Knowledge and Practice of Infection Control Among Midwives
CHAPTER ONE
RESEARCH AIM
In order to address the research question, the aim of the study is to determine the knowledge, attitudes and practices of nurses regarding infection prevention and control in Maiduguri.
RESEARCH OBJECTIVES
Based on the aim, the following objectives have been set for the study to determine:
- The knowledge of midwifes in infection prevention and control in Maiduguri.
- The attitude of midwife in infection prevention and control in Maiduguri.
- The practices of midwife in infection prevention and control in Maiduguri
- To make recommendations to the risk programme and policies in Maiduguri
CHAPTER TWO
LITERATURE REVIEW
INTRODUCTION
In this chapter, an overview of existing literature on the Hospital-acquired infection and aspects related to knowledge, attitude and practices of midwifes in infection prevention and control is presented. Due to limited studies conducted in Africa on this topic, the researcher decided to broaden the literature review to other continents. Broadening the literature review to other continents enabled the researcher to gather the latest and updated data on the topic. Furthermore, the literature review showed that infection prevention and control and hospital-acquired infections are not only a problem in Africa but also affect developed countries as indicated in the review. The review includes relevant research findings on knowledge, attitude and practice of nurses in infection prevention and control. The purpose of the literature review was to understand what is currently known about knowledge, attitude and practices of nurses in infection prevention and control. The role of nurses in infection prevention and control, as well as the impact of inadequate knowledge in infection prevention, were included in the literature review. Furthermore, the impact of negative and positive attitudes towards infection prevention and control and nurses’ understanding of the code of conduct regarding infection prevention and control was reviewed too.
LITERATURE REVIEW
The researcher identified key terms and variables in this case knowledge, attitude and practices in infection prevention and control among nurses to perform a literature review. Electronic databases such as PubMed was used to search for relevant articles and journals to perform a literature review. Textbooks as well as online articles were used to perform a literature review.
Hospital-acquired infection
Health-acquired conditions (HACs) are complications that originate from a stay in a clinical or hospital facility (Lobdell, Stamou & Sanchez 2012:65). Hospital-acquired infections are also known as nosocomial infections (Khan, Ahmad & Mehboo 2015:509-514). Hospital-acquired infection is an infection contracted by the patient
while receiving care in a health facility but not seen at the time of admission (Nejad, Allegranzia, Syed, Ellis & Pittet 2011:757-765). Hospital-acquired infections are the main challenge for low and middle-income countries with inadequate health-care resources (Shahida, Islam, Dey, Islam, Venkatesh & Goodman 2016:28-39). Health-care associated infections (HAI) is a major worldwide safety concern for both patients and health-care professionals (Nejad, Allegranzi, Syed, Ellis & Pittet, 2011:757-765). 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 (Shahida et al., 2016:28-39).
According to McQuoid-Mason (2012:353-354), hospital acquired infections may develop from surgical operations, urinary catheter, central lines and endotracheal tubes in intubated patients. According to Khan et al. (2015:509-514), 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. According to NICE (2014:5), 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.
Unnecessary and improper use of broad-spectrum antibiotics, especially in health care settings, is elevating nosocomial infection (Khan et al., 2015:509-514). Nosocomial infections can be prevented by practicing hand hygiene, identifying patients at risk of nosocomial infections and following standard precautions to decrease transmission (Mehta, Gupta, Todi, Myatra, Samaddar, Patil, Bhattacharya
- Ramasubban 2014:149-163). Infection prevention in special subset patients – burns patients, include identifying the source of the organism, identification of organisms, isolation if required, early removal of necrotic tissue, prevention of tetanus, early nutrition and surveillance (Mehta et al., 2014:149).
INFECTION-RELATED DISEASES
Mayo Clinic (2016:1) defines infectious disease as conditions caused by bacteria, viruses, fungi or parasites. Some infectious diseases can be passed from one person to the other while others are acquired by ingesting contaminated food. According to Mandal (2012:1), Staphylococcus is one of the five most common causes of infection following injury or surgery and it affects around 500,000 patients in American hospitals annually. The spread of Staphylococcus aureus (S. Aureus) is through air droplets and through direct contact with objects that are contaminated with the bacteria. Mandal (2012:1) states that S. Aureus can be prevented by observing good hygiene and regular hand hygiene. Moreover, the fatal strain Methicillin Resistance Staphylococcal Aureus may also be prevented from spreading by adopting proper hand washing habits. Infection-related diseases have adverse clinical and economic consequences. As indicated by Nathwani, Raman, Sulham, Gavaghan and Menon (2014:32), patients who acquire Multidrug Resistance Pseudomonas aeruginosa seem to have an increased death rate and length of hospital stay. The most common types of nosocomial infections are surgical wound infections, respiratory infections, genital-urinary infections and gastrointestinal infection (Shahida et al., 2016:33). According to Pasquale, Aliberti, Mantero, Bianchini and Blasi (2016:1) hospital acquired pneumonia is a frequent cause of nosocomial infection with mechanical ventilation demonstrating the main risk factor specifically ventilator-associated pneumonia.
CHAPTER THREE
RESEARCH METHODOLOGY
INTRODUCTION
This chapter includes the research methodology that was applied to determine the knowledge, attitudes and practices of nurses/Midwife regarding infection prevention and control in Maiduguri,Borno state, Nigeria. The research design, population and sampling procedures, data collection and data analysis methods are also discussed.
AIM OF THE STUDY
The aim of this study is to determine the knowledge, attitudes and practices of nurses regarding infection prevention and control within a tertiary hospital.
THE OBJECTIVES OF THE STUDY
The objectives of this study were to determine:
- the knowledge of nurses in infection prevention and control in Maiduguri
- the attitude of nurses in infection prevention and control in Maiduguri
- the practices of nurses in infection prevention and control in Maiduguri
- To make recommendations to the risk programme and policies of the tertiary hospital.
CHAPTER FOUR
RESEARCH FINDINGS
INTRODUCTION
In this chapter, the findings on the data collected and analysed are presented. The study results are described, discussed and analysed data is presented in tables, histograms and graphs. Data was analysed to determine nurses’ knowledge, attitude and practices in infection prevention and control at federal government Hospital in Maiduguri. The Statistical package (IBM SPSS version 22) was used to analyse data with the support of an experienced statistician from Stellenbosch University. The collected data was captured on to excel spreadsheet that was prepared by the statistician for the purpose of the study.
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATION
INTRODUCTION
Within this chapter, the study findings will be discussed in terms of the study aim and objectives along with the conceptual framework, study limitations, future recommendations and the conclusion of the research study.
DISCUSSION
The aim of the study is to determine the knowledge, attitude and practices of nurses regarding infection prevention and control within a tertiary hospital in Nigeria. Infection-related diseases are still the main cause of death in Nigeria according to the 2013 health profile acquired by World Health Organization (WHO) statistics.
According to WHO (2016:1) a huge gap still exists between the knowledge accumulated over the past decades and implementation of infection control practices. This gap is even deeper in poor-resource settings with devastating consequences. Every advance and investment in health care is undermined by breaches in infection control measures (WHO, 2016:1).
The current study revealed that 76.4% (table 4.13) of nurses did not receive appropriate vaccination regarding infection prevention and control. Furthermore, 61% (table 4.13) of the nurses indicated that personal protective equipment is not always accessible. Therefore, both patients and nurses are exposed to hospital acquired infections. The researcher has observed that nurses do not apply infection prevention and control measures in the hospital setting which is required to ensure patient safety. In agreement with the current study, 23.6% (table 4.13) of the nurses indicated that they do not wash their hands before and after direct contact with the patients. According to WHO the prevalence of hospital acquired infection (HAI) in Nigeria/Africa is high. However, 42.1% (table 4.13) of the nurses of the current study indicated that screening of patients to detect colonization even when there is no evidence is not done at the tertiary hospital. These findings are in agreement with Razine, Azzouzi, Barkat, Khoudri, Hanssouni, Chefchaouni and Abouqua (2012:1) who determined the prevalence of HAI in the University Medical Center of Rabat, Morocco. The study revealed that HAI prevalence was 10.3%. Urinary tract infection.
RECOMMENDATIONS FOR FUTURE RESEARCH
- Barriers affecting compliance to infection prevention and control measures among nurses.
- The role of policy makers, stakeholders and government leaders in infection prevention and control in a clinical setup.
- The impact of the shortage of nurses on infection prevention practices.
- The perceptions and knowledge of nurses against Hepatitis B vaccinations with regard to infection prevention and control.
- The wrong usage of antibiotic and its impact on infection prevention and control.
CONCLUSION
Based on the findings, it is evident that lack of personal protective equipment is one of the barriers to infection prevention and control (61%). The study further revealed that workshops relating to infection prevention and control (IPC) are poorly organised as 86.7% of the nurses did not attend workshops related to IPC yearly. Vaccination against preventable infections is not a priority as 96.4% of the nurses did not receive any vaccinations. Therefore, it can be concluded that nurses in the current study have a satisfactory level of knowledge and positive attitude towards infection prevention and control. However, the practice of infection prevention and control scores were poor (Table 4.6), hence posing a risk of infection transmission leading to increased rates of hospital acquired infections.
References
- Abbas, M. & Pittet, D. 2016. Surgical site infection prevention: a global priority.
- Journal of Hospital Infection 93(4):319-322. Available at:
- www.journalofhospitalinfection.com/article/s0195-6701 (16)30127-X/full text.
- Advisory Committee on Dangerous Pathogens, 2015. Management of Hazard Group 4 viral haemorrhagic fevers and similar human infectious disease of high consequence, ACDP: 1-103.
- Arthi, E., Abarna, V., Bagyalakshmi, R., Anitharaj, M. & Vijayasree, S. 2016. Assessment of Knowledge, Attitude and Practices of hand hygiene among nursing and medical students in a tertiary care hospital in Puducherry, India. International Journal of Contemporary Medical Research, 3(4):1203-1206.
- Ambulatory Surgical Center Quality Collaboration. 2016. Safe Injection Practices
- Toolkit. Available at:https://www.google.co.zm/?gfe-rd=ssl&ei=8982V8nQKYnFaN6KkcgE#q=ASC+quality + collaboration+ injection+safety. [Date accessed: 16 November 2015]
- Aftab, H.B., Zahid, M.F., Zia, B., Reaheem, A. & Beg , M.A. 2015. Knowledge, Attitude, and Practices of healthcare personnel regarding the transmission of pathogens via Fomites at a tertiary care hospital in Karachi, 3(1):208.
- Anderson, D.J., & Sexton, D.J. 2016. Antimicrobial prophylaxis for prevention of
- surgical site infection in Adults. Available at: http://www.uptodate.com/contents/antimocrobial-prophylaxis-for-prevention-of-surgical-site-infection-in-adults. [Date accessed: 20 June 2016]
- Benson, S. & Powers, J. 2011. Nursing Made Increasingly Easy, 9(3):36-41.
- Bhebhe, L.T., Rooyen, C.V. & Steinberg, W.J. 2014. Attitudes, Knowledge and Practices of health care workers regarding occupational exposure of Pulmonary Tuberculosis. African Journal of Primary Health Care & Family Medicine , 6(1):597.
- Brink, H., Van der Walt, C. & Van Rensburg, G. 2012. Fundamentals of Research Methodology for health care professionals. 3rd edition. Cape Town: Juta.