Background: Surgical site infections (SSIs) remain among the most common healthcare-associated infections, contributing to increased morbidity, prolonged hospital stays, and higher healthcare costs. Nursing students play a crucial role in infection prevention; however, inadequate knowledge and clinical skills may compromise effective SSI control. Strengthening education and training is essential to reduce SSI incidence in clinical settings.
Aim: This study aimed to assess the knowledge, perceptions, and practices of nursing students regarding SSI prevention and management in Swat, Pakistan.
Methodology: A descriptive cross-sectional design was employed among 165 third- and fourth-year Bachelor of Science in Nursing (BSN) students from Malakand College of Nursing and Ismail Nursing College. Data were collected using a validated 17-item structured questionnaire based on World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) guidelines. The tool assessed knowledge, clinical practices, effectiveness of preventive strategies, SSI management, and training needs using a 5-point Likert scale. Data was analyzed using SPSS version 27, applying descriptive statistics including frequencies, percentages, means, and standard deviations.
Results: Findings revealed that students demonstrated good knowledge of key SSI prevention practices, including hand hygiene, sterile techniques, and postoperative wound care. Moderate awareness was observed regarding prophylactic antibiotic use and patient education. Clinical mentorship and training were identified as highly effective in enhancing students’ competencies.
Conclusion: Nursing students showed adequate knowledge and positive attitudes toward SSI prevention. Continuous professional training and curriculum reinforcement are recommended to further improve infection control practices.

Surgical site infection, Surgical site infection prevention, Nursing students, Infection control, Clinical training.

Surgical site infection (SSI) is considered a disease that happens during or around the swab of the surgical incision within 30 days of surgery or within one year in the case of an implant. SSI is the microorganism contamination of the surgical wound in the course of or after surgery, which causes either localized or systemic infection.[1] Prevention and management of SSI involve effective practice of infection control, sterile practices, and evidence-based clinical practices. Nursing students are future healthcare professionals who are involved in the process of treating the patients in the course of their clinical training, and thus, they need to have sufficient knowledge and skills with infection prevention. Effective strategies are defined as systematic measures such as hand hygiene, aseptic practices, sterilization measures, and proper wound care practices aimed at decreasing the occurrence and complications of SSI in hospitals.[2]

Surgical site infections remain one of the most common healthcare-associated infections worldwide. Global reports indicate that SSI accounts for approximately 20% of all healthcare-associated infections in hospitalized patients.[3] The prevalence of SSI in developed countries ranges from 2% to 5% of surgical procedures, while rates in developing countries may reach 10% to 20% or higher due to limited infection control resources.[4] Studies conducted in South Asia have reported SSI rates ranging between 9% and 23% among surgical patients. Hospitals in Pakistan also experience significant challenges in infection prevention, where overcrowding, limited resources, and gaps in clinical training may increase the risk of postoperative infections.[5]

Surgical site infections are some of the factors that are contributing significantly to patient morbidity, prolonged stays in the hospital, and other costs incurred in healthcare and, in extreme cases, death. SSI patients tend to take more time on antibiotic treatment, undergo subsequent surgeries, and increase the overall healing period.[6] Such complications burden the healthcare systems and lower the general quality of care provided to patients. The best way to do this is to implement effective steps that will mitigate such risks and enhance the outcomes of surgery. One of the main agents in the process of enacting infection control practices during the perioperative period is the healthcare workers, especially nurses.[3]

Nursing students are part of the healthcare workforce and, as such, are given clinical training in hospitals. In wound care, monitoring the patient, and managing them after surgery, they are exposed to the circumstances where extreme hygiene is demanded. Poor knowledge, insufficient clinical practice, and exposure to infection control practices can have an impact on their capability to prevent surgical site infections. Infection prevention and control practices are the main areas where competencies need to be developed among nursing students through clinical education and structured training programs.[7,8]

Preventive measures against surgical site infections whose evidence-based approaches are proper hand hygiene, sterilization of surgical tools, proper use of personal protective equipment, sterile field maintenance, and proper postoperative wound care. Antimicrobial prophylaxis, preoperative patient preparation, and environmental purity are also factors in minimizing the risk of infections. Nursing students should learn about these strategies and use them regularly in clinical practice to provide safe care to patients and reduce the spread of infections.[9]

Clinical supervision and educational intervention are important in enhancing infection control measures among nursing students. Knowledge and practical skills in prevention of surgical infections can be enhanced through structured teaching sessions, simulation training, and mentorship by experienced nurses.[10] Those institutions that integrate infection prevention training into the nursing courses show a higher adherence to standard precautions and achieve higher patient safety results. The combination of theoretical and clinical education is the key to becoming a competent future nurse.[11]

The special needs of healthcare facilities observed in the Swat region are associated with a lack of resources like time, workload, and training in order to prevent infections in patients. Knowledge of the characteristics of awareness and practices of nursing students on SSI prevention is significant to establish gaps in education and enhance training approaches. Researching effective approaches to preventing and managing surgical site infections in nursing students may help to reinforce infection control educational strategies and enhance clinical competence and patient safety in health facilities.

To evaluate the effective preventive and management strategies of SSI prevention and management among nursing students in Swat, a descriptive cross-sectional research design was used. This design helped the researcher to evaluate knowledge, perceptions, and practices of the participants at one point in time and come up with a clear picture of the current level of understanding of SSI prevention strategies. The research was done in two well-established nursing colleges in the Swat district in Khyber Pakhtunkhawa: Malakand College of Nursing and Ismail Nursing College. This selection was based on the fact that they are institutions offering undergraduate nursing education as well as having clinical affiliations with key healthcare facilities in the area where students are exposed to surgical and medical ward rotations.

The study sample was composed of undergraduate (BSN) students studying in their third and fourth years. This group of students was chosen as they had already taken basic nursing subjects and were undergoing training in clinical practice, especially in the surgical wards and the operating room environment. They were appropriate candidates to consider clinical practice and knowledge in the context of SSI prevention because of their exposure to clinical practice. The sample size of the study was 165 nursing students. The participants were selected by a non-probability convenience sampling method after fulfilling the inclusion criteria and were accessible at the time of data collection. The inclusion criteria were third- and fourth-year BSN students who had already had one surgical clinical rotation and were willing to take part on a voluntary basis. The students who participated in the study were first- and second-year students, students on leave, and those who refused to take part.

Data collection procedure: The questionnaire used to collect data was a structured 17-item questionnaire that was based on the internationally recommended guidelines on prevention of surgical site infections, specifically, those given by the WHO and CDC guidelines. The questionnaire adopted a five-point Likert scale from strongly agree to strongly disagree and was divided into four sections that covered the current nursing practice, effectiveness of the SSI prevention strategies, management of surgical site infections, and nurse education and training. The questionnaire was checked by nursing faculty and clinical experts before the actual data collection to provide content validity. A pilot study with about 10 percent of the sample was carried out to determine the clarity and understanding of the questions, and some revisions were made on the same.

Data collection was initiated by formally seeking the permission of the principals of the chosen nursing colleges. Students were contacted at their classes or lecture halls, and the aims and importance of the research were discussed with them. The participants were assured that their responses would be treated with confidence and only be used by the research. The questionnaires were administered, and the respondents were assigned about 15-20 minutes to respond to them in a calm and controlled setting after informed consent was provided in writing.

Data analysis procedure: All questionnaires were verified after the data collection was completed. The obtained data were coded and uploaded into the statistical package of social sciences (SPSS) version 27 to be statistically analyzed. A brief presentation of the findings was characterized by descriptive statistical techniques. Frequencies and percentages were calculated to present the demographic data of participants and their answers to separate questions of the questionnaire. The mean and standard deviation values were determined as well to measure the aggregate extent of agreement or disagreement with each of the SSI prevention strategies and management practices.

To provide easy interpretation and visualization of the results, the results were analyzed in tables and graphical formats that included bar charts and pie diagrams. These statistical tests were used to determine the level of awareness and perception of the nursing students on effective measures that can be used to prevent and control surgical site infection in their practice.

Demographic characteristics of participants: The demographic profile of the 165 nursing students shows that most participants are young adults, with 115 students (69.7%) aged 23-24 years, followed by 46 students (27.9%) aged 21-22 years, and a small proportion of 4 students (2.4%) aged 25-26 years. Male students represent a substantial majority at 147 (89.1%), while female students account for only 18 (10.9%), reflecting the gender composition of the nursing programs in Swat. The distribution across academic semesters is relatively balanced, with 58 students (35.2%) in the 4^th semester, 54 students (32.7%) in the 6^th semester, and 53 students (32.1%) in the 8^th semester, denoting similar representation of students in the various phases of clinical training. The given demographic trend gives a homogenous sample in terms of age and semester stage, which enables focusing on the analysis of knowledge, perceptions, and practices related to SSI prevention and management among the nursing students, and the gender difference must be considered when generalizing the findings to the general population.

Table 1: Demographic characteristics of participants

The analysis of nursing students’ responses regarding current SSI prevention practices indicates a strong awareness and adherence to evidence-based measures. Most students strongly agreed that proper hand hygiene reduces the risk of surgical site infections, with 95 (57.6%) indicating “strongly agree” and 52 (31.5%) selecting “agree,” while only a small minority were neutral or disagreed. Similarly, the majority emphasized maintaining sterile technique during wound care, with 88 (53.3%) strongly agreeing and 60 (36.4%) agreeing. Proper sterilization of surgical instruments was strongly acknowledged by 92 (55.8%) of students, while 54 (32.7%) agreed. Preoperative skin preparation was also recognized as crucial, with 84 (50.9%) strongly agreeing and 63 (38.2%) agreeing. Overall, over 85% of participants consistently agreed or strongly agreed with all four key statements, demonstrating that nursing students in Swat possess a high level of knowledge regarding standard SSI prevention practices, reflecting both classroom education and clinical exposure.

Table 2: Nursing students’ practices related to SSI prevention

The discussion of the responses given by the nursing students on the effectiveness of strategies in preventing surgical site infections (SSI) shows that they have a good understanding of evidence-based interventions. The majority were found to be effective in the use of prophylactic antibiotics, with 78 (47.3%) strongly agreeing and 65 (39.4%) agreeing. The importance of having a sterile operating room environment was highlighted, and 90 (54.5%) strongly agreed and 55 (33.3%) agreed, which showed knowledge of environmental control in infection prevention. Patient education was also realized to be important, with 72 (43.6%) strongly agreeing and 70 (42.4%) agreeing. Wound care in the postoperative period was also held in high regard, as 88 (53.3%) strongly agreed and 60 (36.4%) agreed. In all four strategies, more than 80% of the students were in agreement with the measures or strongly agreeing on the measures, meaning that nursing students in Swat have a good understanding of the essential SSI prevention measures, which can be suggested by both theoretical and clinical practice experiences.

Table 3: Perception of effectiveness of SSI prevention strategies

The response analysis on management of SSI and nursing education portrays a high level of agreement among the students on the importance of nurses in the timely detection and treatment of infections. Most students, 94 (57.0%), strongly concurred with the statement that early detection of the signs of infection positively impacts patient outcomes, and 53 (32.1%) concurred with the statement. On the same note, 90 (54.5%) strongly agreed and 55 (33.3%) agreed that nurses are significant in taking care of surgical wounds. In terms of the influence of education, 86 (52.1%) strongly agreed and 59 (35.8%) agreed that nursing education positively influences the knowledge of SSI prevention, and 92 (55.8%) strongly agreed and 54 (32.7%) agreed that clinical training makes a positive change in infection control practices. Constant professional training was also greatly considered, with 88 (53.3%) of them strongly agreeing and 60 (36.4%) of them agreeing. Altogether, these results suggest that students understand the importance of theoretical education and clinical training to achieve successful SSI prevention, as they are aware of evidence-based nursing interventions and the importance of continuous professional education to ensure high-quality standards of infection control.

Table 4: Management of SSI and nursing education

The study involved exploring the knowledge and perceptions and practices of nursing students on the prevention and management of SSI in Swat. The results show that most of the students have excellent knowledge of evidence-based SSI prevention strategies such as hand hygiene, sterile procedures, preoperative skin cleaning, and prophylactic antibiotics. This state of awareness is correlated with the research results provided by Kanjirath et al. who have found that nursing students who attended tertiary hospitals exhibited a high level of knowledge of infection prevention principles in the cases of their exposure to both theoretical and clinical training.[12] This is indicated by the majority consensus regarding the importance of early detection and observation of signs of infection to reduce the number of complications that would occur during the postoperative period.

The findings also indicate that the perceived efficacy of clinical training as well as continuous professional education is high in strengthening SSI prevention practices. These findings are in line with the theory of experiential learning as presented by Kolb, which stresses the significance of practical involvement and reflection in applying theoretical knowledge to practice. [13] The understanding by students of the value of constant professional training is in line with the international practice standards that encourage persistent competency growth as a way of ensuring the standards of infection control are upheld.

In comparison, the results are echoed by local research on the topic carried out in Pakistan, which can prove that nursing students’ awareness of infection control practices can be enhanced significantly when they are exposed to surgical rotations and mentorship programs.[14] Nonetheless, there was a minor difference in the perception of prophylactic antibiotic use, with the lower percentage of the students strongly agreeing on its effectiveness. This can be indicative of disparities in the clinical practices that are witnessed in the partnered hospitals or dissimilarities in faculty focus in training. Other low- and middle-income contexts have reported similar discrepancies, with resource limitations, non-adherence to protocols, and differences in the clinical supervision influencing the application of theoretical knowledge into practice.[3]

The overpowering nature of the male participants in this research could also have affected the overall results given the sociocultural influence in professional learning in Khyber Pakhtunkhwa. These gendered views of clinical confidence and assertiveness have the possibility of influencing self-reported practices, and this was highlighted in studies on cultural influences in nursing education.[15] This good score of knowledge and practice domains is in line with the social cognitive theory developed by Bandura, which holds that self-efficacy, observational learning, and reinforcement have a critical influence on learning skills and adopting a behavior in a clinical setting.[16]

Finally, the research shows that properly organized educational and clinical experiences are effective in providing nursing students with the necessary knowledge and practical skills that can prevent and manage SSIs. The discrepancies in the consensus about some of the strategies highlight the importance of uniformity in the implementation of protocols, supporting evidence-based practices, and professional mentoring as the means to maximize infection control skills.

Recommendations

• Nursing curricula should incorporate regular, structured training modules on SSI prevention, emphasizing practical skills in hand hygiene, sterile techniques, and wound care management.
• Clinical mentorship programs should be strengthened to ensure that students consistently observe and practice evidence-based SSI prevention strategies under supervision.
• Continuous professional development workshops and refresher courses should be conducted to update students on evolving guidelines from the WHO and CDC regarding infection control.
• Healthcare institutions affiliated with nursing programs should standardize SSI prevention protocols to minimize variations in clinical practices and reinforce the application of theoretical knowledge.
• Nursing educators should employ simulation-based learning and scenario-based assessments to improve students’ confidence and critical decision-making in managing postoperative patients.
• Future research should explore longitudinal assessment of SSI prevention knowledge and practices across different academic years to identify gaps and improve curriculum design.
• Policy makers and educational authorities should ensure access to adequate resources, including personal protective equipment and sterilization supplies, to facilitate the practical implementation of SSI prevention measures.

The study has concluded that nursing students in Swat exhibit an adequate level of knowledge and positive perceptions towards prevention and management of SSI. The study respondents were found to be very knowledgeable in the basic infection control measures such as hand washing, sterilization, preoperative skin preparation, and postoperative wound management. Mentoring, clinical training, and lifelong professional education were found among the main contributors to the successful implementation of SSI prevention strategies. Although it was possible to find small gaps in perceiving prophylactic antibiotic usage and some management practices, the overall results of the study suggest that systematic educational programs, combined with the practice, are helpful to develop the competence of nursing students in terms of preventing SSIs. These findings support the idea of the need to incorporate evidence-based practices into classroom and clinical training to provide uniform and effective infection control practices among nurses of the future.

The authors would like to express their sincere gratitude to Dr. Shah Hussain, Principal/Associate Professor, Janbar, College of Nursing, Swat, for his invaluable supervision, guidance, and support throughout the course of this study.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Corresponding Author:
Abdur Rahman
Department of Nursing
Malakand College of Nursing, Swat, Pakistan
Email: [email protected]

Co-Authors:
Mumtaz Ali Khan, Muhammad Nisar Khan, Abdur Rahman, Abubakr Siddique, Faisal Khan, Abdul Mustaqeem
Department of Nursing
Malakand College of Nursing, Swat, Pakistan

Shah Hussain
Department of Nursing
Janbar College of Nursing, Swat, Pakistan

Mumtaz Ali Khan and Muhammad Nisar Khan contributed to data collection and data analysis. Abubakr Siddique and Faisal Khan were involved in data collection and literature review. Abdul Mustaqeem contributed to data collection and data organization. Shah Hussain and Abdur Rahman were responsible for the interpretation of the findings.

Ethical Approval was obtained from the Malakand College of Nursing, Swat, Ref No MCN/IRB/2026/2.

The authors declare that there is no conflict of interest regarding the publication of this paper.

Abdur Rahman is the guarantor of this study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.

https://doi.org/10.63096/medtigo3062422

Khan MA, Khan MN, Rahman A, et al. Effective Strategies to Prevent and Manage Surgical Site Infection Among Nursing Students in Swat. medtigo J Med. 2026;4(2):e3062422. doi:10.63096/medtigo3062422 Crossref