is a main aspect of improving practice of aseptic technique needed for infection
control in health care. From the patients perspective, being in the hospital can be physically
exhausting and emotionally distressing, it is therefore expected that the patient will want to
leave the hospital as soon as he gets better without any accompanying hospital acquired
infection and this can be achieved if the nurse has the right attitude towards aseptic technique
and practises it efficiently and effectively (Berry, 2008). It is based on this the researcher
1

seeks to investigate the attitude and practice of nurses towards aseptic techniques in state
hospitals, Ogun state.
1.2 STATEMENT OF PROBLEM
The operating room complex environment, including the nursing personnel, may play
a role in the transmission of nosocomial infections; and therefore DeLaune and Ladner
(2008) state that nosocomial infections may be transmitted to the patient by the nursing
personnel who fail to practise or carry out the sterile technique principles. It is necessary to
give careful attention to the creation and maintenance of a safe and acceptable therapeutic
operating room complex environment in order to prevent the potential development of
nosocomial infections, because the integrity of the patients skin is compromised during a
surgical procedure.
The bodys largest and most important organ is the skin and its functional components
are the cutaneous layer that includes the epithelium and the connective tissue. The skin also
includes structures in the cutaneous layer, such as the sweat and the sebaceous glands, hair
and nails. The cutaneous layer consists of two main layers which are known as the epidermis
and the dermis. When a wound occurs, the skin and its components become involved in the
healing process in other to restore the integrity of the skin (Mulder, 2012)
The intact skin plays an important role in the prevention of infection or disease
because it is part of the bodys first line of defence against infection, involves good health
and entails natural biochemical, mechanical as well as anatomic protection (Fortunato, 2009).
The source of pathogens for most wound infections is the endogenous flora of the patients
skin, mucous membranes or hollow viscera. When the skin or mucous membranes are
incised, the exposed tissues are at risk for contamination with endogenous flora (Mangram,
2009)). An aseptic technique must be used during any invasive procedure which breaches the
bodys natural defences, for example the skin, mucous membranes, or when one is handling
equipment which will enter a normally sterile area (Xavier, 2009).
Infection may also occur from the normal colonisation of the patients skin or it may
enter the wound from dispersed bacteria in the air of the operating room, hence the rationale
for using specialised air-conditioners to reduce potential infection. Bacteria that are
responsible for infections, such as wound infections, are introduced into the wound at the
time of the surgical procedure and may only be noticed weeks after the surgical procedure
(Fry and Fry, 2007:802). In the practical situation, within the operating room, it is important
2

to classify the degree of contamination of the surgical wound in order to determine whether
the nosocomial infection was introduced within the operating room complex, because a clean
site may become contaminated depending on the type of wound, the pathological findings,
the anatomical location or a break in the aseptic technique (Fortunato, 2009). Patients have a
right to be protected from preventable infection and nurses have a duty to safeguard the
wellbeing of their patients (King 2008). An aseptic technique should be implemented during
any invasive procedure that bypasses the bodys natural defences, e.g. the skin and mucous
membranes, or when handling equipment such as intravenous cannula and urinary catheters
that have been used during these procedures. Whilst it is difficult to maintain sterility, it is
important to prevent contamination of sterile equipment. Poor aseptic techniques can lead to
contamination. By having the right attitude and high level of practice asepsis can be
maintained.
It is observed that a nurses attitude towards hand washing compliance worsened
when the demand for aseptic technique was high. There are two significant problems that are
found to influence the level of practice of aseptic technique which include poor practice areas
with high intravenous therapy workloads, such as theatres and intensive care units, often
seemed to demonstrate the poorest aseptic practice. For instance, hand washing is often found
to be poor, intravenous ports are often not cleaned and syringes are often re-used after being
placed on the patients bed linen. Secondly, the wrong attitude, included being a chief nursing
officer rather that a sister nurse, being male; working in an intensive care unit (ICU); working
during weekdays rather than weekends; wearing gowns and gloves; performing activities
with high risk for cross infection; and having many opportunities for hand hygiene per hour
of patient care. All these affect the attitude nurses have towards aseptic technique. (Didier
2013)
Despite nurses educational background and training and continuous efforts made in
the promotion of the practice of aseptic techniques, many nurses seems not to be performing
it. This may be probably due to wrong attitude, inadequate knowledge and so on. Its based
on this submission that the researcher intends to carry out a research on the attitude and
practice of nurses towards aseptic techniques.

1.3 OBJECTIVES OF THE STUDY

The objective of this research is to:
3

1.
2.
3.
4.

Find out the nurses attitude towards aseptic technique.

Assess the level of practice of aseptic technique among nurses.
Find out if the nurses attitude affect the practice of aseptic technique
Find out relationship between nurses level of experience and their practice of aseptic

technique
5. Find out relationship between nurses educational background and their practice of
aseptic technique.
1.4 SIGNIFICANCE OF THE STUDY
This study will be useful in correcting nurses attitude towards aseptic techniques and
also to improve the practice of aseptic technique among nurses. The information provided
will help nursing administrators in knowing area to address as continued education and
seminars are organized for the nurses.
The result of this study will assist in nursing education as it provides information to
guide the development of nursing curriculum and training courses related to attitude and
practice of aseptic techniques.
This study will help the government to understand that practise of aseptic technique is
of utmost importance hence the need to be involved in the provision of protective devices for
all nurses
The important of the study to the nation is that it will help to reduce the high rate of
cross infection from resulting into increased mortality rate. The significance of the study is
that it will serve as a basis for further study to include all the doctors, nursing personnel and
nursing students.
1.5 RESEARCH QUESTIONS
1. What is the attitude of nurses towards aseptic technique?
2. What is the level of practice of aseptic technique among nurses?
3. What is the relationship between the nurses attitude and the practice of aseptic technique?
4. What is the relationship between nurses years of experience and their practice of aseptic
technique?
5. What is the relationship between nurses educational background and their practice of
aseptic technique?
4

1.6 RESEARCH HYPOTHESIS

1. there is no significant relationship between the nurses attitude and the practice of aseptic
technique?
2. there is no significant relationship between nurses years of experience and their practice of
aseptic technique?
3. there is no significant relationship between nurses educational background and their
practice of aseptic technique?
1.7 SCOPE OF RESEARCH
This study is to be carried out among nurses at State Hospitals, Ogun state. The nurses
used were nurses from male surgical ward, female surgical ward, male medical ward, female
medical ward, children ward, theatre and labour ward.
1.8 LIMITATIONS
This research would have covered a wider range of population but it was limited to state
hospital Ota and state hospital Ilaro because of distance of the researcher to the hospital and
because of unavailability of the nurses as well as their changes in duty roster.
1.9 OPERATIONAL DEFINITIONS OF TERMS
1. Aseptic techniques: a set of specific practices and procedures performed in the ward with
the goal of minimizing contamination by pathogens.
2. Practice: is the act of an activity or skills so as to acquire or maintain proficiency in it
3. Nurses: are people who provide services essential to or helpful in the promotion,
maintenance and restoration of health and well being.
4. Cross infection: is a type of infection that is normally transmitted between individuals
who are infected with different microorganisms
5. Attitude: is the disposition or state of mind, a settled way of thinking or feeling that affects
an individuals behaviour.

CHAPTER TWO
LITERATURE REVIEW
2.1 HISTORY OF ASEPTIC TECHNIQUE

An ancient record shows that antiseptic techniques date far back into history. The ancient
Chinese, Persians and Egyptians had methods for water sanitation and antisepsis for wounds.
The ancient Greeks and Romans used silver vessels to restore fresh liquid and wine, settlers
in the Australian use silver ware and pioneers of the American west put silver and copper
coins in drinking water for the same purpose (Lois, 2013).
The modern concept of asepsis evolved in the 19th century. Ignaz semmelweis showed that
washing the hands prior to delivery reduced puerperal fever in the ward of viennas lying-in
hospital. After the suggestion Louis Pasteur, who proved that microoganism caused spoilage
and could be transported via the air, placing booth in flasks with long shaped necks, after
boiling the booths, observed that no microorganisms grew in the flask, then Joseph Lister
began soaking his surgical dressings in carbolic acid (phenol) because he heard that carbolic
acid has been used to treat sewage in Carlise and the fields that had been treated were now
free of parasitic causing diseases, leading to a dramatic decrease in the number of post
operational infections (Mokhoro, 2012).
Joseph Lister introduced the use of carbolic acid as an antiseptic and reduced surgical
infection rates especially in 1870 when it saved the lives of many Prussian soldiers. Some
countries like England and America were still in opposition to his germ theory though. The
turning point for Lister came on October 26, 1877 when he had the opportunity to perform a
simple knee operation (wiring a fracture kneecap, which entailed deliberate conversion of
simple fractured into a compound fracture), which often resulted in generalised infection and
death. The success of this operation forced people to accept that this method greatly added to
the safety of operative surgery. The culmination of his emphasis on the principle of
preventative medicine was the opening of the institute in 1981. These are a few of the reasons
why Joseph Lister is often referred to as the father of antiseptic surgery (Elana, 2012).
Furthermore, Pittet (2012) stated that Lawson Tait went from antisepsis to asepsis by
introducing principles and the iconic statutes that have remained valid to this day. He also
identified Ernst Von Bergmann as the person who introduced the autoclave, a device used for
practice of steam sterilization of surgical instruments under pressure. He equally explained
how the Arabian physicians in the middle ages used Mercury chloride to prevent sepsis in
wounds by introducing hypochlorite and iodine as a treatment for open wounds in 1825 and
1839 respectively.
2.2 WHAT IS ASEPTIC TECHNIQUES
7

Mosby (2009) stated that aseptic technique is any health care procedure in which
added precautions such as sterile gloves and instruments are used to prevent contamination of
a person, object or area by microorganisms. It helps to prevent contamination from
microorganism by applying the strictest rules and utilizing what is known about infection
prevention to minimize the risk of experiencing an infection. It is also the application of
preventative measures taken to reduce the likelihood of introducing microorganisms.
Rotter (2012) explains that there are two types of aseptic technique and they include:
sterile techniques and surgical aseptic techniques. Sterile technique is a technique that aims to
achieve total absence of microorganisms. Some cleaning and care procedure needs to be done
in a sterile manner so that infection is not contacted. Requirements for sterile technique
include: Running water and soap, a sterile kit or pad, gloves (sometimes in the kit), a clean
dry surface and a clean paper towel. Its important that hand are thoroughly washed and dry
at all times when handling supplies. There is need to wear mask over the nose and mouth, and
also to keep all supplies within reach so as not to drop when needed. Suzanne et al (2010)
stated that surgical aseptic techniques are the use of surgical practices that restrict
microorganisms in the environment and prevent contamination of surgical wounds. This type
of techniques is commonly used in the operating room. Application of surgical asepsis is
especially required during procedure that requires internal perforation of a client skin, when
skin integrity is broken (surgical incisions or burns), during procedures that involves the
insertion of catheters of surgical instrument into sterile body cavities, and it is also used in
labour and delivery and in burns unit and diagnostic or special procedure areas in many
settings. Achieving surgical asepsis requires donning a hair cover, mask protective eye wear
and shoe cover and performing a hand scrub, donning a sterile gown and sterile gloves. Any
break in techniques while performing these steps can result in contamination and that
increases the patients risk for infection

2.3 IMPORTANCE OF ASEPTIC TECHNIQUE

The importance of aseptic technique cannot be overemphasized. Every year, the rate
of hospital acquired infections keep increasing, many of which are preventable. Prevention of
these infections is the responsibility of all nurses; it is not considered an unpredictable
complication but rather a potentially preventable adverse event. Aseptic technique is
carried out to prevent the users clothing from becoming contaminated with pathogenic
8

microorganisms which may subsequently be transferred to other patients in their care

(Callaghan 2008).It is also carried out to prevent the users clothing becoming soiled, wet or
stained during the course of their duties.
It is carried out to prevent transfer of potentially pathogenic microorganisms from
user to patient thereby preventing the spread of cross infection and making an individual
healthy and reducing the rate of mortality and morbidity.
Practice of aseptic technique helps to prevent the user acquiring infection from the patient
(DoH 2009a), there is decreased risk of transfer of infection from patient to patient as well as
from nurse to patient or patient to nurse, it also helps to reduce the spread of harmful
microorganisms and minimises the patient risk of exposure to microorganism.
2.4 PRINCIPLE OF ASPETIC TECHNIQUES
Centres for disease control and prevention (2012) stated that the following principles
should be adhere to in order to achieve asepsis this includes cleaning of the surface that
sterile pack is to be placed on and ensuring that all items in a sterile field are sterile. However
hand decontamination must be done prior to any procedure. in addition is decontamination of
the setting with detergent and water and wipe and then dried before any procedure is carried
out. Ensure all fluids and materials that will be used are sterile and check sterile pack for
evidence of damage or moisture penetration.
It is imperative to ensure non sterile items are not placed in the sterile field, single use
items should not be re-used even on the same patient. Do not continue to use sterile item if
they become contaminated during the procedure. Reduce activity in the immediate vicinity of
the area in which the procedure is to be performed to reduce the risk of air borne
contamination and when pouring fluids, only the lids and inner can of the pouring container is
considered sterile, the pouring container should not touch the receiving container and
splashing should be avoided. In case of wounds, they should be exposed for the minimum
time to avoid contamination and maintain temperature. Soiled dressings should be removed
carefully (a large amount of microorganisms can be shed into the air when dressing are
removed). If possible, 30minutes should be left after bed making or domestic cleaning before
exposing or dressing wounds, or performing any other aseptic procedures.
Before any aseptic technique procedure, all packaged sterile items for the procedure
should be assembled, the packaging should be confirmed to be intact and that expiry date has
not exceeded. The packaged sterile items such as needles and syringes should be opened
carefully by peeling back the packaging and not pushing it through the backing paper. It is
important to know that the use of sterile gloves is essential when carrying out procedures
9

requiring high level of sterility together with the use maximal sterile barrier precautions
including a sterile gown, sterile gloves and a large sterile drape. Gloves should be changed
and hands decontaminated at any stage when contamination has occurred.
2.5 REASONS WHY ASEPTIC TECHNIQUES IS NOT PRACTISED
Kozier et al (2009) identifies that there are some reasons why some nurses do not
perform aseptic techniques. One of the reasons includes lack of adequate equipment. When
nurses on the ward do not have enough equipment, there is the tendency to improvise or
economise which is very instrumental in the increased rate of cross infection. Another
reason is availability of time, not all nurses have the time to carry out aseptic technique, this
is because in many hospital settings a nurse gets to take care of more patients than she can
handle during her shift, this gives no room to practice aseptic technique in the ward.
In addition, Kozier explains that it is difficult to practise aseptic technique because
many nurses lack the self confidence in the ability to perform the techniques properly, they
feel that they cannot practice it well as a result of low self esteem which could come from
the rank or years of experience in the work. Still many nurses do not practice aseptic
technique because they are short staffed. When a nurse handles one or two wards, it will be
quite difficult for the nurse to implement aseptic techniques because she is under pressure to
care for the patients to the best of her ability during her shift.
Kozier further explains that a nurse might decide not to practice aseptic technique
because she lacks the appropriate attitude about the procedure, this is often seen when a
nurse feels that the ward manager or someone in higher authority is to practice aseptic
technique or that it is to be practised at a certain time like in the mornings on weekdays and
not on weekends. Nurses also decide not to practice aseptic technique due to a lack of
appropriate knowledge about the benefits of the procedure to the patients
Nurses might as well have a wrong attitude towards aseptic technique, thinking it is a
waste of time and resources and that their work would be faster, thereby accomplishing
more if they cut aside the protocols of aseptic technique (Rowley, 2006).
Many health practitioners feel that practicing aseptic technique is not cost effective as
some nurses would unnecessarily wear expensive sterile gloves for the simplest intravenous
procedures and wound management. Also the idea that the practice of aseptic technique is
labour intensive discourages nurses from practicing aseptic technique, this is seen in cases
10

where two nurses carry out a simple procedure as injecting a drug into a burette. There is
also the issue of poor practice itself which could be attributed to years of experience in a
particular field that requires constant a regular practice f aseptic technique, like areas with
high intravenous therapy workload such as intensive care and theatres often seem t
demonstrate the poorest aseptic practice. There could be issues like poor hand washing, not
cleaning intravenous ports, and re-using of syringes after placing them on bed linen
(Rowley, 2006).
2.6 THEORETICAL FRAMEWORK
The theoretical framework that applies to this study is the knowledge, attitude and practice
model.
Rogers proposed DOI theory (diffusion of innovation) in 1962. This theory tries to
describe the process that new ideas spread over time. The theory studies are highly focused
evaluations that measure changes in human knowledge, attitude and practice in response to a
specific intervention. it consists of features such as, the spreading occurs because f the
passing of time, and that most people will experience the usage, not the adoption of an
innovation. In recent years the innovation diffusion theory has been integrated into three
stages: knowledge, attitude and practice. KAP model is a quantitative method to provide
access to quantitative and qualitative information. It reveals misconceptions that may
represent obstacles to the activities that we would like to implement or potential barriers to
behaviour change.
A KAP can measure the extent of a known situation, confirm or disprove a hypothesis;
provide new tangents of a situations reality. It also suggests an intervention strategy that
reflects specific local circumstances and the cultural factors that influence them and plan
activities that are suited to the respective population involved (Hubbard and Hayashi 2013)
RELEVANCE OF KAP MODEL TO THE STUDY
The learning knowledge of the nurse affects her learning attitude, while learning attitude
affects, and is shown, through the learners behaviour. On the other hand, it also enhances the
knowledge, attitude and practices of specific themes, and identifies what is known and done
about various health related subjects. KAP model establishes the baseline for use in future
assessments and help measure the effectiveness of health education activities ability to
change health related behaviours.
11

It has been employed in the nursing field from 1960s to teaching nurses how to improve
their techniques in practice, the cognitive learning was focused on the knowledge and ability
of realization, the affective learning means to change subjects intention, attitude or norms to
adjust themselves through hygiene education. Psychomotor learning requires nurses to learn
some skills compared which practice which required the changing of behaviour as target.
Conventional thinking in the field of health is that knowledge affects the nurses attitude
directly, and the attitude is transformed into behaviour. Xie (2013) discovers in her research
that if nurses have a higher level of knowledge, her learning attitude is relatively more
positive. Other related studies find that knowledge will directly affect the attitude and
practice, and that attitude will directly affect the practice or intentions, except that the degree
of impacts that knowledge affects practice through attitude is better than that of knowledge
affects practice directly. Therefore this work uses KAP framework as a base to develop the
required assessment tool.
The researcher found that the KAP model will help nurses to utilise their knowledge of
aseptic technique. In other to carry this out, their attitude towards aseptic technique has to be
examined. Since their attitude is being transformed into their behaviour, assessing nurses
attitude will determine how effective and efficient they practice aseptic technique.
2.7

EMPIRICAL STUDIES
Pankaj et al (2014), in his study a study to assess the attitude and practice of aseptic

technique applied in nursing practice among staff nurses working in selected hospital,
revealed that the overall practices mean score for (YES) was (15.08 4.08) that is 75.40% of
the total score. This implies that the staff nurses maintain very good practices of aseptic
techniques applied in nursing practice. Also the study shows that the nurses attitude towards
aseptic technique was good as they were able to fill the correct answer to pertinent questions.
There was significant association found between demographic variable like years of working
experience and the attitude towards aseptic technique applied in nursing practice among staff
nurses variables like year of working experience. This shows that high cadre nurses have the
right attitude towards aseptic technique than low cadre nurses; this is due to their years of
experience and effectiveness in the work. There was significant association found between
the practices and the variables like sex. Hence it was concluded that it is essential to raise
awareness about aseptic technique on attitude and practices while providing nursing care to
patients and its impact on health; and develop health seeking behaviours among the patients
12

and caregivers to provide better care and improve the quality of life. However there was no
relationship between level of education and practice of aseptic technique.
As revealed by Offra in his study on knowledge, attitude and behaviour of Indonesian
nurses with respect to aseptic techniques. The highest mean score for knowledge of aseptic
technique applied in nursing practice is 63.33% f the total score indicates that staff nurses
have very good level of knowledge. The mean score of the answers to all attitude questions
that were in agreement with the preferred attitude was 67%. Agreement was unsatisfactory
for use of personal protective equipment. The level of practice of aseptic technique is also
rated at 73.2%. The nurses attitude was significantly good, same as the practice.
Unsworth (2011) carried out a study at the clinic of school of health community and
education studies, Northumbria University, Newcastle- upon- Tyne, UK, on the knowledge,
attitude and practice of aseptic techniques among nurses. the results of the study shows that
85.5% of nurses were knowledgeable; all most all nurses had the right attitude and practice
towards aseptic technique. Common challenges experienced include wound dressing using a
single nurse procedure. The research also identifies misconceptions about aseptic techniques
and factors that hinder practice of aseptic techniques among nurses. But in all the nurses
practise of aseptic technique is rated at 75% which is commendable
A study carried out by Aaron (2015) in Warri, Delta state, on the practice of aseptic
techniques among nurses, reveals that 99% staff nurses in university Teaching hospital Warri
have high knowledge about aseptic techniques and they practice it effectively
As observed by Faukner (2013) in his study on attitude of nurses towards aseptic
techniques in Netherlands institute for health services in Netherlands among the nurses in the
institute, The mean score of the answers to all attitude questions that were in agreement with
the preferred attitude was 67% showing that the nurses had a good attitude towards aseptic
technique
In the study carried out by Peterhams (2014) in an Indonesian healthcare establishment on
the attitude and practice of nurses towards aseptic techniques, of the 456 nurses, 77% had the
right attitude towards aseptic technique and 63% effectively practice aseptic technique
regularly.

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CHAPTER THREE
RESEARCH METHODOLOGY
3.1 RESEARCH DESIGNS
Descriptive study method was used in assessing the attitude and practice of nurses
towards aseptic technique at state hospitals in Ogun State.
3.2 RESEARCH SETTINGS
The research was conducted at conducted at State Hospitals in Ogun state. Ogun is a
state in south western Nigeria. Created in 3 rd of February, 1976, it borders Lagos state to the
south, Oyo and Osun states to the north, Ondo state to the east and the Republic of Benin to
the west. Abeokuta is the capital and the largest city in the state.
The state consists of 20 local governments each with its own state hospital. The state
hospitals in ogun state are funded and operated by the Ogun State government with a mission
statement to ensure the provision of safe, quality, affordable, adequate, equitable and
accessible health services to all people in Nigeria. They offer medical services on internal
14

medicine and gynaecology. The area of study comprises of health care workers from state
selected hospitals in the state.
3.3 TARGET POPULATION
The research study population are nurses at state hospitals ogun state.
3.4 SAMPLING TECHNIQUE
Researcher first collected the data as regards total number of nurses at state hospital ogun
state from appropriate authority. This was used in calculating the sample size using appropriate
formula. Researcher employed multi stage sampling technique. Each senatorial district of the state
serves as a cluster. Researcher selected a district using simple random technique. Following this the
researcher collected the list of state hospitals in the randomly selected district and l then selected a
hospital from this list using simple random technique. Convenience sampling method was used in
collecting data from the data from the nurses in the selected hospital until the calculated sampling size
was accomplished.

Yemane (1967) was used in calculating the sample size which states:
n/1+n (e2). Where N=sample size which is 140, and e is the error of margin. Therefore
140/1+140(0.053)2,
140/1+140(0.0028)
140/1.393 = 100.
3.5 INSTRUMENT FOR DATA COLLECTION.
The basic instrument for this study was self constructed and validated questions that
elicited information about the respondents attitude and practice of aseptic techniques. The
questionnaire was the major instrument used for this study. The questionnaires were made up
of section A, B and C.
Section A: this includes questions 1-8 and deals with the demographic data of the
respondents, which includes age, religion, sex, marital status and educational background.
Analysis will be presented according to the response of the respondents using tables.
Section B: this includes questions 9- 14 and deals with information relating to the nurses
attitude towards aseptic techniques. It will be scored using a 5 point rating scale, by
15

comparing their mean values with a central mean of 3, this is achieved by using the average
mean of strongly agreed (5), agreed (4), neutral(3)disagreed (2) and strongly disagreed (1) :
((5+4+3+2+1)/4)=3. A mean of above 3 shows percentage of respondents with right
responses to the attitudinal statements while a mean below 3 shows the percentage of
respondents with wrong responses to the attitudinal statements
Section C: this runs from question 15 27 and deals with information relating to their
practice towards aseptic techniques. Respondents were asked 9 practice question and every
Yes was scored 1 and No was scored 0, every positive practice was also scored 1 and other
practice scored 0, result was added and graded.
Good practices are for respondents that scored above 7-9
Bad practices are for respondents that scored below 7.

3.6 VALIDITY/RELIABILITY OF INSTRUMENT

Validity: The instrument was validated through content and facial validity by research
supervisor.
Reliability: For reliability, the attitude and practice questions were tested with 20 nurses who
have the same characteristics as subjects in the actual study but outside the study setting. This
was conducted twice within two weeks interval and results were subjected to reliability test.
The reliability test result was 0.65
3.7 METHODS OF DATA COLLECTION
Letter of permission was collected from the school; the application was submitted to the
selected hospital for gaining permission. Following approval the purpose of study was
explained to the nurses willing to participate in the study. The questionnaires were then
distributed to nurses and they were encouraged to complete the questionnaire within two or
three days after which the answered questionnaires retrieved back.
3.8 METHOD OF DATA ANALYSIS
The collected data was analysed using SPSS software version 2.0 for windows. The analysis
includes descriptive statistics (frequency and percentages) to answer each research question. .
16

3.9 ETHICAL CONSIDERATION

Before administering the questionnaire to the respondents, permission was obtained
from the appropriate authority. the confidentiality of the information given was ensured by
keeping the identity of the respondents secret and not requesting for their names. Researcher
was ensured that the participant voluntarily participates in filling the questionnaire after fully
explaining that they have a right to participate or not to participate and to withdraw at any
stage of the process. Participants were assured that no harm will be inflicted during the course
of carrying out the research work. Researcher ensured that personal biases and opinions do
not get in the way of the research. Lastly, Researcher ensured that the results of the research
are accurately represented.

CHAPTER FOUR
ANALYSIS OF DATA
4.1 FREQUENCY TABLE
This chapter presents the analysis of data collected and discussion of the result obtained from
the findings. Analysis was presented in tables according to the response of the respondents in
each sections of the questionnaire.
SECTION A
TABLE 1: SOCIO DEMOGRAPHIC DATA

VARIABLES

FREQUENCY

PERCENTAGES

18-24 years

12

12.6

25-30 years

47

49.5

31-35 years

16

16.8

Age

17

36 and above years

20

21.1

Total

95

100.0

Male

27

28.4

Female

68

71.6

Total

95

100.0

Christianity

76

80.0

Islam

18

18.9

1.1

95

100.0

Yoruba

69

72.6

Hausa

15

15.8

Igbo

9.5

Others

2.1

95

100.0

Single

29

30.5

Married

64

67.4

Divorced

1.1

Widow

1.1

95

100.0

RN

14

14.7

RNM

30

31.6

BNSC

49

51.6

2.1

Gender

Religion

Traditional
Total
Tribe

Total
Marital status

Total
Level of Education

Others
18

Total

95

100.0

Below 10 years

37

38.9

10- 20 years

38

40.0

21-30 years

15

15.8

5.3

95

100.0

Theartre

38

40.0

Male surgical ward

31

32.6

female surgical ward

20

21.1

6.3

95

100.0

Years of experience

41 years and above

Total
Ward

Others
Total

Table 1 of the analysis shows that most of the respondents (49.5%) falls within the age
bracket 25-30 years and 71.6% are females. Also most of the respondents (40.0%) had 10-20
years experience and had below 10 years experience (38.9%) and most of the respondents
51.6% are degree holders

SECTION B
TABLE: 2 ATTITUDE TOWARDS ASCEPTIC TECHNIQUES
The table below was analysed using the mean of responses. The agreement and disagreement
of the respondents with the statements was determined by comparing their mean values with
a central mean of 3, this is achieved by using the average mean of strongly agreed (5), agreed
(4), neutral(3)disagreed (2) and strongly disagreed (1) :((5+4+3+2+1)/4)=3.A mean of above
3 shows majority of respondents agreeing with the attitude statements while a mean below 3
shows respondents disagreeing with the attitude statement
19

VARIABLES

Aseptic technique

SA (5)

24(25.3%)

A(4)

N(3)

50(52.6%)

should be practiced

1(1.1

D(2)

0%

%)

SD(1)

20(21.1

MEA

REMA

NX

RK

3.6

agreed

1.8

disagre

%)

in all nursing
procedures
Aseptic technique

4(4.2%)

3(3.

should only be

2(2.1

54(54.7

34(35.8

%)

%)

2(2.1

53(55.8

37(38.9

%)

%)

%)

0%

8(8.4%

73(76.8

%)

2%) %)

ed

practiced at
favorable times
Aseptic technique

2(2.1%)

1(1.1%)

should only be

1.7

disagre
ed

practiced by the
chief nursing officer
The manner sterile

14(14.7%)

0%

equipments or

1.6

disagre
ed

materials is placed
has nothing to do
with spread of
infections
Splashing of fluids

90(94.7%)

5(5.3%)

0%

0%

0%

4.9

agreed

44(46.3%

47(49.5%)

1(1.1

1(1.1%

2(2.1%)

4.4

agreed

%)

during procedure is
one major way
contamination takes
place
Maintenance of
Aseptic technique
determines duration
of hospitalization

The table above shows the attitude of nurses towards aseptic technique; Analysis shows that
level of agreement of the students to the attitudinal questions. Mean score is 3, a mean of
20

above 3 indicates percentage of respondents with right responses to the attitudinal statements
while a mean below 3 shows the percentage of respondents with wrong responses to the
attitudinal statements. Majority of the nurses responded favourably to the questions showing
that they have a right attitude towards aseptic technique.

SECTION C
TABLE 3: PRACTICES OF ASCEPTIC TECHNIQUES

VARIABLES

RESPONSES F

Do you practice aseptic technique

YES
NO

TOTAL

95
-

100
-

95

How often do you practice aseptic techniques

Every time
Every month
Anytime

Total
Do you make use of protective equipment when
practicing aseptic technique

YES
NO

100

21
7
67

22.1
7.4
70.5

95

100.0

93
2

97.9
2.1

Total

95

Do you ensure privacy when practicing aseptic

techniques

YES
NO

92
3

Total

96.8
3.2

95

Do you clean surfaces before starting

procedures
Do you wash your hands before any procedure

95
-

100
-

YES
NO

93
2

97.9
2.1

95
Liquid soap
hand sanitizer
antiseptic lotion
Others

decontamination

21

100.0

YES
NO

Total
Which type of agent do you use for

100.0

43
38
9
5

100.0
45.3
40.0
9.5
5.3

Total

95
YES
NO

Do you perform aseptic technique during

wound dressing only

23
72

Total

24.2
75.8

95

Which type of agent do you use for sterilization

Methylated spirit
Radiation
Heat
Chemicals

78
3
6
8

Total

sterilization

Boiling
Jik solution
Chemicals
sterile procedure
Hand sanitizer
Radiation
Heat
Savlon
YES
NO

Do you wear gown, gloves and mask during

assisting surgery or delivery

70.5
10.5
1.1
1.1
1.1
1.1
12.6
2.1

78
17

82.1
17.9

95
15 seconds
5 seconds
10 seconds

Total

100.0

67
10
1
1
1
1
12
2

Total
A social hand washing should take at least

100.0
82.1
3.2
6.3
8.4

95

What other procedures have you used to ensure

100.0

89
4
2

100.0
93.7
4.2
2.1

95

100.0

Table 3 shows the practice of the nurses toward aseptic techniques, all the respondents(100%)
practiced aseptic techniques, however 70.5% practice aseptic techniques anytime, while
22.1% practice it every time. Furthermore 82.1% of the respondents indicated that the agent
they use for sterilization is methylated spirit, majority of the respondents indicated they
mostly uses boiling technique for sterilization.82.1% of the respondents also said they wore
gown, gloves, and mask during assisting surgery or delivery.

TABLE 4: SUMMARY OF LEVEL OF PRACTICE

22

PRACTICE

FREQUENCY

PERCENTAGES

GOOD PRACTICE

87

91.6%

BAD PRACTICE

8.4%

TOTAL

95

100%

91.6% of the respondents had good practice and 8.4% had bad practice.

4.2 TEST OF HYPOTHESIS

Hypotheses 1: there is no significant relationship between the nurses attitude and the practice
of aseptic technique?

TABLE5: Relationship between the nurses attitude and the practice of aseptic
technique
.
Do you make use of protective equipment when practicing aseptic technique * Aseptic technique should be practiced
in all nursing procedures Cross tabulation
Count
Aseptic technique should be practiced in all nursing procedures
Strongly agreed
Somewhat
Neutral
Strongly
agreed
Do you make use of
protective equipment when
practicing aseptic technique
Total

disagreed

Yes

22

50

20

93

No

24

50

20

95

Chi-Square Tests
Value
Df

Asymp. Sig. (2sided)

Pearson Chi-Square
Likelihood Ratio
Linear-by-Linear Association
N of Valid Cases

Total

6.044a
5.632
1.945
95

3
3
1

23

.109
.131
.163

P-value of 0.109 is greater than =.05, therefore there is no significant relationship between
the attitude of respondents and practice of aseptic practice.

Hypotheses 2: there is no significant relationship between nurses years of experience and

their practice of aseptic technique?

TABLE 6: Relationship between nurses years of experience and their practice of aseptic
technique

Years of experience * How often do you practice aseptic techniques Crosstabulation

Count

Years of experience

Below 10 years
10- 20 years
21-30 years
41 years and above

Total

How often do you practice aseptic techniques

Every time
Every month
Anytime
10
4
23
8
2
28
2
1
12
1
0
4
21
7
67

Chi-Square Tests
Value
Df

Total
37
38
15
5
95

Asymp. Sig. (2sided)

Pearson Chi-Square
Likelihood Ratio
Linear-by-Linear Association
N of Valid Cases

2.834
3.217
1.758
95

6
6
1

.829
.781
.185

As shown by the tables above, the higher the level of experience, the fewer the practice of
aseptic techniques. P value =0.829 which is greater than =0.05with a df (degree of freedom)
6, there is no significant relationship between years of experience and aseptic technique.
Nurses with more years of experience tend to neglect the practice of aseptic techniques.
24

Hypotheses 3: there is no significant relationship between nurses educational background

and their practice of aseptic technique?

Table 7: Relationship between the nurses educational background and their practice of
aseptic technique

Level of Education * How often do you practice aseptic techniques Crosstabulation

Count
How often do you practice aseptic techniques
Total
Every time
Every month
Anytime
RN
2
1
11
RNM
10
2
18
Level of Education
BNSC
7
4
38
Others
2
0
0
Total
21
7
67

Chi-Square Tests
Value
df

14
30
49
2
95

Asymp. Sig. (2sided)

Pearson Chi-Square
Likelihood Ratio
Linear-by-Linear Association
N of Valid Cases

11.507a
10.525
.021
95

6
6
1

.074
.104
.884

From the cross tabulation above, nurses generally, irrespective of level of education practice
aseptic techniques anytime they like but there is no significant relationship between the
educational status and practice of aseptic technique with P-value =0.074 which is greater
than =0.05.
4.3 ANSWERING OF RESEARCH QUESTIONS

RESEARCH QUESTION 1
What is the staff nurses attitude towards aseptic technique?
25

The table above shows the attitude of nurses towards aseptic technique; Analysis shows that
level of agreement of the students to the attitudinal questions. Mean score is 3, a mean of
above 3 indicates percentage of respondents with right responses to the attitudinal statements
while a mean below 3 shows the percentage of respondents with wrong responses to the
attitudinal statements. Majority of the nurses responded favourably to the questions showing
that they have a right attitude towards aseptic technique.
RESEARCH QUESTION 2
What is their level of practice of aseptic technique?
Result shows that Overall, 91.6% of the respondents had good practice and 8.4% had bad
practice.

RESEARCH QUESTION 3
What is the relationship between the nurses attitude and the practice of aseptic technique?
Analysis shows that there is no significant relationship between the attitude of respondents
and practice of aseptic practice.
RESEARCH QUESTION 4
What is the relationship between nurses years of experience and their practice of aseptic
technique?
Above analysis reveals that there is no significant relationship between years of experience
and aseptic technique.
RESEARCH QUESTION 5
What is the relationship between nurses educational background and their practice of aseptic
technique?
Above analysis shows that there is no significant relationship between the educational status
and practice of aseptic technique.

26

CHAPTER FIVE
DISCUSSION OF FINDINGS
5.1 DISCUSSION OF FINDINGS
The study sought to find out the attitude and practice of nurses towards aseptic techniques
in prevention of cross infection in state hospitals, Ogun state. From table 1 analysis shows
that 14.7% of nurses are registered nurses, 31.6% have midwifery training along with their
registered nurse certificates, 51.6% have their degrees in nursing making them the highest
percentage of respondents. There is no significant relationship between the educational status
and practice of aseptic technique as contrasted by Pankaj et al (2014), in his study a study to
assess the attitude and practice of aseptic technique applied in nursing practice among staff
nurses working in selected hospital, revealed that the overall practices mean score for (YES)
was (15.08 4.08) that is 75.40% of the total score. This implies that the staff nurses
maintain very good practices of aseptic techniques applied in nursing practice. However there
was no relationship between level of education and practice of aseptic technique.
Table 2 shows the attitude of nurses towards aseptic technique; Majority of the nurses
responded favourably to the questions showing that they have a right attitude towards aseptic
technique. This is in support of the study carried out by Unsworth (2011) at the clinic of
school of health community and education studies, Northumbria University, Newcastleupon- Tyne, UK, on the knowledge, attitude and practice of aseptic techniques among nurses.
the results of the study shows that 85.5% of nurses were knowledgeable; all most all nurses
had the right attitude and practice towards aseptic technique.
27

Table 4 shows that all nurses 91.6% of the respondents had good practice of aseptic
technique. The results of this study is in agreement with the study carried out by
Jennifer(2010), whose study on the practice of aseptic technique by staff nurses in a
university hospital, Netherland revealed that 92% of the nurses effectively practice aseptic
technique.
Table 5 shows that there is no relationship between the nurses attitude and practice of
aseptic technique this is in line with the study carried out by Peterhams (2014) in an
Indonesian healthcare establishment on the attitude and practice of nurses towards aseptic
techniques, of the 456 nurses, 77% had the right attitude towards aseptic technique and 63%
effectively practice aseptic technique regularly.
Furthermore most of the respondents had 10-20years of experience, while 38.9% of the
respondents had less than 10 years of experience, only 5.3% had above 41 years of
experience. Table 6 reveals that there is no significant relationship between years of
experience and aseptic technique. This is in contrast with the work carried out by Pankaj et al
(2014), in his study a study to assess the attitude and practice of aseptic technique applied in
nursing practice among staff nurses working in selected hospital, revealed that the overall
practices mean score for (YES) was (15.08 4.08) that is 75.40% of the total score. This
implies that the staff nurses maintain very good practices of aseptic techniques applied in
nursing practice. Also the study shows that the nurses attitude towards aseptic technique was
good as they were able to fill the correct answer to pertinent questions. There was significant
association found between demographic variable like years of working experience and the
attitude towards aseptic technique applied in nursing practice among staff nurses variables
like year of working experience. This shows that high cadre nurses have the right attitude
towards aseptic technique than low cadre nurses; this is due to their years of experience and
effectiveness in the work.

5.2 IMPLICATION FOR NURSING PRACTICE

The adverse health outcome of ignoring practice of aseptic technique is such that cannot be
ignored. Health caregiver especially nurses should intensify efforts in ensuring regular
practice of aseptic technique to reduce mortality rates due to nosocomial infection. This
study has brought into light that the best means to help in the elimination of this practice is
through organising more seminars to encourage the nurses to continue the practice of aseptic
28

technique. This suggests need for nurses to collaborate with all stakeholders involved in the
care of patients in the ward.

5.3 SUMMARY
The study was aimed at determining the attitude and practice of aseptic techniques
among nurses at Ogun state hospitals. Aseptic technique is any health care procedure in
which added precautions such as sterile gloves and instruments are used to prevent
contamination of a person, object or area by microorganisms. It helps to prevent
contamination from microorganism by applying the strictest rules and utilizing what is known
about infection prevention to minimize the risk of experiencing an infection. It is also the
application of preventative measures taken to reduce the likelihood of introducing
microorganisms.
Despite nurses educational background and training and continuous efforts made in
the promotion of the practice of aseptic techniques, many nurses seems not to be performing
it. This may be probably due to wrong attitude, inadequate knowledge and so on. Its based
on this submission that the researcher intends to carry out a research on the attitude and
practice of nurses towards aseptic techniques.
The research is a descriptive study method. 100staff nurses participated in the study,
data collected were analysed using statistical package for social science and were presented
in frequency tables and charts. The research findings show that majority of the respondents
have a good attitude of aseptic technique. Also majority of the respondents practice aseptic
technique effectively and efficiently. However findings show that there was also no
relationship between attitude and practice of aseptic technique. Also there is no significant
relationship between variables like level of experience and years of education and the
practice of aseptic technique.
5.4 CONCLUSSION
The study was set to assess the attitude and level of practice of aseptic technique
among staff nurses. Although the study revealed a right attitude towards and good practice of
aseptic technique among nurses, however there is still need for nurses to be more educated on
this topic. This will go a long way in ensuring provision of quality healthcare.
5.4 RECOMMENDATIONS
29

With references to the findings of this study, the following recommendations were made:
To the nurses:
1. Nurses should attend more seminars on aseptic technique to be more acquainted with
new ideas in practicing aseptic technique in a more better.
2. They should make use of protective devices such as wearing of hand gloves, apron,
goggle and ensure appropriate hand washing to minimise the transfer of infections
from the nurse to the patients and from the patients to the nurses
3. They should ensure regular practice of aseptic technique
To the health management board
1. There should be regular supply of protective equipment to all hospitals and nurses
2. They should organise seminar for all nurses on practice of aseptic techniques
To the government
1. Government should employ more nurses to reduce the workload as more workload on
the nurses has been found to reduce the practice of aseptic technique
2. The government should ensure that hospitals are well supplied with equipments and
supplies that will aid the practice of aseptic technique.

5.5 SUGGESTION FOR FURTHER STUDY

The research study was carried out on a few representatives of the entire State hospitals in
Nigeria. Hence, the researcher suggests that larger population should be studied so as to have
a different view of nurses attitude and practice of aseptic technique and so as to help develop
new approach that will help make the practice of aseptic technique easy. This will allow for
generalisation of the study by the future researches

30

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33

OGUN STATE SCHOOL OF NURSING, ILARO.

QUESTIONNAIRE ON ATTITUDE AND PRACTICES OF NURSES TOWARDS
ASEPTIC TECHNIQUES IN PREVENTION OF CROSS INFECTION
Dear Respondents,
I am a final year student of the above named institution carrying out a study on the
attitude and practice of nurses towards aseptic techniques in prevention of cross infection in
State Hospital, Ogun State. Your sincere response in this questionnaire will be needed to
complete this study.
All information provided will be strictly held in confidence and only be used for
academic purposes, writing of names is not required, and you are only expected to tick in the
space provided below if you are willing to participate.
Thanks
Yours faithfully
Thomas E. I.
(Nursing Student)
SECTION A: SOCIO- DEMOGRAPHIC DATA
1. Age- (a) 18-24 years { }(b) 25-30 years { } (c) 30& above

{ }#

2. Gender (a) male { } (b) female { }

3. Religion (a) Christianity { } (b) Islam { } (c) traditional tradition { } (d) others { }
4. Tribe (a) Yoruba { } (b) hausa { } (c) igbo { } (d) others (specify) _______________
5. Marital status (a) single { } (b) married { } (c) divorced { } (d) widow { }
6. Level of education (a) RN { } (b) RNM { } (c) BNSC { } (d) others (specify)
________
7. Year of experience (a) below 10 years (b) 10-20 years (c) 20-30 years (d) 30 years and
above
34

8. Ward (a) male medical ward (b) female medical ward (c) male surgical ward (d) female
surgical ward
SECTION B: ATTITUDE TOWARDS ASEPTIC TECHNIQUE
Tick the ones that apply
S/N
9

Strongly

Somewhat Neutral

Somewhat Strongly

agree

agree

disagree

Aseptic technique should

be practised in all nursing

10

procedures
Aseptic technique should
only be practised at

11

favourable times
Aseptic technique should
only be practised by the

12

chief nursing officer

The manner sterile
equipments or materials
is placed has nothing to
do with spread of

13

infections
Splashing of fluids during
procedure is one major
way contamination takes

14

place
Maintenance of Aseptic
technique determines
duration of
hospitalization

SECTION C: PRACTICES OF ASEPTIC TECHNIQUES

15. Do you practice aseptic technique? Yes { } no { }
16. How often do you practice aseptic techniques?
35

disagree

Every time { }

every month { }

Every year { }

anytime { }

17. If no, why? Specify reasons _____________________

18. Do you make use of protective equipment when practicing aseptic technique? Yes { } no
{ }
19. Do you ensure privacy when practicing aseptic techniques? Yes { }

No { }

20. Do you clean surfaces before starting procedures? Yes { } no { }

21. Do you wash your hands before any procedure? Yes { } no { }
22. Which type of agent do you use for decontamination? (a) Liquid soap (b) hand sanitizer
(c) antiseptic lotion (d) alcohol rubs
23. Do you perform aseptic technique during wound dressing only? Yes { }

No { }

I dont know { }
24. Which type of agent do you use for sterilization? (a) Methylated spirit (b) radiation (c)
heat (d) chemicals
25. What other procedures have you used to ensure sterilization? _____________________
26. Do you wear gown, gloves and mask during assisting surgery or delivery? (a) Yes (b) no
27. A social hand washing should take at least (a) 15seconds (b) 5seconds (c) 10seconds

36