Knowledge, Attitude, and Practice of Standard Precautions Among Healthcare Workers in Federal Medical Centers, Owo
Chapter One
Objectives of the study
General objective
To assess health care workers’ knowledge, attitude and practice precautions and associated factors in Federal Medical Centers, Ondo state, from June 10 to 30, 2021.
Specific Objectives
- To assess health care workers practice of standard precautions
- To assess factors associated with health care workers practice of standard precautions
CHAPTER TWO
LITERATURE REVIEW
Health care workers practice of standard precaution
A cross-sectional study of HCWs in various health settings showed varying levels of practice of standard precautions. Hand hygiene compliance is 86.3 %, 77.7 %, 57% and 35 % in India, Nigeria, respectively. concerning sharp handling practices is 52 %, 69.3 %, 78.9 %, and 66.6 %, never recap needles. In terms of PPE practices, 18.1 % of HCWs had good appropriate utilization PPE, 87.2 % had good PPE practices, 91.6 % of HCWs wore gloves before handling patients, and 73.5 % wore gowns when performing procedures in India, Ondo state town, northern Nigeria, and Nigeria, respectively.
A cross-sectional study conducted from the three hospitals, among 300 HCWs in Trinidad and Tobago, 86.3% of HCWs always wash their hands with soap and water after taking a sample, while 83.1% wash their hands immediately after coming in contact with blood and body fluids. 94% of HCWs dispose of sharp materials in a safety box and 95.7% of workers dispose of used needles in its designated bin, 52% never recap their needles after use and 67.3% of HCWs never had a NSI. In general, from this study 32(44%) of HCWs had good practices while 168 (56%) of HCWs have poor practices (Unakal et al., 2017).
A cross-sectional study was done among 862 healthcare providers working in two tertiary health care institutions in Chennai and Madurai (India), appropriate use of PPE among the healthcare professionals was only 156 (18.1%). The reason for the inappropriate use of PPE was non- availability (Archana et al., 2018).
Another finding from a study conducted in Public Hospitals of Nigeria, among 332 HCWs indicates that compliance with various aspects of standard precautions also differs among HCWs. In this study, it was found that compliance to hand washing before and after patient care was 77.7%. Hand washing before and after glove use was 67.8%, wearing gloves when touching blood/body fluids 95.5%, gloves before touching mucous membrane and non-intact skin 91.6%, wearing gown/apron to protect when carrying out procedures 73.5% (Esu et al., 2019).
Similarly, in a study conducted in northern Nigeria among 421 HCWs of private and public health facilities, the study result indicates that only 70.1% usually wear gloves before handling patients or patients’ care products, but 2.6% reported handwashing before wearing the gloves, 10.7% wash hands after removal of gloves, and 72.4% change gloves after each patient contact . About 20.2% usually wear a face mask and 35.6% wear protective garments when necessary. Furthermore, 14.3% reported that they do not sterilize instruments before use and 39.7% could not disinfect working surfaces when necessary. Only 3.3% of the respondents reported reuse of needles and blades and 5.7% reuse disposable items regularly. Only 3.3% had a sharp disposal system in their workplaces. The majority of, 98.6%, the respondents reported that the major reason for non- compliance to universal precautions is the non-availability of the equipment. However, 39.7% reported that they do not have a functioning autoclave (Amoran and Onwube, 2013).
A facility-based cross-sectional study conducted in Ghana among 100 HCWs from two health facilities shows that many HCWs were non-compliant with standard precautions, only half of the respondents protect themselves against BBFs. Very few respondents always wear eye protection and waterproof aprons and about a third of(33,4%) respondents recap needles after use and always report NSIs (Akagbo et al., 2017).
A cross-sectional study on 772 participants was undertaken at public hospitals in Addis Baba. Approximately, 61.5% of the participants always changed gloves between patient contacts, and 21.11% of them always recapped used needles. Out of the standard precautions practice elements, only safe injection management was practiced above fifty percent (50%). Of the participants, 57.6%, 28.4%, 8.7,2.9% and 2.5% washed their hands always, often, sometimes, seldom and never, respectively, after any direct contact risk experience of respondents were 29.63 (6.95%) and 6.04 (6.02%) year overall SP compliance 66.1% (Angaw, 2019).
Another cross-sectional study in Ondo state zone of Nigeria found that 145 (58.8%) of 250 study participants have good hand hygiene practices, 218 (87.2%) have good PPE practices, 222 (88.8%) have good injection safety practices, 169 (67.6%) have good sharps handling practices, and 202 (80.8%) have good instrument processing and waste management practices and over all compliance standard precautions was 65% (Beyamo et al., 2019).
CHAPTER THREE
METHOD AND MATERIALS
Study Design
An institutional-based quantitative cross-sectional study was undertaken in Federal Medical Centers, Owo, Ondo state.
Population
Source of Population
The source population was all HCWs working in Federal Medical Centers, Owo.
Study Population
The study population was all HCWs in private and public hospitals who had at least six months of work experience. They included physicians, nurses, laboratory technician, midwifery, Anesthetists, and pharmacy.
Inclusion and Exclusion Criteria
Inclusion criteria
All hospital HCWs with a minimum of six months and above were included in the study.
Exclusion criteria
HCWs who were on annual leave, on maternity leave, and ill during data collection were excluded from the study.
CHAPTER FOUR
DATA ANALYSIS AND RESULT
Socio-demographic characteristics of health care workers
The total number of health care workers participated in the study was 442 which makes a response rate of 97.5%( with 12 non resondants). More than half of the respondents, 231 (53%), were females and the majority of respondents’, 278 (63%), were married. Nearly three-fifth of respondents’ were between the age range of 25-30 years and about two-fifth were nurses by their profession. 265(60%) of the participants were first-degree holders. Interms of hospitals kind, governmental hospitals accounted for 43% of the total, while private hospitals accounted for 57%. Interms of leve, Secondary, tertiary, and primary hospitals accounted for 4(57%), 2 (29%), and 1 (14%), respectively (Table 3).
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATION
Discussion
The current study revealed that overall compliance with SP among HCWs in Federal Medical Centers, Owo was 41% [95% CI =36.7, 45.9)], implying that 4 out of every 10 HCWs followed SPs. As a result, 6 out of every 10 HCWs may be exposed to occupational risk, particularly nosocomial infection. However, the level of compliance in this study is lower than when compared to a study conducted in Ondo state zone (65%) and Lagos state (66.1%) (Angaw, 2019; Beyamo et al., 2019), but higher than a study conducted in hdya zone (15%) (Yohannes et al., 2019). This discrepancy could be attributed to differences in the study site, participants, study period and availability of resource to implement standard safety precauation, as well as poor supervision, workload, and HCWs irresponsibility. For instance, the practice of following standard precautions was aided by continuous guidance, training, real-time feedback and educational interventions would provide all HCWs with the required necessary information (Mpamize, 2016).
Accordingt to a recent study, HCW compliance is higher in private hospitals compared to in public hospitals. This research is similar to a study done in Tanzania. According to a Tanzanian study, private facilities had nearly double the chance of obtaining recommended IPC level compared to public facilities (Kinyenje et al., 2020). This could be attributed to lower patient volumes, superior individual expertise availability, dedication to duty, or HCWS commitments to carry out routine activities more efficiently than public hospitals (Oli et al., 2016).
HCWs with 2-5 years and 6 years of experience were more likely to follow SPs than these with less than two years of experience which is similar with a study conducted in the Bale zone (Zenbaba et al., 2020). Therefore, HCWs with a longer year of experience are more compliant than these with a shorter stay. This could be due to that HCWs with many years of experience had enough knowledge about infection-prevention procedures, disease transmission mechanisms, and disease prevention methods; because they might attend more seminars, conferences, and training sessions. For instance, according to Vaz & Mcgrowder ,2010 the longer a stay in the field is the more likely they are to be aware of universal precautions.
HCWs in facility where a steady water supply were more compliant SPs when compared to these working in the facility with no continuous water supply. The result is lower than a finding in Hawassa teaching and referral hospitals which shows that the HCWs who had running tape water in their workroom were approximately three times more likely to be compliant than these who did not have (Bekele et al., 2020). These differences may be due to availability and accessibility of water in different setting. Auhors explained that a pleasant environment, as well as adequate supplies of basic necessities such as water, contributes to a greater compliance with IPC principles (Loftus et al., 2012; Thomas et al., 2009).
Healthcare workers with availability PPE were more likely to follow standard precautions than those who did not have access. In the present study, it is lower than a study in the Ondo state (Beyamo et al.,2019) which indicates that individuals with availability PPE were approximately ten times more likely than those without availability PPE. This disparity could be health-care professionals’ unwillingness to follow standard protocols, as well as a lack of infection-control supplies and equipment such as masks, goggles, and alcohol-based hand rub, which have been identified as obstacles to following standard precautions. The problem of non-practice of standard precautions measures was aggravated by a lack of supplies and equipment (Lee, 2009).
HCWs who had access to IP guidelines were more compliant SPs compared to those who did not have. The current study result is lower than a finding from in Hydya zone which reported that with access to IP guidelines were 2.5 times more likely to follow standard precautions than these without (Yohannes et al., 2019).This could be due to increased understanding and dedication to standard measures as a result of having access to the document. The mismatch could be because of the lack of access to the document that led to a failure to follow standard precaution procedures.
According to the authors, professional attitudes and beliefs play a role in the implementation of universal precautions (DeJoy et al., 2000). In this study, 51.8% of study participants had a positive attitude regarding infection prevention SP compliance. This result is lower than that of a study conducted in Wolaita Sodo (93.4%) (SH et al., 2017) and Lagos state (80%) (Biniyam et al., 2018). Differences in educational attainment, support super vision, HCW motivation, job experience, and HCW awareness could all contribute to this imbalance. However, evidence suggests that IP committees’ monitoring, encouragement, and initiative role may increase HCWs’ positive attitudes regarding IP (Berriós-Torres et al., 2017).
Handwashing is taken as the most important and effective approach for reducing the spread of diseases and infectious organisms (Alemu et al., 2015; Workers et al., 2015). In this study, 27% of HCWs wash their hands with soap and water every time when coming into touch with body fluids, and 27.4% wash their hands after coming into contact with body fluids. The result is lower than a study conducted in India in Trinidad and Tobago. After taking a sample, 86.3% of HCWs always wash their hands with soap and water, and 83.1% wash their hands soon after coming into contact with blood or body fluids (Unakal et al., 2017). These discrepancies could be attributed by a lack of SPs supplies, awareness initiatives, availability of supplies, and awareness initiatives for these standard measures. Authors also declar that, after attending an educational symposium or participating in a 30-minute training program, compliance with recommended precautions increased from 48% to 74% (Peponis et al., 2017; Wolf, 2005).
Regarding waste segregation, one- tenth of HCWs always dispose infectious medical waste in the yellow colored-coded dustbin, which is below the WHO standard which requires a minimum of 80% adherence . Such significant differences may be attributed by lack of dedication to waste separation practices, a lack of color coded waste collecting bins. This problem was also analyzed through observation of the present study.
Conclusion
Two-fifth of health care workers compliance to standard precautions and availability of consistent water supplies, availability of Personal Protective Equipment, types of hospital, service year, access to infection prevention guideline and attitude were independently associated with compliance with infection prevention standard precautions.
Recommendation
To Owoal health office and Owo zonal health office
- The Owoal health office and the Owo zonal health office should give and will organize a mandatory seminar, workshop, or training for health care workers to ensure that infection prevention standard precautions are properly
- Regular assistance and support of supervision is required to each hospitals
To hospitals
- Each hospital administrator must address insufficient standard precaution supplies such as personal protective equipment (PPE), waste collecting bins, hand hygiene items, water
- To improve compliance and implementation of infection prevention standard precautions, each hospitals IP committee should be organized, and frequent support supervision should be
- Further investigation is neede to distinguish between the levels of HCWS compliance in private and public
REFERENCES
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- Amoran, O. E., & Onwube, O. O. (2013). Infection control and practice of standard precautions among healthcare workers in northern Nigeria. In Journal of Global Infectious Diseases (Vol. 5, Issue 4, pp. 156–163). https://doi.org/10.4103/0974-777X.122010.
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