ABSTRACT
Hemodialysis
is a critical treatment for patients with chronic kidney disease (CKD),
particularly in Nigeria, where the prevalence of CKD is rising due to factors
like hypertension, diabetes, and glomerulonephritis. As the number of patients
requiring hemodialysis increases, so does the risk of infections, which remain
a significant cause of morbidity and mortality among these patients. Infections
can occur due to the invasive nature of hemodialysis, which involves repeated
vascular access, prolonged hospital stays, and the use of catheters and other
medical devices that can serve as potential sources of infection. The study
examines the knowledge, attitude and practice of patients on Hemodialysis
towards infection control in FMC, Abeokuta Ogun State. The study
population was consisting of all accessible registered hemodialysis patients
attending Federal Medical Centre (FMC), Abeokuta, Ogun State. The target
population for this study is estimated 46 registered hemodialysis patients
attending Federal Medical Centre (FMC), Abeokuta, Ogun State. This figure was
for the month of April to August, 2024 and was supplied by the administrative
unit of the Hospital. Questionnaire was used as the instrument for data
collection. Description statistics will be applied to give meaning to the data.
The descriptive analysis was done using table and simple percentage. The study
also discovered a favorable correlation between good knowledge and practice.
Setting up training programs for patients might therefore be helpful in refocusing
and enhancing their usual measures for infection prevention is anticipated, as
well as facilitation positive mindset and behavior. It was recommended it is the hospital managers organize
intensive training programs for these nurses as an ongoing component of staff
development. The findings of the study are summarized here under for ease of
understanding. The study revealed that there is acceptable level of
hemodialysis patients knowledge regarding infection control standard
precautions in FMC, Abeokuta Ogun State.
TABLE
OF CONTENT
Title Page
i
Declaration Page
ii
Certification iii
Dedication
iv
Acknowledgement vi
Table of Contents
vii
Abstract x
CHAPTER ONE: INTRODUCTION
1.1 Background
to the Study
1
1.2 Statement
of the Problem
3
1.3
Purpose of the Study 4
1.4 Research
Questions
5
1.5 Significance
of the Study
5
1.6 Operational
Definition of Terms
6
CHAPTER TWO: LITERATURE REVIEW
2.1 Conceptual
Review
7
2.1.1 Hemodialysis
7
2.1.2 Knowledge of patients on Hemodialysis 13
2.1.3 Principle of infection control 16
2.1.4 Obstacles of non-compliance on standard precautions 18
2.2 Theoretical Review 18
2.2.1 Application of the Theory 20
2.3 Empirical Review
21
CHAPTER THREE: METHODOLOGY
3.1 Research
Design
27
3.2 Research
Setting
27
3.3 Target
Population 28
3.4 Sampling
Size 29
3.5 Sampling
Techniques 29
3.6 Instrument
for Data Collection 29
3.7 Validity
of the Research Instrument 30
3.8 Reliability
of instrument 30
3.9 Method
of Data collection 30
3.10 Method of Data analysis 30
3.11 Ethical Consideration 31
CHAPTER FOUR: RESULT AND
INTERPRETATION OF FINDINGS
4.1 Data
presentation 32
CHAPTER FIVE: SUMMARY, CONCLUSION
AND RECOMMENDATIONS
5.1 Discussion
of Findings
38
5.2 Implication
to nursing 41
5.3 Limitation
of the study 42
5.4 Summary
of Findings 42
5.5 Conclusion
42
5.6 Recommendation
43
5.7 Suggestion
for Further Research
43
REFERENCES 44
APPENDIX
50
CHAPTER
ONE
INTRODUCTION
1.1 Background to the Study
Hemodialysis is a
critical treatment for patients with chronic kidney disease (CKD), particularly
in Nigeria, where the prevalence of CKD is rising due to factors like
hypertension, diabetes, and glomerulonephritis. As the number of patients
requiring hemodialysis increases, so does the risk of infections, which remain
a significant cause of morbidity and mortality among these patients. Infections
can occur due to the invasive nature of hemodialysis, which involves repeated
vascular access, prolonged hospital stays, and the use of catheters and other
medical devices that can serve as potential sources of infection.
Infection control
practices are essential to reducing the risk of infections among hemodialysis
patients. However, the effectiveness of these practices depends significantly
on the knowledge, attitude, and practices (KAP) of the patients themselves.
Patients' understanding of infection control, their perceptions of its
importance, and their adherence to recommended practices can greatly influence
the outcomes of infection prevention strategies.
In Nigeria, the level
of awareness and adherence to infection control practices among hemodialysis
patients is influenced by several factors, including education, access to
healthcare information, and the quality of healthcare services. Studies have
shown that patients with better knowledge of infection control are more likely
to adhere to preventive measures, thereby reducing their risk of infection (Akanbi
et al., 2020). However, gaps in knowledge, negative attitudes towards infection
control, and poor practices remain significant challenges that need to be
addressed to improve patient outcomes.
Hemodialysis (HD) is
one of several renal replacement treatments (RRTs) used to remove excess fluids
and waste products and restore chemical and electrolyte balances in patients
with renal failure (Uoda, 2019). Hemodialysis is moving towards more novel
procedures, biomaterials, and devices; however, every new treatment or
technology must be backed up by good data (Shimokura et al., 2011; Shimokura,
Weber, Miller, Wurtzel, & Alter, 2006).
Hemodialysis began as
an external vascular circuit in which the patient's blood was pumped into
polyethylene tubing and delivered to the dialysis filter or membrane (dialyzer)
through a mechanical pump. The blood is then returned to the patient after
passing through a semi-permeable membrane on one side of the dialyzer. The
dialysate solution, which is made up of purified water and electrolytes, is
pushed through the dialyzer in the opposite direction as blood flows through
the semi permeable membrane. In most situations, systemic anticoagulation (with
heparin) is administered to keep the hemodialysis circuit from clotting (Ahmad,
Tan, Wu, & Beathard, 2021).
Patients on
hemodialysis (HD) have a significantly higher risk of life-threatening
infections. The majority of bloodstream infections are linked to vascular
access, with a central venous catheter accounting for 70% of all infections
(CVC)(Patel & Brinsley-Rainisch, 2018).Infections cause significant
morbidity and are the second leading cause of death in people with end-stage
renal failure, after only cardiovascular illnesses. Patients on HD are prone to
viral infections such as hepatitis B (HBV), hepatitis C (HCV), HIV, and
influenza, in addition to bacterial infections. HCV outbreaks in HD facilities,
which continue to occur with alarming regularity, are frequently the result of
inadequate infection control methods(Nguyen et al., 2016).
Bloodstream infections
have been linked to lapses in infection control methods such as hand hygiene
and environmental cleaning. Several infection control methods, including hand
cleanliness, proper catheter care, the use of antiseptic agents, checklists,
and staff and patient education, are all strongly recommended by the CDC for
minimizing infections (Mokrzycki et al., 2021).The CDC and other organizations,
such as the Association for Professionals in Infection Control and
Epidemiology, recommend that dialysis employees be properly trained on Standard
Precautions and other infection control procedures (Faltas, 2018).
The background for this
study is framed by the need to understand the current state of KAP among
hemodialysis patients in Nigeria, with the aim of identifying areas for
improvement and developing strategies to enhance infection control practices.
This understanding is crucial for healthcare providers, policymakers, and
educators in designing effective interventions that can reduce the incidence of
infections and improve the quality of life for hemodialysis patients in
Nigeria.
1.2 Statement of the Problem
Infection control among patients undergoing
hemodialysis is a significant public health concern in Nigeria. Despite the
critical importance of preventing infections, there is evidence to suggest that
many hemodialysis patients in Nigeria have inadequate knowledge, display poor
attitudes, and engage in suboptimal practices related to infection control.
This issue is exacerbated by factors such as low levels of health literacy,
insufficient patient education, and limited access to resources necessary for
effective infection prevention (Olawale et al., 2019).
Hemodialysis patients are particularly vulnerable to
infections due to the repeated vascular access required for their treatment,
prolonged exposure to healthcare settings, and the frequent use of indwelling
catheters, which are potential sources of infection. These infections not only
lead to increased morbidity and mortality but also impose a significant burden
on the healthcare system (Akanbi et al., 2020). Despite the availability of
guidelines and protocols for infection control in hemodialysis units, the lack
of adherence to these practices by patients remains a pressing issue. The
problem, therefore, lies in the apparent disconnect between the knowledge
patients possess and the practices they adopt. Even when patients are aware of
the risks, there is often a gap between their knowledge and their actual behaviours,
which may be influenced by cultural beliefs, fear, or misunderstanding of the
importance of infection control measures (Ibrahim & Mustapha, 2021).
Furthermore, healthcare providers may not always effectively communicate the
risks and necessary precautions to patients, leading to inadequate patient
education and poor infection control outcomes.
This study seeks to address this gap by exploring the
knowledge, attitudes, and practices of hemodialysis patients towards infection
control in Nigeria. By identifying the specific factors that contribute to poor
infection control practices, the study aims to inform the development of
targeted interventions that can enhance patient education and improve infection
control outcomes in this vulnerable population.
1.3 Objectives of the Study
The
broad objective of the study is to examine the knowledge, attitude and practice
of patients on Hemodialysis towards infection control in FMC,
Abeokuta Ogun State. The specific objectives of this study therefore,
are:
1.
To assess hemodialysis patient’s
knowledge regarding infection control standard precautions in FMC, Abeokuta
Ogun State.
2. To
examine the hemodialysis patient’s attitude regarding infection control
standard precautions in FMC, Abeokuta Ogun State.
3. To
ascertain hemodialysis patient’s practices regarding infection control standard
precautions in FMC, Abeokuta Ogun State.
1.4 Research Questions
The
research questions to be used in this study include;
1. What
is the level of hemodialysis patient’s knowledge regarding infection control
standard precautions in FMC, Abeokuta Ogun State?
2. What
is the hemodialysis patients attitude regarding infection control standard
precautions in FMC, Abeokuta Ogun State?
3. What
is the level of hemodialysis patient’s practices regarding infection control
standard precautions in FMC, Abeokuta Ogun State?
1.5
Research Hypothesis
H₀:
There is no significance between hemodialysis patient’s knowledge regarding
infection control standard precautions in FMC Abeokuta
H₁:
There is significance between hemodialysis patient’s knowledge regarding
infection control standard precautions in FMC Abeokuta
1.6 Significance of Study
The
significance of this study on the knowledge, attitudes, and practices (KAP) of
patients undergoing hemodialysis towards infection control in Nigeria is
multifaceted, addressing critical gaps in healthcare and contributing to both
academic knowledge and practical applications. Firstly, the study has important
implications for public health, particularly in reducing the burden of
infections among hemodialysis patients. Infections are a leading cause of
morbidity and mortality in this population, and understanding the factors that
influence infection control practices is crucial for developing effective
interventions. By identifying deficiencies in patients' knowledge and
attitudes, the study can inform the design of educational programs that target
specific areas of need, ultimately leading to better infection control outcomes
and improved patient safety. Secondly, the findings of this study will be
valuable for healthcare providers, including nephrologists, patients, and other
professionals involved in the care of hemodialysis patients. By highlighting
the relationship between KAP and infection control, the study can guide
healthcare providers in enhancing their communication strategies and patient
education efforts. Improved patient-provider interactions can lead to greater
patient adherence to infection control practices, reducing the incidence of
infections and associated complications. Furthermore, the study will contribute
to the existing body of literature on infection control in healthcare settings,
particularly in low-resource environments.
1.7 Scope of the Study
This
study is confined to the hemodialysis unit at the Federal Medical Centre (FMC)
in Idi Aba, Abeokuta, Ogun State, Nigeria. All data collection and analysis is
occurring within this healthcare facility, providing specific insights into
infection control practices within this particular setting. The study focuses
exclusively on patients receiving hemodialysis treatment at FMC. It includes a
diverse range of patients, considering various demographic variables such as
age, gender, duration of treatment, and educational background. This allows for
an understanding of whether these factors influence knowledge, attitude, and
practices regarding infection control.
1.8 Operational Definition of Terms
·
Knowledge of Infection Control:
This refers to the information and understanding that patients on hemodialysis
have about infection control measures, such as hygiene practices, proper
handling of dialysis equipment, and ways to prevent infections related to
dialysis treatment. It is measured by assessing patients' responses to
questions about infection transmission, prevention strategies, and standard
precautions.
·
Attitude towards Infection Control:
This involves the beliefs, perceptions, and feelings of hemodialysis patients
toward the importance and necessity of infection control practices. It is
measured by evaluating patients' agreement or disagreement with statements
about infection control, their perception of risks, and their level of concern
for infection prevention during dialysis.
·
Practice of Infection Control:
This refers to the actual behaviors and actions that patients on hemodialysis
engage in to prevent infections, such as hand hygiene, wearing protective gear,
following prescribed protocols, and reporting signs of infection. It is
measured by observing or self-reported adherence to recommended infection
control practices.
·
Hemodialysis: A medical
procedure for patients with end-stage renal disease or chronic kidney failure,
where blood is filtered through a machine to remove waste products and excess
fluid. In this study, it specifically refers to patients undergoing this
procedure at FMC Idi-Aba, Abeokuta.
·
Infection Control: A set of
practices and protocols aimed at minimizing the risk of infection transmission
within healthcare settings, especially relevant to dialysis due to the high
risk of bloodborne infections. This includes hand hygiene, sterilization of
equipment, and patient education on infection prevention.
·
Patients on Hemodialysis:
Individuals receiving hemodialysis treatment at FMC Idi-Aba, Abeokuta, due to
kidney failure or other renal issues, who are the focus of this study. This
group is specifically examined for their infection control knowledge, attitude,
and practices.
·
FMC Idi-Aba, Abeokuta: Federal
Medical Centre (FMC) Idi-Aba, a tertiary healthcare facility in Abeokuta, Ogun
State, Nigeria, where the study is conducted. It is the setting in which
infection control practices among hemodialysis patients are being evaluated.
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