A Study of Knowledge and Compliance With Infectious Disease Control Among Pre-service Final Year Students of Middle Level Healthcare Provider Institution in Nigeria
CHAPTER ONE
OBJECTIVES OF THE STUDY
General Objective:
The main objective of the study is to elicit the knowledge, attitudes and practices of Pre-service final year students regarding compliance with infectious disease control in Middle level healthcare provider institution, Nigeria.
Specific Objectives:
The specific objectives are to:
- assess the knowledge of medical students regarding compliance with infectious disease control in Middle level healthcare provider institution.
- examine the attitude of medical students regarding compliance with infectious disease control in Middle level healthcare provider institution.
- assess the level of medical students practices on compliance with infectious disease control in Middle level healthcare provider institution
CHAPTER TWO
LITERATURE REVIEW
INTRODUCTION
This chapter will identify and enlightens the knowledge, attitudes and practices of pre-service final year students regarding compliance with infectious disease controls. The review of the related literature will be discussed under the following headings: concept of infectious disease, Infection prevention and control, Pre-service final year students role in infection prevention and control, Standard precaution, Management of patient environment; Patient outcome in the clinical environment, Knowledge towards infection prevention and control; Hand hygiene, Attitudes towards infection prevention and control; injection and sharp safety, Practices towards infection prevention and control; use of personal protective equipment, Patient education, Hospital surveillance, and Negligence.
CONCEPT OF INFECTIOUS DISEASE CONTROL
Hospital infections are infections that are acquired in the health care facilities that were not present or incubating at the time of the client admission. It includes those infections that become symptomatic after the client or patient is discharged as well as infections among medical personnel, who fail to practice proper procedure in care of patient. (14)Compliance on the part of health care workers with standard precautions has been recognized as an efficient means to prevent and control hospital infections or healthcare-associated infections. Such measure does not only protect the patient, but also Health care workers and the environment (14).
Studies throughout the world document that hospital acquired infections are a major cause of morbidity and mortality. A high frequency of hospital infections is evidence of a poor quality of health services delivery and leads to avoidable cost. Many factors contribute to the frequency of infection acquired in the hospital. Hospitalized patients are often immune-compromised, they undergo invasive examinations, treatments, and patient care practices and the hospital environment may facilitate the transmission of micro-organisms among patients. Progress in the prevention of hospital infections has been made; changes in medical practices continually present new opportunities for development of infections(15).
Infectious disease is a major worldwide safety concern for both patients and health-care professionals. Risk factors include lack of proper health care facilities such as isolation units, sinks, bed space; appropriate waste management, decontamination of equipment and hand hygiene facilities(16).Organisms that are frequently involved in hospital-acquired infections include Streptococcus spp., Acinetobacter spp., enterococci, Pseudomonas Aeruginosa, Coagulase-negative staphylococci, Staphylococcus aureus, Bacillus cereus, Legionella and Enterobacteria family members. These micro-organisms can be transferred from person to person, environment and contaminated water and food, infected individuals, contaminated health care personnel’s skin or contact via shared items and surfaces(17). Health care associated infections can develop either as a result of health care intervention (such as medical or surgical treatment) or from being in contact with a health care setting. They can worsen current or primary conditions, increase the length of hospital stay and increase mortality rates(17).
Lack of knowledge and improper use of broad-spectrum antibiotics, especially in health care settings, is elevating infectious disease (18). Infectious diseases can be prevented by practicing hand hygiene, identifying patients at risk of infectious diseases and following standard precautions to decrease transmission(19).
CHAPTER THREE
METHODOLOGY
INTRODUCTION
This chapter will present and describe the totality of the research methodology to be employed for the study. It will provide procedure outline for the conduct of this project study through systematic investigation of relevant variables of interest. The procedure to be adopted for this research workcomprises research design, research setting, target population, sample size determination, sampling technique, intervention, research instrument, reliability and validity, inclusion and exclusion criteria, data collection and data analysis procedure and ethical consideration that will be apply to determine the knowledge, attitudes and practices of pre-service final year students regarding infection compliance with infectious disease control.
RESEARCH DESIGN
A quantitative, descriptive study will be used. It is suitable for this research work because it will allow the researcher to make careful record of what will be observed in such a way that information obtained from a representative sample of the population will be properly analyzed. This will help to minimize errors and enhance good interpretation of the results.
RESEARCH SETTING
This research setting will be confine to the Knowledge, Attitude and Practice of medical students at the Middle level healthcare provider institution with emphasis to compliance with infectious disease control. The Hospital is a government tertiary health facility in Imo State with different units and sections such as Pediatric, Surgical, Medical, Maternitywards; others are laboratory, casualty and outpatient units.
TARGET POPULATION
The target population for this study are pre-service final year students working in University of Middle level healthcare provider institution which comprise of:Doctors (), Nurses (), Medical Laboratory Scientist (), Community Pre-service final year students (), Making total population of ().
CHAPTER FOUR
DATA ANALYSIS AND RESULTS INTERPRETATION
INTRODUCTION
This chapter deals with the findings obtained from the study as pertains to respondent demographics, their knowledge, attitudes and practice concerning infectious diseases and their prevention. A total of 292 questionnaires were distributed and the same number received for analysis giving a response rate of 100%.
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATIONS
INTRODUCTION
This chapter deals with discussion of study findings, conclusions arrived at and recommendations derived.
DISCUSSION
A total of 292 respondents took part in the study giving a response rate of 100%. The demographics of our study population were that of a mainly youthful age distribution, predominantly male (68%), Our population was mainly Christian (69.18%) while the rest were Muslims. On the year of study, third years (41.78%) and fourth years (33.56%) made the largest contribution of respondents. This would imply that their knowledge concerning infectious diseases and prevention would still be fresh as was recently taught to them during microbiology and immunology in Biomedical classes or during the clinical orientation offered to all medical students moving over from Biomedical to clinical years.
All the respondents had fully completed at least one clinical rotation among the four, vis; Internal Medicine, Surgery, Pediatrics and Obstetrics and Gynecology. This would imply that all of them would have had ample time to interact with patients and were encountered with situations where prevention of infectious diseases was needed. Of more importance is the fact that within the 30-day period prior to the conduction of the study, all of the respondents had interacted with patients; the majority having interacted with between 10 and 20 patients in their respective rotations.
The respondents’ knowledge base and attitudes as far as infectious diseases is concerned was impressive. All 292 knew what infectious diseases were going ahead to offer the correct description and even going further to give the standard precautionary measures against infectious diseases. This excellent knowledge level could be implied to be attributed to the various forms of training they have been receiving over the years e.g. biomedical classes and clinical orientation.
It comes as a great shock therefore, that this high degree of knowledge, awareness and positive attitudes seen has little translated into practice. For instance, HBV vaccination among the respondents was very low at 30.14%. This means that only 88 of the total 292 had received vaccination against this highly contagious infection, especially in a hospital setting. To compound the problem, of these 88, only 54 had received the complete regimen of three doses. This means that only 18.49% of the respondents had achieved effective immunity against HBV. In as far as handwashing and hospital waste disposal is concerned, practice still leaves much to be desired. Only 40(13.70%) practiced hand washing after coming into contact with items or environment surrounding the patient knowing very well that these are sources of germs that can be picked from one patient to the next and cause infection in a susceptible host. Their disposal of medical waste need some improvement for we see them dumping all waste in the safety box knowing that different specially designated bins exist for different type of medical waste. Handling of blood and/or body fluids and needle stick injuries also need much improvement. Reporting of such accidents to the supervisor in charge is a key component of prevention of nosocomial and all infections in general, something the respondents seemed to overlook or omit. It is not all gloom though, as their constant and proper use of PPEs is uplifting. For instance, the respondents’ use of gloves on all patients when needed and not only on HIV suspected or HIV positive cases need to be applauded.
Despite much needing to be done as far as KAP of our study respondents concerning infectious diseases, studies elsewhere have had worse results. Nepalese pre-service final year students, for instance, were found to be worse of. Only 16%, 14% and 0.3% of the respondents had high scores for knowledge, attitude and practice respectively (Paudyal et al., 2008). Our study respondents also unanimously (100%) agreed that that all patients are a source of infection as opposed to only 41.8% of pre-service final year students in (Amin et al., 2013) study among medical students. Saudi medical students were not better placed either. Their knowledge level was found to be far much lower than that of our study(Amin et al., 2013). The reports were similar among Nigerian pre-service final year students in 2012. 50% of them had no knowledge of universal precautions of infection control(Amoran & Onwube, 2013).
The poor practice as far as medical waste disposal is concerned was also seen among third year dental students in India back in 2013. 67.5% were not even aware of correct waste disposal methods for needles and sharps(Gambhir et al., 2013). On the side of handwashing, our study findings are far worse than the 43.30% of Nigerian pre-service final year students who did not know that their hands had to be washed before and after patient care and also, despite them having a lower handwashing compliance (38.78%) (bello et al., 2011), the compliance in our study is far much lower.
CONCLUSION
Medical students of KIU, despite having excellent knowledge and good attitude towards infectious diseases, the translation of this knowledge into practice leaves quite a lot to be desired. Their uptake of the HBV vaccine is very low the key factor being cost implications. More needs to be done in terms of educating the incoming and continuing clinical students on proper protocols pertaining prevention of nosocomial and infections at large.
RECOMMENDATIONS
To the Students
- Translate their excellent knowledge and good attitude concerning infectious diseases into good preventive practice.
- Strive to get vaccinated against HBV since it is a highly contagious infection that quickly spreads especially in the clinical setting where patients can infect unimmunized pre-service final year students who further spread to other patients they get to serve.
- Always strive to report to the appropriate supervisor in cases of accidents in the clinical setting involving sharps, blood and body fluids for the appropriate measures to be taken.
To UITH Hospital Administration
- Ensure that the installed alcohol wash dispensers are always refilled and at no given time is there no clean water supply in the wards and taps are fully functional.
- Facilitate full immunization of all clinical staff, students included, against HBV at a subsidized cost if not for free.
REFERENCES
- Amin, T. T., Al Noaim, K. I., Bu Saad, M. A., Al Malhm, T. A., Al Mulhim, A. A., & Al Awas, M. A. (2013). Standard precautions and infection control, medical students’ knowledge and behavior at a Saudi university: the need for change. Global Journal of Health Science, 5(4), 114–125. https://doi.org/10.5539/gjhs.v5n4p114
- Amoran, O., & Onwube, O. (2013). Infection control and practice of standard precautions among medical students in northern Nigeria. Journal of Global Infectious Diseases, 5(4), 156. https://doi.org/10.4103/0974-777X.122010
- Ariyaratne, M., Gunasekara, T., Weerasekara, M. M., & Kottahachchi, J. (2013). Knowledge , attitudes and practices of hand hygiene among final year medical and nursing students at the
- University of Sri Jayewardenepura, 15–25. https://doi.org/DOI: http://dx.doi.org/10.4038/sljid.v3i1.4761 Key
- Bello, A. I., Asiedu, E. N., Adegoke, B. O. a, Quartey, J. N. a, Appiah-Kubi, K. O., & OwusuAnsah, B. (2011). Infectious diseases: knowledge and source of information among clinical health care students in Ghana. International Journal of General Medicine, 4, 571– 574. https://doi.org/10.2147/IJGM.S16720
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- Dasgupta, S., Das, S., Chawan, N. S., & Hazra, A. (2015). Infectious diseases in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian Journal of Critical Care Medicine : PeerReviewed, Official Publication of Indian Society of Critical Care Medicine, 19(1), 14–20. https://doi.org/10.4103/0972-5229.148633
