Assessment Of The Knowledge And Practice Of Infection Control And Standard Precautions Among Dental Care Providers

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Assessment Of The Knowledge And Practice Of Infection Control And Standard Precautions Among Dental Care Providers


Abstract


Health care workers (HCWs) are at a high risk of needle stick injuries and blood borne pathogens, such as HIV, and Hepatitis B and C viruses, as they perform their clinical activities in the hospital. This study was therefore designed to determine the knowledge, attitude and practice of standard precautions among DCWs in Federal Medical Centre Ebute-Metta Lagos State, Nigeria.

This is a cross-sectional study carried out among 200 health workers at Federal Medical Centre Ebute-Metta Lagos State. They were selected through a stratified sampling technique. The instrument used for data collection was a semi-structured questionnaire that assessed the knowledge, attitude and practice of standard precautions.

The age of the respondents ranged from 22–60 years, with a mean age of 38.3+9.1 years. Majority of the respondents had good knowledge 79.0%, attitude 70.0% and practice 91.50% of standard precautions respectively. Less than half of the respondents 87 (43.5%) reported always recapping needles after use, 52 (26.0%) always detach needles from syringes and 105 (52.5%) had experienced needle stick injuries in the last one year. Furthermore, respondents showed poor immunization status as only 40.0% had been immunized against hepatitis B virus.

The study recommended training and re-training of staffs regularly on standard precautions; hepatitis B virus immunization should be made compulsory, needle recapping should be prohibited, unsafe and unwarranted use of injections should be minimized and a post exposure prophylaxis protocol should be in place with a well-known designated focal person.


Chapter One


Introduction

1.1 Background of the Study

The prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental disabilities in humans is known as health care or healthcare. Health professionals (providers or practitioners) in allied health areas provide healthcare. These health professionals include physicians and physician associates. Healthcare includes dentistry, midwifery, nursing, medicine, optometry, audiology, pharmacy, psychology, and other health professions. It encompasses work in primary care, secondary care, and tertiary care, as well as public health.
Infections that are neither present nor incubating when a patient enters the hospital are known as hospital acquired infections. At any given time, about 9% of inpatients have a hospital-acquired infection, equating to at least 100,000 infections each year. Their consequences range from patient pain to long-term or permanent disability, and hospital-acquired infections are responsible for just a small percentage of patient deaths each year. Standard Precautions are the minimal infection-prevention precautions that apply to all patient care in any environment where healthcare is provided, regardless of the patient’s suspected or proven infection status. These evidence-based strategies are intended to protect healthcare workers while also preventing infection spread among patients.

Many infection control methods, including as proper hand cleanliness and the application of fundamental precautions during invasive operations, are simple and inexpensive, but they necessitate employee accountability and behavioral change, as well as improved staff education, reporting, and surveillance systems. Guidelines for Isolation Precautions in Hospital was the first document produced by the CDC in 1983, and it included a section on blood and body fluid precautions. When a patient is known or believed to be contaminated with blood-borne diseases, the section recommends taking preventive actions.

In 1985, the Universal Precautions were created to protect health-care workers against blood-borne diseases caused by needlesticks and mucous membrane exposure to contaminated blood and bodily fluids. However, unless there was obvious blood, the Universal Precautions did not apply to nasal secretions, sputum, perspiration, tears, urine, or vomitus.

Standard precautions are extensively promoted as a way to protect DCWs against occupational exposure to bodily fluids and the risk of infection with blood-borne pathogens that comes with it. While performing their tasks, DCWs may be exposed to blood-borne and other illnesses through contact with bodily fluids. DCWs routinely treat patients whose HBV, HIV, or hepatitis C virus (HCV) status is unknown, and patients might be asymptomatic for months or years while infected. The occupational health of the global health care workforce, which numbers around 35 million individuals and accounts for around 12% of the working population, has been neglected (Wilburn & Eijkemans 2004: 451).

Every year, approximately three million DCWs are exposed to blood-borne pathogens through percutaneous exposure. More than 90% of these infections occur in developing nations, with 15,000 HCV, 70,000 HBV, and 500 HIV infections possible as a result of these injuries. Occupational sharps exposures are responsible for around 40% of HBV and HCV infections in DCWs worldwide, as well as 2.5 percent of HIV infections (WHO 2002: 74). These infections have far-reaching health repercussions. For example, 60–85 percent of HCV infections result in chronic liver disease, which increases the risk of liver cirrhosis and cancer (CDC 1998: 1–39).

5.6 million DCWs globally who handle sharp equipment, according to the Occupational Safety and Health Administration (2002), are at risk of occupational exposure to blood-borne diseases. In a Nigerian teaching hospital, needle stick injuries were shown to be the most common (75.6%) mechanism for occupational exposure (Orji, Fasubaa, & Onwudiegwu 2002:75–78). These injuries are frequently under-reported for a variety of reasons, including the stigma associated with an eventual HIV infection in the injured HCW. Because HIV and HCV do not have vaccines, the best way to avoid infection is to take conventional measures on a daily basis.

Against this backdrop, the objective of this study is to describe the knowledge, Attitudes and Practices (KAPs) for standard precautions in infection control among hospitals staff in Federal Medical center Ebute-Metta, Lagos state.


1.2 Statement of the Problem

The following issues of knowledge, attitude, and practice of standard precautions among health care workers are revealed by the investigation: Nurses come into contact with patients on a daily basis, and as a result, they are susceptible to sharp injuries and a variety of infections. To prevent infection transmission, it is critical to follow conventional measures. Despite the fact that a protocol for infection control in hospitals exists in Palestine, it varies in its application from hospital to hospital. Furthermore, after studying papers from the Palestinian Health Information Centre at the Ministry of Health, it was discovered that there are no statistics on nurses’ awareness and practice of SP and SI measures among health care personnel.

In public secondary health facilities, especially in resource-constrained areas, compliance with recommended procedures is low, exposing DCWs to infection risk. Despite the higher risk of infection due to higher disease prevalence, low level awareness of the risks associated with occupational exposure to blood, inadequate supply of personal protective equipment (PPE), and limited organizational support for safe practices, HCW occupational safety is frequently neglected in low-income countries (Sagoe-Moses, Pearson, Perry, & Jagger 2001: 538–41). Patients’ blood and other bodily fluids are growing more dangerous to those who care for them. As a result, suitable steps are required to guarantee that DCWs follow conventional precautions and limit the risk of infection (Bamigboye & Adesanya 2006: 112–116).


1.3 Objective of the Study

The main objective of this study is assessment of the knowledge and practice of infection control and standard precautions among dental care providers, specifically the study aims to:

  1. Determine the demographic distribution the dental care providers in Federal Medical Centre, Ebute-Metta
  2. Investigate the knowledge of standard precautions among dental care providers in Federal Medical Centre, Ebute-Metta
  3. Examine the attitude of dental care providers towards standard precautions in Federal Medical Centre, Ebute-Metta
  4. Investigate the practice of standard precautions among dental care providers in Federal Medical Centre Ebute-Metta

1.4 Research Question

  1. What is the demographic distribution the dental care providers in Federal Medical Centre, Ebute-Metta?
  2. What is the level of knowledge of standard precautions among dental care providers in Federal Medical Centre, Ebute-Metta?
  3. What is the attitude of dental care providers towards standard precautions in Federal Medical Centre, Ebute-Metta?
  4. How is the practice of standard precautions among dental care providers in Federal Medical Centre Ebute-Metta?

1.5 Significance of the Study

The knowledge and practice of standard precautions among two types of health care personnel (doctors and nurses) in the Federal Medical Center in Lagos state is investigated in this study. It also looks into the elements that encourage or discourage the behaviour. The state’s Health and Human Services Secretariat (HHSS), hospital management, and other stakeholders will use the study’s findings to create and target relevant measures/interventions to increase compliance with standard precautions among health care personnel. The health-care personnel will be the ultimate beneficiaries of the study’s findings-based actions.


1.6 Scope of the Study

This study was designed to determine the knowledge, attitude and practice of standard precautions among dental care providers. Geographically, the study will be delimited to healthcare works in Federal Medical Centre Ebute-Metta a developing urban area with rising cases of HIV/AIDs and other infectious diseases. This study will be carried between october 2020 to june 2021.


1.7 Limitation of the Study

One limitation of this study was the self-report method of assessment of practice of standard precautions; the level of adherence to standard precautions may have been better assessed by observation, although observation will likely influence normal routines.

Also, some of the information requested in the data collecting tool may be under-reported due to recall bias, but to minimize this limitation, a short period of recall (three months) was requested in the questionnaire.


1.8 Definition of Terms

Some definitions of terms that will used in the study were as below;

Knowledge:

The Oxford Advanced Learners Dictionary (2001: 658) defines knowledge as the information, understanding and skills that one gains through education or experience. It also defines knowledge as the state of knowing about a particular fact or situation. In this study, knowledge refers to the awareness of basic principles of standard precautions.

Practice:

Practice is the usual or expected way of doing something in a particular organization or situation (Oxford 2001: 912). In this study, practice refers to the extent that health care workers implement recommended strategies of standard precautions.

Standard Precautions:

The Centers for Disease Control and Prevention defines standard precautions as a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered. It is based on the assumption that every person is infected or colonized with an organism that could be transmitted in the healthcare setting and thus health care workers need to apply infection control practices during the delivery of health care. The same definition/assumption applies in this study.

Nurses:

Nurses are persons whose jobs are to take care of the sick or injured people, usually in a hospital (Oxford Learners Dictionary 2001:801). In this study, nurses refer to registered nurses and nurse/midwives working in public secondary health facilities.

Doctors:

A doctor is a person who has been trained in medical science and whose job is to treat ill or injured people (Oxford 2001: 343). In this study, doctors refer to graduates of medical schools working as medical practitioners in public secondary health facilities.

Occupational Exposure:

Occupational exposure is defined by the Occupational Safety and Health Administration (OSHA) of US Department of Labour as reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties. The same definition applies in this study.

Blood-borne infections:

OSHA defines blood-borne infections as infections from pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, HBV and HIV. In this study, blood-borne infections are infections from pathogenic microorganisms that are present in human blood, are capable of causing disease in human, and are predominantly transmitted via blood and blood contact.


Chapter Five


Summary, Conclusions and Recommendations

5.1 Introduction

This chapter summarizes the findings on the Knowledge, Attitude and Practice of Standard Precautions Among Health Care Workers in Lagos state, Federal Medical Centre, Ebute-Metta as case study. The chapter consists of summary of the study, conclusions, and recommendations.


5.2 Summary of the Study

In this study, our focus was on the Knowledge, Attitude and Practice of Standard Precautions Among Health Care Workers in Lagos state, Federal Medical Centre, Ebute-Metta as case study. The study is was specifically focused on examining the knowledge of standard precautions among dental care providers in Federal Medical Centre, Ebute-Metta, the attitude of dental care providers towards standard precautions in Federal Medical Centre, Ebute-Metta and investigating the practice of standard precautions among dental care providers in Federal Medical Centre Ebute-Metta. Four research questions guided the study.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 200 responses were validated from the enrolled participants where all respondent are healthe care workers in Federal Medical Centre, Ebute-Metta, Lagos State.


5.3 Discussion of Findings

The study shows that majority of the respondents were aware of standard precaution as a form of universal precaution against infection. Furthermore, majority of the respondents demonstrated good knowledge, attitude and practice towards standard precaution. The study shows majority of the respondents were females, nursing profession and had served between 1-5 years as a health worker in the hospital. This finding is consistent to Tobin EA (2013)’s study in Edo State, South-South Nigeria; but slightly different from a study in Federal Teaching Hospital Gombe, Nigeria by Abdulraheem IS (2012) where the respondent were 6-10 years in service. Furthermore, the respondents demonstrated high awareness of standard precaution which is similar to the findings from previous studies.

The sources of information for standard precaution for most of the respondents were workshop and seminar which is similar to other study. This is not surprising as most of the health workers do attend various seminar and workshop for on the job training and retraining. In addition, more than half of the respondents demonstrated good knowledge of standard precaution. This finding is different from previous studies in Nigeria which found lower level of knowledge. The finding in this study was not surprising as the respondents demonstrated high awareness of standard precaution, however in some previous studies the high awareness did not necessarily translate to knowledge of standard precaution. The demonstration of knowledge in the study by the respondents goes to show that the respondents probably do attend seminars and workshops which is usually the avenue to learn new and best practices by medical practitioners.

Similarly, the respondents exhibited good attitude towards standard precaution by agreeing to go for medical check-up in case of a needle stick injury and wearing double hand gloves as a way of protecting oneself when managing HIV and HBV positive patients. This is in line with the findings from a previous study by Abdulraheem IS (2012). The appreciable knowledge of standard precaution can be said to probably have encouraged positive attitude towards standard precautions by the respondents. Furthermore, the respondents practiced standard precaution which is similar to previous studies in Nigeria. In terms of specific standard precaution practices there are some variations with previous studies. Some of the respondents affirmed they do not recap needle after use and detach needles from syringe after use which is similar to previous study where the respondents admitted not to or never recap needle after use. The prevalence of needle stick injuries from this study is similar to what was reported in Nigeria, Indonesia and other studies.


5.4 Conclusions

With respect to the analysis and the findings of this study, the following conclusions emerged;

Standard Precaution as a life saving measure is more relevant in the medical field because of the increasing number of people living with HIV/AIDS, Hepatitis and other infectious diseases worldwide. The study shows the knowledge, attitude and practice of standard precautions among health care workers in agos state, was fair as majority of the health care workers has good knowledge, attitude and practice of standard precautions respectively. However, majority of the Health Care Workers still recapped needles, while few detach needles from syringes. In addition, over half of the Health Care Workers had experienced needle stick injuries which should be a concern both to the management of the hospital and stakeholders as most of the health workers will be susceptible to infections. The effective knowledge, attitude and practice of standard precautions among Health Care Workers in Federal Medical Centre, Ebute Metta, are of absolute necessity because of the rising population of HIV-infected individuals in the study area and lack of immunization of some of the respondents against HBV. Therefore, both the management of the hospital, stakeholders at the state ministry of health and health workers union should strive to promote strict compliance to standard precautions in order to prevent infections from sharps, blood and body fluid pathogens.


5.4 Recommendation

Based on the findings the researcher recommends that;

  1. A comprehensive infection prevention and control (IPAC) program sh ould be developed at all levels of healthcare in Nigeria, namely federal, state, local government and health facility levels.
  2. The government should established IPAC committees in the federal and state ministries of health and IPAC teams at the facility level.
  3. Knowledge of the standard precautions, including additional (transmission-based) precaution and infection control and prevention, should be improved among dental care providers
  4. Health facility managers should ensure regular supply of personal protective equipment and other items required for IPAC in their facility.
  5. A clinician should be appointed as PEP focal person in each health facility and trained on how to handle cases of occupational exposure.
  6. Awareness of the importance of hepatitis B vaccination should be increased among dental care providers.

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Frequently Asked Questions


What are the standard precautions in health care for infection control?

Infection control standard precautions in health care. 1 Hand hygiene1. 2 Gloves. 3 Facial protection (eyes, nose, and mouth) 4 Gown. 5 Prevention of needle stick injuries2. 6 Respiratory hygiene and cough etiquette. 7 Environmental cleaning. 8 Linens. 9 Waste disposal.

Is there a gap in knowledge and practice of infection control?

Gaps have been identified in knowledge and practice of infection control among doctors’ and nurses’ in the study; hence, it will be beneficial for all HCW to receive formal and periodic refresher trainings.

Do healthcare workers in Nigeria know about standard precautions of infection control?

The overall knowledge and attitude toward standard precautions of infection control among healthcare workers in the two tertiary hospitals in the south-south and north-central Nigeria was good.

What factors influence compliance with standard precautions among health workers?

Knowledge and training in standard precautions, high risk perception and longer duration of professional experience have been shown to be associated with improved compliance with standard precautions among health workers (Kermode et al., 2005; Luo et al., 2010). 

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