TABLE OF
CONTENT
CHAPTER
ONE
INTRODUCTION
1.1
Background to the Study
1.2
Statement of Problems
1.3
Purpose of Study
1.4
Specific Objectives
1.5
Research Questions
1.6
Hypothesis
1.7
Scope of Study
1.8
Significance of the Study
1.9
Limitation of the Study
1.10 Operational
Definition of Terms
CHAPTER
TWO
LITERATURE
REVIEW
Introduction
2.1 Etiology
of Nosocomial Infections
2.1.1 Causes And Transmission of Nosocomial
Infections
2.1.2 Standard Measures for Nosocomial Infection
Treatment
2.1.3 Components of the Standard Measures for
Nosocomial Infection Treatment
2.2 Measures for Nosocomial Infections
Prevention
2.2.1 Hand Hygiene
2.2.2 Personal Protective Equipment (PPE)
2.2.3 Gloves
2.2.4 Gowns
2.2.5 Mouth, Nose, and Eye Protection
2.2.6 Respirator y Hygiene/Cough Etiquette
2.2.7 Patient Placement
2.2.8 Patient Care Equipment and Instruments/Devices
2.2.9 Care of the Environment
2.2.10 Textiles and Laundry
2.2.11
Safe Injection Practices
2.2.12
Infection Control Practices for Special Lumbar Puncture Procedures
2.3 Nurses Knowledge of Nosocomial Infections
2.4 Nursing Measures Utilized for the
Prevention of Nosocomial Infections
2.5 Conceptual Framework
2.5.2 Application Of Green Precede-Proceed Model To
The Study
CHAPTER
THREE
RESEARCH
METHOD
3.1
Research Setting
3.2
Research Design
3.3 Research Population
3.3.1
Target population
3.3.2 Assessable Population
3.4 Sample And Sampling Technique
3.5 Instrument for Data Collection
3.6 Validity
of Instrument
3.7 Reliability of the Instrument
3.8 Ethical Consideration
3.9 Method of Data Collection
CHAPTER
FOUR
PRESENTATION
4.1 Socio-Demographic data of the respondents n
= 34
4.1 Socio-demographic data
4.2 Results for research questions
4.2.1 Research question one
4.2.2 Research questions two
CHAPTER FIVE
DISCUSSION OF FINDINGS
5.1 Introduction
5.1.1 Nurses’ knowledge of nosocomial infections
5.1.2 Nursing measures utilized for the prevention
of nosocomial infections
5.1.3 Research Hypothesis
5.2 Summary
5.3 Conclusion
5.4 Implication
to nursing
5.5 Recommendation
REFERENCES
APPENDIX
1
APPENDIX
2
CHAPTER
ONE
INTRODUCTION
1.11
Background
to the Study
Nosocomial infection also known as
Hospital Acquired Infections (HAI) is a localized or systemic infection
acquired in a hospital or any other health care facility by a patient admitted
for a reason other than the pathology present during admission. It may also
include an infection acquired in a healthcare facility that may manifest 48 hours
after the patient's admission into the health care facility or discharge (Hildron,
Edwards, Patel, Horan, Sievert, Pollock & Fridkin, 2008). Epidemiological studies
report that nosocomial infections are caused by pervasive pathogens such as
bacteria (Lepelletier, Perron, Bizouarn, Caillon, Drugeon, Michaud & Duveau,
2005), viruses (De-Oliveira, White, Leschinsky, Beecham, Vogt, Moolenaar, Perz &
Safranek, 2005) and fungi present in air, surfaces or equipment. The pathogens
are not present or incubating prior to the patient's admission into healthcare
facility and are most likely transmitted by direct person-to-person contact during
invasive medical procedures (Anderson, Kaye, Chen, Schmader, Choi, Sloan &
Sexton, 2009). Some of the pathogens are highly resistant to antimicrobial
agents, andthis necessitates the prescription of more potent and costly antimicrobial
agents (Mulvey & Simor,2009).
Nosocomial infections are prevalent nationally
and internationally; and occur in patients of all age groups: neonates (Aly,
Herson, Duncan, Herr, Bender, Patel & EI-Mohandes, 2005), immuno-compromised
adults and the elderly (Lepelletier, Perron, Bizouarn, Caillon, Drugeon,
Michaud& Duveau, 2005). The most frequent
types of nosocomial infections
are those associated with
the urinary tract, surgical
wounds, respiratory tract and
blood stream (Lo, 2008). It is a
serious global public health issue, causing the suffering of 1.4 million people
across the world at any given time (WHO, 2007).
Nosocomial infection in developing
countries is difficult to address because it is such a complex problem with
diverse underlying causes. International non-governmental organizations (INGOs)
and inter-governmental organizations such as United Nations agencies add a
unique perspective to the push for infection control measures in hospitals in
the developing world. However, these
organizations have not been able to address all facets of the problem such as
infrastructure, leadership and individual health care worker behavior. Nosocomial infection control is not simply a
matter of encouraging hand hygiene in settings where clean water and soap may
not be consistently available. Nor is infection control a matter of providing
supplies to health care workers who are not trained to use them properly (WHO,
2010).
The burden of HAI is already substantial
in developed countries, where it affects from 5% to 15% of hospitalized
patients in regular wards and as many as 50% or more of patients in intensive
care units (ICUs) (WHO, 2009). In developing countries, the magnitude of the
problem remains underestimated or even unknown largely because HAI diagnosis is
complex and surveillance activities to guide interventions require expertise
and resources (Allegranzi & Pittet, 2008). Surveillance systems exist in
some developed countries and provide regular reports on national trends of
endemic HAI (Pittet, Allegranzi, Sax, Bertinato, Concia & Cookson, 2005)
such as the National Healthcare Safety Network of the United States of America
or the German hospital infection surveillance system. This is not the case in
most developing countries (WHO, 2010) because of social and health-care system
deficiencies that are aggravated by economic problems. Additionally,
overcrowding and understaffing in hospitals result in inadequate infection
control practices, and a lack of infection control policies, guidelines and
trained professionals also adds to the extent of the problem.
Hospital-wide HAI prevalence varied
between 2.5% and 14.8% in Algeria (Vincent, Rello, Marshall, Silva, Anzueto
& Martin, 2009), Burkina Faso (DiA, Ka, Dieng, Diagne, Dia & Fortes,
2008), Senegal and the United Republic of Tanzania (Atif, Bezzaoucha, Mesbah,
Djellato, Boubechou & Bellouni, 2006). Overall HAI cumulative incidence in
surgical wards ranged from 5.7% to 45.8% in studies conducted in Ethiopia (Messele,
Woldemedhin, Demissie, Mamo & Geyid, 2009) and Nigeria (Kesah, Egri-Okwaji,
Iroh & Odugbemi, 2009). The latter reported an incidence as high as 45.8%
and an incidence density equal to 26.8 infections per 1000 patient-days in
paediatric surgical patients (Kesah, Brewer, Yingrengreung & Fairchild, 2009).
In a study conducted in the surgical wards of two Ethiopian hospitals, the
overall cumulative incidence of patients affected by HAI was 6.2% and 5.7% (Messele,
Grottolo, Renzi, Paganelli, Sapelli, Zerbini & Nardi, 2009). In a study
from Nigeria, the implementation of an infection control programme in a
teaching hospital succeeded in reducing the rate of HAI from 5.8% in 2003 to
2.8% in 2006 (Abubakar, 2007).
In Nigeria, nosocomial infection rate of
2.7 % was reported from Ife, while 3.8 % from Lagos and 4.2 % from Ilorin
(Odimayo, Nwabuisi & Adegboro, 2008).
The cause of nosocomial infections might be endogenous or exogenous.
Endogenous infections are caused by organism present as part of the normal
flora of the patient, while
exogenous infections are acquired
through exposure to
the hospital environment, hospital
personnel or medical devices (Medubi, Akande &
Osagbemi, 2006). Nosocomial infection
rates vary substantially by body site, by type of hospital and by the infection
control capabilities of the institution. The proportion of infections at each
site is also considerably different in each of the major hospital services and
by level of patient risk (Taiwo, Onile & Akanbi, 2005).This is exemplified
by surgical site infections (SSIs) which are most common in general survey,
whereas urinary tract infections and blood stream infections are most frequent
in medical services and nurseries. Rates
of nosocomial infection vary by surgical subspecialty, low in ophthalmology and
high in general surgery. The differences are largely due to variations in
exposure to high risk devices or procedures (Tolu, 2007).
Urinary tract infections (UTI) represent
the most common (34%) type of nosocomial infections. Indwelling catheters cause
the majority while others are caused by genito urinary procedures (Tolu, 2007).
Surgical wound infections
represent 17% nosocomial infection
and are the
second most common hospital
acquired infections. The
classification of wound infections is based on the degree of bacterial
contamination, including clean, clean contaminated and contaminated. Co-morbid
and contamination of the surgical site contribute to the infection rate. The
risk factors for surgical wound infections include age, obesity, concurrent
infection and prolonged hospitalizations. The origin of the bacterial agent is
dependent on direct inoculation from a host’s flora, cross-contamination, the
surgeon’s hands, air-borne contamination and devices such as drains and
catheters (Odimayo, Nwabuisi& Adegboro, 2008). Lower respiratory infection
(LRI) or pneumonia represents 13 % of nosocomial infections (Taiwo, Onile &
Akanbi II, 2005). This is the most
dangerous of all nosocomial infections with acase fatality rate of 30%. It manifests in the intensive care unit or
post-surgical recovery room.
Endotracheal intubation and tracheostomy dry the lower respiratory tract
mucous and provide entry for microbes.
This study therefore aims at investigating
nursing measures utilized for the prevention of nosocomial infection in the
labour ward of University of Calabar Teaching Hospital (UCTH), Calabar, Cross
River State, Nigeria.
1.12
Statement
of Problems
Nosocomial infections have been recognized as a
problem affecting the
quality of health care and a principal
source of adverse healthcare outcomes.
Within the realm
of patient safety, these infections have serious impact such as
increased hospital stay days, increased
costs of healthcare, economic hardship
to patients and their families and even deaths, are among the many negative
outcomes (Anderson, Kaye, Chen, Schmader, Choi, Sloan & Sexton, 2009).
Further more, it was noted that Doctors
and Midwives were not observing strict Aseptic measures. It is with the above
information the researcher carried out this study to investigate nursing
measures utilized for the prevention of nosocomial infection in the labour ward
of University of Calabar Teaching Hospital (UCTH), Calabar.
1.13
Purpose
of Study
The
purpose of this study is to investigate nursing measures utilized for the
prevention of nosocomial infection in the labour ward of University of Calabar
Teaching Hospital (UCTH), Calabar.
1.14
Specific
Objectives
i.
To ascertain the level of
knowledge of nosocomial infection among nurses in UCTH, Calabar.
ii.
To identify the nursing
measures utilized for the prevention of nosocomial infection in the labour ward
of UCTH, Calabar.
1.15
Research
Questions
i.
How much do nurses in
University of Calabar Teaching Hospital (UCTH), Calabar know about nosocomial
infection?
ii.
What nursing measures are
utilized for the prevention of nosocomial infections in the labour ward of
UCTH, Calabar?
1.16
Hypothesis
There is no significant relationship
between thelevel of knowledge of nosocomial infection and nursing measures
utilized for the prevention of nosocomial infection in the labour ward of UCTH,
Calabar.
1.17
Scope
of Study
The
study is focused on investigating the nursing measures utilized for the
prevention of nosocomial infection in the labour ward of UCTH, Calabar. It will
also look at the level of knowledge of nosocomial infections among nurses in
UCTH, Calabar.
1.18
Significance
of the Study
The
findings of this study will be of significance to the following categories of
people;
Health Workers: They will find this
study to be an important tool for counselling patients suffering from
nosocomial infections.
Nurses And Midwives: The findings in this
study will aid nurses and midwives with deciding the most suitable infection preventive
measure for a particular individual at a particular time. The findings in this
study will also provide nurses and midwives with more insight on nosocomial
infections, which will help them give comprehensive health talks on it treatment
and prevention.
Researchers:
The findings in this study will also serve as a resource material to
researchers who wish to embark on related researches in the nearest future.
1.19
Limitation
of the Study
The limitation encountered by the
researcher was inability to distribute the questionnaire to all the nurses in
Calabar at the early stage of the research. This was due to the three
shift-duties of nurses (morning, evening and night) in all the various
hospitals in Calabar. However, the researcher overcame it by distributing
questionnaire during the morning and evening shift, face to face, whereby she
collected completed filled questionnaire at the spot.
1.20
Operational
Definition of Terms
The key terms in
this research were defined as follows:
·
Nosocomial:
This simply is a disease
originating in a hospital.
·
Infections:
This is referred to the
process of infecting or the state of being infected bacteria or fungi that
generates to a disease while being admitted in the hospital.
·
Nurse:
This simply means a person trained to care for people diagnosed of nosocomial infection.
·
Prevention:
This is simply the act of stopping nosocomial infection from happening or occurring.
·
Measure:
This refers to a means of achieving a purpose of preventing the occurrence of
nosocomial infections in labour ward.
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