ABSTRACT
Although nurses prevent and control infections they lack the necessary knowledge to practice infection prevention and control. There is low compliance to infection control precautions including hand hygiene, the use of gloves and sharps management as a result of limited knowledge, poor staff attitude towards infection control measures leading to prolonged stay of the patients in the hospital, functional disability or reduced quality of life, high resistance to antimicrobial agents, emotional stress, additional financial costs for both the patients and their families and finally unnecessary deaths. This infections are actually preventable. It was essential to explore the nursing intervention toward their prevention.
Objective: The purpose of the study was to determine the nursing intervention to the promotion of infection control in Irrua Specialist Teaching Hospital.
Methodology: This study was a descriptive, cross-sectional study which employed simple random sampling method and a semi structured questionnaire was used to collect data from nurses in Irrua Specialist Teaching Hospital. The sample size of 88 participants was used. Data was analyzed and tables, graphs, pie charts and percentages were generated.
Study findings: The findings of the study revealed that 65.9% of the respondents were female while 34.1% were male. The diploma nurses constituted 48.9%, enrolled 29.5% and 21.6% of the respondents were graduates with degree award. Greater percentage of the respondents were diploma holder. Modal age group is 21-29 (48.9%, majority the respondents had experience of 1-5 years (58%). 51.1% of the respondents were very knowledgeable about hospital acquired infections, 37.5% of the respondents were quite knowledgeable about Hospital acquired infections. 81.8% of the respondents strongly agreed that every patient should be treated as if they carry blood borne. On the same note, 83.0% of the respondents said they always observe the infection control practices 90.9% of the respondents stated that they don’t recap needles after use. 96.6% of the respondents said they place disposable sharps in safety box immediately after use. Results also indicate that, 96.6% of the respondents always use gloves when doing procedure while 3.2% of the respondents sometimes use gloves when doing procedure.
Conclusions. The respondents are more knowledgeable, having a positive attitudes towards but with low level of practices promotion of infection control.
Recommendations.
Health facilities should provide every nurse with guidelines on infection control measures, and should strictly supervise the nurses to ensure compliance.
Health facilities should provide adequate disposal material to the nurses.
Nurses should be given opportunities to upgrade and males also need to be encouraged to offer nursing course.
CHAPTER ONE
INTRODUCTION
1.1 Background of study
Hospital acquired infections (HAIs) also called nosocomial infections are infections obtained by the patient, 48 hours after admission at the hospital or a health facility for reasons which are not related to the infections or before admission to the facility, patient was not previously infected (Kelly et.al, 2012).
HAIs occur worldwide and affect hundreds and millions of people and they are related with high rates of morbidity and mortality among patients who are admitted in the hospitals or health facility and are a major problem to patients’ safety and in settings where health care is to be made safe, their close watch and avoidance should be the top most priority (WHO, 2009). Health workers (HWs) are as well having an increased chances of getting these infections (Iliyasu et al, 2016).
Globally, over 1.4 million people are affected by HCAIs (WHO, 2010). The prevalence of patients affected by HAIs in developed countries is ranging from 5% to 10% and about 15% to 40% of the patients are in critical care units (CDC, 2010). The prevalence of Hospital Acquired Infections in Africa is varying from 2.5% to 14.8% in Algeria, Senegal, Burkina Faso, and Tanzania (WHO 2011). Bacteria, fungi, viruses, and parasites are the causative agents of HAIs (David McQuoid-Mason 2012).
The end results of HCAIs in accordance to WHO, 2009 and New York State Department of Health 2014, are the prolonged stay in the hospital, functional disability or reduced quality of life, high resistance to antimicrobial agents, emotional stress, additional financial costs for both the patients and their families and finally unnecessary deaths.
HCAIs have drawn a lot of attention of patients, government and other regulatory bodies including associations, because most of these HCAIs are actually preventable. According to
MOH (2011), the spread of HCAIs like Human Immunodeficiency Virus, Hepatitis and other blood microbes commonly occur through unsafe injections, contaminated hands, sharps injuries and other unsafe medical procedures.
Infection control measures reduce the spread of HAIs and they involve immediate hand washing after exposure to lessen on the danger of disease transmission, the utilization of personal protective Equipment to reduce contact with infectious objects, as well as proper disposal of sharps reducing needle-stick injuries CDC (2010). A violation in infection control customs assists in the spread of infections either from patient to patient, patient to health workers and health worker to patient and attendants or even among staffs therefore all the HWs, attendants, patients should strictly stick on Infection Control instructions (CDC, 2010).
Nursing intervention to the influence the prevention of Hospital Acquired Infections (Aftab et al, 2015).
Globally, the knowledge about prevention and control of Hospital Acquired Infections by nurses is rated high as compared to the Attitude, Practices and compliance which are low as a result of lack of resources and training opportunities and excessive workloads in Saudi Arabia and Italy as stated by Amin and Al Wehedy (2009) and Permeggiani (2010) respectively.
In Africa, a study conducted in Ethiopia employing a cross – sectional design found out that the knowledge about hand washing was fair while practice was low (Admasu, 2008). In a study carried out in northern Nigeria 421 Health Care Workers were interviewed among them 77.9% described Universal precautions and infection control. A bout 70.1% always wear gloves before handling a patient or their property. 12.6% reportedly washed their hands before wearing gloves. 10.7% washed their hands after wearing gloves and 72.4% changed gloves after handling a patient (Iliyasu et al, 2016).
Meanwhile a survey conducted in Zambia revealed inadequacy of knowledge as well as low compliance as common among the nurses therefore need to step up educational programs to improve compliance with recommended infection control guidelines (Katowa P, 2008).
In Nigeria, a study conducted in the surgical, medical and obstetrics wards at Mulago National Referral Hospital in Edo show that almost all HCWs knew to wash their hands. Hand washing was valued more as a means of self-protection than as a means of preventing patient to patient transmission, consistent with the prevailing belief that infection control was important for occupational safety. Sinks were not readily accessible, and soap at sinks was uncommon throughout the medical and obstetrics wards but more commonly available in the surgery wards. Alcohol gel was rarely available (Charles W. Acher et al. 2010).
In view of this background, this study was conducted in Irrua Specialist Teaching Hospital with the purpose of assessing nursing intervention for the promotion of infection control.
1.2 Problem statement
Hospital acquired infections (HAIs) have worldwide occurrence both in developed and developing countries resulting in increased morbidity and mortality among hospitalised patients and they should be controlled, mandatory using the infection control measures (WHO, 2010). Although nurses try to prevent and control infections they lack the necessary knowledge to practice infection prevention and control (CDC, 2010). This has led to the prolonged stay of the patient in the hospital, functional disability or reduced quality of life, high resistance to antimicrobial agents, emotional stress, additional financial costs for both the patients and their families and finally unnecessary deaths. The national service provision assessment survey conducted by MOH showed that only 6 % of health facilities had all infection control items while supervisory visits to health facilities in Arua District in 2006 revealed that less than 60 % of the assessed facilities implemented the required infection control measures (Christine K. Nalwadda et al, 2014).
There is low compliance to infection control precautions including hand hygiene, the use of gloves and sharps management. Many reasons for noncompliance have been identified including limited knowledge, poor staff attitude towards infection control measures (WHO, 2010).
The Ministry of health (MOH) of Nigeria has put five basic measures to prevent and control Infections within the health facilities. These include hand hygiene, adequate protective wear, proper sterilization, proper sharps disposal and safe waste management (MHO, 2011). Monitoring and supervision has also been done to determine adherence to the procedures to control hospital acquired infections (MHO, 2011).
Despite all the efforts in place, patients obtain infections during their course of care. Therefore the main purpose of this study was to determine the knowledge, attitude and practices on prevention and control of HAIs among nurses in Irrua Specialist Teaching Hospital.
1.3 Objectives of the study
General objective
To determine the Knowledge and Practices of Nurses Regarding Hospital-Acquired Infection Control Measures.
Specific objectives
1. To determine the knowledge of nurses in Irrua Specialist Teaching Hospital promotion of infection control in 2022.
2. To establish the attitude towards prevention and control of Hospital Acquired Infections among nurses of Irrua Specialist Teaching Hospital in 2022.
3. To determine practices of the nurses in Irrua Specialist Teaching Hospital regarding prevention of Hospital Acquired Infection in 2022.
1.4 Research questions
1. What is the knowledge on prevention and control of Hospital Acquired Infection among nurses in Irrua Specialist Teaching Hospital in 2022?
2. What is the attitude towards prevention and control of Hospital Acquired Infection among nurses in Irrua Specialist Teaching Hospital in 2022?
3. What are the practices of nurses in Irrua Specialist Teaching Hospital on prevention and control Hospital Acquired Infection in 2022?
1.5 Significance of the study
The results of this study are of great benefit to the following groups of people;
Nurses; this study will provide the nurses with the valuable information they need in infection control that will increase their capacities in increasing their compliance.
Patients; being one of the reasons of this study, they will definitely be assured of their safety and improved care thus quality of life is increased, medical care costs are reduced, and length of stay in the hospital is reduced.
The hospital administrators. This study will enable them gain better insight on the nursing intervention to the on Hospital Acquired Infections prevention and control and will able them evaluate on-going or completed programmes on infection control and this can also be replicated to other health facilities in the country. Policies can also be formulated and implemented to ensure that patients are protected from infections acquired as they visit hospital facilities for health care. The policies formulated may be national or institutional and they can be translated in to context appropriately. The external stakeholders such as donor community can be informed on where to allocate funding in order to benefit both the health workers and the patients.
Nursing research; this study will also act as the guideline and source of information for other researchers and can be used to validate the infection control guidelines to improve on the patients outcomes during care.
Academicians; this study will increase knowledge needs on the already known facts about prevention and control of hospital acquired infections. This study will avail the researcher with relevant information on the nursing intervention to the promotion of infection control as a way of promoting infection control.
1.6 A Conceptual framework
The conceptual frame work below shows the relationship between the independent and dependent variables. The dependent variable is prevention and control of HAIs and the independent variables are the nursing intervention to the at Irrua Specialist Teaching Hospital.
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