ABSTRACT
Infection is one of the most important
problems in health care services worldwide and occupational exposure to
pathogens forms a major concern among Nurses, the largest team among healthcare
professionals. Unfortunately, Universal
precautions are not well understood or implemented by health care
practitioners, though crucial in the prevention and transmission of blood-borne
pathogens like HIV. The purpose of the study is to assess knowledge, awareness and
compliance of Infection control guidelines among Nurses at the Lagos State
University Teaching Hospital, Ikeja Nigeria. A cross-sectional survey was conducted in March 2015 with a 19-item self-administered questionnaire used as the
instrument for the study. The sample of the study comprised of 103 Nurses. Findings from the study
revealed that almost all (93.2%) the respondents were very knowledgeable of universal precautions with significantly more females (75.4%) than males (42.9%)
(p<0.0001). More respondents (92.9%) who were employed in the health sector
for 16 years and over reported high levels of awareness of universal
precautions than those who were employed for less than five years
(p<0.0001). More Nurses (79.5%) reported frequent compliance with universal precautions. Excess work load and emergency situations featured
most frequently among the respondents as factors that militate against the utilization of infection
control guidelines. The researcher recommends
that the hospital management incorporate Infection control/safety measures in their
orientation programs for newly hired staff, regular in-service program and
continuing education programs to help improve compliance with Infection Control
guidelines.
TABLE
OF CONTENTS
PAGES
Title
Page i
Certification ii
Dedication iii
Acknowledgement iv
Abstract v
Table of Contents vi
CHAPTER ONE: INTRODUCTION
1.1 Background
of the Study 1
1.2 Statement of the Problem 4
1.3 Purpose
of the Study 6
1.4 Research
Questions 6
1.5 Significance
of the Study 6
1.6 Delimitation and Limitations of the Study 8
1.7 Conceptual Definition of Terms 9
CHAPTER TWO: LITERATURE
REVIEW
2.0 Introduction 10
2.1 Knowledge
about the prevention and control of Infection 11
2.2 Attitudes towards the
prevention and control of Infections 14
2.3 Practices regarding the prevention and control of Infection 18
2.4 Compliance with UPs to prevent
exposures to BBV 18
2.5 Conceptual
Framework 21
2.6 Summary 23
CHAPTER THREE: RESEARCH METHODOLOGY
3.0 Introduction 25
3.1 Research
Design 25
3.2 Area of
Study 25
3.3 Target Population
26
3.4 Sample and Sampling Technique 26
3.5 Instrumentation 26
3.6 Validity / Reliability of Instrument 27
3.7 Procedure for Data collection 28
3.8 Method of Data Analysis 29
3.9 Ethical Consideration 29
CHAPTER FOUR: DATA ANALYSIS
4.0 Introduction 31
4.1 Demographic characteristics
of the respondents 31
4.2 Analysis of Demographic Data 32
CHAPTER FIVE: SUMMARY OF FINDINGS, DISCUSSIONS,
CONCLUSION AND RECOMMENDATION
5.1. Introduction
46
5.2.
Discussion of Research Questions 46
5.3 Summary 51
5.4 Conclusion 52
5.5 Implication to Nursing Education and Practice 54
5.6 Recommendation 55
5.7 Suggestion
for Further Studies 56
REFERENCES 57
APPENDIX 64
CHAPTER ONE
INTRODUCTION
1.1 Background
of the Study
Infection is one of the most important
problems in health care services worldwide. It constitutes one of the most
important causes of morbidity and mortality associated with clinical, diagnostic
and therapeutic procedures. (Larceda 2003). It has been found that between 5%
and 10% of patients admitted to acute care hospitals acquire at least one
infection (Klevens et al 2007), (Pittet et al 2008).
Infection
refers to the invasion and multiplication of micro-organisms in body tissues,
which may be clinically unapparent but result in local cellular injury due to
competitive metabolism, toxins, intracellular replication or antigen-antibody
response (Chou 2004). Infectious agents refer to micro-organisms (bacterial,
fungal, viral) that are capable of causing disease in man, his domestic animal
and even plants. Health practitioners (e.g. Nurses) who
have direct contact with the patients and other hosts have been reported being
at risk of contracting and spreading infections. (Ibekwe
and Ibeziako, 2006)
Health care workers are at a high risk
of needle stick injuries and blood-borne pathogens as they
perform their clinical activities in a hospital (Beltrami et al 2000). They
are exposed to blood-borne infections by pathogens, such as human
immunodeficiency virus (HIV), hepatitis B and hepatitis C viruses, from sharp
injuries and contacts with blood and other body fluids (Gerbeding 1994). According
to a World Health Organization (WHO) estimate, in year 2004, sharp injuries resulted
in 16 000 hepatitis C virus, 66 000 hepatitis B virus and 1000 HIV infections
in health care workers worldwide (Pruss-Ustun
2005). Recapping,
disassembly, and inappropriate disposal increase the risk of needle stick
injury. [(Kennedy AM, Elward AM, Fraser VJ (2004), Bratzler DW et al 2005)] The incidence rate of these causative
factors is higher in developing countries for the higher rate of injection
with previously used syringes. (Akyol 2009) Developing
countries where the prevalence of HIV-infected patients is very high, record
the highest needle stick injuries too (Akyol 2009). Needle
stick injuries were also reported as the most common occupational health hazard
in a Nigerian teaching hospital.(Orji
EO, Fasubaa OB, Onwudiegwu U, Dare FO, Ogunniye SO (2002). Infection control
measures are therefore needed to ensure patient safety and prevent
cross-infection, (patient to staff, staff to patient, patient to staff to
patient).
In 1983, the United States
Centre for Disease Control and Prevention (CDC) published a document that
recommended blood and body fluid precautions when a patient was known or
suspected to be infected with blood-borne pathogens. In
1987, the CDC recommended that regardless of patients infection status, the
precautions must be consistently used. This extension of blood and body fluid
precautions to all patients is referred to as “universal blood and body fluid
precautions” or simply “universal precautions.”(WHO
2009) These precautions include set of precautions devised to prevent
transmission of all known blood-borne pathogens including HIV, hepatitis B virus,
and hepatitis C virus to/from health care personnel when providing first aid or
other health care services. This applies to blood and other body fluids
containing visible blood and also to vaginal secretions and semen. In 1996, the CDC included the universal
precautions in a new prevention concept called the “standard precautions,”
which are devised to be used for the care of all patients in hospitals
regardless of their diagnosis or presumed infection status and now replace the
“universal precautions.”
Standard
precautions include hand washing; use of barriers (e.g., gloves, gown,
cap, mask); care with devices, equipment and clothing used during care;
environmental control (e.g., surface processing protocols, health
service waste handling); adequate discarding of sharp instruments including
needles; and patient’s accommodation in accord to requirement levels as an
infection transmission source. (WHO 2004). Another important measure is
adequate professional immunization, as this guarantees anticipated protection
against immune-preventable diseases.
Standard Precautions
policy for infection control provides the tool/guidelines for the stakeholders
(health care workers and administrators), to enable implementation of infection
control measures in and organized and guided way, and to allow provision of
monitoring mechanisms to timely identify and correct breaches in infection
control activities and procedures (Pittet et al 2008), (Bolyard et al 1998).
Nurses are members of the healthcare team, employed in essentially
every kind of healthcare setting and have primary responsibility for a
significant portion of patient care. Given the nature of their working
environment, responsibilities and duties, nurses are on the frontline of
numerous biological occupational hazards and should cultivate the habit of
minimizing these hazards through adequate use of safety measures.
1.2 Statement of the Problem
It is also well recognized
that the risk of transmission of pathogens when providing medical care and the
reduction rates can be kept low through appropriate
standardized prevention procedures.
The National HIV
Sero-prevalence sentinel reports show an exponential increase in the HIV
prevalence rate in Nigeria (NSSS 2000). Similarly, high rates of Hepatitis B
and C have been reported in Nigeria and Africa as a whole (Odunoye 2003), however, it has
been documented that the level of compliance with the use of proven infection
control measures by healthcare workers (HCWs) has been disappointing (Demir 2009), despite the
fact that evidence-based procedures promoting appropriate practices in HCWs
settings are published (WHO 2009).
Among the HCWs, nurses have a critical role to play in
prevention efforts and they are an important population to study their level of
knowledge, attitudes, and behaviour regarding infection control. However, up to
date these issues have received only limited attention .
The risk of suboptimal compliance may be
increased in developing countries like Nigeria due to such factors as
inadequate funding for infection control educational programs, high patient
load per nurse, crowded operating rooms, and inadequate resources (e.g.,
personal protective equipment (PPE), sharps containers, operating theatre
scrubs and hand wash detergent dispensers). The researcher’s personal
observation and complaints from infection control personnel in government
hospitals during the recent Ebola outbreak suggested that non-compliance was a
significant problem in the Nigerian healthcare system. It is for this purpose this research is
conceived.
1.3 Purpose of
the Study
This research
seeks to determine the:
1.
Knowledge level of
nurses in LASUTH, regarding infection control guidelines
2.
Attitudes of nurses in
LASUTH towards infection control guidelines
3.
Degree to which nurses
in LASUTH comply with the CDC infection control guidelines.
4.
Factors influencing compliance of Nurses in
LASUTH regarding infection control guidelines.
1.4 Research Questions
1.
What is the level of LASUTH Nurses knowledge of the CDC infection
control guidelines?
2.
What are the attitudes of nurses in LASUTH towards infection control
guidelines?
3.
What is the level of LASUTH Nurses compliance with infection control
guidelines?
4.
What are the factors influencing compliance with Infection control
guidelines by Nurses?
1.5 Significance
of the Study
This study
when completed will enlighten nurses and student nurses on the measures to take
to protect themselves from potential biological hazards to which they are
exposed, in an attempt to decrease nurse turnover and promote effective
delivery of nursing services. It will also help in planning of health
programmes aimed at improving their quality of life and coping strategies.
The study
will also serve as a guide to the Government in determining factors which
negatively affect safety and effectiveness of health services rendered by the
nursing workforce and increase level of preparedness in tackling potential
disease outbreaks.
The study findings may contribute to the
review of the education curriculum of nurses trained locally or in-service
trainings on identified areas where knowledge is inadequate. Also, the study
findings may lead to a review of work place related occupational health and
safety regulations and policy such as introduction of a compulsory provision
for personal protective measures by the employer for nurses identified to be at
risk at the employers cost, which is currently non-existent. It will also serve as a means of decreasing cost
expenditure through interviewing and orientating newly employed nurses, thus
improving the quality of healthcare services rendered.
The study
provides a knowledge base for further research in the nursing profession that
addressed after studying, all aspects of nurses’ compliance with infection
control and its relationship with other factors in the clinical environment.
Finally, the study may indirectly lead
to safer work place practices by introduction of safer working methods where
they are non-existent and monitoring of nurses’ compliance to safer practices.
1.6 Delimitation and
Limitations of the Study
The
major limitation of this study was that the assessment of compliance with
infection control guidelines was based on the respondents own determination and
admission rather than independent observation of their actual practice. It
could be expected that Nurses would over-report their level of
compliance with infection control policies in an effort to please their
supervisors.
This study covers all
aspects of clinical nursing practice, excluding mental health (psychiatric)
nursing. However, no attempt was made in this study to establish comparisons
between practice areas in nursing because the population sample came from a
wide range of practice settings in the entire teaching hospital. Convenience sampling
method has been used. Although this method lacks external validity (data generalizability), it
was used for easier sample recruitment and higher response rate
(Bowling 2009).
1.8
Conceptual Definition of Terms
1. Attitude: refers to the way a person views something or tends to behave
towards it, often in an evaluative kind of way” (Collins English Dictionary,
1991).
2. Compliance: refers to the routine activities and actions of a nurse towards prevention and control
of infection. These include the use of personal protective equipment, hand
hygiene and proper waste disposal in the hospital.
3. Infection control: Infection control in health care setting are measures
practised by health care workers (nurses) to decrease transmission and acquisition
of infectious agents such as staphylococcus aureus, hepatitis A,B,C virus,
Bacillus species, herpes zoster, etc
4. Knowledge: refers to the ability of a nurse to gain, retain and use information regarding
infection control, in terms of standard precautions and universal precautions.
5. Nurses: are health
workers including midwives and general nurses trained and licensed to practice
by the Nursing and Midwifery Council of Nigeria, working in LASUTH Ikeja.
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