ABSTRACT
Health care
workers, particularly nurses are at risk of infection because they constantly
come into contact with infected tissues, fluid, blood and blood products. By
complying with infection control measures a lot of infections can be prevented.
Some survey studies have been conducted in Nigeria on knowledge, perception
attitude and practice of infection control and they concluded that there was
inadequate adherence to infection control practices and this could be addressed
by organizing training and retraining programmes. This study therefore examined
the effects of a training programme in promoting infection control in two
teaching hospitals in Ogun State.
The study
adopted a pretest-posttest quasi experimental design. The sample consisted of 87 participants. They
were made up of experimental group which consisted of 42 registered nurses from
Babcock University Teaching Hospital (BUTH). Ilishan-Remo, Ogun State. The
control group was 45 nurses from Olabisi Onabanjo University Teaching Hospital.
The training programme consisted of 4 modules on infection control. The
programme lasted 4 weeks. The instruments used for data collection were
Knowledge about Infection Control Questionnaire (r = 0.79); Perceptions about
Infection Control Questionnaire (r = 0.80); Attitudes towards Components of
Infection Control Questionnaire (r = 0.62); Practice of Infection Control
Questionnaire (both self-reported and observation checklist) (r =0.62). Four
research questions were answered and three hypotheses were tested at 0.05 alpha
level. Data were analysed using descriptive statistics and Students’ T-test.
Findings showed
that the mean age in the experimental group was 34.92 and SD 8.99 while the
control group was 47.43 and SD 6.60. The mean for years of experience in the
experimental group was 10.42 and SD 9.95 while in the control group was 21.89
and SD 8.72. On attitude, 30 participants (69.0%) had positive attitude in the
experimental group compared to 21 participants (46.7%) in the control group.
The mean difference was 4.02. On perception, 32 participants (76.0%) in the
post intervention had good perception compared to nonein the control group. The
mean difference was 8.36. On knowledge, 26 participants (62.9%) in the post
intervention had high knowledge compared to none participant in the pre
intervention. The mean difference was 7.24. On infection risk reduction in the
intervention group, 28 participants (66.7%) have experienced sharp injury pre
intervention and none post intervention. Significant differences were found
between mean practice score of participants in the experimental and control (p =
0.001) and between self reported and observed practices (p = 0.000) but there
was no significant difference between the mean knowledge score in the
experimental and control group (p = 0.149).
The training
programme was effective in improving the level of knowledge, attitude,
perception and practice of infection control. Based on these findings, it is
recommended that there should be adequate provision of facilities for infection
control. Training and retraining should be organized for all nurses and other
categories of healthcare workers to promote adherence to infection control.
TABLE OF CONTENTS
Content Page
Title Page i
Certification ii
Dedication iii
Acknowledgements iv
Abstract v
Table of Contents vi
List of Tables ix
List of Figures x
Appendices xi
List of Abbreviations xii
CHAPTER
ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 4
1.3 Objective of the Study 5
1.4 Research Questions 5
1.5 Hypotheses 6
1.6 Scope of the Study 6
1.7 Significance of the Study 6
1.8 Justification for the Study 7
1.9 Operational Definition of Terms 7
CHAPTER
TWO: REVIEW OF LITERATURE
2.0 Introduction 9
2.1 Overview of infection prevention and control 9
2.2 Knowledge Attitude and Practice of Infection Control 13
2.3 Standard Precautions 17
2.4 Empirical Studies on Infection Control Measures 22
2.5 Theoretical/Conceptual Framework Precede Model 31
2.6 Appraisal of Literature Review 34
CHAPTER
THREE: METHODOLOGY
3.0 Introduction 36
3.1 Research Design 36
3.2 Population 37
3.3 Sample size and sampling Technique 38
3.4 Instrumentation 42
3.5 Validity and Reliability of the Instrument 43
3.6 Data Collection Procedure 44
3.7 Method of Data Analysis 46
3.8 Ethical Consideration 46
CHAPTER
FOUR: DATA ANALYSIS, RESULTS AND DISCUSSION
OF FINDINGS
4.0: Introduction 47
4.1: Demographic Data of Participants 54
4.2: Discussion ofEffects of Training Programme on Perception of Participants 55
4.3: Discussion of Hypotheses 57
CHAPTER
FIVE: SUMMARY, CONCLUSION AND
RECOMMENDATIONS
5.1: Summary 61
5.2: Conclusion 63
5.3: Recommendations 63
5.4: Limitation of Study 64
5.5: Suggestion for Further Studies 64
REFERENCES 65
APPENDICES 75
LIST
OF TABLES
Table Page
3.1: Sampling Distribution for Intervention Group 40
3.2: Sampling Distribution for Control Group 41
4.1: Demographic Data of Participants 48
4.2: Descriptive statistics showing Effect of Training on Participants’ Attitudes in the Experimental Group 49
4.3: Descriptive statistics showing Effects of Training on Participants’ perceptions in the Experimental Group 50
4.4: Descriptive statistics showing Effects of Training on Participants’ knowledge in the Experimental group 51
4.5: Pre Intervention Responses of Participants on Exposure or Injury Experience in Experimental Group and Control Group 51
4.6:Post Intervention Responses of Participants on Exposure or Injury Experience in Experimental and
Control Group 52
4.7: T-test Showing Differences between the Mean Knowledge Score of Participants in Experimental
group and Control Group 53
4.8: T-test Showing Differences between the Mean Practice Score of Participants in Experimental
Group and Control Group 53
4.9:T-test Showing Differences between Self-reported and Observed Practices of Infection
Control in the Experimental Group 54
LIST
OF FIGURES
2.1: The Chain of Infection 11
2.2: Precede Framework Adapted to Nursing
Intervention to promote
Infection
Control 33
APPENDICES
I. Informed
Consent
II. Questionnaire
III. Reliability of Instruments
IV. BUHREC Approval Letter
V. Letter of Introduction to
the Teaching Hospitals
VI. Letter of Approval from OOUTH
VII. Training
Programme for Participants
VIII-XI Intervention Packages
XII. Pictures from Field Work
XIII Similarity Index (Turnitin)
LIST OF ABBREVIATIONS
BUTH- Babcock University Teaching Hospital
CDC- Center for Disease Control and prevention
CEU- Continuous Education Unit
CHER- Children Emergency
CMPC- Community Medical Primary Care
COPD- Casualty Outpatient Department
CSSD- Central Sterile Supply Department
CVC- Central Venous Catheter
HBV- Hepatitis B Virus
HCV- Hepatitis C Virus
HCW- Healthcare Waste Management
HIV- Human Immunodeficiency Virus
ICU- Intensive Care Unit
NSIs- Needle Stick Injuries
OOUTH- Olabisi Onabanjo University Teaching
Hospital
PEP- Post Exposure Prophylaxis
PMTCT- Prevention of Mother-to-Child Transmission
PRECEDE- Predisposing, Reinforcing, Enabling,
Constructs in
Educational
Diagnosis and Evaluation
PPE- Personal Protective Equipment
SP- Standard Precautions
WHO- World Health Organisation
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Infection
control is an aspect of healthcare delivery that deals with the curtailment of
the spread of infection within the healthcare set-up, be it from
patient-to-patient, patient-to-staff, staff-to-patients or staff to staff.
According to World Health Organisation (WHO, 2011) the components of infection
prevention and control are as follows: organisation, technical guidelines,
human resources, surveillance, microbiology laboratory support, environment,
evaluation and links with public health and other services. Organisation
involves setting up a programme, formation of the infection control committee
and inter-professional team, which should include physicians, nurses,
microbiologists, epidemiologists, infection control specialists, information specialists
and others. The committee must have a good working relationship with one
another, because their work entails collaboration with other departments, staff
and programmes. Technical guidelines involve developing, disseminating and
implementing technical evidence-based information in preventing the risks of
infection. Human resources involve training and re-training of health care
personnel in preventing infections and the training of infection control
professionals. It guarantees a pool of adequate staff responsible for infection
prevention and control activities.
Surveillance
is the tracking of demonstrated or suspected spread of infection. It involves
the collection of data on epidemic and detection of outbreaks as well as the
assessment of level of compliance with infection control practices, response to
outbreaks and documentation of the situation of healthcare associated
infection. Surveillance is important in that it causes early detection,
identification, isolation and intervention, and results in effective infection
prevention. Microbiology laboratory supports generate data, standardised
laboratory techniques and promotes interaction between infection control
activities. The environment refers to the minimum requirements for infection
control. It includes water, ventilation, hand-hygiene equipment, placement of
patient as well as isolation facilities, sterile supply storage, building
conditions and renovation activities. Evaluation has to do with monitoring,
assessment and report of infection prevention and control outcomes, processing
and strategizing at national level and in healthcare facilities. It mirrors the
impact of the infection control programmes. Links with public health and other
services ensures proper coordination and collaboration between staff and
departments in the events of mandatory reporting and activities such as waste
management and sanitation, bio-safety, occupational health, patients and
consumer’s care and the quality of health care (Hebden, 2015; Stempliuk &
Eremin, 2015; WHO, 2011).
There
are various sources of infections. Healthcare associated infections (HAI) are
infections that develop in the course of healthcare and results in aggravating
illnesses and may lead to deaths, extends the duration of hospital stay, and
calls for more interventions at an added cost to the one already expended by
the patient’s initial disease. Its occurrence is an indicator of the quality of
patient care, adverse event and an issue of patient safety. The sources
includes adverse drug events, surgical complications, microorganism isolates,
antimicrobial resistance, decreasing trends in intensive care units, exogenous
microorganisms such as bacteria, fungi, viruses, protozoan from other patients,
endogenous flora of the patients- residual bacteria residing on the patient’s
skin, mucous membrane, gastro intestinal tract, respiratory tract, inanimate
environmental surfaces, contaminated objects, patient room touch, surfaces,
equipment, medication, individual patient, medical equipment, devices, hospital
environment, contaminated drugs and foods and hospital flora in the healthcare
environment. Other sources include doctors’ white coats, nurses’ uniform,
hospital garments, privacy drapes, stethoscopes, bed rails, common hospital
surfaces, contaminated water, compromised immune system, negligence or poor
attitude of hospital staff, hands of health care workers. It could be from
patient to patient, patient to environment, staff to patient, renovation works
in the hospital (Hans, 2012; Stubblefield, 2014; WHO, 2011).
Healthcare
workers generally are at risk of infection, because they constantly come into
contact with infected materials such as tissues, fluid, blood and blood
products. There are several infection control measures aimed at controlling the
spread of infectious diseases, such as hepatitis B and C, Human
immunodeficiency virus (HIV) and other life threatening infections. Moreover,
the hospital waste itself is a potential source of infection hence the need for
proper infection control measures. It has been found that healthcare workers do
not adhere strictly to the various infection control measures, probably because
they do not recognise such, or they lack adequate knowledge, or could be due to
poor attitude towards infection control measures, including non-availability of
materials and equipment (Amoran & Onwube, 2013).In a study conducted at the
Federal Medical Center (FMC), Gombe, in North Eastern Nigeria among nurses, it
was found that some respondents were not aware that standard precautions is
applied to all patients, and majority of the respondents have poor knowledge of
the components of standard precautions (Saidu, Habu, Kever, Dathini, Inuwa,
Maigari et al, 2015).
Standard
precautions are infection control measures that are put forward by the United
States Centre for Disease Prevention & Control (CDC), in 1996. By complying
with standard precautions, a lot of infections can be avoided, such as
occupational exposure to pathogens. While some health workers are familiar with
the infection control measures, some are not. This may be due to lack of
awareness or knowledge and moreover, the attitude that some who are familiar
with the infection control measures, show towards practice is not encouraging.
When one considers the importance of adequate knowledge and practice of
infection control measures, by the healthcare workers, one cannot but think of
what to do to improve on that knowledge and practice. Jain, Dogra, Mishra,
Thakur and Loomba (2012), in their study among doctors and nurses in a tertiary
care hospital, found that there is lack of knowledge and practice regarding
basic infection control measures. This deficit in knowledge can be improved
through educational intervention. Wasswa, Nalwadda, Buregyoya, Gitta, Anguzu
and Nuwama (2015), in their study on implementation of infection control in
health facilities in Uganda, found that with prior training on infection
control, the respondents were more likely to wash their hands. Level of
education and a prior nosocomial infection experience will have a role in the
practice of infection control measures. In-service training on infection
control measures will boost the practice of infection control measures.
Amoran
and Onwube (2013) found that inadequate workers’ knowledge on infection control
and environment related problems are crucial issues that need urgent attention.
According to Gebresilassie, Kumei, and Yemane (2014) in their study, “there is
suboptimal and inconsistent practice of standard precautions in the healthcare
setting that put patients and healthcare workers at significant risk of
acquiring infections”. They also emphasized the need for in-service training
for the healthcare workers on infection control. Adly, Amin and Abd El-aziz,
(2014) found that intervention influenced the compliance of nurses with
infection control measures, because of the knowledge gained during the
intervention or training programme. There is a standard of infection control
measures that can guarantee infection safety among health workers and patients.
1.2 Statement of the Problem
Healthcare
workers generally are at risk of infection. WHO (2006), reported that among the
35million health workers worldwide, about 3 million sustain percutaneous
exposures to the blood borne pathogens each year, including 2 million to
Hepatitis B virus (HBV), 0.9 million to Hepatitis C virus (HCV) and 170,000 to
Human Immunodeficiency virus (HIV). These injuries may result in 70,000 HBV;
15,000 HCV and 5,000 HIV infections. Nurses are at higher risk of being
infected with blood-borne pathogens from clinical blood exposure through
injuries with sharp instruments and needle-stick injuries if infection control
measures are not strictly followed. This is because they are usually the first
contact with a patient on arrival in the hospital and provide 24 hour patient
care. Studies have also shown evidence of clinical nurses becoming infected due
to occupational exposure (Centers for Disease Control & Prevention,
2012). Abdulraheem, Amodu, Saka, Bolarinwa
& Uthman (2012), in their study, among health workers in North Eastern
Nigerian found that the level of knowledge and implementation of standard
precautions is below standard to guarantee infection safety. They concluded
that there is still much to learn and implement when it comes to infection
control measures.
Furthermore,
in some health institutions, the researcher observed that some nurses do not
adhere to the components of standard precautions while providing nursing care.
For example, few nurses were observed not to wash their hand after removing
gloves and before commencing another procedure. In some of the wash hand basins
in the outpatient department, liquid soap is not available for health workers
and patients to wash their hands. When blood or body fluids are spilled on the
floor, the house keepers do not decontaminate with hypochlorite solution before
mopping with soap and water. The health institutions infection control units
are not well equipped to function effectively to ensure compliance to standard
precautions. It is in the light of the gaps that the researcher became
interested in planning a training programme on knowledge, perception, attitude
and practice of infection control for nurses at Babcock University Teaching
Hospital (BUTH), Ilisan-Remo, Ogun state.
1.3 Objective of the
Study
The
main objective of this study is to determine the effects of a training
programme on infection control among nurses. The specific objectives are to:
NURSING INTERVENTION FOR THE PROMOTION OF INFECTION CONTROL IN TWO TEACHING HOSPITALS IN OGUN STATE, NIGERIA
