Postoperative Wound Care Practices of Acute Care Nurses: An Integrative Review

ABSTRACT

This integrative review aimed to describe the postoperative wound care practices and knowledge of nurses in acute care settings. Whittemore and Knafl's framework was used to identify and synthesise relevant studies. Full‐text, primary articles published after 2000, focusing on postoperative wound care by nurses in hospital settings, were included. Quality appraisal was undertaken using the Mixed Methods Appraisal Tool (MMAT) for qualitative and quantitative studies and the Standards for QUality Improvement Reporting Excellence (SQUIRE) 2.0 for quality improvement (QI) studies. Five databases were searched (MEDLINE, Scopus, CINAHL, Embase and Web of Science) in August 2024. Of the 5329 studies, 36 articles were included. Inductive content analysis was used for data synthesis. Three categories were identified: Variation in using a holistic approach impacts optimal wound care practice, nurses' surgical wound care practices are shaped by individual factors, organisational support, and resource availability, and nurses' participation in surgical wound care is influenced by role clarity and multidisciplinary collaboration. In conclusion, this integrative review highlights that acute care nurses predominantly focused on technical dressing procedures with limited emphasis on comprehensive assessment, documentation, nutrition and patient education. Therefore, adopting a more holistic approach in surgical wound care could minimize practice variations among nurses.

Summary.

• Acute care nurses mainly focused on the technical dressing procedure with limited emphasis on comprehensive wound assessment, documentation, nutritional assessment and patient education.

• Nurses' current practices are shaped by their knowledge, organisational culture and resource constraints.

• A clearer understanding of nurses' scope of practice is essential to optimise their role in evidence‐based wound management.

• Adopting a holistic approach using standardised wound care protocols and validated wound assessment tools is recommended to minimise practice variations among nurses.

1. Introduction

Globally, over 313 million surgical procedures are conducted per year [1], and surgical wounds are the most common wounds managed within acute care settings [2]. However, surgical incisions are vulnerable to complications, including surgical site infections (SSIs), often associated with increased morbidity, mortality, hospital length of stay and healthcare costs [3]. SSIs are one of the most common complications following surgery [4]. A recent systematic review and meta‐analyses reported an overall pooled SSI incidence of 11% (95% CI 10%–13%) among general surgical patients [5]. The incidence rate of SSIs is higher in low‐ and middle‐income countries (LMIC), accounting for 38% of deaths among patients with SSIs [6]. Thus, minimising the potential for SSIs and promoting optimum healing of surgical wounds is crucial, but largely depends on evidence‐based surgical care interventions.

Despite the advancements in evidence‐based surgical care interventions and the establishment of national and international clinical practice guidelines (CPGs) over the past 25 years, SSIs remain a significant clinical challenge [7, 8, 9, 10]. Researchers in the field suggest that inconsistent application of CPGs, along with the wide availability of wound care products and aggressive marketing of products lacking strong supporting evidence, may contribute to persistently high rates of SSIs [2, 11, 12]. These issues can lead to inappropriate care decisions, highlighting the complexities that healthcare professionals, particularly nurses, encounter when applying evidence‐based approaches to postoperative wound care [13].

Postoperative wound care activities are performed predominantly by nurses with the support of the multidisciplinary team [14]. Therefore, nurses need to have the requisite knowledge and practices to ensure optimal patient outcomes during the immediate postoperative period [2, 15]. Interventional research and quality improvement (QI) studies report initiatives to improve surgical wound outcomes of patients undergoing surgeries [8], providing an extensive evidence base on nursing activities. A recently published scoping review by Tobiano et al. [16] explored nursing activities to prevent postoperative wound complications in patients undergoing colorectal surgeries. Review findings suggested that nurses primarily performed delegated, technical tasks and highlighted the importance of identifying more activities that could be performed independently by nurses to improve postoperative wound outcomes. Overall, variations in the use of clinical guidelines have hindered nurses' ability to provide evidence‐based care and subsequently contribute to negative postoperative outcomes [16]. To bridge this gap, an integrative review is needed to comprehensively synthesise acute care nurses' wound care practices and interventions during the postoperative period. Synthesising this information may offer a nuanced understanding of how nurses' current postoperative wound care practices align with the evidence‐based recommendations in CPGs. These review findings will also offer insights into surgical nurses' knowledge of evidence‐based postoperative wound care. It is also crucial to understand the challenges nurses in acute care settings face when implementing evidence‐based postoperative wound care strategies. These insights will inform the development of targeted education and training programmes to improve adherence.

1.1. Aim

To describe nurses' postoperative wound care practices in acute care settings. Subsumed under this overarching aim are the following objectives:

1. To describe acute care nurses' postoperative wound care practices.

2. To describe nurses' knowledge of evidence‐based postoperative wound care practices.

3. To identify barriers and enablers nurses encounter when providing evidence‐based postoperative wound care.

4. To describe strategies for acute care nurses' adherence to evidence‐based postoperative wound care practices.

2. Methods

2.1. Design

This integrative review was guided by Whittemore and Knafl [17] framework, which involves five stages: (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis and (5) presentation of findings. Integrative reviews focus on synthesising diverse sources of information, including qualitative and quantitative data, to provide a comprehensive understanding of complex topics [17]. The reporting of the integrative review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Statement 2020 [18]. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024577099).

2.2. Problem Identification

The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework was used to define the research question and search terms [19] (Table 1). This framework comprises qualitative, quantitative, mixed methods and QI research and aligns with the focus of this review.

TABLE 1.

SPIDER framework.

S	Acute care nurses who are involved in postoperative wound care activities
PI	Postoperative wound care practices
D	Peer‐reviewed primary studies
E	Alignment of postoperative wound care activities with evidence‐based recommendations Knowledge of evidence‐based postoperative wound care practices Barriers and facilitators for implementing evidence‐based postoperative wound care practices Strategies used to increase adherence to evidence‐based postoperative wound care practices
R	Qualitative, quantitative and mixed method and Quality Improvement studies Studies published 2000 onwards

2.3. Literature Search

An initial limited search of MEDLINE(EBSCO), Scopus, CINAHL Complete (EBSCO), Embase and Web of Science was undertaken to identify articles on the topic. In consultation with a health librarian, the text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles, were used to develop a full database search strategy (Supporting Information File 1). The search strategy, including all identified keywords and index terms, was adapted for each included database. Next, the reference lists of all included studies were reviewed and hand searched (backward search) for eligible articles that may have been missed during the primary search.

Following the search, all identified citations were uploaded into EndNote 21 (Clarivate Analytics, PA, USA). Duplicates were initially removed, and then clearly irrelevant studies were removed by one author. The remaining citations were imported into the Covidence systematic review software (www.covidence.org), where further duplicates were removed. Titles and abstracts were then screened by two independent reviewers against the inclusion criteria. Then, potentially relevant full‐text articles were assessed against the inclusion criteria by two independent reviewers. Reasons for the exclusion of full‐text articles were recorded and reported in the PRISMA flow diagram (Figure 1). Where appropriate, any disagreements between the reviewers at each stage of the selection process were resolved through discussion or with an additional reviewer. Table 2 summarises the inclusion and exclusion criteria with the justifications.

FIGURE 1.

PRISMA flow diagram.

TABLE 2.

Inclusion and exclusion criteria.

Inclusion criteria	Justification
Quantitative studies Qualitative studies Mixed method studies QI studies	Empirical evidence is important for gaining a nuanced understanding of nurses' practice in the clinical setting
Studies conducted in surgical wards, and surgical ICUs, in acute care settings	Postoperative wound care activities are frequently undertaken in those settings
Studies published from 2000 onwards	Substantial changes in surgical care practices have resulted since the publication of the updated clinical practice guideline on SSI prevention in 1999 by the Centers for Disease Control and Prevention (CDC) [7]
Studies with full texts available	To review the details of studies not covered in the abstract Full‐text articles facilitate comprehensive data extraction, reproducibility and transparency of results, contextual understanding, completeness of evidence, and enable the quality assessment of the included studies
No language restrictions	To reduce the risk of language bias

Exclusion criteria	Justification
Studies that assessed the postoperative wound care activities among children	Compared to adults, children demonstrate unique surgical complications and outcome profiles [20]
Clinical Practice Guidelines or published documents from professional organisations	Guidelines are secondary sources based on evidence synthesis and/or expert opinions, non‐peer‐reviewed, and the information included in these documents is not only focused on nurses
Protocols and grey literature (unpublished studies or theses that have not undergone peer‐review process)	Grey literature is not peer‐reviewed

2.4. Data Evaluation

Data were extracted from included papers using data extraction tables specifically developed by the reviewers. Data extraction tool development was guided by the SPIDER framework and key findings relevant to the review questions. The data extraction tool was piloted with 3–5 included studies, and changes were made, with further modifications occurring during data extraction as needed. The data, including aim, design, setting, sample characteristics, data collection, and findings relevant to the acute care nurses' postoperative wound care practices, knowledge, barriers, and facilitators, were extracted. The first named reviewer undertook the extraction, and data were verified for accuracy and completeness by a second reviewer. Regular meetings were held to discuss discrepancies in data entry, and disagreements were resolved through discussion, with a third reviewer available to arbitrate. One reviewer, who is a co‐author of some of the included studies, was assigned to assess different studies to prevent conflicts of interest. Another reviewer from the team independently assessed those studies.

2.5. Quality Appraisal

The quality appraisal of the included studies was undertaken simultaneously alongside data extraction. Two quality appraisal tools: Mixed Methods Appraisal Tool (MMAT) version 2018 [21] and the Standards for QUality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines [22] were used to assess the quality of studies before the data analysis stage. MMAT was used to evaluate the methodological rigour of qualitative, quantitative and mixed‐method studies based on design‐specific criteria [21]. The SQUIRE 2.0 was applied to assess quality and completeness of reporting in QI studies based on 18 criteria [22].

2.6. Data Analysis and Presentation of Findings

A systematic approach was used to analyse qualitative, quantitative, mixed‐method and QI data, following the integrative review guidelines [17]. The process explained by Elo and Kyngäs [23] was used to conduct an inductive content analysis and identify patterns in the data. Inductive content analysis was used since it is the recommended approach when there is limited or fragmented knowledge of the phenomenon of interest. To incorporate quantitative data into the synthesis, a data‐based convergent qualitative synthesis design was used to transform numerical data into textual descriptions (qualitising) for synthesis [24]. Then, the qualitative data and qualitised data from quantitative studies were coded. An iterative comparative approach was used to compare extracted meaning units. Similar codes were then grouped to create sub‐categories, which were subsequently collapsed to generate final categories. Key study characteristics and data relevant to the research questions were summarised and presented in tabular form. The findings from the inductive content synthesis are presented as categories and sub‐categories with a comprehensive description for each category.

2.7. Rigour

Whittemore's [25] guidance for rigour for secondary research was used in this integrative review. The understanding of participant data, labelling of the final categories, and reduction of potential reviewer bias was achieved through regular meetings with the team. Comprehensive evaluations of each study strengthened the credibility of the synthesised data for bias, limitations, relevance to the review questions, and methodological consistency. The accuracy and consistency of findings were ensured by using more than one reviewer for the screening, data extraction, quality appraisal, and analysis phases. An audit trail of decisions was enacted through documentation of the analytic process. This involved collapsing meaning units and building subcategories to create categories. Following this, a description of each category was developed based on the extracted data. In line with Whittemore's [25] focus on transferability, all data extraction tables are presented with context, enabling readers to assess the applicability of the findings across diverse clinical settings. Moreover, a comprehensive systematic search strategy and precisely documenting search decisions ensured data accuracy. Systematic quality checks conducted at each stage allowed consistency and quality of the integrative review.

3. Results

Results of the database searches are detailed in the PRISMA flow diagram (Figure 1) [18]. In July 2024, 5352 studies from five databases, as well as backward citation searching, were identified. Of these, 3052 were screened, and 36 studies were included in the review after full‐text screening. The key characteristics of the included studies, along with a summary of the key findings, are outlined in Tables 3, 4, 5. No studies identified or focused strategies for promoting acute care nurses' adherence to evidence‐based postoperative wound care practices. Consequently, findings related to objective 4 could not be synthesised due to insufficient data.

TABLE 3.

Summary of characteristics of included studies (n = 36).

Characteristic	N (%)
Continent of origin
Africa (Cameroon, Ethiopia, Nigeria, Sudan, Tanzania)	9 (25.0)
Asia (Bangladesh, Iraq, Jordan, Malaysia, Pakistan, Saudi Arabia, Vietnam)	12 (33.3)
Europe (Belgium, Greece, Ireland, Italy, Turkey)	6 (16.7)
America (Brazil, Haiti, USA)	3 (8.3)
Oceania (Australia)	6 (16.7)
Country income
Low‐income (Ethiopia, Sudan)	5 (13.9)
Lower middle‐income (Bangladesh, Cameroon, Haiti, Jordan, Nigeria, Pakistan, Tanzania, Vietnam)	12 (33.3)
Upper middle‐income (Brazil, Iraq, Malaysia, Turkey)	7 (19.5)
High income (Australia, Belgium, Greece, Ireland, Italy, Saudi Arabia, USA)	12 (33.3)
Study type
Qualitative	3 (8.3)
Quantitative	29 (80.6)
Mixed methods	3 (8.3)
Quality Improvement	1 (2.8)
Methods
Survey	21 (58.3)
Observations	5 (13.8)
Chart audits	2 (5.6)
Interviews	1 (2.8)
Observations with interviews and/or focus groups	2 (5.6)
Chart audit with interviews and focus groups or observations	3 (8.3)
Survey with interviews and focus groups or observations	2 (5.6)
Setting
Single site (hospital)	17 (47.2)
Multi‐site (hospitals)	17 (47.2)
Conferences	2 (5.6)
Study focus
Postoperative wound care	16 (44.5)
SSI prevention	17 (47.2)
Surgical wound assessment and documentation	3 (8.3)

Abbreviations: SSI = surgical site infections; USA = United States of America.

TABLE 4.

Key results of included studies.

Author, country	Aim(s) and design	Setting, sampling, sample size and eligibility criteria	Data collection	Key results
				Postoperative wound care practices	Postoperative wound care knowledge
Abdulla and Jarelnape [26] a Sudan	Determine surgical nurses' knowledge and practice regarding postoperative infection prevention at a military hospital in Sudan Descriptive cross‐sectional study	Surgical section and OR of a military hospital (1 hospital) Simple random sampling n = 122 nurses Staff nurses aged between 25 and 45 years, with ≥ 1‐year experience	One‐off, self‐administered questionnaire (Modified Postoperative infection preventive Questionnaire)	Hand hygiene practice—never: 35, 28.7%, sometimes: 21, 17.2%, always: 66, 54.1% Use an antiseptic solution to ‘prep’ the area around a surgical incision; maintaining sterility—never: 30, 24.6%, sometimes: 20, 16.4%, always: 72, 59% Assess and monitor incision site for bleeding—never: 32, 26.2%, sometimes: 15, 12.3%, always: 75, 61.5% Use a topical cream for skin care for postoperative infection—never: 21, 17.2%, sometimes: 15, 12.3%, always: 86, 70.5% Document all wound assessment data—never: 17, 13.9%, sometimes: 20, 16.4%, always: 85, 69.7% Postoperative dressing change—never: 24, 19.7%, sometimes: 16, 13.1%, always: 82, 67.2% Vital signs assessment before wound dressing—never: 19, 15.6%, sometimes: 17, 13.9%, always: 86, 70.5% Identify common contributing factors to prevent postoperative infection—never: 22, 18%, sometimes: 12, 9.8%, always: 88, 72.1% Perform routine lab tests postoperatively—never: 33, 27.0%, sometimes: 15, 12.3%, always: 74, 60.7%	N, % of ‘correct’ answers related to knowledge on post operative infection and prevention – Definition: 24, 19.7% – Classifications: 53, 43.4% – Signs and symptoms: 83, 68% – How to treat: 28, 23% – How to diagnose: 48, 39.3% – EB guidelines: 38, 31% (p < 0.001) – Risk factors: 60, 49.2% Complications: 33, 27.1%
Altaweli et al. [27] Saudi Arabia	Assess nurses' knowledge and practice acute surgical wounds management Descriptive, cross‐sectional study	Medical and surgical wards (4 hospitals) Non‐probability convenience sampling n = 221 nurses Nurses working in adult medical/surgical wards full time and caring for surgical patients and nurses; employed by the health department experienced in caring for adult surgical wounds	One‐off self‐administered online survey Self‐developed questionnaire with 44 items based on literature review and recommendations/best practice Face validity	RR—61.3% Following wound care guidelines—61.1% Always follow WHO HH procedures—79.2% HH solution usage: alcohol‐based hand rub—52.9%, Chlorhexidine gluconate 4% (soap)—54.8% 69.2% practice HH before wound dressing, 70.1% after wound dressing Factors affecting surgical dressing product choice: wound appearance ‘highly important’ (48.4%) or ‘important’ (43.9%), consultant's preference ‘highly important’ (28.5%) or ‘important’ (58.8%), transparency/visibility ‘highly important’ (26.2%) or ‘important’ (52.9%) Factors that make a surgical dressing ideal: strong adherence ‘highly important’ (25.8%) or ‘important’ (61.5%), removes excess exudate and toxic components ‘highly important’ (43.4%) or ‘important’ (49.8%), has a high moisture vapour transfer rate ‘highly important’ (25.3%) or ‘important’ (55.7%), impermeable to bacteria ‘highly important’ (37.1%) or ‘important’ (46.2%), transparency/visibility ‘highly important’ (26.2%) or ‘important’ (52.9%), water resistance ‘highly important’ (30.8%) or ‘important’ (53.9%)	‘Good’ knowledge of the available wound products: 54.3% Identified all markers of granulation tissue: 49.8% Knew classic signs of inflammation: 74.7% Identified general signs of wound infection: 67% Identified poor HH practices, patients' comorbidities, poor aseptic surgical technique as SSI‐contributing factors: 82% Identified SSI as the commonest complications of surgical wounds: 84.6% A dry and warm wound environment is identified as a key factor in promoting optimal wound healing: 57.9% 1–3 post‐operative days is identified as appropriate time for removing an initial surgical dressing: 38% Knew aims, and objectives of NPWT: 64.7% Contraindications for NPWT: wound dehiscence‐58%, active bleeding: 52%
				Resources for EB practices rated by > 50% as ‘highly important’ or ‘important’—journal articles, international websites, internet search, hospital wound team, industry representatives, department policy/procedure, hospital library
Atiyah et al. [28] Iraq	Assess the nursing performance and practices in terms of the optimal performance criteria universally adopted within the variable dressing surgical wounds, and determine the relationship between the nurse's performance and socio‐demographic characteristics Descriptive observational design	Surgical wards (3 hospitals) Purposive sampling n = 55 nurses Inclusion criteria NR	An observational tool Adopted version of AL‐Ajloni questionnaire with 27 items on surgical wounds without a drain and 12 items on surgical wounds with drain Mean < 1.5 = low (L), 1.5–2.5 = moderate (M) > 2.5 = high (H)	Preparation of patient and equipment (Mean score) Review physician order for dressing change—2.5, Prepare equipment—2.5, Identify the patient—1.8, Explain procedure to the patient—1.6, Instruct patient not to touch area or sterile supplies—1.9, Provide privacy 1.8, Patient's position comfortably‐2.0, Expose only wound site—1.7, Wash hands—1.8, Open sterile dressing sets on trolley—2.6, Open bottle of antiseptic solution and pour into the sterile basin—2.1, Place disposable bag within reach away from work area—2.3 Applying dressing for patients (Mean score) Remove tape, pull parallel to the skin, and pull toward dressing, remove the remaining adhesive tape from skin—1.9, Wear disposable gloves—2.5, Remove old dressing—2.1, Dispose soiled dressing into the disposable bag—2.0, Remove gloves by pulling out the inside of them—2.3, Put on sterile gloves—2.3, Clean wound with antiseptic solution; use gauze swab—2.6, Clean from top to bottom—2.3, Clean wound inner to outer using separate swab for each stroke—2.1, Use dry gauze to dry wound—2.0, Cover the wound with sterile gauze—2.7 Applying dressing for patients with drains (Mean score) Clean site of drain as recommended—1.9, Cut and remove suture—2.0, Instruct the patient to take a deep breath hold it—1.5, Grasping the drain by its full width at the level of skin—1.7, Pull the drain out by its required length—1.8, Apply dry sterile dressing to drain—2.7, Remove gloves and dispose in bag—2.6, Apply tape over dressing—2.0, Apply tape over drain—2.7, Assist to a comfortable position—1.8, Dispose of supplies—1.9, Wash hands—2.0 Documentation after dressing (Mean score) Signs of inflammation—1.4, signs of infection—1.4, drain amount, colour, odour—1.3, date and time—2.6	Not assessed
Ayamba et al. [29] a Cameroon	Assess nurses' knowledge and practices in the management and prevention of SSIs Cross‐sectional study	All nurses working in the hospital irrespective of the unit (1 hospital) Convenience sampling n = 40 nurses All nurses working in the respective hospital during the period	One‐off, self‐administered questionnaire Questionnaire development NR No of items NR Face validation Knowledge scoring −53.8%–100% = Good −00%–46.2% = Poor Practice scoring 54.5%–100% = Good 0%–45.5% = Bad Open ended questions were analysed using thematic analysis	N (%) who agreed Wound dressing equipment should be sterilised before each use—40, 100% HH is important in preventing SSI—40, 100% Shaving reduces the chances of infections after surgery—40, 100% Patient nutrition is a nursing concern in the prevention of SSI—31, 77.5% Antibiotics should not be given to post‐surgical patients with infection—40, 100% Wounds should be cleaned from inside out 40, 100% Participants disagreed Vital signs are not important in monitoring patients after surgery—39, 97.5% Gloves protect only the nurses from infections—39, 97.5% Cotton is preferable to use in wound cleaning to gauze—39, 97.5%	N (%) who agreed Ever involved in care of patient with SSIs—28, 70% ○ SSI is common in hospital—38, 95% Nurses have a role in care and management of patient with SSIs—40, 100% Microorganisms responsible for SSIs come only from patient's skin—18, 45% Early signs of SSIs: Odour—32, 80%, Fever—65, 26%, Vomiting—3, 7.5%, Redness—34, 85%, Pain—40, 100%, Drainage—38, 95% Patient hygiene is important in preventing SSIs—40, 100% HH is important in caring for SSIs—39, 97.5% Monitoring of patients' vital signs after surgery is necessary—39, 97.5% Solutions used in cleaning surgical wounds: Povidone iodine—40, 100%, Normal saline—39, 97.5%, H2O2—3, 7.5%, Dakins—2, 5%, Alcohol—23, 57.5% 100% disagreed on applying lotions to surgical wounds
Balodimou et al. [30] a Greece	Investigate nurses' knowledge of SSI prevention Prospective, observational study	Surgical wards (1 hospital) Convenience sampling n = 148 nurses and assistant nurses Nurses working in adult surgical dept	One‐off self‐administered survey Questionnaire developed based on published SSI prevention guidelines No of items NR Face validity and backward and forward translation	Not assessed	Knew full definition of SSI time of occurrence—2.7% Knew SSI classification according to the body part either opened or manipulated during the surgery—40.5% Knew surgical wound classification—58.1% Knew the length of time to protect initial dressing—43.9% Advise to have a bath 48 h post‐operatively—50.7% Wound dressings: Interactive dressings for wounds healing by secondary intention—60.1%; sterile technique as appropriate for surgical dressing changes—87.2% Knew HH should be performed before and after wound dressing and contact with surgical site—91.2% Knew ‘the proper way to choose wound dressing’—93.9%
da Mata et al. [31] Brazil	Identify nursing actions in the prostatectomy perioperative period and in preparing patients for discharge Cross‐sectional, retrospective	1 large hospital Convenience sampling n = 121 medical records Medical records of all patients who underwent prostatectomy Aug 2009–Aug 2010	Medical record review (Data collection tool developed by researchers for review data extraction)	Nursing wound care identified during postoperative period for sample: Dressing of surgical incision—91, 75.2%, dressing for drain—86, 71%, drain discharge measurement—58, 47.9%, drain removal—24, 19.8% Discharge education on surgical wound care—1, 0.8%	Not assessed
Ding et al. [32] Australia	Describe surgical nurses' postoperative wound care practices and alignment with EB guideline recommendations Prospective, observational pilot study	4 surgical wards (ICU, neurovascular, orthopaedic, general; 1 tertiary hospital) Convenience sampling 60 surgical nurses and 60 episodes of wound management Nurses working in surgical wards, managing ‘clean’ surgical wounds healing by primary intention	Direct observation of episodes of wound management (dressing changes) Observational tool developed based on several CPGs and standards related to SSI prevention No of items NR Content validity Use of ‘Think Aloud’ and retrospective probing to help explore decision‐making processes during wound assessment	Dressing management: Dressing left intact for 48‐h postoperatively—3, 5%, HH before dressing change—57, 95%, remove old dressing with gloved hand—56, 93.3%, HH after removing old dressing—56, 93.3%, setting up aseptic fields and using sterile wound dressing—51, 85%, clean gloves using non‐touch technique where indicated—26/42, 61.9%, sterile gloves and technique used where indicated—14/18, 77.8%, used sterile saline for wound cleansing if dressing change before 48 h—8, 13.3%, environmental control—60, 100%, wear PPE when contamination risk—28, 46.7%, HH after dressing change—49, 81.7% Wound management patient education: Observed in 18/60, 30% including post‐discharge and follow up, 47/60, 78.3% not given education on safely showering 48‐h after surgery Topical antimicrobial agents: Did not use topical antimicrobial agents on surgery wounds healing by primary intension—17, 28.3% Wound assessment method: Direct observation—60, 100% Documentation of wound care: Progress notes—44, 73.3%, wound assessment chart—15, 25%, both (14, 23.3%), neither—15, 25% Documentation contents: Type of wound—5, 8.3%, duration—0, 0%, location—27, 45%, dimension—4, 6.7%, clinical characteristics of wound bed—16, 26.7%, wound edge appearance—1, 1.7%, peri‐wound appearance—11, 18.3%, exudate type and colour—16, 26.7%, infection: signs and symptoms of infection documented—3, 5.0%, None for pain, presence of foreign bodies and prior wound treatments and therapeutic outcome	Not assessed
Do et al. [33] Vietnam	Identify key components of a surgical wound assessment nurses in Vietnam could collect when conducting a surgical wound assessment; explore nurses' perceptions on current practices in surgical wound assessment and their requirements for a surgical wound assessment tool Qualitative, descriptive study	Surgical wards (1 large hospital) Convenience sampling 13 surgical nurses Working in a surgical ward, graduated from a nursing programme, ≥ 1 year experience in surgical nursing, ability to communicate in Vietnamese	Scenario with a photograph of a patient with a surgical wound given to participants to ‘Think Aloud’ how/what they would assess in scenario, semi‐structured interviews around general surgical wound assessment, risk factors for healing and assessment tool Scenario and interview questions developed based on the Standards of Wound Management guideline No of items NR	Think Aloud data—2 categories emerged: (1) clinical surgical wound characteristics—only 4 subcategories of surgical wound characteristics mentioned frequently (wound edge, periwound skin, volume of exudate, signs of infection), 7 subcategories infrequently/rarely mentioned (wound site, wound dimension, wound bed, colour or type of exudate, signs of haematoma, odour, wound pain); (2) risk factors associated with delayed surgical wound healing—1 subcategory frequently identified: patient and treatment factors; 3 subcategories infrequently mentioned, surgical procedure factors, wound healing environment factors, individual knowledge and skills factors Interview data—(1) Participants' perceptions of current practices for surgical wound assessment identified 3 main categories: an inadequate systematic approach to wound assessment, lack of standard guidelines, need for the implementation of a more structured wound assessment approach. (2) Nurses' requirements from a surgical wound assessment tool identified 4 categories: ‘meeting international and national standards’, ‘comprehensive but concise’, ‘understandable and user friendly’, a ‘scoring system’ Think Aloud and interview data Similarities: Clinical surgical wound characteristics category, wound edge, peri‐wound skin, the volume of exudate and signs of infection were frequently in both. Other wound characteristics, such as wound site, wound dimension, wound bed, colour or type of exudate, signs of haematoma, odour and wound pain were less frequently collected Only nutrition and comorbidities were identified as risk factors associated with slower surgical wound healing in both Differences Smoking, drinking and mental wellbeing were frequently described as factors associated with wound healing by nearly 77% of participants during the think‐aloud section, only 15% in the interview	Not assessed
Do et al. [34] Vietnam	Determine postoperative wound assessment documentation by acute care nurses; explore their perception of factors constraining adequate nursing documentation Sequential exploratory mixed method	4 surgical wards (1 hospital) Q: Random selection—method not reported I: Purposive sampling Q: 200 records from surgical wards I: 13 surgical nurses Q: all patients who underwent elective or emergency surgery February–April 2016 I: Surgical ward nurses, graduated nursing programme, ≥ 1 year experience, ability to communicate in Vietnamese	2 phases: Retrospective (1) chart audit (Q); (2) semi structured interviews (I) (Q: Chart audit tool developed based on Standards for Wound Management [Wounds Australia]; I: Some questions developed based on analysis of Q phase; some developed by research team)	Chart audit (Q)—first 5 days post operation: no documentation about incision location, wound dimension, wound bed (in wounds healing by secondary intention) or odour—0, 0%; < 10% colour and type of exudate recorded; swelling (30%) and pain (41.5%) documentation; exudate volume documented in 90% Interviews (I): Emerging key categories—perceived unimportance of nursing documentation; difficulty to change existing practices; personal factors	Not assessed
Famakinwa et al. [35] a Nigeria	Determine the level of knowledge and practice of postoperative wound infection prevention among nurses Descriptive cross‐sectional study	Surgical units–surgical wards and OR (1 hospital) Purposive sampling N = 100 nurses Nurses who were on duty through 5 days period of the study	One‐off, self‐administered questionnaire (No details on questionnaire development) Knowledge and practice categories are not defined	N, % for precautionary measures for prevention of postoperative wound infection Exemption of staff with URTI—73, 13.3% Strict adherence to asepsis—71, 12.9% Control of visitors and workers movement (traffic)—68, 11.3% Sterile dressing of incision site—73, 13.3%	N, % for knowledge of infection control Good: 66, 66% Fair: 17, 17% Poor: 17, 17% N, % for knowledge of prevention of postoperative wound infection Good: 32, 32% Fair: 8, 8% Poor: 60, 60%
Fonseca and Cooper [36] USA	Identify opportunities for improvement in postoperative sternal incision care; implement evidence‐based processes to reduce incidence of surgical wound infections in cardiothoracic surgery patients QI study	3 cardiac surgery units (1 trauma centre and teaching hospital) Convenience sampling 44 RNs (98 response rate) RNs working in cardiac surgery units, volunteered to participate	One‐off self‐administered online survey post implementation of QI intervention The survey consisted of 5 Likert‐type questions+ a drag‐and‐drop exercise on steps of the new Guidelines Intervention: Postop incision care guidelines revised based on literature and released to staff, a new surgical wound cleansing product was supplied, and RN education provided	Drag and drop exercise of ordering steps in wound care procedure (Correct answers, %) Verify correct patient with 2 identifiers (84%), explain procedure (73%), wash hands/clean gloves (78%), remove soiled dressing (82%), observe for signs of infection (49%), open 2% chlorhexidine single‐use applicator (31%), apply sterile gloves (49%), hold the applicator sponge down and pinch wings on applicator once to break ampule and release antiseptic (36%), cleanse incisions as directed (40%), allow to air dry 30 s or as directed (38%), wash hands (27%)	5‐point Likert scale responses Familiarity with CDC guidelines for surgical incision: 9 (20.5%) ‘do not have any knowledge’; 24 (54.5%) ‘do not pay attention’; 11 (25%) ‘good’ knowledge Postop guidelines easy to follow: ‘neither difficult or easy’ 2 (4.5%); somewhat easy 9 (20.5%); easy 33 (75%) One‐step chlorhexidine applicator affected time to complete incision care: ‘definitely increased’ 3 (7%); ‘slightly increased’ 4 (9.3%); no change 3 (7%); ‘slightly decreased’ 5 (11.6%); ‘decreased’ 28 (65.1%) Able to complete EHR documentation on shift: ‘sometimes forget’ 1 (2.3%); ‘usually’ 5 (11.4%); ‘always’ 38 (86.4%) Aware of EHR HH monitoring system: ‘limited knowledge’: 4 (9.1%); ‘good knowledge’ 15 (34.1%); ‘strong knowledge’ 25 (56.8%)
Gillespie et al. [2] Australia	Describe nurses' self‐reported knowledge and practices in management of acute wounds Cross‐sectional survey	4 surgical, 3 medical wards (1 hospital) Convenience sampling 120 nurses Registered and enrolled nurses working in medical or surgical wards, employed in full‐ or part‐time	One‐off self‐administered questionnaire, with survey packs distributed to nurses (Developed based on wound care practice and modalities)	93 (77.5%) correctly identified optimal wound healing required ‘the provision of a moist warm environment’; 27 (22.5%) identified other factors 96 (80.0%) correctly identified general signs of infection 117 (97.5%) correctly stated poor hand washing practice, patient comorbidities, poor aseptic technique contribute to SSIs 59 (50.4%) unaware of national wound practice standard Knowledge on dressing products: inadequate 25 (21.2%), satisfactory 52 (44.1%), good 35 (29.7%), excellent 6 (5.1%) Highly important rating of ‘characteristics that making surgical dressing ideal’: ‘ability of dressing to remove excess exudate and toxins’ 76 (65.5%), ‘impermeable to bacteria’ 68 (58.1%), ‘strong adherence’ 45 (38.1%), ‘high moisture vapour transfer rate’ 36 (32.1%), ‘water resistance’ 35 (29.9%), ‘visibility of wound’ 33 (28.4%)	Use of national wound practice standard: unaware 59 (50.4%), yes sometimes 12 (10.3%), yes often 17 (14.5%), yes always 29 (24.8%) Surgical dressing first time removal: day 1–3 [correct response] 31 (27.0%), day 5–7 51 (44.3%), day 10–14 3 (2.6%), dressing leaks 10 (8.7%), advised by doctor 20 (17.4%) Highly important rating of factors guiding dressing product choice: ‘Wound appearance’ 90 (75.6%), ‘patient condition’ 57 (48.7%), ‘availability’ 43 (35.8%), ‘surgeon's preference’ 37 (31.6%), ‘water resistance’ 19 (16.4%), ‘time constraints’ 7 (6.7%), ‘cost’ 6 (5.0%) 87.4% (n = 104), correctly identified indications for NPWT Primary sources of information for EB wound care rated ‘always used’: wound care specialist nurses 89 (75.4%), policies and procedures 70 (60.7%), journal articles on hospital website 40 (36.4%), national/international standards 23 (20.7%), wound product industry representatives 19 (16.5%), hospital library 19 (17.3%), web (i.e., Google) 14 (12.6%)
Gillespie et al. [11] Australia	Describe documented wound care practices in patients following surgery and to compare these with current evidence‐based guidelines for the prevention of SSI Retrospective clinical chart audit	Medica; records from 3 hospital sites in one HHS district Random sampling (generated to draw sample based on ICD‐10 code) 152 medical records Patients undergoing surgery January 2010–May 2012, with procedures classified as ‘clean’ or ‘clean contaminated’, endoscopic procedures without incision and non‐surgical procedures excluded	Electronic medical record access and audit (Audit tool developed based on literature and best practice guidelines)	Wound assessment tool documentation completion: none 37, partial 24, fully 63 (41.1%), progress note uses without tool 28 (18.4%‐documented as day cases) Occasions of dressing change during admission: any occasion (at least once) 73 (48.0%), change of condition 93, discharge 53, outpatient 97 93 (61.8%) had no documents assessments made on change of condition as inpatient Documented postoperative complication: 15 (9.9%) complications, 4 (2.6%) clinical signs of SSI Does not specifically state that nurses completed the reported practices, but likely	Not assessed
Gillespie et al. [14] Australia	Describe and compare current surgical wound care practices across two hospitals Prospective comparative design	6 surgical units (Hospital A), 11 surgical units (Hospital B) Consecutive sampling of wound care episodes to select wound care episodes, and not for patients or nurses. (110; Hospital A, 140; Hospital B) 154 nurses (56, Hospital A, 98, Hospital B) 257 Post op patients (113, Hospital A; 114; Hospital B)	Structured observations and chart audits (modified previously used observation tool) 9 observed wound dressing practices 10 aspects of wound care documentation	Adherence to HH guidelines was highest prior to dressing change (Hospital A: 107/113, 95%; Hospital B: 131/144, 91%) Lowest after dressing change (Hospital A: 8/113, 7%; Hospital B: 16/144, 11%) Use of clean gloves in a non‐touch technique (Hospital A: 88/113, 78%; Hospital B: 90/144, 63%). Pre‐emptive analgesia (Hospital A: 49/113, 43%, Hospital B: 48/144, 33%), PPE (A: 53%, B: 58%), change gloves after removal of old dressing (A: 66%, B: 54%), wash hands after removing old dressing (A: 66%, B: 56%), maintaining aseptic fields (A: 81%, B: 82%), dress wound using non‐touch technique (A: 83%, B: 85%) Statistically significant differences between hospitals in relation to hand hygiene adherence (p = 0.021), and the use of clean gloves in a non‐touch technique (p = 0.016) According to Chart audit findings, most wound assessments documented in patients' HER progress notes (221/257, 86.0%) Across both sites, the most documented wound characteristic was type of wound (Hospital A: 43/113, 38%; Hospital B: 70/144, 49%). Wound location (Hospital A: 38/113, 34%; Hospital B: 65/144, 45%), duration of wound (A: 20%, B: 1%), dimension (A: 13%, B: 1%), clinical characteristics of wound bed (A: 437%, B: 12%), wound edge appearance (A: 27%, B: 4%), peri wound appearance (A: 27%, B: 3%), exudate type and colour (A: 24%, B: 5%), S7S of infections (A: 14%, B: 4%), wound pain (A: 46%, B: 10%) The differences between sites were statistically significant (p < 0.05) across all 10 aspects of wound documentation	Not assessed
Gizaw et al. [37] Ethiopia	Assess the knowledge, practices, and associated factors towards postop wound care among nurses working in public hospitals Descriptive cross‐sectional study	All units from 7 public hospitals in one district/zone, Ethiopia Consecutive sampling 458 nurses All permanent nurses who had work experience (≥ 6 months) in postoperative wound care	A one‐off self‐administered survey (questionnaire adapted from previous studies)	Mean ± SD practice score: 33.2 ± 7.9 (14–45) 48.0% (95% CI 43.4%–52.4%) had good practice (above mean) in postop wound care An adequate supply of personal protective equipment (AOR = 3.38 [1.29–8.84]), using IP guidelines (AOR = 5.03 [2.16–11.7]) and the presence of an adequate wound care materials (AOR = 3.67 [1.71–7.88]) were significantly associated with the practices	Mean ± SD knowledge score: 7.2 ± 2.3 (1–13) 44.3% (95% CI 39.5%–48.9%) had good knowledge (above mean) of postop wound care Male nurses (adjusted odds ratio [AOR] = 1.90 (1.25–2.89)), nurses working in gynaecology and labour unit surgical unit (AOR = 0.42 [0.18–0.95]):reference: surgical ward; work experience of ≥ 2 years in surgical units (AOR = 2.97 [1.10–8.02]): reference < 2 years' experience in surgical units, working in a general hospital (AOR = 1.94 [1.16–3.26]): reference primary hospital, working in tertiary hospital (AOR = 3.31 [1.81–6.08]): reference primary hospital, prior training (AOR = 2.89 [1.38–6.02]): reference no prior training were significantly associated with the knowledge
Karadag and Addis [38] Turkey	Investigate the effectiveness of various stoma care nurse roles Descriptive study	Nurses attended stoma care conference (working in surgical wards of public hospitals) Convenience sampling 80 nurses Nurses attended the first national stoma therapy conference and course in Turkey	One‐off self‐administered questionnaire (questionnaire developed based on WECT member's handbook 2000)	Given information about surgery to patients; ‘Always’—27, 33.8%, ‘Sometimes’—36, 45%, ‘Never’—12, 15% Given information about surgery to relatives; ‘Always’—19, 23.8%, ‘Sometimes’—38, 47.5%, ‘Never’—18, 22.5% Given information about stoma complications; ‘Always’—13, 16.2%, ‘Sometimes’—38, 47.5%, ‘Never’—21, 26.3% Given information about stoma products; ‘Always’—14, 17.5%, ‘Sometimes’—19, 23.7%, ‘Never’—40, 50% Training patients with incontinence; ‘Always’—15, 18.8%, ‘Sometimes’—36, 45%, ‘Never’—19, 23.8% Training other health professionals; ‘Always’—8, 10%, ‘Sometimes’—37, 46.3%, ‘Never’—22, 27.4% Reflecting stoma care research results in practice; ‘Always’—12, 15%, ‘Sometimes’—27, 33.8%, ‘Never’—32, 40% Support for stoma care nursing research; ‘Always’—24, 30%, ‘Sometimes’—23, 28.8%, ‘Never’—19, 23.8% Conducting stoma care research; ‘Always’—7, 8.8%, ‘Sometimes’—22, 27.5%, ‘Never’—40, 50% Stoma siting; ‘Always’—1, 1.3%, ‘Sometimes’—2, 2.5%, ‘Never’—73, 91.2% Changing stoma bag; ‘Always’—16, 20%, ‘Sometimes’—28, 35.0%, ‘Never’—31, 38.8% Empty a stoma bag; ‘Always’—14, 17.5%, ‘Sometimes’—38, 47.5%, ‘Never’—23, 28.8% Parastomal skin care; ‘Always’—20, 25%, ‘Sometimes’—33, 41.2%, ‘Never’—21, 26.3% Wound dressing; ‘Always’—13, 16.3%, ‘Sometimes’—22, 27.4%, ‘Never’—41, 51.3% Pressure sore care; ‘Always’—37, 46.3%, ‘Sometimes’—26, 32.4%, ‘Never’—9, 11.3% Fistula care; ‘Always’—13, 16.3%, ‘Sometimes’—13, 16.3%, ‘Never’—44, 55% Colostomy irrigation: ‘Sometimes’—13, 16.3%, ‘Never’—50, 62.5%	Not assessed
Khudhair [39] Iraq	Assess nurse's practice concerning postoperative wound care and to identify the relationship between nurse's practice and their demographic characteristic Descriptive study	Surgical wards and ICU (1 hospital) Purposive sampling 25 nurses Nurses working in surgical wards and ICUs, with ≥ 1 year of experience	An observation tool (no details on tool development) Cutoff point = 2; mean ≥ 2 = significant; mean < 2 = non‐significant	Nurses had ‘adequate’ practice concerning post‐operative care on; HH before wound care, preparing waterproof cover, remove and discard soiled dressing with clean gloves, application of correct dressing and nurses had ‘inadequate’ practice on warm irrigant or solution, providing privacy, apply goggles, gowns if necessary, prepare equipment and open sterile equipment, apply sterile gloves, apply clean draw sheet around surgical site, irrigate wound, dry wound edges with sterile gauze, assess wound, assist client for comfortable position, dispose used equipment, remove gloves, goggles and gowns, HH after dressing, documentation There was an association between the nurses' years of experience and their practice (p < 0.05)	Not assessed
Labeau et al. [40] a Belgium	Development of an evaluation tool and subsequent evaluation of intensive care unit (ICU) nurses' knowledge of the SSI prevention guideline Descriptive cross‐sectional study	Flemish Society for Critical Care Nurses' annual congress 650 ICU nurses Nurses attended for Flemish Society for Critical Care Nurses' annual congress	A self‐administered survey Questionnaire developed based on CDC SSI prevention guidelines Face and content validity	Not assessed	Mean score: 2.61 out of 9 293, 45%—primarily closed incisions must be protected for 24–48 h 254, 39%—the appropriate time to shower or bathe with uncovered incisions is unresolved. 65, 10%—postop surveillance by itself succeeds in reducing the incidence of SSI The correct classification of SSI was known by 46, 7% 299, 46%—stitch abscesses are not to be reported as SSI 13, 2% recognised the exact time frame in which emerging superficial incisional infections are classified as SSI Linear regression identified male gender is independently associated with better scores compared to female (p < 0.001; B ± standard error 0.51 points ± 0.12; 95% confidence interval 0.27–0.75) (adjusted R 2 = 0.02)
Lin et al. [12] b Australia	Identify the facilitators of and barriers to nurses' adherence to EB wound care CPGs in preventing SSIs Exploratory qualitative design	1 Surgical ward (1 tertiary care hospital) Convenience sampling (For FGDs) Purposive sampling (for interviews) 4 FGDs (18 nurses), 2 individual interviews (senior wound care staff) and 11 wound care procedure documents EN, RN, clinical facilitators, nurse unit managers, wound management specialists who worked on full‐time basis	Used ethnographic data collection techniques; semi‐structured individual interviews, FGDs and examination of existing hospital wound care policy and procedure documents (Formulation of interview questions and the data analysis process were guided by TDF)	Not assessed	Not assessed (Table 5)
Lin et al. [43] Australia	To evaluate the effectiveness of the implementation of a multi component intervention designed to prevent SSIs Mixed method evaluation study	1 surgical ward (1 tertiary hospital) Convenience sampling (For wound care practice audit and FGDs) Purposive sampling (for interviews) 20 nurses (wound care practice audit) 4 FGDs (17 nurses), 2 individual interviews (senior wound care staff) EN, RN and nurses in senior management roles, working in fulltime or part time basis	Direct observation using nursing wound management audit tool Focus groups and individual interviews using an interview guide (observational tool used in a previous study, interview guide was developed based on observational study findings and the implementation strategies used)	Compared with the baseline, there were improvements in compliance with ANTT principles in the correct choice of clean gloves, changing patients' dressings using ANTT correctly and advising patients that they could take a shower 48‐h post‐surgery. However, correct choice of sterile gloves decreased from 83% before the intervention to 33% post‐intervention. Adherence to wearing PPE when contamination is expected and educating patients on wound care (other than advising patients on showering post‐surgery) during dressing change remained low, and contamination of the wound was similar to baseline. Documentation was improved from 75% to 100%; however, the completeness of documentation remained an issue, with information on some aspects of the wound missing Nurses' adherence to ANTT technique, hand hygiene post‐wound care and documentation of wound care episodes improved after the implementation Staff perceived that the change champion, poster, quiz and the strategies used to promote the use of the new Wound Care Template were effective	Not assessed
Mengesha et al. [4] a Ethiopia	Assess the practice of nurses and identify factors associated with it regarding prevention of SSIs in Addis Ababa city public hospitals Descriptive cross‐sectional study	Surgical units (2 tertiary hospitals and 2 secondary hospitals) Stratified simple random sampling technique 409 surgical nurses Nurses working in the surgical units of selected public hospitals in Addis Ababa city	One‐off, self‐administered questionnaire with 25 items (The questionnaire was adapted from a previous study and pre tested)	RR—98% The mean ± SD practice score—58.36 ± 7.36 (27–75) ‘good’ practice—200, 48.9% N, % for practices reported as ‘Always’; ○ used alcohol and chlorhexidine gluconate—259, 63.3% ○ HH before and after a dressing change—268, 65.5% ○ HH before wearing surgical gloves—131, 32% ○ Used sterile dressing material for wound cleaning—322, 78.7% ○ Aseptic technique during dressing—313, 76.5% ○ Used povidone‐iodine and normal saline for surgical wound cleansing—254, 62.1% ○ Assessed and monitored surgical site—301, 73.6% ○ Separated infected dressing from non‐infected—252, 61.6% ○ Wore a face mask during surgical wound care—69, 16.9% ○ Cleansed and disinfected the dressing trolley surface with anti‐septic solutions—214, 52.3% ○ Discarded the soiled materials in the proper place after wound dressing—359, 87.8% Factors significantly associated with nurses' SSI prevention practices: Having a BSc degree (AOR = 4.35, 1.73–10.95), use available IP guidelines in their routine practice (AOR = 2.72, 1.73–4.28), having work experience of more than 2 years (AOR = 1.71, 1.10–2.64) Nurses rated their practice as unsatisfactory 56, 13.7%, satisfactory 341, 83.4%, very satisfactory 12, 2.9% The possible factors affecting their practice were: Insufficient knowledge about SSIs—19, 4.6%, inadequate resources to implement surgical safety checklists—154, 37.7%, insufficient performance monitoring systems—101, 24.7%, lack of SSI assessment and preventive measure feedback systems—60, 14.7% and other factors—372, 91% (including excessive workload, staff inadequacy, lack of training to upgrade their level of practice, small chance to learn and develop knowledge and skills through formal education, lack of encouraging programmes, insufficient orientation programmes during unit rotation, unsuitable hospital environment and negligence and lack of interest as a result of the harassing hospital environment)	Not assessed
Moran and Byrne [44] Ireland	Explore cardiothoracic nurses' current knowledge of wound care post cardiac surgery and their self‐reported competence in wound care Descriptive cross‐sectional study	Cardiothoracic units (8 public and private hospitals) Non‐probability census sampling (including all) 158 nurses All nurses working in cardiothoracic units	One‐off, self‐administered questionnaire‐based survey (Questionnaire was adapted based on 2 questionnaires used in previous studies. Consisted of 18 questions on wound healing and prevention of wound infection and a vignette with a photograph of a sternal wound to assess nursing knowledge of cardiac wound management)	RR—31.2% Self‐reported competency Participants who reported that they had updated their knowledge in the previous 2 years reported a significantly higher mean self‐rated competency (6.6 versus 5.9) than those who had not updated their knowledge in this period (t = 2.3, df = 152, p = 0.023). There was no difference in the self‐reported competency between nurses working in the public and the private hospitals	Vignette and photograph Mean ± SD knowledge score for Vignette and photograph (Public: (1.6 ± 0.8), Private: 1.2 ± 0.9) There was a significantly lower mean score in nurses working in public hospitals for questions based on the vignette than those in the public hospitals (p = 0.031) Knowledge of wound healing and management 68/148 (45.9%) of the nurses correctly identified that ‘normal saline’ was the cleansing agent of choice in acute wounds. 45.9 (n = 68/148) also said that they would use chlorhexidine/alcohol 2%/70%, 7.7% (n = 12/148) would use povidoneiodine (Betadine) to cleanse a wound A very small percentage of nurses in hospitals B (9.1%, n = 1/11) and F (35.9%, n = 28/78) identified that ‘normal saline’ was the preferred cleansing solution Only 22/155 (14.2%) knew the correct length of time (minimum 48 h) to remove the initial postop wound dressing, 104/155 (67.1%) reported that they would remove the dressing within 72 h postoperatively Only 34/155 (21.5%) knew that provision of a moist wound environment was the main objective for a granulating wound 46.2% (n = 73/156) also knew that rehydration and debridement was the main treatment for a necrotic wound Only 13/152 (8.6%) recognised the risk factors for developing infection in cardiac wounds 133/156 (85.3%) identified the progression of bacterial growth in a wound (contamination, colonisation, critical colonisation and infection) 43/155 (27.7%) identified the signs and symptoms of SSI (superficial drainage, fresh dehiscence, excessive incisional pain, and leucocytosis) 140/157 (89.2%) nurses identified the correct advice to give patients about managing sternal clicking complications following cardiac surgery 66/121 (54.5%) of nurses in the public hospitals than the private hospitals 9/34 (26.5%) correctly identified factors that inhibit wound healing (metabolic diseases, lifestyle factors, medications) (p = 0.004) 91/121 (75.2%) of nurses in the public hospitals than the private hospitals (38.2%,13/34) correctly identified that sternal wounds were associated with high mortality (p < 0.001)
					47/122 (38.5%) of nurses working in public hospitals than in private hospitals (44.1%, 15/34) reported that they had updated their wound care knowledge in the previous 2 years Nurses who had updated their knowledge had significantly higher total knowledge scores than those who had not (t = 2.02, df = 135, p = 0.046) 128/155 (82.6%) identified the clinical nurse specialist in wound care as their major source of information The nurses were asked to identify which additional resources they required to assist them with wound management 40.5% (64/158) suggested the need for further training in the form of study days or Sessions, 9/158, 5.4% suggested the need for staffing, time, adequate funding and opportunities to attend study days majority of participants identified, 38% (60/158) needed education (information/guidelines), 7.8% (13/158) needed availability and information of new dressings/appropriate dressings, 7.2% (12/158) needed algorithms/posters/protocols/photographs, 4.8% (8/158) needed access to nurse specialist (tissue viability nurse/link nurse), 4.8% (8/158) suggested cardiac specific wound care guidelines, 1.3% (2/168) suggested concise wound assessment charts, 1.3% (2/158) suggested availability of dressings
Mwakanyamale et al. [45] Tanzania	Assess nursing practice on postoperative wound care by nurses in surgical wards Cross‐sectional study	3 Surgical wards (1 hospital) Multistage cluster sampling n = 71 nurses (53 RN and 18 EN) Surgical nurses working in surgical wards, aged 18–60 years, on duty at the time of data collection	A checklist on standard nursing practice on wound care (an internationally acceptable pre‐designed checklist that follows the standard's principles of wound dressing) Practice scoring < Mean = poor > Mean = Good	Overall practice – 30, 42.3% = good practice – 41, 57.7% had poor practice Nurses with a degree had significantly good practices compared to diploma (p = 0.003) or certificate level nurses (p = 0.006) Preparation phase – Place items within reach—100% – Discuss with patient about procedure—81.7% – Assemble all needed supplies—64.8% – HH before and after procedure—49.3% – Assist patient to a comfortable position—43.7% – Ensure cleanliness—0% – Ensure patient's privacy—0% – Close room/screen—0%	Not assessed
				Usage of dressing equipment – Put on gloves‐99% – Remove old dressing‐100% – Use forceps—52% – Soak with normal saline—99% – Observe wound—48% – Dispose inner dressing—97% – Remove gloves—68% – Put on sterile gloves—63% Dressing phase – Arrange dressing forceps—20% – Put antiseptic solution—87% – Inspect wound—32% – Dipper into solution with forceps—35% – Use gauze in one direction—30% – Clean from least contaminated—34% – Use fresh gauze—23% – Apply dressing solution—85% – Apply dry sterile dressing—90% – Use tape or plaster—100% Counselling and documentation – Clean all used equipment—100% – Record any changes in the wound—10% – Instruct patient to avoid tempering with wound—15% – Document wound changes—0% – Report patient comfort—0% – Record date and time—0% – Discuss on nutrition with patient—0% – Instruct patient to report changes—0% Proper use of available dressing materials – Dust dressing trolley for carrying equipment—45, 63,4% – Place waste bag within reach—61, 85.9% – Use disposable gloves to open the wound—54, 76.1% – Using toothed dissecting forceps to lift the inner dressing off slowly—51,71.8% – Use normal saline if dressing stick on the wound—64, 90.1% – Pour antiseptic solution into kidney dish or galley pot—52, 73.2% – Use sterile gloves when dressing the wound—38, 53.5% – Clean wound using forceps—22, 31% – Use single sterile gauze in one direction only—20, 28.2% – Use fresh gauze to dry the wound—33, 46.5% – Apply dressing solution as prescribed—71, 100% Apply dry sterile dressing—71, 100%
Nawaz and Bibi [46] a Pakistan	Assess knowledge and competency of cardiothoracic nurses in wound management Descriptive cross‐sectional study	Cardiothoracic units of private and public hospitals (2 hospitals) Sampling technique NR n = 87 cardiothoracic nurses	One‐off, self‐administered, self‐developed questionnaire (Details on questionnaire development NR)	RR—55.8% Not assessed	Recognise wound infection—24, 27.6% Recognise tissue type in the wound's photos—9, 10.3% Recognised the wound‐healing phase—20, 23% Determine whether vacuum‐assisted closure is needed or not—53, 60.9% Normal Saline as recommended cleaning solution—66, 75.9% Timing of initial post‐operative dressing removal—30, 34.5% Identify factors that inhibit wound healing—55, 63.2% Managing a patient with wound leakage—23, 26.4% Recognise symptoms and signs of surgical wound infection—27, 31% Identified the cleansing agent as depicted in the picture—63, 72.4% No significant difference among wound care among private and public sector
Oluwakemi et al. [47] a Nigeria	Assess knowledge, attitude, and SSIs prevention practices among nurses Descriptive cross‐sectional study	Surgical wards and OR (1 large hospital) Convenience sampling n = 250 nurses Nurses who work in the above units, are free and willing to participate	One‐off, self‐administered questionnaire (no details on questionnaire development)	Washing hands when they are visibly soiled—84.9%, sometimes—15.1% Using sterile technique to change dressing—‘often’: 71.4%, ‘sometimes’: 28.6% Change damp sterile dressing as often as possible—‘sometimes’: 45% Complying with surgical wound guidelines—‘very often’: 16%, ‘often’: 34% Using hand gloves and other protective devices—‘very often’: 22.3%, ‘often’: 27.3% Washing their hands before and after caring for a surgical wound—‘very often’: 34.9% Being safety conscious while caring for surgical wound—‘very often’: 17.6%; ‘often’: 30.7%, ‘indifferent’: 6.3% High level of correlation between attitude and practice; r = 0.763; p = < 0.01	Identified contaminated personnel hands as major sources of SSIs—68.1% Identified the need to wash hands or sanitise the hands after handling soiled linen—97.9% Place of jewelleries preventing proper hand washing—40.3%; having no idea—22.7%. Washing hands or sanitising before simple surgery or caring of surgical wound—92.4% Wash hands before commencing work at the surgery ward—86.1% Positive and moderate correlation between knowledge and attitude toward SSI prevention; r = 0.695; p < 0.001 Positive and moderate correlation between knowledge and practice; r = 0.570; p < 0.01
Qasem and Hweidi [48] a Jordan	Assess the level of Jordanian nurses' knowledge regarding EB guidelines for the prevention of SSIs, to describe the relationship between nurses' knowledge and selected socio‐demographics, to examine the differences in nurses' knowledge with respect to selected dichotomized variables, and to identify the most significant predictors of Jordanian nurses' knowledge regarding evidence‐based guidelines for preventing SSIs Cross‐sectional study	Acute care settings; SICU, MICU, IMU, CCU, CICU Surgical wards and Orthopaedic wards (4 large hospitals) Convenience sampling n = 200 nurses Registered nurses working in acute care settings, Age > 20 years, having BSc or higher education, can read and understand English, Jordanian, working full‐time	One‐off, self‐administered questionnaire developed based on a previous study and SSI prevention guidelines Knowledge scoring; percentiles Q1—< 25th percentile = Very low Q2—25th–50th = Low Q3—50th–75th = Moderate Q4—> 75th = High	Not assessed	Mean ± SD of total knowledge = 3.28 ± 1.72 (0–7); Median = 3 Overall knowledge was ‘Low’ Very Low = 27, 13% Low = 91, 45.5% Moderate = 32, 16% High = 50, 25% Recommended period to protect a primarily closed incision—106, 53% Appropriate time to shower or bathe with an uncovered incision—51, 25.5% Surveillance succeeds in reducing the incidence of SSI—54, 27% Elective surgery and remote site infections—139, 69.5% SSIs classification—72, 36% Classification of stitch abscesses as SSI—50, 25% Criteria of superficial incisional infection classified as SSI—15, 7.5 Significantly high knowledge was reported among nurses who attended surgical related training (p = 0.001) Predictors of knowledge–No of credit hours of surgical related training (p = 0.001) and total years of nursing experience (p = 0.001) with 16.7% variance in knowledge
Sadaf et al. [49] a Pakistan	Assess nurses' knowledge and practices towards prevention of SSIs Descriptive cross‐sectional study	Surgical wards (1 hospital) Simple random sampling n = 111 Staff nurses aged between 18 and 50 years, ≥ 1 year experience, consented to participate Only female nurses included	One‐off, self‐administered questionnaire used in previous study	HH before and after wound dressing—64, 48.6% HH before wearing surgical gloves—41, 41.5% Use sterile dressing material for cleaning surgical wound—36, 44.5% 4 practices were excluded since the row total exceeded the sample size. Please see the last column	Factors influence the incidence of SSI – Puncture rate of surgical gloves 12, 10.8% – Staff existing and re‐entering theatre—50, 45% – Removal of jewellery, artificial nails, and nail polish—54, 48.6% – Preoperative showers with antiseptics—64, 57.7% – Prophylactic antibiotics—2, 1.8% – Duration of surgery—58, 52.3% – Prolong preoperative hospitalisation—66, 59.5% Increased pain and discharge from wound site indicate SSIs—2, 1.8% Malnourished patients and relatively healthy persons have an equal chance of developing SSIs—15, 13.5%
Sadia et al. [50] a Pakistan	Assess nurses' knowledge and practice regarding prevention of SSI and to determine relationship between both variables Descriptive correlation study	Surgical wards (2 hospitals) Convenience sampling n = 131 Female, staff nurses age between 18 and 50 years, ≥ 1 year experience, consented to participate	One‐off, self‐administered questionnaire used in a previous study Knowledge scoring Correct answers for > 14 questions = Good < 14 questions = Poor Practice scoring ‘always’ and ‘often’ practice > 14 questions = Good ‘Did not ever practice’, ‘rarely’ and ‘sometimes’ = Poor	N, % of practices do ‘often’ + ‘always’ – Alcohol and chlorhexidine gluconate is the most common antimicrobials used in the ward—103, 78.7% – HH before and after dressing change and touching the surgical site—103, 78.7% – HH before wearing gloves—63, 48.1% – Perform glucose tests after surgery for diabetes patients—107, 81.7% – Administer hypoglycaemic medications as prescribed after surgery—110, 84% – Assess BMI—26, 19.9% – Advise malnourished patients to get high protein diet—109, 83.2% – Advise malnourished patients to avoid contact with people with infections—93, 71% – Advise malnourished patients to eat fruits and vegetables—101, 77.1% – Use sterilised dressing materials for cleansing surgical wound—86, 65.7% – Use Povidone‐iodine and normal saline for cleansing surgical wound—103, 78.7% – Use an aseptic method during wound dressing—85, 64.9% – Use an antiseptic technique to obtain swab culture—75, 57.3% – Assess and monitor surgical site—92, 70.2% – Separate infected from non‐infected cases during dressing—77, 58.8% – Use face mask during cleansing surgical wound dressing—99, 75.6% – Clean and disinfect the surface of the dressing trolley with antiseptic solution—69, 52.7% – Discard soiled material in the proper place after wound dressing—77, 58.8% A strong negative correlation between knowledge and practice; p < 0.001 r 2 = −0.56	Correct blood sugar level to prevent SSI—84, 64.1% Best antiseptic solution to disinfect the dressing trolley surface—33, 25.2% Correct purpose of surgical HH—97, 74.1% Steps of HH—85, 64.9% Benefit of wound dressing—36, 27.5% Timing of changing surgical dressing—19, 14.5% Method of selecting dressing solution—40, 30.5% Purpose of maintaining nutritional status for surgical patients—95, 72.5% Type of diet for postoperative patient—77, 58.8% Surgical patients with compromised immune system—84, 64.1% Prevent infection of patients with immunodeficiency disorder—63, 48.1% Diagnosis of SSI—51, 39.9% Sign of no SSIs—55, 42.0% Laboratory tests used to ensure SSI—44, 35.6%
Sameerkasim and Hadi [51] Iraq	Determination the level of nurses' practices toward surgical wound care Descriptive cross‐sectional study	Emergency unit and surgical unit (1 hospital) Purposive sampling 30 nurses Inclusion criteria not stated	Direct observation using wound care checklist; adapted from American College of Surgeons MS cutoffs 1.00–1.66: Poor 1.67–2.33: Fair 2.34–3.00: Good	Wound dressing changes practices (mean) HH (wash or 60% alcohol based handrub)—2.67 Remove old dressing using gloved hand or plastic bag—3.00 Inspect the dressing for drainage or any foul odour—1.47 Coil the dressing inside the glove or plastic bag and discard—2.3 Disinfect hands using 60% alcohol—2.83 Wound cleansing practices (mean) Clean and prepare an area, and set out supplies—2.3 HH (wash or 60% alcohol based handrub)—2.8 Soak clean gauze in tap water or sterile cleansing solution—3.0 Dab around the incision line away from the centre of wound—1.2 Use cotton swab to remove any blood or crust that has formed‐1.9 Rinse the wound with pat dry using gauze or clean towel—2.7 Remove the dressing daily to inspect and clean around the wound—2.1 Wound covering practices (mean) Clean and prepare an area, and set out supplies—2.2 HH (wash or 60% alcohol based handrub) —2.7 Disinfect tweezers and scissors with alcohol—2.6 Cut pieces of tape longer than wound and hang them on side of the table edge—2.8 Remove old tape and dressing with a glove or plastic bag—2.7 Check old dressing for drainage or odour—1.8 Coil the dressing inside the glove or plastic bag and discard—2.2 HH (wash or 60% alcohol based handrub)—2.8 Put on clean gloves—2.2 Lift the packing material out using tweezers and cutoff a length—2.4 Use a cotton swab to push packing into the wound and tunnelled areas—1.8 Apply dressing that extends at least 1 in. over the wound edges—2.7 Remove gloves and HH—2.4	Not assessed
				Drain management practices (mean) HH‐2.6 Firmly held the tube near the skin where near it comes out of the skin using one hand—2.2 Pinch tubing with other hand using thumb and index finger—2.7 Using a alcohol pad squeeze the tube flat to push the clots through the tube—2.7 Use a gloved hand to open the cap at the end of the tube—2.7 Hold the opening away from the body and empty the drain contents into a measuring container—2.4 Record the amount and colour of the drainage—1.7 Hold the drain away from body and squeeze the drain until it is flat and close the cap—2.5 Discard the drainage to sink or larger amounts to toilet—2.1 Remove gloves and HH— 2.3 Surgical drain site care practices (mean) Used gloved hand or plastic bag to remove dressing—3.0 Inspect dressing for drainage or foul odour—1.8 Coil the dressing inside the glove or plastic bag and discard—2.1 HH‐2.7 Clean wound and skin around drain tube—2.6 Open the package and remove the gauze dressing—2.6 Touching only the edges of the gauze, place the opening around the tubing of the drain—2.0 Layer bandages around the tubing and the wound site to protect the drain from falling out—2.7 Tape the dressings or wraps a bandage around to keep them in place—2.9 Overall skills Remove wound dressing—good (2.4), clean wound—fair (2.2), pack wound—good (2.4), care for the surgical drain—good (2.4), change the dressing around drain—good (2.5) Overall practices on wound care—good, 2.4
Sham et al. [52] a Malaysia	Assess the knowledge and practice of preventing SSI among nurses A cross‐sectional study	Orthopaedic, Surgical, OR, Obstetrics, and Gynaecology Wards (2 hospitals) Convenience sampling n = 306 All consented nurses directly involved in patient care at Orthopaedic, Surgical, OR, Obstetrics and Gynaecology wards/units	One‐off, self‐administered questionnaire adapted from a previous study	N, % of practices do ‘always’ – Alcohol and chlorhexidine gluconate are the most common antimicrobial used in the ward—212, 69.3% – HH before and after dressing change and touching the surgical site—288, 94.1% – HH before wearing sterile gloves—272, 88.9%% – Perform glucose test after surgery for diabetes patients—202, 66% – Administer hypoglycaemic medications as prescribed after surgery—200, 65.4% – Assess BMI—121, 39.5% – Advise malnourished patients to get a high protein diet—207, 67.6% – Advise malnourished patients to avoid contact with people with infections—198, 64.7% – Advise malnourished patients to eat fruits and vegetables—164, 53.6% – Use sterilised dressing materials for cleansing surgical wound—263, 85.9% – Use Povidone‐iodine and normal saline for cleansing surgical wound—221, 72.2% – Use an aseptic method during wound dressing—272, 88.9% – Use an antiseptic technique to obtain swab culture—256, 83.7% – Assess and monitor surgical site—246, 80.4% – Separate infected from non‐infected cases during dressing—223, 72.9% – Use face mask during cleansing surgical wound dressing—283, 92.5% – Clean and disinfect the dressing trolley with an antiseptic solution—275, 89.9% – Proper waste disposal after wound dressing—275, 89.9%	Method of disinfecting surgical site—256, 83.7% Blood sugar level to prevent SSI—190, 62.1% Best antiseptic solution to disinfect the dressing trolley surface—173, 56.5% Purpose of surgical HH—290, 94.8% Steps of HH—253, 82.7%% Benefit of wound dressing—276, 90.2% Timing of changing surgical dressing—171, 55.9% Method of selecting dressing solution—273, 89.2% Purpose of maintaining nutritional status for surgical patients—270, 88.2% Type of diet for postoperative patient—280, 91.5% Surgical patients with compromised immune system—224, 73.2% Prevent infection of patients with immunodeficiency disorder—98, 32% Diagnosis of SSI—109, 35.6% Sign of no SSIs—259, 84.6% Laboratory tests used to ensure SSI—282, 92.2% Knowledge is significantly associated with the ward they are working (p = 0.01)
Sickder et al. [41] a Bangladesh	Identify nurses' practices for SSI prevention and their barriers and facilitators, and to propose direction for improving nurses' practices for SSI prevention Mixed method design	Quantitative General and orthopaedic department (3 hospitals) Simple random sampling (lottery method) 182 RNs Inclusion criteria not given Qualitative 1 tertiary level hospital	Quantitative One‐off, self‐administered questionnaire A previously developed questionnaire was used with permission Qualitative FGD Guide or IDI guides used (probe questions for the IDIs of the nursing administrators were different from those in the FGDs)	Postoperative incision care—Always: 89, 48.9%, Hand Hygiene Practice—Always: 94, 51.4%	Not assessed
		Purposive sampling 22 RNs (3 FGDs) and 3 nurse administrators (3 IDIs) Inclusion criteria not given
Sürme et al. [53] Turkey	Determine the knowledge and practices of nurses worked at surgical clinics regarding wound healing Descriptive cross‐sectional study	Surgical clinics (public and private hospitals in 1 province) No sampling technique 311 nurses Nurses working at surgical clinics in public and private hospitals of selected province, voluntary participation	One‐off, self‐administered questionnaire (20 items) Developed based on literature and expert opinion Principal component analysis (PCA)	Four factors identified; position and localization, evaluation of wounds, mobilisation and nutrition, discharge education Performed wound dressings at the clinics (38.5%) (only 5.8% of them performed the wound dressing regularly) Reasons for not performing wound dressings: patient volume (58.2%), not thinking as a nursing task (47.6%), lack of nurses (47.3%) Nurses did not use a wound care form (% not reported) Position and localization (‘Always’) Positioning suitable for the wound of the patient (231, 74.3%) Determining the localization of the wound (152, 48.9%) Evaluation of wound (‘Always’) Daily observing the wound in terms of flow, rush, and temperature increase (180, 57.9%) Evaluating the drains for colour (204, 65.5%) Evaluating the drains for amount (222, 71.4%) Evaluating the drains for odour (105, 33.8%) Evaluating the wound area for sensitivity and pain (156, 50.2%) Mobilisation and nutrition (‘Always’) Encouraging the patient for early mobilisation after the surgery (168, 54.0%) Providing adequate hydration of the patient (205, 65.9%) Making suggestions about nutrition of the patient (198, 63.7%) Discharge education practices (‘Always’) Wound care (141, 45.3%) Time of the suture removed (116, 37.3%) Time of the body bath (119, 38.3%) Precautions to prevent constipation (133, 42.8%) Food groups for faster wound healing (93, 30.0%) Hygiene education to prevent infection on the incision area (127, 40.8%) Importance of exposure to trauma of the incision area (128, 41.2%) Supporting the wound area for cough, sneeze, and vomit (135, 43.4%) Medications with negative effects on wound healing (35, 11.3%) Situations to admit to the hospital (134, 43.1%)	The mean ± SD wound healing knowledge score—62.0 ± 8.4 Mean knowledge score is significantly higher in university graduate nurses—63.1 ± 8.4 (p < 0.05) N (%) for knowledge questions NR
Tegegn et al. [54] Ethiopia	Assess nursing practice and associated factors regarding postop wound care among nurses working in government hospitals in 2 zones of northeast Ethiopia Descriptive cross‐sectional study	Governmental hospitals in the south Wollo zone and Oromia special zone (5 hospitals) Simple random sampling (computer‐generated randomization) 402 nurses All nurses, working surgical ward, OR, recovery, gynaecology, and medical wards Nurses who were severely sick and on annual leave were excluded	One‐off, self‐administered questionnaire Adapted and modified from previous comparable studies in Ethiopia Categorised into 2 groups: ‘good’ practice (> mean) and ‘poor’ practice (≤ mean)	RR—97.81% 200 (49.8%) scored above the mean for postoperative wound care practices Nurses had ‘always’ practiced ○ HH before and after wound dressings (301, 74.9%) ○ HH before wearing sterile gloves (248, 61.7%) ○ Assess patients, BMI after surgery (231, 57.5%) ○ Advise my patient to take vegetable and fruits after surgery as needed (214, 53.2%) ○ Advise malnourished patient to take nutritious protein diet (253, 62.9%) ○ Placing bags for soiled items within patient reach (271, 67.4%) ○ Inspect the gauze for wet and colour of discharge (290, 72.1%) ○ Put on disposable (clean) gloves when opening wound (269, 66.9%) ○ Clean surgical wound from clean to dirty area (271, 67.4%) ○ Use sterile dressing materials for cleansing surgical wound (294, 73.1%) ○ Use single‐sterile gauze in one direction (236, 58.7%) ○ Clean the wound by using forceps (240, 59.7%) ○ Use Povidone‐iodine or normal saline for surgical wound cleansing (288, 71.6%) ○ Use aseptic technique to take swab culture (264, 65.7%) ○ Assess and monitor surgical site condition (289, 71.9%) ○ Separate infected from non‐infected during dressing (289, 71.9%) ○ Used face mask during wound dressing (231, 57.5%) ○ Clean and disinfect dressing trolley with antiseptic solution (280, 69.7%) Significantly associated factors Availability of a wound management tool [AOR = 1.6; 95% CI (1.11, 2.50)] Documentation of wound assessment and management [AOR = 2.19; 95% CI (1.44, 3.34)]	Not assessed
Tesfaye et al. [55] Ethiopia	Assess SSI prevention practice and associated factors among nurses working at public hospitals in the western part of the southern nation, nationalities, and peoples' regions of Ethiopia Descriptive cross‐sectional study	Public hospitals in the western part of the Southern Nation, Nationalities, and Peoples' Region (5 hospitals) Random sampling (Sampling technique not specified) 402 nurses (questionnaire) and 63 (15%) nurses for observation All nurses who were working in selected public hospitals and working in OR, surgical ward, ICU, Paediatric ward, Gynaecology/obstetrics ward, Surgical referral clinic (SRC), and Emergency units	Self‐administered questionnaire to assess attitudes, knowledge and self‐reported practices +2 observational checklists to assess actual nurses' SSIs prevention practices Developed by referring to different studies and international guidelines and institutional factors (adopted and revised from previous similar studies)	The mean (±SD) self‐reported SSIs prevention practice score was 9.33 (±2.77) Actual ‘good’ practices Vs self‐reported ‘good’ practices (n = 63) HH just before wearing a glove (3, 17) HH after changing wound dressing (22, 27) Assess and monitor surgical wound (20, 28) Use sterile forceps and other dressing materials for dressing surgical wounds (26, 29) Use aseptic techniques during surgical wound dressing (26, 28) Use the normal saline solution for cleansing surgical wound (26, 30) Use a face mask during surgical wound dressing (23, 13) Discard soiled materials in the proper place after wound dressing (25, 27) 30 (47.6%) (95% CI: 41, 50.7) of nurses had overall ‘good’ self‐reported practice and 26 (41.3%) (95% CI: 28.6, 52.4) had ‘good’ observed practice related to SSI prevention The measurements indicated a moderate agreement between self‐reported and observed practices (kappa = 0.42, p = 0.001) Having BSc degree (AOR = 2.04; 95% CI: 1.31, 3.18), p < 0.001, previous training on IP (AOR = 2.23; 95% CI: 1.42, 3.49), p < 0.001, having good knowledge (AOR = 1.82; 95% CI: 1.13, 2.90) p < 0.05, having good attitudes (AOR = 2.61; 95% CI: 1.67, 4.10), p < 0.001, having SSIs prevention guidelines (AOR = 2.45; 95% CI: 1.34, 4.47), p < 0.01 were associated with good SSIs prevention practice	The mean (±SD) knowledge score was 6.52 (±1.56), 215 (53.5%) nurses had ‘good’ knowledge toward SSI prevention strategies. Institutional factors 281 (69.9%) reported that surgical supplies is available in their working units Only 65 (16.2%) reported that there is SSI prevention guidelines in their units and 80% of them reported they used those guidelines to update their knowledge
Timmins et al. [42] Haiti	Describe the facilitators and barriers for nurses to perform quality wound care Descriptive, qualitative study	3 units (General surgery, orthopaedics and maternity) (1 hospital) Observations (Random sampling but not specified) Interviews (Convenience and snowball sampling) 15 nurses (Observation) 13 nurses + 3 medical residents (Interviews)	Data collection via observations and interviews	Observation findings Actions well integrated into practice Use of a cleaning solution Single‐use gauze to clean and dry the wound Application of disposable glove to remove the soiled dressing Safe disposal of soiled dressings Application of a new sterile dressing Patient privacy Comfort measures and positioning Visual inspection of the wound Actions to strengthen in wound care practice Aseptic technique Hand hygiene pre‐ and post‐care Patient identification Explanation of the procedure Pain assessment Patient education Nursing documentation	Not assessed
Zucco et al. [56] a Italy	Assess the level of knowledge, the attitudes and adherence to EB recommendations for SSI prevention and to describe influences that motivate nurses to adopt EB practices for SSI prevention Descriptive cross‐sectional study	General or specialist surgical wards, ORs, ICUs (36 hospitals) Multi‐stage sampling Hospitals‐stratified sampling Nurses–Random sampling 1305 nurses	One‐off self‐administered questionnaire (developed in accordance with WHO guidelines for SSI prevention and a literature review)	RR—99.4% Initial dressing replacement ≤ 48 h—392 (32.9%), > 48 h—643 (55.1%) after surgery and Uncertain‐140 (12.0%) Performed wound culture in case of SSI signs and/or symptoms “always/often”—973 (77%) Reported using of single‐use PPE in patients with an infections always/often”—1187 (93.2%) 184 (14.1%) reported the proper duration of antibiotic prophylaxis (< 24 h after surgery) Reported the correct frequency for dressing change—719 (55.1%) Always/often used, adhesive drapes for surgical incision—754 (61.9%)	1178 (90.7%) correctly identified obesity and 960 (74.2%), smoking as risk factors for onset of SSIs. 343 (28.9%) didn't know right definition of ‘bundle’ Sources of information; Guidelines (73.6%), Continuing education courses (51.6%)

Abbreviations: EB = evidence based, HH = hand hygiene, NPWT = negative pressure wound therapy, NR = not reported, RR = response rate, WHO = World Health Organisation.

^a Key findings relevant to the postoperative phase were extracted.

^b Please see Table 5 for key results related to barriers and facilitators.

TABLE 5.

Key barriers and facilitators for implementing postoperative wound care practices.

Author	Barriers	Facilitators
Abdulla and Jarelnape [26] a	Lack of formal training on postoperative infection prevention‐78, 63.9% Non‐use of existing infection prevention guidelines‐91, 74.6% Time constraints‐76.2, 93% Staff shortage‐58, 47.5% Inadequate facilities and equipment‐88, 72.1% No surveillance system n, % not reported	Not reported
Famakinwa et al. [35] a	Inadequate facilities, such as sterilising equipment‐76, 21.5% Work demand‐87, 24.6% Discouragement by colleagues‐45, 12.7% Poor attitude by nurses‐67, 18.9% Use of incorrect aseptic techniques‐79, 22.3%	Not reported
Lin et al. [12]	Adhering to aseptic technique: Confusion about when to use clean vs. sterile gloves Knowledge and information seeking: Policy and procedure documents are outdated or hard to locate, Wound care policies are dispersed across multiple documents, nurses rely on senior staff for guidance instead of written protocols Documenting wound care: Unaware of documentation guidelines and unclear about what to record, Lack of hospital guidance on wound documentation, Time constraints limit documentation quality and completeness Educating and involving patients in wound care: Uncertainty about the timing of patient education	Adhering to aseptic technique: Awareness of the importance and consequences of SSIs, mandatory aseptic technique training module, dedicated programme on handwashing adherence Knowledge and information seeking: Actively seeking information when needed, Trust in senior staff as a source of knowledge Documenting wound care: Wound care senior staff aware of wound care documentation issues Educating and involving patients in wound care: Understanding the importance of patient participation in wound care
Sickder et al. [41] a	Inadequate knowledge; insufficient knowledge of updated HH methods Inadequate resources and budgets; insufficient HH products, lack of wound care guidelines, limited budget for training Insufficient performance monitoring systems; insufficient monitoring of HH practice and wound dressing technique Lack of surveillance systems related to SSI prevention; No SSI assessment system, lack of feedback on SSI preventive measures	Willingness; willingness of the nurses and interdisciplinary team on SSI prevention Team support; peer support, leader support
Timmins et al. [42]	Materials and resources; lack of resources Nurse‐to‐patient ratios, workload and support; low nurse‐to‐patient ratio, unfair work delegation, lack of housekeeping support Roles and responsibilities of nurses; confusion about nursing roles and responsibilities, Limited collaboration between nurses and doctors Knowledge and training of nurses; inadequate wound care training, gaps between education and clinical practice, Lack of standard curricula across programmes, confusion due to inconsistent practices by doctors	Materials and resources; adequate supply of wound care materials Nurse‐to‐patient ratios; professional conscience Roles and responsibilities of nurses; clarify nursing roles and responsibilities, teamwork Knowledge and training of nurses; wound care protocol, ongoing training sessions

^a Key findings relevant to the postoperative phase were extracted.

3.1. Quality Assessment

During the quality appraisal using the MMAT (Supporting Information File 2), we found that the reporting quality of included studies varied. All included studies passed the initial screening criteria for the MMAT, indicating their suitability for inclusion. Any distinction in their quality after that point is subjective, as there is no cut‐off value for high or low quality. Whilst six quantitative descriptive studies and two qualitative studies met all reporting criteria, several other studies had notable limitations. Common issues in descriptive quantitative studies included limited description of the target population, use of convenience sampling, small sample sizes, or the lack of validated measures, which potentially limited generalisability. The one included QI study met all 18 reporting criteria of the SQUIRE 2.0 tool (Supporting Information File 2).

3.2. Content Analysis

In this review, categories were identified using inductive content analysis. Analysis was based on the textual or numerical data (numerical data was qualitised) presented in the findings, discussion sections, and appendices of the included articles. Three categories were identified inductively related to nurses' postoperative wound care practices in acute care settings including: ‘Variation in using a holistic approach impacts optimal wound care practice’, ‘nurses' surgical wound care practices are shaped by individual factors, organisational support, and resource availability’ and ‘nurses' participation in surgical wound care is influenced by role clarity and multidisciplinary collaboration’. Table 6 provides an overview of these categories, including their nine sub‐categories.

TABLE 6.

Categories, subcategories and contributing studies.

Categories	Sub‐categories	Contributing studies
Variation in using a holistic approach impacts optimal wound care practice	Nurses often focus on caring for the surgical incision, yet significant knowledge and practice variations prevail	Abdulla and Jarelnape [26]; Altaweli et al. [27]; Atiyah et al. [28]; Ayamba et al. [29]; Balodimou et al. [30]; Ding et al. [31]; Famakinwa et al. [35]; Fonseca and Cooper [36]; Gillespie et al. [2]; Khudhair [39]; Labeau et al. [40]; Lin et al. [43]; Mengesha et al. [4]; Moran and Byrne [44]; Mwakanyamale et al. [45]; Nawaz and Bibi [46]; Oluwakemi et al. [47]; Qasem and Hweidi [48]; Sameerkasim and Hadi [51]; Sickder et al. [41]; Tegegn et al. [54]; Tesfaye et al. [55]; Timmins et al. [42]; Zucco et al. [56]
	Variations in the comprehensiveness of surgical wound assessment and documentation	Abdulla and Jarelnape [26]; Atiyah et al. [28]; Ding et al. [32]; Do et al. [34]; Do et al. [33]; Gillespie et al. [11]; Gillespie et al. [14]; Khudhair [39]; Lin et al. [12]; Lin et al. [43]; Mengesha et al. [4]; Sürme et al. [53]; Tegegn et al. [54]; Timmins et al. [42]; Mwakanyamale et al. [45]; Sadia et al. [50]; Sham et al. [52]
	Nutritional assessment during surgical wound care is limited	Sadia et al. [50]; Sham et al. [52]; Sürme et al. [53]; Tegegn et al. [54]
	Patient education and engagement are important for better surgical wound outcomes	Balodimou et al. [30]; da mata et al. [31]; Ding et al. [32]; Karadag and Addis [38]; Labeau et al. [40]; Lin et al. [12]; Lin et al. [43]; Mwakanyamale et al. [45]; Qasem and Hweidi [48]; Sürme et al. [53]; Timmins et al. [42]
Nurses' surgical wound care practices are shaped by individual factors, organisational support, and resource availability	Nurses' knowledge, attitudes and behaviours impact their use of an evidence‐based approach	Abdulla and Jarelnape [26]; Altaweli et al. [27]; Do et al. [34]; Famakinwa et al. [35]; Gillespie et al. [2]; Gizaw et al. [37]; Karadag and Addis [38]; Lin et al. [12]; Mengesha et al. [4]; Moran and Byrne [44]; Qasem and Hweidi [48]; Sickder et al. [41]; Tesfaye et al. [55]
	Organisational support influences nurses' knowledge and practice of evidence‐based wound care	Abdulla and Jarelnape [26]; Atiyah et al. [28]; Balodimou et al. [30]; Gizaw et al. [37]; Karadag and Addis [38]; Mengesha et al. [4]; Qasem and Hweidi [48]; Sickder et al. [41]; Tegegn et al. [54]; Tesfaye et al. [55]; Timmins et al. [42]
	Resource availability curtails nurses' ability to engage in evidence‐based wound care practices	Abdulla and Jarelnape [26]; Do et al. [34]; Famakinwa et al. [35]; Gizaw et al. [37]; Lin et al. [12]; Mengesha et al. [4]; Sickder et al. [41]; Timmins et al. [42]
Nurses' participation in surgical wound care is influenced by role clarity and multidisciplinary collaboration	Understanding nurses' and other health professionals' scope of practice in surgical wound care	Lin et al. [43]; Sürme et al. [53]; Timmins et al. [42]
	Collaborating with the multidisciplinary team to provide evidence‐based wound care	Do et al. [34]; Sickder et al. [41]; Timmins et al. [42]

3.2.1. Variation in Using a Holistic Approach Impacts Optimal Wound Care Practice

This category emphasises that a holistic approach to surgical wound care extends beyond the technical aspects to provide comprehensive and individualised care, thereby improving surgical recovery. This category included four subcategories describing incision management, assessment and documentation, nutrition, and patient education, all of which align with key elements of a holistic approach to surgical wound care. However, our findings highlight that holistic practice was not always evident.

In terms of incision management, nurses often focus on the technical aspects of wound care, such as dressing changes in postoperative wound care. However, incongruencies in knowledge and uptake of guidelines on aseptic technique, even during dressing change, were reported in the included studies [4, 26, 32, 35, 47, 50, 52, 55]. When exploring hand hygiene (HH) practices, studies reported that the compliance rates were lower after the procedure compared to before [14, 32, 36, 39]. HH and the use of gloves also varied across the studies [4, 49, 50, 52, 54, 55]. Use of non‐touch technique during clean glove use, based on the level of contact involved, was described in only two studies [14, 32]. Nurses had generally reported a low level of knowledge regarding the appropriate timing for the removal of the initial surgical dressing [2, 27, 30, 32, 40, 44, 46, 48, 56]. Overall, this varied knowledge and inconsistent application of wound care standards undermined the comprehensive nature of holistic care.

There were disparities in the comprehensiveness and details of wound assessment and documentation. Most of the included studies did not specifically focus on the content of wound assessments conducted by nurses. Among those that did, the assessments were often found to be lacking, particularly in terms of addressing pain [14, 32, 33] and risk factors associated with delayed wound healing [33, 44]. Do et al. [34] identified key barriers to adequate nursing documentation, including its perceived lack of importance, resistance to changing established practices, and personal challenges such as limited knowledge, low confidence and poor writing skills. Ultimately, inadequate assessment and documentation by nurses disrupted a holistic approach to wound management, reducing the effectiveness of care and continuity.

Focusing on nutrition and patient education in postoperative wound management was inconsistent across studies. Only four included studies focused on nutrition as a component of wound care [50, 52, 53, 54]. Although patient education is a key aspect during surgical wound care, only 11 studies focused on patient education and engagement [12, 30, 31, 32, 38, 40, 42, 45, 48, 53] and the comprehensiveness and consistency of patient education also varied. Overall, this lack of focus on nutrition and patient education highlights the need for a more holistic approach in achieving optimal surgical wound outcomes.

3.2.2. Nurses' Surgical Wound Care Practices are Shaped by Individual Factors, Organisational Support and Resource Availability

This category is supported by three sub‐categories that emphasise internal and external factors shaping nurses' surgical wound care practices. Nurses' effective application of knowledge in wound care was hindered by a myriad of individual factors. Nurses reported varying levels of knowledge related to evidence‐based wound care guidelines [2, 26, 48]. Included studies also reported inconsistencies in how nurses updated their knowledge of surgical wound care [12, 27, 34, 38, 41, 44]. Nurses mostly relied on hospital wound care nurses as the primary source of information, and there was limited use of peer‐reviewed journal articles and national or international wound care websites, which are considered more reliable and updated resources [2, 12, 27, 44] Do et al. [33] highlighted that the lack of knowledge and expertise in wound care management was due to ‘inadequately designed nursing curriculum programs’ (p. 11). Years of experience in nursing [4, 48] and surgical care [37], as well as previous related training [37, 55] positively influenced nurses' knowledge and practice on postoperative wound care. Another factor influencing nurses' postoperative wound care practices was attitudes. Nurses with good attitudes were more likely to engage in SSI prevention activities [55]. Conversely, poor attitudes were reported as a factor that hinders nurses' SSI prevention practices [35].

Organisational support influenced nurses' knowledge and practice of evidence‐based wound care. In four included studies, the availability of wound management tools [54] and infection prevention guidelines [4, 37, 55] were reported to have influenced nurses' knowledge and practices. Inadequate staff education and training were other factors highlighted across studies [4, 26, 28, 30, 37, 38, 41, 42, 48, 55]. The absence of surveillance systems and insufficient performance monitoring and feedback to evaluate staff performance were also identified as organisational‐level barriers [4, 41] hindering the use of evidence‐based wound care practices. However, support and information from peers, as well as receiving sufficient motivation from nursing managers through the sharing of relevant knowledge and skills, were identified as facilitators for implementing effective SSI prevention practices [41].

Limited resources curtailed nurses' ability to engage in evidence‐based wound care practices. Human and material resource constraints were reported, including staff shortages [4, 12, 26, 34, 35, 37, 42], poor HH facilities, that is, HH products [41], having to walk lengthy distances to HH stations [42], and insufficient budget support, especially for staff training [40]. The lack of an adequate wound care formulary was reported as a barrier in some low‐resourced contexts [4, 26, 35, 37]. Gizaw et al. [37] highlighted that the availability of personal protective equipment (PPE) and wound care materials significantly influenced nurses' surgical wound care practices.

3.2.3. Nurses' Participation in Surgical Wound Care is Influenced by Role Clarity and Interdisciplinary Collaboration

This category, supported by two sub‐categories, describes role clarity and multidisciplinary collaboration during surgical wound care. For surgical nurses, role clarity reflected an understanding of their own scope of practice and that of other professions and utilising that knowledge to deliver effective patient care. Nurses had a limited understanding of their scope of practice or role, and the roles of other professionals in surgical wound care [53]. In some settings, the responsibility of wound care has evolved, and doctors have taken over many of the wound care responsibilities while nurses have been tasked to perform ongoing wound care, especially in the absence of doctors [42]. However, in other settings, doctors perceived wound dressing management as solely their responsibility. Such ambiguity in work dynamics impacted nurses' perceptions of their scope of practice in wound care.

Across included articles, multidisciplinary collaboration was described as the process where nurses and physicians worked together, shared knowledge, and utilized their diverse skills to deliver quality postoperative wound care [41, 42]. The willingness of nurses and other healthcare professionals to work together facilitated interprofessional collaboration [41, 42]. This teamwork among nurses and doctors was viewed as an important element of wound care, with nurses describing this as ‘sharing the responsibility’ and ‘nurses as the immediate collaborator of the doctor’ [42]. However, at times, professional hierarchy between nurses and doctors challenged nurses' ability to participate in multidisciplinary collaboration [42]. The tacit influence of professional hierarchy hindered nurses' ability to ‘correct a doctor’ or have their suggestions heard when it came to revising patient care plans [34, 42]. Nurses tended to neglect documenting patient care, perceiving it as having less value among other healthcare professionals, since on most occasions, the doctor's documentation was referred to rather than the documentation of the nurses [34]. These issues limited nurses' full participation in surgical wound care and potentially led to suboptimal wound care delivery.

4. Discussion

4.1. Summary of Main Findings

In this integrative review, we aimed to synthesise evidence on acute care nurses' postoperative wound care practices, knowledge, and the factors influencing adherence to evidence‐based guidelines, to identify strategies that support best practice. We undertook an inductive synthesis of 36 studies, encompassing primary studies from 21 countries, to ensure a comprehensive understanding of wound care delivery by acute care nurses. The included studies reflect varied methodological approaches and healthcare environments, highlighting both common and context‐specific challenges in implementing effective postoperative wound care practices.

The findings highlight that nurses often lack a holistic approach to surgical wound care, with critical aspects such as patient education, assessment, documentation, and nutrition frequently overlooked. There is a clear need for a paradigm shift from task‐oriented to patient‐centred wound care, guided by a comprehensive framework that integrates person‐centred principles in postoperative care [57]. Our findings also suggest that practising effective postoperative wound care is determined not only by nurses' internal factors, but also by external influences. These systemic and contextual limitations often result in low‐value, outdated care that may compromise patient outcomes. Furthermore, role ambiguity and limited interprofessional collaboration, particularly between nurses and doctors, restrict nurses' engagement in postoperative wound care. McInnes et al. [58] emphasise that a clear understanding of professional roles and effective interdisciplinary relationships is essential for guiding nurses' participation in wound care. Achieving this clarity supports the development of a multidisciplinary, patient‐centred wound care approach that enhances collaboration, evidence‐informed practice, and postoperative recovery.

4.2. Comparisons with Other Studies

The first category in our review describes a lack of a holistic approach to postoperative surgical wound care. Effective wound care requires a person‐centred approach, seeing the patient as a whole [59], including their overall health, lifestyle, and individual needs. While incision care and dressing changes are undeniably essential components of wound care, it is equally crucial to include other areas of holistic postoperative wound management [60], such as comprehensive assessment and documentation, nutrition, and patient education. However, other studies highlight nurses' primary focus on incision management in the absence of using a holistic approach, which aligns with our findings [59, 61, 62]. Plausibly, a selective approach may be due to insufficient education on the multifaceted components that comprise holistic postoperative care [61]. Although comprehensive assessment and documentation are integral to postoperative wound care [60], our review findings describe variations in the content of wound assessment and documentation by nurses. Inconsistencies in patient assessment and documentation of care among nurses are not limited to wound care alone [3]; other studies have shown 10 that such issues are common across nursing practice in general [63]. Lack of patient education was another key finding described in the first category of this review. While our findings highlight nurses' uncertainty relative to the timing of wound care education, previous research suggests that the variability of wound care education increases when nurses lack the requisite knowledge or confidence in providing postoperative education to patients [64, 65, 66]. Using effective communication, tailoring and delivering information based on the patient's needs, and integrating technology during patient education could optimise clinical outcomes [67].

The second category describes the role of personal, organisational, and resource‐related factors in shaping nurses' postoperative wound care practices. Similar to our findings, previous studies also highlight the contribution of personal factors like knowledge deficits to clinical practice variation, often stemming from gaps in nursing education and continuous professional development [68, 69]. This may lead to nurses being engaged more in ritualistic traditional practices based on their experiences rather than evidence‐based care [16, 70, 71, 72], and may subsequently result in low‐value care and patient harm. Positive staff attitudes and behaviour towards new initiatives increase implementation success, highlighting the need to keep current with the most up‐to‐date evidence [73]. However, practice variations are not always the consequence of nurses failing to maintain current knowledge, but may also be the consequence of several organisational barriers [71]. Notably, the lack of availability and access to guidelines, ambiguity in benchmarks or standards for practice, variations in guideline quality, contextual implementation challenges, especially in low‐resourced settings, may result in suboptimal and outdated wound care practices [74]. Organisational support is critical to the success of evidence‐based wound care practice. Organisations must create a positive learning culture, as the absence of such a culture is identified as a barrier to implementing evidence in healthcare settings [73]. Additionally, leadership support has been identified as a significant organisational factor [73, 75] that influences other factors like culture, resource allocation, staff monitoring, and feedback for the successful implementation of new strategies. Another organisational factor identified is the availability of required resources, which determines the extent to which nurses can effectively implement evidence‐based wound care practices. Similarly, Li et al. [73] identified that financial resources, staffing and workload, time constraints, and staff education and training contribute to effective evidence‐based practice implementation in healthcare settings. Finally, hospitals have a responsibility to provide ongoing professional development and continuous education for staff, and it is essential to strengthen clinical competencies and improve patient outcomes [76]. Overall, there are many considerations for healthcare leaders to ensure high‐quality wound care practices in their organisations, and identifying key organisational factors is essential to support nurses in delivering effective surgical wound care.

The final category illustrated how role clarity and multidisciplinary collaboration influence nurses' participation in surgical wound care. A lack of clarity regarding nursing roles in surgical wound care, limited interdisciplinary collaboration, and a hierarchical work dynamic are identified as major factors hindering nurses' ability to deliver high‐quality care [34, 42, 43, 53]. Role clarity fosters collaboration, supports a full scope of practice, and strengthens nurses' professional identity within the team [58]. Conversely, role ambiguity results in professional frustration, leading to increased workplace dissatisfaction and conflicts [77]. Previous studies also highlight a struggle within interprofessional teams related to varying scopes of practice and how they are enacted in healthcare settings where wound management is undertaken [78, 79]. A positive multidisciplinary approach improves wound care by bringing together diverse expertise, leading to coordinated treatment, timely intervention, ensuring continuity of care, and improving healing outcomes [80]. Ultimately, this increases patient safety. A team approach in wound management relies on the interdependence of its members, who share responsibility and accountability for reaching the desired outcomes [81]. However, similar to our review findings, Tang et al. [82] highlighted that unequal power relationships and a lack of mutual understanding, respect, and communication are major barriers to effective nurse‐physician collaboration. Effective communication and understanding of roles between team members is essential in multidisciplinary collaboration, and nurses are pivotal in facilitating information exchange between nurses and clinicians as they have the most contact time with patients [80]. Ubbink et al. [9] involved a multidisciplinary team to develop guidelines for acute wound care, highlighting the importance of multidisciplinary perspectives. Gillespie et al.'s [80] earlier review recommends using a bundled approach, sharing responsibility, and adhering to best practice as strategies that multidisciplinary teams can use to prevent postoperative wound complications like SSIs.

4.3. Strengths and Limitations

We recognise this review has its strengths and limitations. A key strength is the breadth of the literature search, which included multiple research databases. Another strength is the inclusion of diverse types of studies conducted across 21 countries. We also followed a detailed registered a priori protocol and undertook an independent review process for each study, involving two reviewers. Yet, as with all reviews, there are also some limitations. First, the review includes research articles written in or translated into English only; thus, it may be subject to language bias. Second, although we carried out comprehensive searches based on a rigorous search strategy, some articles may have been missed. Third, most studies in our review relied on descriptive methodologies, with most using self‐reported data. The quality of included studies also varied. Consequently, these factors may limit the conclusions that can be drawn. In addition, evidence addressing strategies to enhance acute care nurses' adherence to evidence‐based postoperative wound care practices was limited, constraining the depth of synthesis. However, we undertook quality assessments using the MMAT and SQUIRE 2.0 to objectively evaluate the reliability, validity and rigour of the findings from the included studies. We deliberately included studies of varying quality based on our criteria. This approach allowed us to identify patterns and trends consistent with higher‐quality research, enhancing the transparency of our review process and avoiding potential bias.

4.4. Recommendations

To improve the effectiveness of postoperative wound care, clinicians should adopt a holistic approach while adhering to the evidence‐based CPGs. However, the applicability of these evidence‐based guidelines and the factors influencing their implementation in different contexts should be explored [60]. The inconsistencies in nursing practice can be minimised through systematic, evidence‐based approaches in wound care by standardising protocols and using validated assessment tools, which can reduce unwarranted variation and low‐value care that may lead to patient harm [15]. Integrating these strategies may foster a more holistic approach to wound care, contributing to reduced postoperative complications and improved patient outcomes.

Our review also highlights the importance of improving multidisciplinary collaboration and providing organisational support. One strategy to address these issues could be integrating technologies such as photographic documentation and electronic wound monitoring systems that may enhance communication and continuity of care across multidisciplinary teams [83]. Fostering collaboration among healthcare professionals through a clear understanding of interprofessional roles in postoperative wound care will encourage the development of wound care plans and facilitate timely interventions to achieve patient‐specific goals [82]. Additionally, organisational leaders must be responsible for ensuring nurses have access to appropriate resources, such as wound care protocols, equipment, dressings, along with adequate staff, that allow for thorough and person‐centred care [37].

Our findings suggest inconsistencies in nurses' practices highlighting the need for enhancing nursing education. Ongoing professional development should be prioritised to ensure nurses are prepared with the updated evidence‐based knowledge and clinical skills [37, 76]. This includes integrating wound care training into both undergraduate curricula and workplace learning programmes, with particular emphasis on postoperative wound types, risk factors, and assessment techniques [33]. Revisiting existing nursing curricula and identifying the gaps in content, enhancing the coordination between academic institutions and clinical settings are also important to improve pre‐registration nursing education [68, 69]. Simulation‐based education and workshops focused on hands‐on skills can provide practice opportunities to improve the confidence and competence of nurses in wound management. Moreover, addressing the gap in the literature related to strategies to enhance nurses' adherence to evidence‐based postoperative wound care is important. This emphasises the need for future research focused on effective strategies to enhance adherence to best‐practice wound care.

5. Conclusion

The literature surrounding postoperative wound care practices highlighted that acute care nurses predominantly focus on technical dressing procedures with limited focus on holistic surgical wound management. Adherence to evidence‐based recommendations among acute care nurses is influenced by a myriad of internal and external factors. For instance, limited competency undermines nurses' ability to deliver consistent care and often stems from gaps in wound care and limited clinical resources. Notably, nurses' participation in wound care depends on understanding their scope of practice and multidisciplinary collaboration between other healthcare professionals. Overall, the findings of this review emphasise the need to use a holistic, evidence‐based approach to postoperative wound care to reduce practice variation among nurses and improve patient outcomes.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Supporting Information File 1: Database search.

Supporting Information File 2: Quality assessment of included studies using the MMAT and SQUIRE 2.0 criteria.

Gamage G. P., Lovegrove J., Seneviratne S., Tobiano G., and Gillespie B., “Postoperative Wound Care Practices of Acute Care Nurses: An Integrative Review,” International Wound Journal 22, no. 11 (2025): e70781, 10.1111/iwj.70781.

Data Availability Statement

The authors confirm that the data supporting the findings of this review are available within the included published articles and their accompanying Supporting Information.