Relationship Between Ward Hygiene And Prevalence Of Nosocomial Infections Among Patients In Two Tertiary Hospitals In Kaduna

Project and Seminar Material for Nursing (Science)

Abstract

Nosocomial or those infections acquired in a hospital setting are a great cause of morbidity in our patients due to their easy transmissibility from a patient to another at times through the health care provider who does not practice appropriate infection control and ward hygiene. Of more importance is the fact that, other than their prevalence going up, resistance to antibiotics has developed within the causative agents of these infections. Patientsand other health staff, are in constant encounter with other patients in the wards and thus may be at risk of getting infected themselves, or acting as a vehicle of spread of these infections throughout the ward. For this reason, this study is about the relationship between ward hygiene and prevalence of nosocomial infections among patients in two tertiary hospitals in Kaduna

Hospital-associated infections or nosocomial infections are those infections acquired during the patient’s stay in hospital. They form a major worldwide public health problem despite advances in our understanding and control of these infections. The best clinical care in the world can be worthless if patients pick up other infections while they are in the hospital. Hospital-associated infections also include occupational infections which occur in health care workers due to occupational hazard (Biberaj, Gega, &Bimi, 2014).

A questionnaire based cross sectional study design with a quantitative component was and that involved 292 patients was utilized. A convenient random sampling technique was employed in recruiting the respondents. Patients, despite having excellent knowledge the relationship between ward hygiene and showed a positive relationship. More needs to be done in terms of educating the incoming and continuing clinical patients on proper protocols pertaining prevention of nosocomial, and infections at large.

Table of Content

Chapter One:

Introduction

1.1 Background of Study
1.2 Problem Statement
1.3 Purpose of the Study
1.4 Objectives of the Study
1.5 Research Questions
1.6 Test of Hypothesis
1.7 Justification of the Study
1.8 Study Scope
1.9 Operational Definitions
1.10 Organization of the Study
1.11 Conceptual Framework

Chapter Two:

Literature Review

2.1 Conceptual Review
2.2 Theoretical Review
2.3 Chapter Summary

Chapter Three:

Methodology

3.0. Introduction
3.1. Study Design
3.2. Study Population
3.2.1. Inclusion Criteria
3.2.2. Exclusion Criteria
3.3. Sample Size Determination
3.4. Sampling Technique
3.5. Data Collection Method
3.5. Measures and Study Variables
3.5.1. Dependent / Outcome Knowledge of Ward Hygiene
3.6. Data Collection Tools and Procedure
3.7. Quality Control
3.8. Data Analysis
3.9 Reliability of the Study
3.10 Validity of the Study
3.11 Ethical Considerations

Chapter Four:

Data Analysis and Result

4.0. Introduction
4.1 Presentation of Results
4.4 Test of Hypothesis

Chapter Five:

Conclusion and Recommendation

5.0. Introduction
5.1. Discussion
5.2. Conclusion
5.3. Recommendations
REFERENCES
APPENDIX

Chapter One

Introduction

1.1 Background of Study

Health is the level of functional or metabolic efficiency of a living being. Health is both responsibility as well as right. It is the responsibility of those with power and right of those without power. The promotion of health is social, and political as well as individual responsibility. Health does not mean the only physical well-being of the individual but also include social, emotional, spiritual and cultural well-being. This is a whole of life view and includes the cyclical concept of life-death-life (Ziebarth, 2016).

Nosocomial infections increase patients’ morbidity, mortality, length of hospital stay and treatment cost (Kaye et al., 2014).

Nosocomial infection refers to as a hospital acquired infections or simply hospital infections are infections occurring during staying 48 hours or longer, which resulted in the use of the 48-hour criterion in several epidemiological surveillance systems (El-Gohary& Al Jubouri, 2014).

Therefore, knowledge about the frequency and distribution of nosocomial infections is important to improve infection control measures as well as to develop effective preventive and curative strategies which, in turn, will help us in decreasing incidence, morbidity and mortality (Dasgupta, Das, Chawan, &Hazra, 2015).

Hospitals provide a favorable transmission path-way for the spread of nosocomial infections, owing partly to poor infection control practices among health workers on one hand and overcrowding of patients in most clinical settings on the other. The importance of hospitalacquired infections goes beyond its impact on morbidity and mortality figures in any country, and has profound economic implications. Prevention of health care-associated infections is the duty of all health care workers. Infection control professionals require evidence-based educational content that facilitates reduction in nosocomial infections. Clinical and support staff in health care institutions are inundated with required training facilitated by accrediting bodies and institutional mandates (Biberaj et al 2014).

Ward hygienes are designed to reduce the risk of acquiring occupational infection from both known and unexpected sources in the healthcare setting. Strict adherence by healthcare workers to standard infection control precautions may prevent a percentage of these risks. For that healthcare workers should have adequate knowledge and practice about standard infection control precautions (Ogoina et al., 2015)

1.2 Problem Statement

Nosocomial infections are infections acquired in the hospital or other health care facilities that were not present or incubating at the time of the client’s admission. It is also referred to as hospital-acquired infections (HAIs). It includes those infections that become symptomatic after the client is discharged as well as infections among medical personnel. Most nosocomial infections are transmitted by health care personnel who fail to practice proper hand washing procedures or change gloves between client contacts (Yakob, Lamaro, &Henok, 2015). A prevalence survey conducted under the auspices of WHO in 55 hospitals of 14 countries representing 4 WHO Regions (Europe, Eastern Mediterranean, South-East Asia and Western Pacific) showed an average of 8.7% of hospital patients had nosocomial infections. At any time, over 1.4 million people worldwide suffer from infectious complications acquired in hospital. The highest frequencies of nosocomial infections were reported from hospitals in the Eastern Mediterranean and South-East Asia Regions (11.8 and 10.0% respectively) (Ginawi et al., 2014). Identifying existing infection control knowledge, attitudes, and practices (KAP) among health care workers (HCWs) is a key first step in developing a successful infection control program. In an effort to raise awareness and provide guidance in combating HAIs in resource limited settings (RLS), the World Health Organization (WHO) launched the Global Patient Safety Challenge.

1.3 Purpose of the Study

To assess relationship between ward hygiene and prevalence of nosocomial infections among patients in Kaduna.

1.4 Objectives of the Study

To identify the level of patients’ knowledge at towards ward hygiene
To determine the attitude of patients on prevention of nosocomial infections
To evaluate the practice of standard basic precautionary measures among patients in the clinical setting.
To identify associated factors of KAP towards ward hygiene.

1.5 Research Questions

What is level of knowledge of patients at towards ward hygiene?
What are the attitudes of patients at on prevention of nosocomial infection?
Do hospitals practice standard ward hygiene in the clinical setting?

1.6 Test of Hypothesis

H0 there is no significant relationship between ward hygiene and prevalence of nosocomial infections
H1 there is significant relationship between ward hygiene and prevalence of nosocomial infections

1.7 Justification of the Study

This study aimed to provide baseline information on knowledge level and practice on prevention of nosocomial infection of patients. It will provide strong body of scientific knowledge which will ensure the highest standards of medical care and practice. This can be achieved through adherence to the evidence based guidelines for prevention of nosocomial infection ultimately improving patients‟ outcomes. Improved outcomes will shorten patient’s length of stay, hospitalization as well as benefit the patient financially with decreased hospital costs. Hospitals also gain benefits as they are continually faced with the challenge of providing cost effective services to patients and communities. Again, future researchers will benefit from this study that, it will provide them the baseline facts needed to compare their study results as necessary though studies have been conducted; still there is poor KAP towards prevention of nosocomial infection in medical and nursing patients who are in clinical attachment. this study will serve as the basis for policy makers in developing health education Programs which may serve as interventions to reduce incidence of nosocomial infections. There is a need to work on the perception, attitude and utilization to reduce mortality and morbidity.

1.8 Study Scope

The study deals with the knowledge, attitude and practice of patients concerning nosocomial infections and ward infection including their relationship.

1.9 Operational Definitions

Nosocomial Infection: Any infection acquired during a patient’s stay in a health care facility, becomes evident 48 hours or more after hospital admission or within 30 days of discharge following in-patient care(Bello et al., 2011)

1.10 Organization of the Study

The study is organized into five chapters.

Chapter one covers; background to the study, statement of the problem, general objective of the study, specific objectives of the study, research hypotheses, significance of the study, limitation of the study, delimitations of the study, operational definition of terms and organization of the study.
Chapter two covers review of related literature.
Chapter Three covers research methodology which includes: introduction, research design, target population, sampling techniques and sample size, data collection instruments, validity and reliability of research instruments, data collecting procedures, data analysis techniques and ethical considerations.
Chapter four covers research results of the study.
Chapter five covers discussions and interpretations of research findings.

1.11 Conceptual Framework

The conceptual framework adopted for the study was that hand washing, waste segregation, policy guidelines and safety injection practices were the independent variables, while infection prevention and control were the dependent variables.

Patients’ attitudes, monitoring and supervision with proper management and planning are the intervening variables.

Chapter Five

Discussion, Conclusion and Recommendations

5.0. Introduction

This chapter deals with discussion of study findings, conclusions arrived at and recommendations derived.

5.1. Discussion

A total of 292 respondents took part in the study giving a response rate of 100%. The demographics of our study population were that of a mainly youthful age distribution, predominantly male (68%), Nigerian (56.16%) but being an International University, several other nationalities such as Nigerians, Kenyans, Cameroonians among others were also represented. Our population was mainly Christian (69.18%) while the rest were Muslims. On the year of study, third years (41.78%) and fourth years (33.56%) made the largest contribution of respondents. This would imply that their knowledge concerning nosocomial infections and prevention would still be fresh as was recently taught to them during microbiology and immunology in Biomedical classes or during the clinical orientation offered to all patients moving over from Biomedical to clinical years.

All the respondents had fully completed at least one clinical rotation among the four, vis; Internal Medicine, Surgery, Pediatrics and Obstetrics and Gynecology. This would imply that all of them would have had ample time to interact with patients and were encountered with situations where prevention of nosocomial infections was needed. Of more importance is the fact that within the 30-day period prior to the conduction of the study, all of the respondents had interacted with patients; the majority having interacted with between 10 and 20 patients in their respective rotations.

The respondents’ knowledge base and attitudes as far as nosocomial infections is concerned was impressive. All 292 knew what nosocomial infections were going ahead to offer the correct description and even going further to give the ward hygieneary measures against nosocomial infections. This excellent knowledge level could be implied to be attributed to the various forms of training they have been receiving over the years e.g. biomedical classes and clinical orientation.

It comes as a great shock therefore, that this high degree of knowledge, awareness and positive attitudes seen has little translated into practice. For instance, HBV vaccination among the respondents was very low at 30.14%. This means that only 88 of the total 292 had received vaccination against this highly contagious infection, especially in a hospital setting. To compound the problem, of these 88, only 54 had received the complete regimen of three doses. This means that only 18.49% of the respondents had achieved effective immunity against HBV. In as far as handwashing and hospital waste disposal is concerned, practice still leaves much to be desired. Only 40(13.70%) practiced hand washing after coming into contact with items or environment surrounding the patient knowing very well that these are sources of germs that can be picked from one patient to the next and cause infection in a susceptible host. Their disposal of medical waste need some improvement for we see them dumping all waste in the safety box knowing that different specially designated bins exist for different type of medical waste. Handling of blood and/or body fluids and needle stick injuries also need much improvement. Reporting of such accidents to the supervisor in charge is a key component of prevention of nosocomial and all infections in general, something the respondents seemed to overlook or omit. It is not all gloom though, as their constant and proper use of PPEs is uplifting. For instance, the respondents’ use of gloves on all patients when needed and not only on HIV suspected or HIV positive cases need to be applauded.

Despite much needing to be done as far as KAP of our study respondents concerning nosocomial infections, studies elsewhere have had worse results. Nepalese health workers, for instance, were found to be worse of. Only 16%, 14% and 0.3% of the respondents had high scores for knowledge, attitude and practice respectively (Paudyal et al., 2008). Our study respondents also unanimously (100%) agreed that that all patients are a source of infection as opposed to only 41.8% of health workers in (Amin et al., 2013) study among patients. Saudi patients were not better placed either. Their knowledge level was found to be far much lower than that of our study(Amin et al., 2013). The reports were similar among Nigerian health workers in 2012. 50% of them had no knowledge of universal precautions of infection control(Amoran & Onwube, 2013).

The poor practice as far as medical waste disposal is concerned was also seen among third year dental patients in India back in 2013. 67.5% were not even aware of correct waste disposal methods for needles and sharps(Gambhir et al., 2013). On the side of handwashing, our study findings are far worse than the 43.30% of Nigerian health workers who did not know that their hands had to be washed before and after patient care and also, despite them having a lower handwashing compliance (38.78%) (bello et al., 2011), the compliance in our study is far much lower.

5.2. Conclusion

Patients in Kaduna, despite having excellent knowledge and good attitude towards nosocomial infections, the translation of this knowledge into practice leaves quite a lot to be desired. Their uptake of the HBV vaccine is very low the key factor being cost implications. More needs to be done in terms of educating the incoming and continuing clinical patients on proper protocols pertaining prevention of nosocomial and infections at large.

5.3. Recommendations

5.3.1. To the Patients

Translate their excellent knowledge and good attitude concerning nosocomial infections into good preventive practice.
Strive to get vaccinated against HBV since it is a highly contagious infection that quickly spreads especially in the clinical setting where patients can infect unimmunized health workers who further spread to other patients they get to serve.
Always strive to report to the appropriate supervisor in cases of accidents in the clinical setting involving sharps, blood and body fluids for the appropriate measures to be taken.

5.3.2. To Hospital Administration

Ensure that the installed alcohol wash dispensers are always refilled and at no given time is there no clean water supply in the wards and taps are fully functional.
Facilitate full immunization of all clinical staff, patients included, against HBV at a subsidized cost if not for free.

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