Assessment Of Knowledge And Practice Of Injection Safety Among Healthcare Workers In State Specialist Hospital, Yola

Project and Seminar Material for Nursing (Science)

Assessment Of Knowledge And Practice Of Injection Safety Among Healthcare Workers In State Specialist Hospital, Yola


Abstract


The World Health Organization (WHO) estimates that approximately 16 billion injections are administered in developing and transitional countries each year. Injection safety is therefore critical in preventing occupational exposure and infection from blood borne pathogens which are issues of public health importance. Thus, such prevention is a vital part of any comprehensive plan for protecting health workers, patients and maintaining a safe environment. The main aim of this study was an assessment of knowledge and practice of injection safety among healthcare workers in state specialist hospital Yola. A descriptive cross sectional study was utilised. A semi structured interviewer administered questionnaire with open and closed ended questions was used to collect information on knowledge and practice of injection safety among health workers. The questionnaire was adapted and modified from the WHO revised tool for injection safety among 270 primary health care workers. The mean age of the respondents was =41.4±8.7 years. The Majority had good knowledge of injection safety but 162 (60.0%) had fair practice. The Majority had good knowledge of injection safety but the practice was fair.


Table of Content


  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Table of Content
  • List of Tables
  • Abstract

Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organisations of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses
  • 4.5 Discussion of Findings

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


Introduction

1.1 Background to the Study

An injection is a skin-piercing exercise done to introduce a substance into the body for prophylactic, curative or recreational intentions. Injections are among the most frequent medical procedures (Kermode, 2004). According to World Health Organization (WHO), each year, about 16 billion injections are dispensed in developing and in countries that are in transition. Unsafe injection practices are not uncommon globally and they convey substantive proportion of avoidable blood borne infections (MOH, 2006a). WHO defines safe injection as the one that does not cause harmful effects to the recipient, does not expose the injection provider to any avoidable health related risks or generate waste that will cause harm to the community (MOH Waste Management Plan, 2008-2012).

Safe injection is a vital component of infection prevention process without which many patients are at risk of being exposed to several non curable and curable infectious diseases. Patients’ seek healthcare for either curatives purpose, preventive (Immunization) or for rehabilitative purpose. Healthcare providers use diverse measures to meet the need of patients including but not restricted to nursing care and pharmacological care. Pharmacological care involves drug administration of injectable medications that may go through different routes including intramuscular, intradermal route, intravenous and subcutaneous among others. Despite the advantages of these routes of drug administration, Canadian Needle Stick Surveillance Network (CNSSN) reports that intramuscular injection seems to be the most frequents route of infection transmission (CNSSN, 2000).

Injections are the most common medical procedure worldwide and 50% of them are said to be unnecessary (WHO/CDC, 2010; MMIS, 2010) and oral medication could have work better in some scenarios(conditions) where injection was the route of drug administration prescribed. Therefore, injections when medical indicated should be administered safely (Adejumo et al., 2013) to avoid risking patients of any avoidable morbidity and mortalities.WHO defines safe injection as a medical procedure that neither causes harm to the patient nor exposes the health- care worker to any avoidable risk and also not result in waste that is hazardous to the community (WHO, 2010).

Nurses and patients are at risk of getting infected and sustaining injuries in the process of delivering nursing care. Measures that help in preventing theses incidences resulting from unsafe injection practices (positive attitude, knowledge about safe injection and safe practices) are vital elements of nursing care, Amado & Saka, (2012).Unsafe injections causes’ serious health burden in many health facilities in developing and develop countries including Kenya. Reuse of syringes and needles, non-aseptic technique, and injection at incorrect anatomical sites are some of the unsafe practices that harm nurses and patients including needle-stick injuries and infections (MOH, 2010).
Studies have also shown that South East Asia records the highest degree of unsafe use injection (75%) including Nepal (Gyawali et al., 2013).Unsafe injections results to beyond tolerated burdens to either individuals, country or to the whole word.

The global burden of unsafe injection estimated by WHO (2008) include 0.34 million HIV infections, 15 million HBV infections, 1million HCV infections, 3million bacterial infections and 850,000 injection site infections. All these are assumed to have been contributed by use of unsafe injectables despite decreasing spread through sexual and vertical means (Riaz H. & Kamal W., 2012).

Despite most injection being given worldwide are provided following safe clinical procedure, viral hepatitis and other infectious disease transmission through unsafe practices, are still on large scale (WHO, 2000). Appropriate and effective measures must be taken to curb this route of transmission of diseases (N.A. Ismail et al., 2007).
Knowledge and adherence to safe injection in developing country is still suboptimal (CDC, 2011), resulting to the use of injection beyond the rational medical use.

A quantitative rapid assessment on safe injection practices in 25 health facilities in northern Nigeria report some vital information on how nurses are divergent in their perception and practices regarding safe injection (Judy M., 2015).Safe practices both at individual and institution level are influenced by the healthcare facility lack of adequate implementation and follow up of safety standard and policies.

Thus, safe injection practice is significantly vital and a breach in this practice (unsafe injection) may cause major harms and contributes to increased infections among the nurses and the patients (Anita Shankar, 2014). Against this backdrop the study aim to investigate the knowledge and practice of injection safety among healthcare workers in state specialist hospital Yola.


1.2 Statement of the Problem

At least 50% of the injections that administered in the developing world each year are unsafe (WHO, 2010). In Nigeria, each person has an average of 2-3 injections per year and 70% of injection providers reported that they had suffered needle stick injuries (MOH, 2005). Clinicians prescribe injections in considerable cases even when oral medications would be preferred and are similarly effective. Primary care givers administer injections to 9 out of 10 of their patients in certain cases, of which 70% are unnecessary or have available oral alternatives. All these injections carry a high risk of transmission of deadly blood borne pathogens (MOH, 2006b). As injections are so common, unsafe injection practices pose a significant risk of disease transmission. Adequate knowledge on the relationship between infection prevention and control with safe injection practices is therefore critical in the prevention of avoidable blood borne diseases (MOH, 2006a)

A nationally representative survey conducted showed that HIV prevalence among adults who reported medical injections in the previous year was 9.2% and was higher than among adults who did not, which was 6.0%. HIV prevalence increased significantly from 8.4% among individuals receiving a single injection to 13.9% among individuals receiving 11 or more injections in the previous year. (Dickson, 2007). Despite the formulation of policies and laws on healthcare waste management, many health care facilities still lack adequate enforcement and suitable legislation for waste handling and disposal (MOH Waste Management Plan, 2008-2012).

Only thirty six percent of facilities have adequate infection control items which include sharps boxes, color coded waste bins and liners, gloves, adequate running water and soap (NESREA, 2010). This study aimed at determining injection safety practices at State Specialist Hospital Yola as a baseline evaluation.


1.3 Aim and Objectives of the Study

The main aim of this study is to examine the Assessment of Knowledge and Practice of Injection Safety Among Healthcare Workers in State Specialist Hospital Yola.

  1. To assess the level of Knowledge and Practice of Injection Safety Among Healthcare Workers in State Specialist Hospital Yola.
  2. To ascertain the practice of Injection Safety Among Healthcare Workers in State Specialist Hospital Yola.
  3. To investigate the factors affecting the implementation of Injection Safety Among Healthcare Workers in State Specialist Hospital Yola.

1.4 Research question

The study will provide answers to the following questions

  1. What is the level of Knowledge and Practice of Injection Safety Among Healthcare Workers in State Specialist Hospital Yola ?
  2. How is the practice of Injection Safety Among Healthcare Workers in State Specialist Hospital Yola ?
  3. What are the factors affecting the implementation of Injection Safety Among Healthcare Workers in State Specialist Hospital Yola ?

1.5 Hypothesis of the Study

  • Ho: There is no association between knowledge of safe injection practices and their socio-demographic characteristics.
  • Hi: There is a association between knowledge of safe injection practices and their socio-demographic characteristics.

1.6 Significance of the Study

Safe injection practices in the health care institutions are a reflection of the level of knowledge of nurses on injection, positive attitude toward injection practices and provision of the necessary support needed. It also determines the patient health outcome or time of stay in the healthcare facilities. There has been much effort to reduce the adverse effects of unsafe handling of injections and the resulting biomedical wastes, however, there have been little studies to determine and assess how knowledge, attitude and practice of nurses affect the provision of safe injection to patients. Majority of the injection given are unsafe and are unnecessary. Whereby 70% of injection given are unsafe (MMIS, 2010) while 58% of the healthcare providers are at risk of injuries (needle- sticks) and blood bone infections (MOH, 2007a) due to this practice. Despite the existing policy and institutional measures, unsafe injection in health facilities has not been adequately addressed.

In State Specialist Hospital Yola, no research has been done addressing nursing practice towards safe injection. Factors such as human (attitude, level of training and knowledge) and institutional factors, which are considered in this study, would be useful in finding a lasting solution the identified gaps in the referral hospital.


1.7 Scope of the Study

Curative or preventive injections can be prescribed and administered by different healthcare providers including doctors and clinical officers (C.Os).This study was limited to the qualified nurses working in NCRH as their knowledge level, attitude and the nature of practice being the independent variables and safe injection as the dependent variable. Injection rooms in the wards and casualty unit and immunization room were the main point of interest for the study.


1.8 Limitation of the Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.


1.9 Operational Definations

i. Clinical Health Care Workers:

All health care providers involved in administering injections and waste generation to final disposal

ii. Safe Injection:

An injection that does not cause any harm to the patient, the injection provider and is safe to the community

iii. Hand Hygiene:

Hand washing either with water and soap or using alcohol based gels or foams that do not require use of water to prevent avoidable contamination while administering injections.

iv. Healthcare Waste:

The total waste stream from a healthcare or research facility that include both potential waste and non-risk materials and by products

v. Sharps:

Any object that can penetrate and injure the skin including, but not limited to needles, scalpels, broken glass, broken capillary tubes and exposed ends of dental wires

vi. Needlestick Injuries:

Lacerations caused by needles that accidentally puncture the skin

vii. Hazardous Wastes:

Any waste that has the potential to harm a person or animals in the environment due to chemical, physical and biological contaminants

viii. Biomedical Waste:

Any waste that is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities in the production of testing of biological products. The universal color coding is black for non-infectious waste, yellow for infectious waste, red for highly infectious waste.


1.10 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows.

  • Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
  • Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
  • Chapter three deals on the research design and methodology adopted in the study.
  • Chapter four concentrate on the data collection and analysis and presentation of finding.
  • Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five


Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the assessment of knowledge and practice of injection safety among healthcare workers in state specialist hospital yola 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 assessment of knowledge and practice of injection safety among healthcare workers in state specialist hospital yola as case study. The study is was specifically focused on examining the level of Knowledge and Practice of Injection Safety Among Healthcare Workers in State Specialist Hospital Yola, ascertaining the practice of Injection Safety Among Healthcare Workers in State Specialist Hospital Yola and investigating the factors affecting the implementation of Injection Safety Among Healthcare Workers in State Specialist Hospital Yola.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 270 responses were validated from the enrolled participants where all respondent are staff of State Specialist Hospital Yola.


5.3 Conclusions

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

  1. There was high level of knowledge in injection safety among workers.
  2. There was no association between knowledge, designation, level of training or the department where one works.
  3. There was over prescription of injectable mode of treatment
  4. Although most of the respondents knew that unsafe injections are associated with transmission of infections such as HIV and Hepatitis B, almost more than half of all the respondents were unaware of the danger of transmitting hepatitis C via unsafe practices
  5. There was poor handling of waste in the areas studied, like lack of personal protective wear and improper waste segregation, transportation and final disposal
  6. The practice on injection safety was poor in most of the areas, like re-use of disposable syringes, recapping of needles and overfilling of safety boxes
  7. There was insufficient provision of injection safety equipment and supplies all of the areas studied
  8. Poor transportation of wastes to the incinerator, like use of wheel barrows was observed
  9. There was no significant association between the reported and observed practice
  10. Injection safety knowledge was significantly associated with hand washing practice.

5.4 Recommendation

Based on the findings the researcher recommends that;

  1. All the health workers should be trained on safe injection practices.
  2. Injection safety Ministry Of Health guidelines should be availed within the relevant the areas in the hospital
  3. All health care workers should be educated on the importance of research and the need to participate voluntarily
  4. Ministry Of Health should address the issue of staff shortage to improve on health care delivery
  5. There is need to educate the community around the health center to understand that oral medications are also effective
  6. Personal protective wears should be availed to all waste handlers in the hospital

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