Measures Utilized For Prevention Of Nosocomial Infection In The Labour Ward Of University Of Calabar Teaching Hospital (UCTH), Calabar

Measures Utilized For Prevention Of Nosocomial Infection In The Labour Ward Of University Of Calabar Teaching Hospital (UCTH), Calabar

Abstract

This research was conducted for estimating the knowledge and prevention of nosocomial infection in the labour wardof university of calabar teaching hospital (ucth), calabar. Two objectives were set, and Two questions and one hypothesis were formulated. A descriptive survey research method wasused for the study. A sample size of thirty-four (34) nurses working in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar. A self-developed questionnaire with seventeen (17) structured questions was the instrument of data collection. Data were collected, analyzed, and presented in tables, pie chart, bar chart, histogram, and percentages. The results revealed that the nurses were well knowledgeable about nosocomial infection, although little deficiencies existed in the area of infection control practice and compliance, such as hand washing frequency. The study indicated that there is a significant relationship between the level of knowledge of nosocomial infection and nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar. This study therefore recommends continuing education/seminar/workshop for all health care givers, to sensitize them with the knowledge and practice of nosocomial infection.

Chapter One

Introduction

1.1 Background to the Study

Nosocomial infection also known as Hospital Acquired Infections (HAI) is a localized or systemic infection acquired in a hospital or any other health care facility by a patient admitted for a reason other than the pathology present during admission. It may also include an infection acquired in a healthcare facility that may manifest 48 hours after the patient’s admission into the health care facility or discharge (Hildron, Edwards, Patel, Horan, Sievert, Pollock & Fridkin, 2008). Epidemiological studies report that nosocomial infections are caused by pervasive pathogens such as bacteria (Lepelletier, Perron, Bizouarn, Caillon, Drugeon, Michaud & Duveau, 2005), viruses (De-Oliveira, White, Leschinsky, Beecham, Vogt, Moolenaar, Perz & Safranek, 2005) and fungi present in air, surfaces or equipment. The pathogens are not present or incubating prior to the patient’s admission into healthcare facility and are most likely transmitted by direct person-to-person contact during invasive medical procedures (Anderson, Kaye, Chen, Schmader, Choi, Sloan & Sexton, 2009). Some of the pathogens are highly resistant to antimicrobial agents, andthis necessitates the prescription of more potent and costly antimicrobial agents (Mulvey & Simor,2009).

Nosocomial infections are prevalent nationally and internationally; and occur in patients of all age groups: neonates (Aly, Herson, Duncan, Herr, Bender, Patel & EI-Mohandes, 2005), immuno-compromised adults and the elderly (Lepelletier, Perron, Bizouarn, Caillon, Drugeon, Michaud& Duveau, 2005). The most frequent types of nosocomial infections are those associated with the urinary tract, surgical wounds, respiratory tract and blood stream (Lo, 2008). It is a serious global public health issue, causing the suffering of 1.4 million people across the world at any given time (WHO, 2007).

Nosocomial infection in developing countries is difficult to address because it is such a complex problem with diverse underlying causes. International non-governmental organizations (INGOs) and inter-governmental organizations such as United Nations agencies add a unique perspective to the push for infection control measures in hospitals in the developing world. However, these organizations have not been able to address all facets of the problem such as infrastructure, leadership and individual health care worker behavior. Nosocomial infection control is not simply a matter of encouraging hand hygiene in settings where clean water and soap may not be consistently available. Nor is infection control a matter of providing supplies to health care workers who are not trained to use them properly (WHO, 2010).

The burden of HAI is already substantial in developed countries, where it affects from 5% to 15% of hospitalized patients in regular wards and as many as 50% or more of patients in intensive care units (ICUs) (WHO, 2009). In developing countries, the magnitude of the problem remains underestimated or even unknown largely because HAI diagnosis is complex and surveillance activities to guide interventions require expertise and resources (Allegranzi & Pittet, 2008). Surveillance systems exist in some developed countries and provide regular reports on national trends of endemic HAI (Pittet, Allegranzi, Sax, Bertinato, Concia & Cookson, 2005) such as the National Healthcare Safety Network of the United States of America or the German hospital infection surveillance system. This is not the case in most developing countries (WHO, 2010) because of social and health-care system deficiencies that are aggravated by economic problems. Additionally, overcrowding and understaffing in hospitals result in inadequate infection control practices, and a lack of infection control policies, guidelines and trained professionals also adds to the extent of the problem.

Hospital-wide HAI prevalence varied between 2.5% and 14.8% in Algeria (Vincent, Rello, Marshall, Silva, Anzueto & Martin, 2009), Burkina Faso (DiA, Ka, Dieng, Diagne, Dia & Fortes, 2008), Senegal and the United Republic of Tanzania (Atif, Bezzaoucha, Mesbah, Djellato, Boubechou & Bellouni, 2006). Overall HAI cumulative incidence in surgical wards ranged from 5.7% to 45.8% in studies conducted in Ethiopia (Messele, Woldemedhin, Demissie, Mamo & Geyid, 2009) and Nigeria (Kesah, Egri-Okwaji, Iroh & Odugbemi, 2009). The latter reported an incidence as high as 45.8% and an incidence density equal to 26.8 infections per 1000 patient-days in paediatric surgical patients (Kesah, Brewer, Yingrengreung & Fairchild, 2009). In a study conducted in the surgical wards of two Ethiopian hospitals, the overall cumulative incidence of patients affected by HAI was 6.2% and 5.7% (Messele, Grottolo, Renzi, Paganelli, Sapelli, Zerbini & Nardi, 2009). In a study from Nigeria, the implementation of an infection control programme in a teaching hospital succeeded in reducing the rate of HAI from 5.8% in 2003 to 2.8% in 2006 (Abubakar, 2007).

In Nigeria, nosocomial infection rate of 2.7 % was reported from Ife, while 3.8 % from Lagos and 4.2 % from Ilorin (Odimayo, Nwabuisi & Adegboro, 2008). The cause of nosocomial infections might be endogenous or exogenous. Endogenous infections are caused by organism present as part of the normal flora of the patient, while exogenous infections are acquired through exposure to the hospital environment, hospital personnel or medical devices (Medubi, Akande & Osagbemi, 2006). Nosocomial infection rates vary substantially by body site, by type of hospital and by the infection control capabilities of the institution. The proportion of infections at each site is also considerably different in each of the major hospital services and by level of patient risk (Taiwo, Onile & Akanbi, 2005).This is exemplified by surgical site infections (SSIs) which are most common in general survey, whereas urinary tract infections and blood stream infections are most frequent in medical services and nurseries. Rates of nosocomial infection vary by surgical subspecialty, low in ophthalmology and high in general surgery. The differences are largely due to variations in exposure to high risk devices or procedures (Tolu, 2007).

Urinary tract infections (UTI) represent the most common (34%) type of nosocomial infections. Indwelling catheters cause the majority while others are caused by genito urinary procedures (Tolu, 2007). Surgical wound infections represent 17% nosocomial infection and are the second most common hospital acquired infections. The classification of wound infections is based on the degree of bacterial contamination, including clean, clean contaminated and contaminated. Co-morbid and contamination of the surgical site contribute to the infection rate. The risk factors for surgical wound infections include age, obesity, concurrent infection and prolonged hospitalizations. The origin of the bacterial agent is dependent on direct inoculation from a host’s flora, cross-contamination, the surgeon’s hands, air-borne contamination and devices such as drains and catheters (Odimayo, Nwabuisi& Adegboro, 2008). Lower respiratory infection (LRI) or pneumonia represents 13 % of nosocomial infections (Taiwo, Onile & Akanbi II, 2005). This is the most dangerous of all nosocomial infections with acase fatality rate of 30%. It manifests in the intensive care unit or post-surgical recovery room. Endotracheal intubation and tracheostomy dry the lower respiratory tract mucous and provide entry for microbes.

This study therefore aims at investigating nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar, Cross River State, Nigeria.

1.2 Statement of Problems

Nosocomial infections have been recognized as a problem affecting the quality of health care and a principal source of adverse healthcare outcomes. Within the realm of patient safety, these infections have serious impact such as increased hospital stay days, increased costs of healthcare, economic hardship to patients and their families and even deaths, are among the many negative outcomes (Anderson, Kaye, Chen, Schmader, Choi, Sloan & Sexton, 2009).

Further more, it was noted that Doctors and Midwives were not observing strict Aseptic measures. It is with the above information the researcher carried out this study to investigate nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar.

1.3 Purpose of Study

The purpose of this study is to investigate nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar.

1.4 Specific Objectives

1. To ascertain the level of knowledge of nosocomial infection among nurses in UCTH, Calabar.
2. To identify the nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar.

1.5 Research Questions

1. How much do nurses in University of Calabar Teaching Hospital (UCTH), Calabar know about nosocomial infection?
2. What nursing measures are utilized for the prevention of nosocomial infections in the labour ward of UCTH, Calabar?

1.6 Hypothesis

There is no significant relationship between thelevel of knowledge of nosocomial infection and nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar.

1.7 Scope of Study

The study is focused on investigating the nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar. It will also look at the level of knowledge of nosocomial infections among nurses in UCTH, Calabar.

1.8 Significance of the Study

The findings of this study will be of significance to the following categories of people;

Health Workers:

They will find this study to be an important tool for counselling patients suffering from nosocomial infections.

Nurses And Midwives:

The findings in this study will aid nurses and midwives with deciding the most suitable infection preventive measure for a particular individual at a particular time. The findings in this study will also provide nurses and midwives with more insight on nosocomial infections, which will help them give comprehensive health talks on it treatment and prevention.

Researchers:

The findings in this study will also serve as a resource material to researchers who wish to embark on related researches in the nearest future.

1.9 Limitation of the Study

The limitation encountered by the researcher was inability to distribute the questionnaire to all the nurses in Calabar at the early stage of the research. This was due to the three shift-duties of nurses (morning, evening and night) in all the various hospitals in Calabar. However, the researcher overcame it by distributing questionnaire during the morning and evening shift, face to face, whereby she collected completed filled questionnaire at the spot.

1.10 Operational Definition of Terms

The key terms in this research were defined as follows:

Nosocomial:

This simply is a disease originating in a hospital.

Infections:

This is referred to the process of infecting or the state of being infected bacteria or fungi that generates to a disease while being admitted in the hospital.

Nurse:

This simply means a person trained to care for people diagnosed of nosocomial infection.

Prevention:

This is simply the act of stopping nosocomial infection from happening or occurring.

Measure:

This refers to a means of achieving a purpose of preventing the occurrence of nosocomial infections in labour ward

Chapter Five

Discussion of Findings

5.1 Introduction

This chapter deals with the discussion of findings in relation to the purpose of the study which was to investigate nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar.

5.1.1 Nurses’ knowledge of nosocomial infections

From the findings of this study it was revealed that majority of the respondents, possessed good knowledge of nosocomial infections (94.12%) while minority possessed poor knowledge of nosocomial infections (5.88%). This supportsthe study carried ofSherwood (2008)who documented that a solid background knowledge of epidemiology and micro-organisms would empower nurses with sufficient confidence to question practices and depend on their own ability to make informed decisions. This is not in line with the study of Saka & Adebara(2011) who discovered that poor knowledge on infection prevention was observed, disinfectants such as 0.5% chlorine solution was most commonly used in private hospitals even though the practice of aseptic hand washing was good.

5.1.2 Nursing measures utilized for the prevention of nosocomial infections

From the findings of this study, it showed that the nursing measures used for the prevention of nosocomial infections by nurses in UCTH, Calabar are as follows; gloves, hand washing (hand hygiene), gowns and eye protection devices such as goggles. This does not supports the study of Ogunsola & Adesiji (2008), where they documented that most wards in Nigerian hospitals lack adequate facilities for effective hand hygiene and use the bucket and bowl method as an alternative to running water. This findings does not support the work of Nazarko (2009), who discovered that nurses often fail to practice hand hygiene because they are busy and they feel hand hygiene takes up precious time. This findings support the work of Saka & Adebara (2011), who carried out a study on prevention of nosocomial infections in the new born: the practice of private health facilities in rural communities of Nigeria and discovered that only 29.4% of the hospital health care providers wore protective rubber gloves. This is inline with the study of MaryRocha, Adenicia & Janaina (2010), who conducted a study to evaluate the practice of hand washing, and discovered that there exist the use of gloves and the handling and disposal of needle sticks and other sharp objects among nurses.

5.1.3 Research Hypothesis

There is no significant relationship between the level of knowledge of nosocomial infection and nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar.

The results of the Chi-square test revealed that that there is a significant relationship between the level of knowledge of nosocomial infection and nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar. This findings is in line with the findings of Sherwood (2008) who suggested that a solid background knowledge of epidemiology and micro-organisms would empower nurses with sufficient confidence to question practices and depend on their own ability to make informed decisions.

5.2 Summary

The purpose of the study was to investigate nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar. A descriptive stud design was used with a well-structured questionnaire. Data was collected from 34 nurses working in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar.

Majority of the respondents possessed good knowledge of nosocomial infections (94.12%). The findings in this study also revealed that the nursing measures used for the prevention of nosocomial infections by nurses in UCTH, Calabar are as follows; gloves, hand washing (hand hygiene), gowns and eye protection devices such as goggles. The study revealed a significant relationship between the level of knowledge of nosocomial infection and nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar.

5.3 Conclusion

Based on the research findings, it was concluded that when nurses possess good knowledge of nosocomial infections it will always result in the good practice of nursing measures used for the prevention of nosocomial infections such as; gloves, hand washing (hand hygiene), gowns and eye protection devices such as goggles.

5.4 Implication to Nursing

The study has the following implications in nursing practices

1. This research work will motivate many more researchers of this nature in the nearest future as many would desire to find out the current trends of present years.
2. By the results and findings in this work, nurses will seek measures to prevent the transmission of nosocomial infections from nurses to patient or patient to patient.
3. This research will also stimulate consciousness and continuous practice of the measures for the prevention of nosocomial infections among nurses.

5.5 Recommendation

Based on the findings, the following recommendations were made;

1. Adequate information should be provided on nosocomial infections in hospitals and health centres for both nurses and patients.
2. Efforts should be made to sustain the practice of nursing measures for the prevention and treatment of nosocomial treatments among nurses.
3. Supportive programmes by government for health workers in rural and urban areas for awareness on nosocomial infections should be considered.

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