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NURSING INTERVENTION FOR THE PROMOTION OF INFECTION CONTROL IN TWO TEACHING HOSPITALS

CHAPTER ONE

INTRODUCTION

1.1  Background to the Study

Infection control is an aspect of healthcare delivery that deals with the curtailment of the spread of infection within the healthcare set-up, be it from patient-to-patient, patient-to-staff, staff-to-patients or staff to staff. According to World Health Organisation (WHO, 2011) the components of infection prevention and control are as follows: organisation, technical guidelines, human resources, surveillance, microbiology laboratory support, environment, evaluation and links with public health and other services. Organisation involves setting up a programme, formation of the infection control committee and inter-professional team, which should include physicians, nurses, microbiologists, epidemiologists, infection control specialists, information specialists and others. The committee must have a good working relationship with one another, because their work entails collaboration with other departments, staff and programmes. Technical guidelines involve developing, disseminating and implementing technical evidence-based information in preventing the risks of infection. Human resources involve training and re-training of health care personnel in preventing infections and the training of infection control professionals. It guarantees a pool of adequate staff responsible for infection prevention and control activities.

Surveillance is the tracking of demonstrated or suspected spread of infection. It involves the collection of data on epidemic and detection of outbreaks as well as the assessment of level of compliance with infection control practices, response to outbreaks and documentation of the situation of healthcare associated infection. Surveillance is important in that it causes early detection, identification, isolation and intervention, and results in effective infection prevention. Microbiology laboratory supports generate data, standardised laboratory techniques and promotes interaction between infection control activities. The environment refers to the minimum requirements for infection control. It includes water, ventilation, hand-hygiene equipment, placement of patient as well as isolation facilities, sterile supply storage, building conditions and renovation activities. Evaluation has to do with monitoring, assessment and report of infection prevention and control outcomes, processing and strategizing at national level and in healthcare facilities. It mirrors the impact of the infection control programmes. Links with public health and other services ensures proper coordination and collaboration between staff and departments in the events of mandatory reporting and activities such as waste management and sanitation, bio-safety, occupational health, patients and consumer’s care and the quality of health care (Hebden, 2015; Stempliuk & Eremin, 2015; WHO, 2011).

There are various sources of infections. Healthcare associated infections (HAI) are infections that develop in the course of healthcare and results in aggravating illnesses and may lead to deaths, extends the duration of hospital stay, and calls for more interventions at an added cost to the one already expended by the patient’s initial disease. Its occurrence is an indicator of the quality of patient care, adverse event and an issue of patient safety. The sources includes adverse drug events, surgical complications, microorganism isolates, antimicrobial resistance, decreasing trends in intensive care units, exogenous microorganisms such as bacteria, fungi, viruses, protozoan from other patients, endogenous flora of the patients- residual bacteria residing on the patient’s skin, mucous membrane, gastro intestinal tract, respiratory tract, inanimate environmental surfaces, contaminated objects, patient room touch, surfaces, equipment, medication, individual patient, medical equipment, devices, hospital environment, contaminated drugs and foods and hospital flora in the healthcare environment. Other sources include doctors’ white coats, nurses’ uniform, hospital garments, privacy drapes, stethoscopes, bed rails, common hospital surfaces, contaminated water, compromised immune system, negligence or poor attitude of hospital staff, hands of health care workers. It could be from patient to patient, patient to environment, staff to patient, renovation works in the hospital (Hans, 2012; Stubblefield, 2014; WHO, 2011).

Healthcare workers generally are at risk of infection, because they constantly come into contact with infected materials such as tissues, fluid, blood and blood products. There are several infection control measures aimed at controlling the spread of infectious diseases, such as hepatitis B and C, Human immunodeficiency virus (HIV) and other life threatening infections. Moreover, the hospital waste itself is a potential source of infection hence the need for proper infection control measures. It has been found that healthcare workers do not adhere strictly to the various infection control measures, probably because they do not recognise such, or they lack adequate knowledge, or could be due to poor attitude towards infection control measures, including non-availability of materials and equipment (Amoran & Onwube, 2013).In a study conducted at the Federal Medical Center (FMC), Gombe, in North Eastern Nigeria among nurses, it was found that some respondents were not aware that standard precautions is applied to all patients, and majority of the respondents have poor knowledge of the components of standard precautions (Saidu, Habu, Kever, Dathini, Inuwa, Maigari et al, 2015).

Standard precautions are infection control measures that are put forward by the United States Centre for Disease Prevention & Control (CDC), in 1996. By complying with standard precautions, a lot of infections can be avoided, such as occupational exposure to pathogens. While some health workers are familiar with the infection control measures, some are not. This may be due to lack of awareness or knowledge and moreover, the attitude that some who are familiar with the infection control measures, show towards practice is not encouraging. When one considers the importance of adequate knowledge and practice of infection control measures, by the healthcare workers, one cannot but think of what to do to improve on that knowledge and practice. Jain, Dogra, Mishra, Thakur and Loomba (2012), in their study among doctors and nurses in a tertiary care hospital, found that there is lack of knowledge and practice regarding basic infection control measures. This deficit in knowledge can be improved through educational intervention. Wasswa, Nalwadda, Buregyoya, Gitta, Anguzu and Nuwama (2015), in their study on implementation of infection control in health facilities in Uganda, found that with prior training on infection control, the respondents were more likely to wash their hands. Level of education and a prior nosocomial infection experience will have a role in the practice of infection control measures. In-service training on infection control measures will boost the practice of infection control measures.

Amoran and Onwube (2013) found that inadequate workers’ knowledge on infection control and environment related problems are crucial issues that need urgent attention. According to Gebresilassie, Kumei, and Yemane (2014) in their study, “there is suboptimal and inconsistent practice of standard precautions in the healthcare setting that put patients and healthcare workers at significant risk of acquiring infections”. They also emphasized the need for in-service training for the healthcare workers on infection control. Adly, Amin and Abd El-aziz, (2014) found that intervention influenced the compliance of nurses with infection control measures, because of the knowledge gained during the intervention or training programme. There is a standard of infection control measures that can guarantee infection safety among health workers and patients.

 1.2 Statement of the Problem

Healthcare workers generally are at risk of infection. WHO (2006), reported that among the 35million health workers worldwide, about 3 million sustain percutaneous exposures to the blood borne pathogens each year, including 2 million to Hepatitis B virus (HBV), 0.9 million to Hepatitis C virus (HCV) and 170,000 to Human Immunodeficiency virus (HIV). These injuries may result in 70,000 HBV; 15,000 HCV and 5,000 HIV infections. Nurses are at higher risk of being infected with blood-borne pathogens from clinical blood exposure through injuries with sharp instruments and needle-stick injuries if infection control measures are not strictly followed. This is because they are usually the first contact with a patient on arrival in the hospital and provide 24 hour patient care. Studies have also shown evidence of clinical nurses becoming infected due to occupational exposure (Centers for Disease Control & Prevention, 2012).  Abdulraheem, Amodu, Saka, Bolarinwa & Uthman (2012), in their study, among health workers in North Eastern Nigerian found that the level of knowledge and implementation of standard precautions is below standard to guarantee infection safety. They concluded that there is still much to learn and implement when it comes to infection control measures. 

Furthermore, in some health institutions, the researcher observed that some nurses do not adhere to the components of standard precautions while providing nursing care. For example, few nurses were observed not to wash their hand after removing gloves and before commencing another procedure. In some of the wash hand basins in the outpatient department, liquid soap is not available for health workers and patients to wash their hands. When blood or body fluids are spilled on the floor, the house keepers do not decontaminate with hypochlorite solution before mopping with soap and water. The health institutions infection control units are not well equipped to function effectively to ensure compliance to standard precautions. It is in the light of the gaps that the researcher became interested in planning a training programme on knowledge, perception, attitude and practice of infection control for nurses at Babcock University Teaching Hospital (BUTH), Ilisan-Remo, Ogun state.

1.3 Objective of the Study

The main objective of this study is to determine the effects of a training programme on infection control among nurses. The specific objectives are to:

assess the effectiveness of the training programme on knowledge of participants about

infection control;

determine the effectiveness of the training programme on perceptions of participants

about infection control;

document the effectiveness of the training programme on attitudes of participants

towards infection control;   

implement a training programme on infection control; determine the level of skills possessed and practice of participants on infection control; assess the effectiveness of a training programme on infection risk reduction and ascertain if there is any difference between the self-reported practices and the actual

      observed practices of infection control in the experimental group.      

1.4 Research Questions

This study attempted to answer the following research questions:

What are the effects of training programme on attitudes of participants? What are the effects of training programme on the perceptions of participants? What are the effects of training programme on the knowledge of participants? What is the effect of the training programme on infection risk reduction?

1.5   Hypotheses

These three hypotheses were tested at 0.05 level of significance:

Ho 1.         There is no significant difference in the mean knowledge score of infection control between the experimental group and the control group.

Ho 2.         There is no significant difference in the mean practice score of infection control between the experimental group and the control group.    

Ho 3.         There is no significant difference between the self reported practice and observed practice of infection control in the experimental group.

1.6 Scope of the Study

This study focused on the knowledge, attitude, perception and practice of infection control among nurses. Specific areas are; hand hygiene, use of personal protective equipment (PPE), handling sharps/injection safety, cleaning and disinfection as well as waste management. The independent variable is the training package, and the dependent variables are the participants’ knowledge, attitude, perception and practice.

1.7 Significance of the Study

The importance of the training programme to nurses, patients, hospital and society cannot be over emphasized. The training programme may improve infection control practices among nurses. The practices include: hand washing, donning and removing PPE for example, gloves, gown, mask, eyewear, and injection safety. The study may also improve the knowledge of nurses on the components of standard precautions. Training and practicing standard precautions may lead to a situation where nurses actually feel more protected from the risk of exposures to HIV and Hepatitis, and are more likely to provide improved “physical care”. Nurses also experience less fear and are less judgmental towards patients, thus less likely to stigmatise or discriminate patients, leading to improved “psychosocial or emotional care” when rendering care to patients with highly infectious diseases.  

In the practice of standard precautions, all patients are assumed to be possible sources of infection and must be handled professionally in that regard. The importance of this programme to the hospital is that the patients that receive care are not likely to have nosocomial infection. This may in turn allow the hospital to have recognition which may attract more patronage by Ogun state indigenes and beyond.

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