Nurses Knowledge and Practices Regarding Aseptic Technique Applied with Burn Patients at Teaching Hospitals in Mosul City

: Background: Burns is one of the most serious injuries to mankind, considering the difficulty of treating a burn injury.


INTRODUCTION
Burns have remained a major health problem in most developing countries, increasing mortality and morbidity rates (1) . Burns are wounds caused by the transfer of energy from a heat source to the body, which heats the tissue sufficiently to cause damage (2) . It has been estimated that about 75% of the mortality burn injuries (3) related to infections of burn or other infectious complications in patients with severe burns over more than 40% of Total Body Surface Area (TBSA) (4) . Burn injury patients are at high risk of infections for a variety of reasons. For instance, the readily available exposed body surface, immunocompromising effects of burns, invasive diagnostic and therapeutic procedures and prolonged hospital stay.
Superficial bacterial contamination of the wound can easily advance to invasive infection in these patients. The degree of bacterial wound contamination has a direct correlation with the risk of sepsis (5) . Also have significant short-and long-term consequences for patients (6) . Therefore, aseptic technique used under carefully controlled conditions to reduce pathogen contamination, Failure to follow basic procedures, on the other hand, puts the patient at risk of infection, which can seriously impede recovery or result in death. Nurses reduce risk by paying close attention to hand washing and adhering to guidelines to reduce technical risks associated with patients (7) . In some instances, sophisticated products are available but lack of clinical experience makes them difficult to use (8) . The burn nurse possesses broad-based knowledge and practices of aseptic techniques, diagnostic studies, and rehabilitative and psychosocial skills. The nurse is responsible for wound care and for noting subtle changes that require immediate attention, prevention of infection (9, 10) .

AIMS OF THE STUDY
The aim of this study was to assess nurses' knowledge and practices regarding aseptic technique applied to burn patients at Teaching Hospitals in Mosul City.

METHODOLOGY
The aim of this study was to assess nurses' knowledge and practices regarding aseptic technique applied to burn patients at Teaching Hospitals in Mosul City. To carry out the study, a choice was made descriptive design, and then the current study began after official permission was obtained from the Ministry of Health, Department of Health Nineveh. The data for the original study were collected from nursing staff in Al-Jamhory teaching hospital and Al-Salam teaching hospital. The study started from the 1 st of June until 15 th January 2021. The period of the data collection extends from 1 st July to 15 th November of 2020, a purposive sample for this study selected (60) nurses working in Al-Jamhory and Al-Salam teaching hospital.
The tool was constructed using a review of literature from published research studies (11,12) it is composed of the first part represents the demographic variables of nurses participating in the current study, which include: age, gender, educational level, and years of experience in a burn's wards. The second part was required to assess the knowledge of nurses about aseptic technique in the management of patients with burns. It consisted of (26) Multiple-choice questions about aseptic technique domain and burns domain contains (13) questions for each domains. Part three is related to nurses' practices to an applied aseptic technique in managing patients of burns and measuring through an observation checklist. It consists of prepare the trolley (work surface) and equipment (7) items, prepares the patient, and aseptic technique during the procedure of burns dressing (5) items for each one, dressing burn wound (7) items, assessing and diagnosing (6) items, precision in dressing execution and procedure (9) items, and nursing outcomes (6) items. The answer of the questions in part two is symbolized as (0) for the incorrect answer and (1) for the correct answer. While, scoring of observation checklist items: (3 degrees) For correct and complete step, (2degree) for incomplete step, and (1 degree) for incorrect step. The mean score of nurses' knowledge's was 1-1.33 poor knowledge, 1.34-1.66 average knowledge, and 1.67-2 good knowledge. As for, the mean score of nurses' practices were 1-1.66 = low level, 1.67-2.33= moderate level, and 2.34-3= high level. The validity of the questionnaire was established through a panel of (8) experts chosen to examine the questionnaire. In order to give their opinions about the suitability of the items included in the tool. Some corrections were done to the arrangements of the items. The internal consistency of the questionnaire was (r = 0.83). Statistical Package for the Social Science (SPSS, Version 24) was by using descriptive statistics, and inferential statistical methods. The data significant at P. value ≤ 0.05.  Table 1 showed the findings of this study are agreement about a majority (80.4%) no had a university certificate. Most of the nurses (75%) had working experience of five years and below, and nearly 64.3% of them had no taken course training on aseptic technique.      Table 3 explains the nurses' practices domains level which was equipment preparation domains and patient preparation domains represented a moderate level of practice.  Table 4 showed that there is a statistically significant relationship at p-value equal to or less than 0.05 between the knowledge of nurses and age.   Table 5 demonstrates that there are significant differences between nurses' practices and age. With regard to other demographic variables, there are no statistical differences between nurses' practices and demographic variables (gender, educational level, years of experiences in nursing and burn wards, participation in training courses for aseptic technique, as well as training courses in infection control) at p-value ≤ 0.05. Table (1) indicates a display the higher percentage of age group (26-30) years was 41.7% and lower for age 31 years and more, the majority of gender were 51.7% males in the study, and secondary school nursing certificate, While the lower percentage of Bachelor's graduates in Nursing, as it reached 6.7%. The years of experience in the nursing and the experiences years in burns wards were the highest percentage between (1-5 years). With regard to nurses training courses about aseptic technique the Majority of nurses no have participated in courses training, the percentage was 66.7%. Also, the percentage of nurses who did not participate in the previous course of infection control programs was 60.0%. The findings of this study are contrary to (11) show the highest percentage (67.9%) of the nurses was in the age group of below 25 years. Whilst other findings of this study are agreement about a majority (80.4%) no had a university certificate. Most of the nurses (75%) had working experience of five years and below, and nearly 64.3% of them had no taken course training on aseptic technique. Figure (1) distribution of frequency and percentage overall knowledge domains of nurses' , and table (2) shows nurses' knowledge level more half of nurse have poor knowledge of aseptic technique domains, and fair knowledge of burn domains. Whereas lower percentage represented a good knowledge for each knowledge level domains of burn patients (13) , study disagree with knowledge of aseptic technique among nurses', more than half of nurses (62 %) had a high level of knowledge on aseptic technique, few (37.5%) had an average level of knowledge and none of the respondents had low knowledge of aseptic technique. About sixty three percent nurses had high knowledge on aseptic technique, 37.5% had average knowledge and none of the respondents had low knowledge on aseptic technique. Table (3) explains the nurses' practices domains level which was equipment preparation domains and patient preparation domains represented a moderate level of practice. Whilst the using aseptic technique domains and dressing burns performed domains show a low level of practice. In addition, the practices of assessment and diagnosis domains, and execution and precise performance of the dressing domains were at a moderate level. Ultimately, low level of practice was regarding nursing outcome domains. The findings of this study are (12) found a poor level of practices regarding aseptic technique and infection control measures. In contrast, a study (14) found that the practices were very much adequate because almost all items scored on average above 90% adequate availability (15) , mentions that in the treatment of burned patients, the primary concern is infection prevention and management.

DISCUSSION
As strict aseptic technique, proper use of personal protective equipment, and proper hand washing, another study (16) indicates very good aseptic practices among burn patients. Table (4) shows that there is a statistically significant relationship at p-value equal to or less than 0.05 between the knowledge of nurses and age. As for the other demographic variables, there were no statistical differences between the domains and demographic variables (gender, educational level, years of experiences in nursing and burn wards, participation in training courses for aseptic technique, as well as training courses in infection control programs). Table (5) demonstrates that there are significant differences between nurses' practices and age. With regard to other demographic variables, there are no statistical differences between nurses' practices and demographic variables (gender, educational level, years of experiences in nursing and burn wards, participation in training courses for aseptic technique, as well as training courses in infection control) at p-value ≤ 0.05. (17) A study found an association between nurses' knowledge and years of experience, while no significant relationship between nurses' knowledge and other demographic variables. In addition, there are no statistically significant differences between nurses' practices and their demographic variables.