A SURVEY OF NURSES’ KNOWLEDGE, ATTITUDE AND COMPLIANCE WITH INFECTION CONTROL GUIDELINES IN LAGOS STATE UNIVERSITY TEACHING HOSPITAL (LASUTH)


Content

 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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