Knowledge and Perception of Nosocomial Infection Among Health Workers and Resident of Egor L.g.a in Edo State, Nigeria
CHAPTER ONE
Objectives of the Study
On the whole, accessible data show that needle stick injuries and blood borne pathogens are serious threats to patients, HCWs (Healthcare workers) and to the host community.
Health workers , regardless of specialty, engage in the most direct contact with clients in healthcare settings. Also, existing literature has documented specific examples where nurses are implicated in the transmission of nosocomial infections {Casewell &Phillips, 1977; Ehrenkranz et aI., 1991; Lucent et aI., 2002; Waters et al., 2004; Lepelletier et al., 2005; de-Oliveira et aI., 2005;Pessoa-Silva et aI., 2007). A review of literature has shown that health workers educational programs incorporate courses and instructional approaches that include methods aimed at preparing the Health care practitioner in protocols designed for infection control and as such the reduction and transmission of nosocomial infections. Furthermore, their expertise with regards to knowledge, attitudes and practice to control the spread of infections is well evidenced by their success in licensure exams and relevant assessments over the course of their academic journey (Sherwood et aI., 2007; Smith, 2007). Paradoxically, the evidence highlights otherwise: that is, unabated levels of the spread of nosocomial infections (Anderson et aI., 2009; Scott II, 2009) and the role of healthcare workers including nurses, in the transmission of nosocomial infections (Pittet et aI., 2004; Miner et aI., 2004; Eriksen et aI., 2009; Racca et aI., 2009; Costello et aI., 2010). Additionally, there is some evidence that suggests that the spread of nosocomial infections could be related to a breakdown in knowledge, attitude and practices among healthcare workers (Godin 1996; Pessoa-Silva et aI., 2005; Pittet et aI., 2006). What has not been established is if thisbreakdown is prevalent in novice registered nurses, suggesting the novice registered nurses’ inability to apply their knowledge in awork setting, or that it is in the more experienced registered nurses, suggesting either adecrement of knowledge (Ribby et aI., 2005; Lam et aI., 2004; PessoaSilva et aI., 2007; Suchitra et aI., 2007; Sax et aI., 2007) or a change in attitude and or sloppy practices possibly associated with stressful behavioral interactions with colleagues, workload or other organizational factors (Godin, 1996; Larson et aI., 2000; O’Boyle et aI., 2001; Chenot & Daniel, 2010). With health workers having the most contacts with patients, understanding their knowledge, attitudes and practice patterns with regard to nosocomial infections may be an important mode by which this health care issue may be addressed.
CHAPTER TWO
LITERATURE REVIEW
Overview
The World Health Organization (WHO) defines Nosocomial Infection as an infection acquired in hospital or other health care facility by a patient who was admitted for a reason other than the infection present during admission. This includes an infection acquired in the hospital, or other healthcare facility, but appearing after the patient’s discharge (WHO. 2002). Epidemiological studies reveal that nosocomial infections occur worldwide and to patients of all age groups. Surveys on the prevalence of nosocomial infections conducted under the auspices of World Health Organization (WHO) showed that 5% – 10% of all hospitalized patients are affected by nosocomial infections, with a higher prevalence for patients in intensive care units (WHO, 2002). Moreover, findings in epidemiological studies have shown the causative pathogens the modes of transmission and that the most frequent types of nosocomial infections are associated with the respiratory tract blood stream surgical wounds and urinary tract (WHO, 2002; Lo et aI., 2008).
Nosocomial infections take amajor toll on society and the overall morbidity and mortality associated with these infections are enormous. Complications from nosocomial infections often result in extended lengths of stays in the hospital and increased cost of healthcare (Emori et al.,
1991; Starfield et aI., 2000; Angus et aI., 2001; Zhan &Miller, 2003 and Engemann et aI., 2005).
The most common pathogens are the bacteria. About the year 1938, Price recognized that bacteria recovered from the human body could be divided into two categories: the resident flora (microbiota), or transient flora (Price, 1938). The resident microbiota, also commonly referred to as normal flora consists of bacteria mostly found in the superficial cells of the skin and has protective functions. However, these bacteria may cause infections in nonintact skin. The most dominant species of resident microbiota is Staphylococcus epidermidis. Transient rnicrobiota colonizes the superficial layers of the skin and is more amenable to removal by routine hand hygiene and such bacteria are often acquired by healthcare workers during direct contact with patients, or contaminated environmental surfaces, within the patient’s surroundings (Monarca et aI., 2000; Lepelletier, 2005; Ribby et aI., 2005, & Hayden et aI., 2006). The transmission of transient bacteria depends on the number of microorganisms on the surface, toxins produced during colonization, skin moisture, and the transmission of pathogens by healthcare workers (Price, 1938).
CHAPTER THREE
METHODOLOGY
Design
The design of this study was investigative, cross-sectional and descriptive. The researcher did not attempt to control or manipulate the variables under study, but rather examined how the variables varied with respect to each other.
Participants
Participants were recruited from a target population that included healthcare workers under the category of registered nurses and other healthcare practitioners. The participants were men and women aged 20 years or older recruited from databases of registered nurses including other health workers obtained from 63 health facilities in 8 L.G.A of Edo State. The database had more than 2000 members of alumni graduates from the nursing program together with other health professionals. Because the health facilities employed an associates in nursing with most of the graduates advancing their education and earning a Baccalaureate degree or Master’s degree, it was speculated that some of, the registered nurses would fall into any of the following educational categories: Associates in Nursing (AS). Bachelor’s in Nursing (BSN), Masters in Nursing (MSN) or higher. In addition, the registered nurses in this data base were asked to forward the survey to other registered nurses using the snowball sampling technique in order to increase the diversity of the sample and its size.
Recruitment flyers were also displayed on general information boards at health facilities, calling for volunteer registered nurses to participate in the study.
CHAPTER FOUR
RESULTS
This cross-sectional and descriptive study investigated the Knowledge, Attitudes and Perception of novice and experienced healthcare workers with regard to the spread of nosocomia infections. It also examined if a predictive relationship exists between Organizational support and the level of healthcare workers’ knowledge, attitudes and practices. Data was collected in two ways: on-line survey, and mailed paper and pen I pencil survey format over a6-month period. The survey was completed by health workers including registered nurses aged 20 years or older recruited from databases of alumni from the health facilities and by using a snowball sampling technique. A total of 434 responses were received. Of the 434 survey responses received, 81 (18.7%) were incomplete and 1survey respondent did not meet the inclusion criteria thus leaving a total of 352 (81.1 %) valid surveys for analysis with descriptive and inferential statistics using SPSS PC+ .
This chapter presents the results of the analysis of all valid responses and is divided into
six sections. The first section presents descriptive statistics for the demographics. The second section contains descriptive statistics on the participants’ Knowledge, Perception and Practices with regard to the spread of nosocomial infections. The third section reports the results on comparison of Knowledge, Attitudes and Practices between novice and experienced health workers and registered nurses regarding the spread of nosocomial infections and compares the relationship between these variables. The fourth section reports the responses of health workers regarding organizational support. The fifth section reports the results on relationship between organizational support and the health workers’ Knowledge, Attitudes and Practices nurses with regards to spread of nosocomial infections. The last section offers a discussion of the study findings from the perspectives of the health workers registered nurses’ Knowledge, Attitudes and Practices; addresses the impetus behind the findings and relates the findings with recent data on Nosocomial Infections from the Centers for Disease and Control.
CHAPTER FIVE
SUMMARY
Summarily, the verdicts in several studies reveal three broad categories of burdens placed on our healthcare system by nosocomial infections and many problems for patient safety: the increased cost of healthcare services, the unnecessary loss of human lives and the financial impact on families (Wenzel &Edmond, 2001; Zhan &Miller, 2003; Klevens et aI., 2007; Stone, 2008; Scott II, 2009). Many studies have shown the ease with which healthcare workers can spread nosocomial infections (Price, 1938; Lepelletier et al. 2005; McBryde et al. 2004; Michalopoulos et al. 2006).
Also, it has been documented in several epidemiological studies that healthcare workers
particlJlarly nurses are implicated in the transmission of nosocomial infections (Cohen et al. 2003, de-Oliveira et ai, 2005). in some sub-section of this dissertation study support the notion that the administrations of healthcare facilities have been supportive in instituting measures deemed necessary in reducing the spread of nosocomial infections. Such measures included hiring infection control practitioners; setting aside isolation rooms for patients with communicable diseases; providing disposable medical equjpment and disinfectants for healthcare workers’ use; increasing the nursing staff in order to ensure alow nurse-to-patient ratio and encouraging healthcare workers to participate in seminars and workshops regarding the spread of nosocomial infections. The significant relationship between organizational support and registered nurses’ knowledge where the facility had infection control practitioners, nurses knew their infection control practitioner, facilities provided suitable supplies and equipment, facilities had flyers and posters regarding nosocomial infections and family members questioned the healthcare workers if they determined non-compliance with hand hygiene guidelines by healthcare workers suggest that the role played by administration in healthcare institutions should not be ignored.
CONCLUSION
Bringing to conclusion, this study tackled several gaps in the writing by investigating conceivable reasons for the mystery behind the spread of nosocomial infections. Nosocomial infections have been recognized as a problem affecting the quality of health care and a standard source of undesirable healthcare outcomes. Within the sphere of patient safety, these infections have severe effects as they increase hospital stay days, result in increased utilization of hospital resources and additional therapeutic interventions and thus increase healthcare costs.
More outstandingly, these infections lead to superfluous deaths (Klevens et al. 2007). While the etiology of these infections is well understood, it has been extensively documented in the literature that healthcare workers are involved in the spread of nosocomial infections.
What is more, evidence suggests that the spread of nosocomial infections could be related to a breakdown in knowledge, perception, attitude and practices among healthcare workers (Godin 1996; Pessoa-Silva et aI., 2005; Pittet et aI., 2006).
Still, what has not been established is if this breakdown is prevalent in novice registered nurses, suggesting the novice registered nurses’ inability to apply learnt knowledge in a work setting, or in the more experienced registered nurses; suggesting either a decrement of knowledge or a change in attitude and I or sloppy practices possibly associated with stressful behavioral interactions with colleagues, workload or other organizational factors. Following the data obtained from survey respondents, the results of analysis showed that registered nurses, whether novice or experienced, are knowledgeable about nosocomial infections: their etiology, risk factors for their transmission and the recommended guidelines for reducing their spread. These findings suggest that education has played a key role in the implementation of strategies and protocols for reducing the spread of nosocomial infections. The high level of knowledge is attributable to the concerted efforts by nurse organizations. For example, strong curriculum for nurse education, uniform licensure requirements for new nurse graduates, the call for advancement in registered nurses’ education and stringent mandates from state Boards of Nursing that nurse practitioners demonstrate continuing education before their renewal of licensure might have contributed to the improved strategies of reducing the spread of nosocomial infections.
Lastly, the observed significant associations between organizational support with registered nurses’ Knowledge, perception and Practices lend support to the reduced occurrence of nosocomial infections. These findings affirm that nursing education and organizational support play a crucial role toward implementation of strategies known to reduce the spread of nosocomial infections.
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