Attitude and Practice of Standard Precautions Among Healthcare Workers

Attitude and Practice of Standard Precautions Among Healthcare Workers

Chapter One

Purpose of the Study

The main purpose of the study was to assess knowledge, attitude, practice and availability of standard precautions towards prevention of healthcare-associated infections among Primary

Healthcare Workers in North-Central Zone, Nigeria. This study seeks to specifically assess: 

1. Knowledge of primary healthcare workers on standard precautions towards prevention of healthcare-associated infections in North-Central Zone, Nigeria.
2. Attitude of primary healthcare workers to standard precautions towards the prevention of healthcare-associated infections in North-Central Zone, Nigeria.
3. Practice of primary healthcare workers on standard precautions towards prevention of healthcare-associated infections in North-Central Zone, Nigeria.
4. Availability of standard precautions and devices for primary healthcare workers towards the prevention of healthcare-associated infections in North-Central Zone, Nigeria.
5. Difference between male and female primary healthcare workers ‘attitude towards safety measures in the prevention of healthcare-associated infections in North-Central Zone.

6. Difference between male and female primary healthcare workers ‘practice towards standard precautions in the prevention of healthcare-associated infections in North-Central Zone.

CHAPTER TWO

REVIEW OF RELATED LITERATURE

 Concept of Healthcare-Associated Infections (HAIs)

Healthcare-Associated Infections formerly referred to as Hospital Acquired Infections, are those infections contracted by health care workers due to occupational hazards resulting from non-compliance with standard precautions during handling of patients in healthcare facilities (Biberaj, Gega & Bimi, 2014). Hospitals provide a favourable transmission path-way for the spread of healthcare-associated 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 healthcare-associated infections goes beyond its impact on morbidity and mortality figures in any country, but accompanied with profound economic implications.

Khan, Ahmad, and Mehboob (2015), reported that healthcare-associated infections (HAIs) appeared before the origin of hospitals and became a health problem during the miraculous antibiotic era. These infections not only increased the cost of healthcare, but also an extended hospitalization. This result to elevated morbidity and mortality of health workers from various infections. 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 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 lifedeath-life. The fore mentioned explained the World Health Organization‘s definition of health as the complete state of physical, mental, social wellbeing and not merely the absence of diseases or infirmity (D‘Souza & Umarani, 2014).

Some of these healthcare workers (HCWs) according to Verbeek, Ijaz, Mischke, Ruotsalainen, Mäkelä, Neuvonen, Edmond, (2015), are at risk of developing life threatening infectious diseases due to contact with patients, patients‘ blood or body fluids such as mucus or vomitus. The risk of infection and its consequences vary, but the 20132014 Ebola epidemic in Africa puts health care workers at high risk of a disease with a very high fatality rate in the epidemic areas. Not only nurses and doctors are at risk but also staff engaged in transportation, cleaning and burial of casualties. Also elsewhere, HCWs can be at risk when seeing patients arriving from the epidemic areas. Due to the high risk of infection and the high fatality rate hundreds of HCWs have died in the epidemic areas. Just a decade earlier, healthcare workers lost their lives due to the Severe Acute Respiratory Syndrome (SARS) epidemic. Even though the transmission routes are different, Ebola and SARS do have in common that they are highly infectious, can have fatal consequences and especially affect healthcare workers.

Olajubu, Festus, Olubunmi, Lawal, Obadina, Deji and Anota (2012), opined that it has not been possible to create an environment that is absolutely free of microorganisms which have the potential for causing diseases in our healthcare facilities. This explains why some healthcare workers develop infections in the process of handling patients as they carry out diagnosis and administer various treatments in the healthcare facilities. These healthcare-associated infections are contracted by healthcare workers, either by needle injuries during injection of patients, setting of catheter, blood transfusion or cross matching among others. The most common sites of healthcare-associated infections are surgical wounds, burns, urinary tract, respiratory system, skin, blood and the gastrointestinal tract. Pseudomonas aeruginosa is commonly associated with wound and burns infections while Escherichia coli is predominantly isolated in urinary tract infections. Olajubu, et, al, (2012), postulated that, healthcare associated infections includes: Hepatitis B Virus, Hepatitis C Virus, Tuberculosis, Tetanus, and HIV among others. These infections are commonly acquired from immune-compromised patients, needle stick injuries, contaminated equipment, poorly ventilated healthcare facilities and non-compliance with proper hand hygiene among others.

Urinary tract infection is among the most common type of healthcare-associated infections, which healthcare workers contract through the process of setting catheter or sharing of toilets with patients of the infection without observing the required standard precautions. In the United States, surgical site infections, bloodstream infections, and pneumonia are the other most common types (WHO, 2012). The location of healthcare associated infection depends on the nature of a patient’s hospital procedure. Healthcare-associated infections (HAIs) are considered as a serious problem in the healthcare system, as they are common causes of illness and mortality among healthcare workers (Salah, Alnoumas, Fayda . Enezi, Meshal . Isaeed, Gamal Makboul & Medhat 2012).

According to Bello, Asiedu, Adegoke, Quartey, Appiah-Kubi and Owusu-Ansah (2011), acquisition of healthcare-associated infections among healthcare workers increase the costs of healthcare and places a serious economic burden for the country. Furthermore, it was found that the causative pathogens and their modes of transmission most frequently are those infections of needle stick injuries, the respiratory tract, blood stream, contamination from surgical wounds and urinary tract. Healthcare-associated infections take a major toll on society and the overall morbidity and mortality associated with these infections are enormous with particular concern for healthcare workers who are expected to treat other patients who visit the healthcare facilities. Complications from healthcare-associated infections often result in extended lengths of stay in the hospital and increased cost of healthcare, with reduced number of healthcare workers to handle the ever increasing patients‘ patronage.

Khan, Baig and Mehboob, (2017), postulated that with increasing infections, there is an increase in long term disability, increased antimicrobial resistance, increase in socio-economic disturbance, and increased morbidity and mortality rate. Several information also exists on burden of healthcare-associated infections among healthcare workers because of poorly developed surveillance systems and inexistent control methods. These infections get noticed only when they become epidemic, yet there is no institution or a country that may claim to have resolved this endemic problem. Khan et al, (2017), further reported that pathogens responsible for healthcare- associated infections are bacteria, viruses and fungal parasites. These microorganisms vary depending upon different patient populations, medical facilities and even differences in the environment in which the care is given.

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CHAPTER THREE

METHODOLOGY

Introduction

The purpose of this study was to assess knowledge, attitude, practice and availability of standard precautions towards prevention of healthcare-associated infections among primary healthcare workers in North-Central Zone, Nigeria. To achieve this purpose, the research design, population of the study, sample and sampling techniques, instrument for data collection, validity of the instrument, pilot study, procedure for data collection and procedure for data analyses were described and presented in this chapter.

Research Design   

Ex-post facto research design was used to conduct this study. The researcher chose this design because, the information required already existed with the respondents therefore, cannot be manipulated. According to Simon & Goes (2013), Ex-post facto research design means after the fact design which implies that it studies the fact that had already existed. Ex-post facto research design is ideal for conducting a social research when it is not possible or acceptable to manipulate the independent variables under study. This design explains consequences based on antecedent conditions; determine the influence of a variable on another variable and test a claim using statistical hypotheses testing procedures. The justification of the choice of this design is based on the researcher‘s interest in assessing the knowledge, attitude, practice and availability of standard precautions towards the prevention of healthcare-associated infections among primary healthcare workers in North-Central Zone, Nigeria.

 Population of the Study

Population of this study comprise of 24,741, being all primary healthcare workers in Government owned primary healthcare facilities across the North-Central States of Nigeria (being the summation from North-central states‘ ministries of health reported below). The following is the breakdown for each of the state in North-Central Zone, Nigeria: Kwara State has a total of 2,760 primary healthcare workers (Kwara State Ministry of Health, 2016); Kogi state has 1,650 primary healthcare workers (Kogi State Strategic Health and Development Plan, 2010-2015); Federal Capital Territory (FCT) Abuja has 931 primary healthcare workers (National Primary Healthcare Development Agency, 2016); Niger State has 6,615 primary healthcare workers (Niger State Ministry of Health, 2015); Plateau state has 1,772 primary healthcare workers (Plateau State Ministry of Health, 2015); Benue state has 6,613 primary healthcare (Benue State Ministry of Health, 2016); while Nasarawa State has 4,400 primary healthcare workers (Nasarawa State Ministry of Health, 2015).

CHAPTER FOUR

RESULTS AND DISCUSSION

 Results  

Demographic variables considered in this study includes: Age range in years; Gender; Work Experience and health cadres. Table 4.2.1: shows demographic information of the Respondents used in this study.

CHAPTER FIVE

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

 Summary

The purpose of this study was to assess the knowledge, attitude, practice and availability of standard precautions towards the prevention of healthcare-associated infections among primary healthcare workers in North-Central Zone Nigeria. To achieve this purpose, six research questions and one major hypothesis with six sub-hypotheses were formulated. They aimed at assessing knowledge of standard precautions, attitude towards standard precautions, practice of standard precaution, availability of standard precautions and gender differences in attitude and practice of standard precautions, towards the prevention of healthcare-associated infections among primary healthcare workers in North-Central Zone Nigeria. Ex-post facto research design was used for this study. The population of the study comprises all Primary Healthcare Workers in Government owned hospitals of North-central Zone Nigeria. Three states were randomly selected for the study from North-Central Zone Nigeria. Seven hundred and sixty (760) primary healthcare workers were purposively selected across the three states using multi-stage sampling techniques. A total of 760 researcher‘s structured questionnaire were administered and retrieved for the purpose of data collection (100% retrieval rate). The research questions were answered using descriptive statistics comprised of mean and standard deviation. To analyse the formulated sub-hypotheses for this study, inferential statistics of one sample t-test and t-test statistics were used in this study. All the formulated sub-hypotheses were tested at 0.05 alpha level of significance.

Major findings of the study revealed that:

1. There was significant knowledge of standard precautions towards the prevention of HAIs among PHCWs in North-Central Zone Nigeria. This is because the calculated t.-value of 47.721 is greater than t.crit. of 1.971. PHCWs have the required knowledge of standard precautions to effectively prevent healthcare-associated infections.
2. There was significant attitude towards standard precautions in the prevention of HAIs among PHCWs in North-Central Zone Nigeria. This is because the calculated t-value of 69.828 is greater than t.crit. of 1.971. Primary healthcare workers like to use any standard precautions that will prevent them from acquiring healthcare-associated infections.
3. There was significant practice of standard precautions among PHCWs towards the prevention of HAIs in North-Central Zone Nigeria. This is because the calculated t.-value of 68.437 is greater than t.crit. of 1.971. Primary healthcare workers do practice standard precautions as much.
4. There was no significant availability of standard precautions towards the prevention of HAIs among PHCWs in North-Central Zone Nigeria. This is because the calculated t.-value of 1.948 is less than t.crit. of 1.971. Primary healthcare workers are not provided with most of the safety equipment needed in their healthcare facilities.
5. Female PHCWs‘ attitude towards standard precautions in the prevention of HAIs, is more positive than their male counterparts in North-Central Zone Nigeria. The calculated t.-value of 11.102 is greater than t.crit. of 1.971.
6. Female PHCWs‘ practice standard precautions towards the prevention of HAIs more than their male counterparts in North-Central Zone Nigeria. This is based on the calculated t.-value of 20.313 is greater than t.crit. of 1.971.

Conclusion  

On the basis of the findings of this study, the following conclusion were drawn:

1. Primary healthcare workers have knowledge of standard precautions towards the prevention of healthcare-associated infections in North-Central Zone Nigeria.
2. Primary healthcare workers have positive attitude towards standard precautions in the prevention of healthcare-associated infections in North-Central Zone Nigeria.
3. Primary healthcare workers practice standard precautions towards the prevention of healthcare-associated infections in North-Central Zone Nigeria.
4. Primary healthcare workers in North-Central Zone Nigeria, are not provided with most of the standard precautions needed in their healthcare facilities.
5. Female primary healthcare workers have more positive attitude towards standard precautions for the prevention of healthcare-associated infections, than their male counterparts in North-Central Zone Nigeria.
6. Female primary healthcare workers practice standard precautions towards the prevention of healthcare-associated infections more than their male counterparts in North-Central Zone Nigeria.

Recommendations

On the basis of the conclusions drawn from this study, the following recommendations were made:

1. Government in collaboration with NGOs and Health Educators should maintain training and re-training on knowledge of standard precautions towards the prevention of HAIs among healthcare workers across North-Central Zone Nigeria to sustain and keep updating the acquired skills of standard precautions. This can be done through workshops, seminars and symposia.
2. Government should motivate and encourage healthcare workers to imbibe more positive attitude towards standard precautions for the prevention of HAIs by prompt payment of their salaries and allowances. This will encourage healthcare workers not to relent in their positive attitude imbibed and to see standard precautions not as extra duties but protection.
3. Legislation should be made to mandate Ministries of Health across the states to establish task force to monitor and enforce global best practices among healthcare workers towards use of standard precautions in preventing HAIs with penalties to erring healthcare workers.
4. Government in collaboration with international NGOs should ensure that adequate standard precautions are available across healthcare facilities in North-Central Zone Nigeria, towards preventing HAIs among healthcare workers
5. The management of healthcare facilities should remind healthcare workers that infections have no respect for gender therefore, both male and female healthcare workers should be proactive in their attitude and practice towards the prevention of HAIs through task force on compliance.

Suggestions for Further Studies

Further studies should be carried out to assess the availability and practice of standard precautions towards preventing healthcare-associated infections among healthcare practitioners in tertiary healthcare institutions in Nigeria.

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