INFORMATION, MOTIVATION AND BEHAVIOURAL SKILLS AS PREDICTORS OF UTILIZATION OF UNIVERSAL PRECAUTIONS AMONG NURSES IN SAGAMU, OGUN STATE, NIGERIA

CHAPTER ONE

INTRODUCTION

1. Background to the Study

Health-care providers are at major high-risk for contracting blood-borne infections during the discharge of their duties in health-care facilities now than ever before. Despite the introduction of these preventive procedures in the training of healthcare workers such as nurses, doctors, medical laboratory scientist among others, the possibility of an occupational injury is high due to risk practices among these individuals. Various studies  have revealed that blood-borne infections constitute a sizeable number of serious risk exposures for health-care providers from patients diagnosed with Hepatitis virus (HBV) and Human immunodeficiency virus (HIV) in the course of providing care for these patients (Anozie, Anozie, Lawani, Mamah,  Ajah & Nwali, 2016; Sheth, Leuva & Mannari,  2016) .

Health-care providers carry out a number of tasks which are not limited to administration of drugs by injection procedures, taking birth deliveries, wound dressing, handling blood samples and other body fluids which may result in exposure through percutaneous and needle-stick or other sharps injuries including accidental splashes (Elseviers, Arias-Guillén, Gorke & Arens, 2014).Evidence from a number of studies have reported risk exposures that have resulted to about two to four needle-stick injuries annually among o health-care providers during the process of discharging their duties particularly in Africa (Mbaisi, Ng’ang’a,  Wanzala & Omolo, 2013). Among health-care providers in Nigeria who are exposed to these risks, the nurses are most affected and do not give incident report at each occurrence (Diwe & Chineke, 2013).

Health-care providers can also transmit infective agents associated with blood-borne pathogens from one person to another. Transmission occurs as a result of direct contact with infected blood or blood products, and other body fluids between health-care providers and infected patient. Also,infected body fluids such as blood, sputum and urine can penetrate mucus membranes or enter through open wounds, cuts, abrasions and damaged skin. Blood-borne pathogens may also be transmitted through mucous membrane of the eyes, mouth and nose occasional by splashes. The Needle-stick and sharp object injuries symbolize a major occupational challenge to health-care workers (Memish, Assiri, Eldatlaony, Hathouth, Alzoman & Undaya, 2013).

In 1995, Hospital Infection Control Practices Advisory Committee (HICPAC) in the United States introduced the concept of standard precautions which combines the major features of universal precautions and body substance isolation into a distinct set of precautions to be adopted by health-care workers for the care of all patients in hospitals regardless of their presumed infection status. These precautions are to help prevent the transmission of blood-borne infections. Should these standard precautions be framed into daily operational procedures at health-care facilities and enforced, probably the percentage of compliance would have been more adequate which will transit to minimal occurrence of infection(s).

Health-care workers (especially nurses) are at high risk of becoming exposed to blood-borne infections through needle stick and sharp object injuries (Zehnder, 2010). Various studies had posited a number of factors that affect the utilization of universal precautions by nurses.Three major areas that should not be overlooked include engineering factors such as the form of sharp devices and unavailability of devices (Wilburn & Eijkemans, 2004), organizational factors such as the existence of supplies and policies for reporting, and behavioral factors which are disposal-related issues (Hossein, Hosein, Eesa & Ali, 2016).

These three areas (engineering factors, organizational factors and behavioral factors) are in coherence with the information, motivation measures and behavioural skills the nurses may possess for the application of standard equipment and object-handling precautions. The use of available sharp devices should come with information guiding their usage for all professions, particularly nursing because of the sensitivity of their profession (Hughes, 2008; Rutala & Weber, 2008). Existing policies guiding the procedures for use and monitoring would serve as factors that motivate nurses to apply the precautionary measures (Houser & Oman, 2011). The behavioural factors revolved around their ability to carry out what they have received information about and their willingness to practice these precautions (Ryan, 2009). Majority of the health-care workers are still at high risk of contracting blood-borne infections due to the lack of application of the universal precautions.

1. Statement of the Problem

Over the years, the effects of occupational accidents have generated a lot of concerns for health care managers and workers. The occasional contact with blood and body fluids from infected patients by healthcare workers during treatment without precautionary measures has become a growing concern and as such elicit probe to stem down the tide of occurrence. The World Health Organization (2006) in a program with the theme “Working Together for Health” posited that unsafe working conditions has eroded the confidence of health-care workers in many countries due to work-related illnesses and injuries which has resulted to fear of health workers on occupational infections.

Some studies have linked poor information to the risk of contracting blood-borne diseases among nurses (Abdela, Woldu, Haile, Mathewos & Daressa, 2016) while some others have associated the risk of getting blood-borne infections to low level of professional competence among healthcare providers (Aluko, Adebayo, Adebisi, Ewegbemi, Abidoye & Popoola, 2016). None of these studies have however linked the risk of contracting blood-borne infections to level of information, motivation and behavioral skills. Regular information about the contents of the universal precautions would improve their knowledge and enable them apply the precautions (Quan, Wang, Wu, Yuan, Lei, Jiang, & Li, 2015). Motivation on the other hand is the constant supply of necessary kits and drive that makes applications of the preventive measure optimal (Amoran, & Onwube, 2013). Behavioural skills are the competent skills that are required to maximize the full benefit of utilizing universal precautions (Yousafzai, Janjua, Siddiqui & Rozi, 2015). 

Based on this premise, this study would seek to investigate how these three factors (information, motivation and behavioral skills) can serve as predictors of usage of universal precautions in the prevention of blood-borne infections among nurses. The factors are developed from the IMB (Information Motivation Behavioral skill) Model (Fisher & Fisher, 1992) and used to derive relevant information on this salient issue of concern. The study aimed to assess information, motivation and behavioural skills as predictors of the utilization of universal precautions among nurses in health facilities in Sagamu, Ogun state.