Knowledge, Attitude And Practice Of Standard Precautions Among Health Care Workers In Central Hospital In Sapele

Project and Seminar Material for Nursing (Science)

Knowledge, Attitude And Practice Of Standard Precautions Among Health Care Workers In Central Hospital In Sapele


Abstract


This study was carried out to examine the knowledge, attitude and practice of standard precautions among health care workers in central hospital in Sapele. The study was specifically carried out to assess the knowledge of standard precaution among healthcare workers in central hospital, Sapele; ascertain the attitude of healthcare workers towards standard precaution in central hospital, Sapele; and assess the practice of standard precaution by healthcare workers in central hospital, Sapele. A descriptive survey study was conducted in the study area. The study was carried out among 200 health workers at central hospital, Sapele. 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. Chi-square test was used to determine statistical association between variables. 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.

Keywords: Standard precautions, knowledge, attitude, practice, blood-borne infection, needle stick injury, health care workers, compliance


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 Demographic Analysis
  • 4.2 Answering Research Questions
  • 4.3 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

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

Chapter One


Introduction

1.1 Background of the Study

Health Care Workers (HCWs) are prone to infection of blood borne pathogens whenever they come in contact with infected body parts, blood and body fluids in the course of carrying out their duty1,2,3. Most occupational exposure to blood pathogens usually results percutaneously, mucocutaneously or through blood contact with non-intact skin4,5. According to the World Health Report (6); an estimated three million HCWs all over the world experience percutaneous exposure to blood-borne viruses Hepatits C and B and HIV viruses annually. Similarly, it has been estimated that about 2.5% of HIV cases and 40% of HBV and HCV cases among HCWs worldwide are the result of these exposures1,7,8 .

Furthermore, Hepatitis B Virus (HBV) has been shown to be endemic in places such as China, South East Asia and Sub-Saharan Africa including Nigeria as compared to Europe and North America; coupled with the scourge of HIV AIDS in Nigeria9. Therefore the need for protection among HCWs calls for strict application of standard precautions in health care settings because HCWs are at risk of infection regularly through contaminated hands, relatives/friends of the patients, contaminated environmental surfaces, drugs and intravenous solutions1,10,11.
According to the World Health Organisation12, standard precautions can be defined as a set of infection control measures meant to reduce the risk of transmission of blood borne and other pathogens from both recognized and unrecognized sources. These measures are to be used by HCWs when providing care to all individuals, whether or not they appear infectious or symptomatic. Furthermore, the elements of standard precautions include use of personal protective equipments and other self protection behavioural practices such as hand hygiene, use of gloves and other barriers for example masks, eye protection, face shield, gown12,13,14. Others include proper handling of patient care equipments and linen, environmental control, prevention of injury from sharp devices12,13,14. Knowledge, practice and compliance to standard precaution guidelines by HCWs have been highlighted to be a sure way of preventing occupational infection1,15,16. However, despite the establishment and implementation of detailed standard precaution guidelines for HCWs; knowledge and practice of standard precautions have shown to be low and fair among health workers in developing countries especially in Nigeria17,18,19. Therefore this study was designed to determine the knowledge, attitude and practice of standard precautions among HCWs in Central Hospital In Sapele a developing urban area.


1.2 Statement of the Problem

It is generally known that health-care workers (HCWs) often come in contact with blood-borne pathogens and other microorganisms.[1] These exposures commonly occur during major or minor surgical procedures, during routine clinical and nursing services like simple physical examination, while handling laboratory specimen, and during disposal of hospital wastes as well as during accident and life-saving emergency procedures. On exposure, HCWs can equally transmit healthcare-associated infections (HAI) to their patients and may be the source of infection for their families and communities. Occupational exposure to HAI is of great concern in developing countries where there are higher risks of exposure to blood-borne pathogens, frequent contacts with patients’ body fluids and little or no protection against airborne infections.[2]

To prevent spread of nosocomial infections, the United States’ centers for disease control (CDC) in 1985 introduced Universal precautions to protect HCWs from contact with blood and a number of other body fluids visibly contaminated with blood.[3] However, research around stigma and discrimination in health-related settings implicated Universal precautions as a means by which HCWs discriminate against patients because by failing to mainstream Universal precautions in practice, health professionals are making judgment based on individual’s health status.[4,5]

As a result, in 1996, CDC revised the infection control practice from Universal precautions to Standard precautions (SP). SPs are the minimum infection prevention practices that apply to all patients regardless of suspected or confirmed infection status of the patient in all settings where health care is delivered.[6] These practices are designed to protect both the HCWs and the patients from nosocomial infections. Thus, SPs are crucial in hospital infection control as well as in issues related to biosafety and security of patients, professionals, and students in direct or indirect health-care delivery. For SP to be effective, consistency of application is of the essence. Hence, a combination of an enabling environment (in terms of regular supply of necessary facilities and equipment) and the willingness by HCWs to observe SP at all times is vital for a successful compliance.

Although SPs’ policy was introduced 20 years ago, adherence to these precautions is poor in health-care facilities particularly in resource-limited countries like Nigeria.[7] Hence, HAIs remain a critical challenge for the public health sector. Poor knowledge of infection control practices among HCWs has been noted to hinder compliance with SP.[8] In addition, strengthening SP’ training for HCWs is variously recommended as a major means of promoting adherence to SP and protecting HCWs and patients from nosocomial infections.[9,10] Nonavailability of materials, limited organizational support, and lack of knowledge regarding infection control practices among HCWs were some of the factors responsible for poor compliance to SP.[7,8]

Changing current behavior requires knowledge of the factors that can influence HCWs’ compliance with SP and implementing programs and preventive actions that contribute to the avoidance of occupational exposure.[10] The objective of the present study is to assess the knowledge and practices of SP among tertiary level HCWs in Central Hospital In Sapele. It is also hoped that findings will be of value in determining ways of promoting compliance with SP in all public health institutions in Nigeria.


1.3 Objectives of the Study

Generally, this study seek to assess the knowledge, attitude and practice of standard precautions among health care workers in central hospital in Sapele. Specific objectives are stated below.

  1. Assess the knowledge of standard precaution among healthcare workers in central hospital, Sapele
  2. Ascertain the attitude of healthcare workers towards standard precaution in central hospital, Sapele.
  3. Assess the practice of standard precaution by healthcare workers in central hospital, Sapele.

1.4 Research Question

The following research questions were raised;

  1. What is the knowledge of standard precaution among healthcare workers in central hospital, Sapele?
  2. What is the attitude of healthcare workers towards standard precaution in central hospital, Sapele?
  3. What are the practice of standard precaution by healthcare workers in central hospital, Sapele?

1.5 Research Hypothesis

  • Ho: The knowledge and practice of standard precautions among health care workers in central hospital in Sapele is inadequate.
  • Ha: The knowledge and practice of standard precautions among health care workers in central hospital in Sapele is adequate.

1.6 Significance of the Study

On the whole, available data show that needle stick injuries and blood borne pathogens are serious threats to patients, HCWs and to the host community. The rising prevalence of morbidity and mortality as a result of nosocomial and blood borne infections such as HIV/AIDS, HBV and HCV among others is as a result of lack of awareness, wrong attitude towards and non-compliance with the definitions and recommendations of standard precautions. Compliance with standard precautions has been shown to reduce risk of exposure to blood and body fluids.64 Due to this, surveillance of HCWs’ compliance to standard precautions is an important element of occupational and nosocomial infection control as it enables assessment of risks from occupation exposure to infection.9

This study will expose the level of awareness, attitude and practice of standard precautions among the HCWs and hence could be used as a baseline for intervention. It will also identify gaps which would be recommended for correction through interventions. This study could be used to monitor trends of events concerning knowledge, attitude and practice of standard precautions among health care workers in Central Hospital, Sapele, by reviewing from time to time, the incidence of needle stick injuries and the morbidity and mortality pattern. It will also identify gaps in the standard precaution practices among these HCWs and the results from the study will be used for the planning of health education intervention programme. It will also provide reference material for the academic society as well as further research.


1.7 Scope of the Study

This study is focused on the knowledge, attitude and practice of standard precautions among health care workers. Geographically, the study will be delimited to central hospital in Sapele, Delta State.


1.8 Limitations of the Study

As with any human endeavor, the researcher experienced small impediments while performing the study. Due to the scarcity of literature on the subject as a result of the discourse’s nature, the researcher incurred additional financial expenses and spent additional time sourcing for relevant materials, literature, or information, as well as during the data collection process, which is why the researcher chose a small sample size. Additionally, the researcher conducted this inquiry in conjunction with other scholarly pursuits. Additionally, because only a small number of respondents were chosen to complete the research instrument, the results cannot be applied to other secondary schools outside the state. Regardless of the limits faced throughout the investigation, all aspects were reduced to ensure the best outcomes and the most productive research.


1.9 Definition of Terms

Infection

The capability of microorganisms to enter or invade the underlying tissues of the human body and discover conducive conditions that can facilitate its growth, survival and replication.

Nosocomial Infection:

Nosocomial infection is an infection or toxin that exists in a certain location such as a hospital, now Nosocomial infections is use interchangeably with the terms health-care associated infections and hospital-acquired infections.

Prevention:

Prevention is an action taken to decrease the chance of getting a disease or condition. For Nosocomial infection it includes fully disinfecting skin and equipment, washing hands regularly, wearing protective equipment like face masks and gloves. regularly changing urinary catheters, and removing them as soon as possible, removing hair near a surgical area and prescribing antibiotics only when needed.

Control:

In health care and public health practice settings, infection control includes various measures that prevent and contain the spread of infectious disease.


1.10 Organizations of the Study

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.


Chapter Five


Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the practice of infection control among health workers in General Hospital Lafiagi, Edu Local Government Area Kwara State. The chapter consists of summary of the study, conclusions, and recommendations.


5.2 Summary of the Study

In this study, our focus was to examine the knowledge, attitude and practice of standard precautions among health care workers in central hospital in Sapele. The study is was specifically carried out to assess the knowledge of standard precaution among healthcare workers in central hospital, Sapele; ascertain the attitude of healthcare workers towards standard precaution in central hospital, Sapele; and assess the practice of standard precaution by healthcare workers in central hospital, Sapele.

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 were healthcare workers in central hospital, Sapele, Delta State.


5.3 Conclusions

In conclusion, 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 central hospital, Sapele, 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 central hospital, Sapele, 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 Recommendations

Based on the findings of the study, the following recommendations are proffered.

  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.
  2. Resources should be allocated for Infection prevention and control conferences locally and internationally.
  3. Nursing schools should emphasize the importance of infection prevention and control (Hospital acquired infections) in the syllabus.
  4. The General Nursing Council of Nigeria should continue to emphasize on the introduced a Continuous Professional Development Booklet for Nurses.
  5. Training on infection prevention and control be mandatory yearly and that it should be a requirement for yearly nursing registration.

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