Knowledge And Practice Of Infection Control Among Midwives

Project and Seminar Material for Nursing (Science)

Knowledge And Practice Of Infection Control Among Midwives


Abstract


The aim of the study is to determine the knowledge, attitude and practices of nurses regarding infection prevention and control within a tertiary hospital in Nigeria. A descriptive, research design with a quantitative approach was applied to determine the level of knowledge, attitudes and practices of nurses regarding infection prevention and control within a tertiary hospital in Nigeria. The population for the study was nurses working in clinical environment at a tertiary hospital in Nigeria. 312 nurses were the total population of nurses at this tertiary hospital of which n= 140 (70%) were registered nurses, n= 80 (56%) enrolled nurses, n= 47 (33%) registered midwives, n= 23 (16%) enrolled midwives, n= 10 (7%) certified midwives and n= 12 (8%) registered mental health nurses. According to table 3.1, n= 31 nurses participated in the pilot study (10% of N= 312) while n= 196 nurses participated in the main study (70% of N= 281). The sampling method that was utilized in this study was stratified simple random sampling. This method of sampling enabled the study population to have an equal and independent chance of appearing in the study sample. The current study revealed that 76.4% (table 4.13) of nurses did not receive appropriate vaccination regarding infection prevention and control. Furthermore, 61% (table 4.13) of the nurses indicated that personal protective equipment is not always accessible. Therefore, both patients and nurses are exposed to hospital acquired infections.


Chapter One


Introduction

1.1 Background of the Study

Infection-related diseases are still the main cause of death in Nigeria, according to the 2013 health profile acquired by the World Health Organisation (WHO, 2013) statistics. The burden of disease in Nigeria includes HIV, TB, Malaria, other infectious diseases and respiratory infections. Expansion of the infection prevention and control movements occur due to the increase in infection occurrences in the country. This increase in infection-related disease’s impact the increase health financing in Nigeria with a government contribution to health care of 57.5% above the figures budgeted for (WHO, 2014).

Infectious patients are admitted into hospitals and therefore hospitals have become common settings for transmission of diseases. In hospitals, infected patients are a source of infection transmission to other patients, health care workers and visitors (Sydnor & Perl, 2011). Nosocomial infection, also known as hospital-acquired infections is one of the leading causes of death and has much economic cost due to increased hospitalization and prognosis (WHO, 2015). According to WHO (2010), Hospital acquired infection is defined as an infection occurring in a patient during the process of care within a health care facility which was not present or incubating at the time of admission. These infections are those occurring more than 48 to 72 hours after admission and within ten days after hospital discharge (Collins 2008:2). Due to the admission of patients with different organisms, the hospital environment has become saturated with highly virulent organisms, namely: Staphylococcus aureus, Streptococcus pyogenic, Escherichia coli, Pseudomonas aureginosa and Hepatitis viruses that survive in a hospital. These organisms cause diseases ranging from minor skin infections to life-threatening conditions such as sepsis (Sydnor, & Perl, 2011).

The Nigeria Ministry of Health has indicated that Ebola virus disease epidemic is a public health risk as neighbouring country are suffering from the diseases and therefore preparedness in infection prevention and control measures should be strengthened. Efficient knowledge, good attitude and best practices by nurses in infection prevention and control may contribute to decreasing in infection rate in the hospital.

The Nigeria policy on health has stipulates that the health care institution should provide a safe environment for the patients in their care. Hospital nurses form the backbone of infection prevention and control, therefore possibly, will either contribute to infection transmission or prevent and control infection. According to Damani (2012), the environment in which a patient is nursed must be planned to reduce the risk of transmission of infection. Infection prevention and control measures aim to protect the vulnerable people from acquiring an infection while receiving health care (Damani, 2012). Lack of knowledge, bad attitudes and poor practices amongst nurses in the prevention and control of infections can lead to hospital-acquired infections.

In clinical practice, the researcher has observed cases where nurses handle contaminated linen with bare hands, put needles in the patient’s mattress after giving injections, do not clean the stethoscope between patients and do not wash hands regularly in the clinical environment. Poor infection prevention and control practices among nurses increase the rates of hospital-acquired infections.

Hand hygiene is the single most important intervention to prevent transmission of infection and should be a quality standard in all health institutions. An attitude of not washing hands among individuals involved in the provision of health care can increase the rate of hospital-acquired infections. In a study that was conducted in India, where Nair, Hanumantappa, Hinemath, Siraj and Raghunath (2013:3) assessed knowledge, attitude and practices of hand hygiene among medical and nursing students at a tertiary health care centre, the majority of students had poor knowledge with regard to hand hygiene.

Lack of knowledge among nurses can increase the rate of hospital-acquired infections. This is supported by a study that was conducted in Zimbabwe by Tirivanhu, Ancia and Petronella (2014:73) who determined the barriers of infection prevention and control practices among nurses at the Bindura provincial hospital. The study revealed that the majority of nurses’ lack knowledge on infection control principles as only n= 14 (28%) of n= 50 (100%) nurses had excellent knowledge on infection control principles, n= 21 (42%) of n= 50 nurses did not utilize the infection control manuals. Infection control workshops were poorly organised as 68% of the nurses did not attend any workshop on infection prevention and control practices (Tirivanhu et al., 2014). Hayeh and Esena (2013:47) assessed the infection prevention and control (IPC) practices among health workers at Ridge Regional Hospital in Accra (Ghana). The study showed that knowledge in IPC practices among health care workers was moderate 51% (n= 204), as availability and access to material for IPC practices at the facility was 58% (n= 118) and overall compliance with IPC guidelines was 54% (n= 110).

The World Health Organisation (2016) has indicated that surgical site infections at this particular tertiary hospital in Nigeria are a research priority as there was an increase in wound infections of those people who had surgery at this hospital and this coincides with the researcher’s experiences and proposal. Therefore, this study determined the knowledge, attitude and practices of nurses in infection prevention and control within a tertiary hospital in Nigeria.


1.2 Statement of the Problem

A research problem is an area of concern in which there is a gap in the knowledge base needed for nursing practice (Burns & Grove 2011:146). The researcher has observed that nurses do not apply infection prevention and control measures in the hospital setting which is required to ensure patient safety. Lack of knowledge, attitude and practices in infection prevention and control contribute to high rates of hospital-acquired infections (Jain, Dogra, Mishra, Thaku and loomba, 2012 & Hayeh and Esena, 2013). Uncontrollable nosocomial infection contributes to prolonged stay, morbidity and mortality which put stress on health care economics of the country (Mishta, Banerjee & Gosain, 2014).


1.3 Research Question

1.What is the level of knowledge, attitudes and practices of health care workers in infection prevention and control in Miaduguri ?


1.4 Aim of the Research

In order to address the research question, the aim of the study is to determine the knowledge, attitudes and practices of nurses regarding infection prevention and control in Maiduguri.


1.5 Research Objectives

Based on the aim, the following objectives have been set for the study to determine:

  1. The knowledge of midwifes in infection prevention and control in Miaduguri.
  2. The attitude of midwife in infection prevention and control in Maiduguri.
  3. The practices of midwife in infection prevention and control in Maiduguri
  4. To make recommendations to the risk programme and policies in Maiduguri

1.6 Significance of the Study

This study on the knowledge and practice of infection control among midwives will be of immense benefit to the general public on the concept of infection and will also help the midwives to come to the understanding of the causes of infections during child birth and how to prevent and control it. This study will also assist hospitals to put in place prevention measures to curbing the rate of infection that occur during and after child birth. This study will also add to existing literature in this study domain and will serve as a reference material to scholars, researchers and students who may want to carry out further research on this topic or related area in the future.


1.7 Scope of the Study

This study focuses on examining the knowledge of midwifes in infection prevention and control in Maiduguri. This study will also examine the attitude of midwife in infection prevention and control as well as the practices of midwife in infection prevention and control in Maiduguri. This study will further make recommendations to the risk programme and policies in Maiduguri. This study enroll nurses working at the federal government hospital, Maiduguri as the participants for this study.

The major factors that posed a challenge to the researcher while carrying out this study were inadequate literature on this study domain, insufficient time and finance.


1.8 Definition of Terms

Knowledge:

Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts, skills, or objects. By most accounts, knowledge can be acquired in many different ways and from many sources, including but not limited to perception, reason, memory, testimony, scientific inquiry, education, and practice.

Practice:

Practice is the act of rehearsing a behaviour over and over, or engaging in an activity again and again, for the purpose of improving or mastering it, as in the phrase ‘practice makes perfect’. It is important to note that practise is a verb and should not be confused with the noun practice.

Infection:

The invasion and multiplication of microorganisms such as bacteria, viruses, and parasites that are not normally present within the body. An infection may cause no symptoms and be subclinical, or it may cause symptoms and be clinically apparent.

Control:

Control is a function of management which helps to check errors in order to take corrective actions, manage and prevent infection.

Midwives:

A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery.


Chapter Five


Discussion, Conclusion and Recommendation

5.1 Introduction

Within this chapter, the study findings will be discussed in terms of the study aim and objectives along with the conceptual framework, study limitations, future recommendations and the conclusion of the research study.


5.2 Discussion

The aim of the study is to determine the knowledge, attitude and practices of nurses regarding infection prevention and control within a tertiary hospital in Nigeria. Infection-related diseases are still the main cause of death in Nigeria according to the 2013 health profile acquired by World Health Organization (WHO) statistics.
According to WHO (2016:1) a huge gap still exists between the knowledge accumulated over the past decades and implementation of infection control practices. This gap is even deeper in poor-resource settings with devastating consequences. Every advance and investment in health care is undermined by breaches in infection control measures (WHO, 2016:1).

The current study revealed that 76.4% (table 4.13) of nurses did not receive appropriate vaccination regarding infection prevention and control. Furthermore, 61% (table 4.13) of the nurses indicated that personal protective equipment is not always accessible. Therefore, both patients and nurses are exposed to hospital acquired infections. The researcher has observed that nurses do not apply infection prevention and control measures in the hospital setting which is required to ensure patient safety. In agreement with the current study, 23.6% (table 4.13) of the nurses indicated that they do not wash their hands before and after direct contact with the patients. According to WHO the prevalence of hospital acquired infection (HAI) in Nigeria/Africa is high. However, 42.1% (table 4.13) of the nurses of the current study indicated that screening of patients to detect colonization even when there is no evidence is not done at the tertiary hospital. These findings are in agreement with Razine, Azzouzi, Barkat, Khoudri, Hanssouni, Chefchaouni and Abouqua (2012:1) who determined the prevalence of HAI in the University Medical Center of Rabat, Morocco. The study revealed that HAI prevalence was 10.3%. Urinary tract infection

was the most common (35%) and 34.5% of hospital acquired infection were from critical care units. However, 83.1% (table 4.13) participants of the current study revealed that the hospital does not monitor patients with urinary catheters for urinary tract infections. Razine et al. (2012:1) further revealed that Staphylococcus was the organism most commonly isolated 18.7% and was methicillin- resistance in 50% of cases. Stubblefield (2014:1-9) define nosocomial infections as an infection acquired in a hospital or other health-care facilities within 48 hours after admission that showed no signs of active or incubating infection. Moreover, the patient could have presented with a different disease other than the infection acquired in the hospital. These infections occur up to 3 days after discharge as well as 30 days after an operation (Stubblefield, 2014:1-9). Determining knowledge, attitudes and practices in infection prevention and control among nurses is vital to protect patients from acquiring hospital acquired infections.

A descriptive, research design with a quantitative approach was applied to determine the level of knowledge, attitudes and practices of nurses regarding infection prevention and control within a tertiary hospital in Nigeria. The population for the study was nurses working in clinical environment at a tertiary hospital in Nigeria. 312 nurses were the total population of nurses at this tertiary hospital of which n= 140 (70%) were registered nurses, n= 80 (56%) enrolled nurses, n= 47 (33%) registered midwives, n= 23 (16%) enrolled midwives, n= 10 (7%) certified midwives and n= 12 (8%) registered mental health nurses. According to table 3.1, n= 31 nurses participated in the pilot study (10% of N= 312) while n= 196 nurses participated in the main study (70% of N= 281). The sampling method that was utilized in this study was stratified simple random sampling. This method of sampling enabled the study population to have an equal and independent chance of appearing in the study sample. Upon completion of data collection, data was coded and captured on to excel spreadsheet as advised by a qualified statistician employed by The Biostatistics Unit, Centre for Evidence Based Health Care, Stellenbosch University. The statistician was further consulted for data analysis. A statistical package (IBM SPSS version 22) was used to statistically analyse data. Data was analysed and reported on by using descriptive and inferential statistics, such as frequency tables
and relative frequencies, and graphically illustrated by using bar charts. Continuous variables were summarised, using means and standard deviations.


5.3 Limitations of the Study

This study assessed the knowledge, attitude and practices of all categories of nurses in infection prevention and control at federal government hospital, Maiduguri, which may limit the generalisation of the findings to other hospitals in Nigeria.


5.4 Conclusions

Despite the nurses being knowledgeable (mean score 83%) and having a positive attitude (mean score 81%) towards infection prevention and control the practices were very poor (mean score 48.8%). However if nurses are knowledgeable and have a positive attitude towards infection prevention and control, then the practices of nurses are expected to be good.

Furthermore, according to Florence Nightingale’s Environmental theory, the nurse plays an important role in the translation of knowledge, attitude and practices to the clinical environment, it is concluded that the patients are exposed to infection related diseases due to poor infection prevention and control practices.

As a result of these findings the researcher has concluded that there could be barriers to good practice in infection prevention and control which require further
research. In conclusion, the research question “what is the knowledge, attitudes and practices of nurses in infection prevention and control at hospitals in Nigeria?” has been adequately addressed in this setting.


5.5 Recommendations for Future Practice

Based upon the scientific evidence generated during the study, the following recommendations are discussed below:

  1. The Minister of Health to lobby for sufficient funds from the government so that the Permanent Secretary can allocate enough resources specifically for Infection Prevention and Control. The economic recession that began in 2007 led to austerity measures and public sector cut breaks in many European countries. Reduced resource allocation to infection prevention and control (IPC) programmes is impeding prevention and control of tuberculosis, HIV and vaccine-preventable infections. To mitigate the negative effects of recession, there is need to educate our political leaders about the economic benefits of IPC; better quantify the costs of health-care associated infection; and evaluate the effects of budget cuts on health-care outcomes and IPC activities (O’Riordan & Fitzpatricck, 2015:340-345)
  2. Permanent Secretary to ensure that the resources allocated for infection prevention and control are not deviated to other things. This can be achieved by performing random infection control spot checks of the hospitals.
  3. Resources should be allocated for Infection prevention and control conferences locally and internationally. This will enable infection control team/committee to attend such conferences so that they are updated with the latest evidence-based information. According to the current study, (Variable 2.3.4) n= 169 (86.7%) of the nurses indicated that they do not attend in-service training/workshops related to infection prevention and control.
  4. Nursing schools should emphasise the importance of infection prevention and control (Hospital acquired infections) in the syllabus. Ojulong, Mitonga and Lipinge (2013:1071-1078) assessed students’ knowledge and attitudes of infection prevention and control and their sources of information. The studyrevealed that medical students had better overall scores 73% compared to nursing students 66% and radiology students 61%. The study indicated that serious efforts are needed to improve or review curriculum so that health science students’ knowledge on infection prevention and control is imparted early before they are introduced to the wards.
  5. The General Nursing Council of Nigeria has introduced a Continuous Professional Development Booklet for Nurses. The researcher recommends that training on infection prevention and control be mandatory yearly and that it should be a requirement for yearly nursing registration.
  6. The General Nursing Council of Nigeria through Ministry of Health should facilitate training of trainers in infection prevention and control (IPC) for all health care centers in Nigeria so that in-service training in IPC is provided to health care workers at the institutional level. According to the current study (variable 2.3.6), n= 53 (27.2%) of nurses indicated that the latest infection control and prevention guidelines date is not between 2013-2015, while n= 64 (32.8%) indicated that it is not applicable to know the latest guidelines.
  7. The General Nursing Council of Nigeria should come up with a policy indicating that all nurses should be up to date with immunisation (Hepatitis B Vaccine) for prevention of infection prior to registration. This will ensure compliance. The current study (variable 2.3.8) revealed that n= 148 (76.4%) of the nurses indicated that vaccinations regarding infection prevention are not provided to staff, while 7.7% thought it is not applicable.
  8. The infection control committee should be more proactive so that they can be able to monitor the rate of Hospital Acquired infections as well as giving feedback to nurses and relevant authorities. This will make problems visible and hence actionable. The current study (Variable 2.3.10) revealed that n= 154 (79%) of the nurses who participated in the study indicated that monitoring patients with urinary tract infection and giving feedback on urinary tract infection rates is not done at their hospital
  9. Availability of personal protective equipment required for applying infection control measures at all the times. According to the current study (variable 2.3.9), n=119 (61%) of the nurses indicated that personal protective equipment are not always accessible.
  10. The institutions where the research study was done should ensure adequate facilities for hand hygiene. For example hand basins with running water available as well as disposable hand towels. This will help with compliance with hand hygiene. A study conducted by Mearkle, Houghton, Bwonya and Lindfield (2016:1-6) in which current hand washing practices, barriers to hand washing and available facilities in two Ugandan Specialist eye hospital was assessed. The study revealed that facilities for hand washing were inadequate in some key areas having no provisions for hand hygiene. The study indicated that interventions to improve hand hygiene could include increased provision of hand towels and running water as well as improve staff education to challenge their views and perceived barriers to hand hygiene.
  11. The Tertiary Hospital should ensure that new members of staff (nurses) receive in-service training in infection prevention and control as part of induction. The current study revealed that 86.7% of nurses did not attend inservice training/workshop related to infection prevention and control yearly.
5.5.1 Observation of nurse’ practice and correction of poor practice

According to the current study, it is evident that the practices of nurses in infection prevention and control (mean score of 48.8) were poor. Therefore the infection control team should strictly observe nurses as they practice. This includes auditing of hand hygiene practices, observe the nurses as they perform invasive procedures, a procedure that requires aseptic technique, isolation of infectious conditions to prevent the spread of infection and application of barrier nursing. According to Gastmeier, Behnke, Reichardt and Geffers (2011:207-212), hospitals should compare their own infection rates and find problems concerning specific infection type which should motivate for a careful investigation of procedures of care and the alternatives to improve the situation. Therefore, surveillance plans designed according to exact requirements of the hospital are key component of good infection


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