Measures Utilized for Prevention of Nosocomial Infection in the Labour Ward of University of Calabar Teaching Hospital (UCTH), Calabar (Nursing Science)
CHAPTER ONE
Objectives Of Study
- To ascertain the level of knowledge of nosocomial infection among nurses in UCTH, Calabar.
- To identify the nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar.
CHAPTER TWO
LITERATURE REVIEW
Introduction
In this chapter, related literature on nosocomial infections and nurses’ measures toward the prevention of nosocomial infections will be reviewed. This will be discussed under subheadings as follows;etiology of nosocomial infections, causes and transmission of nosocomial infections, standard measures for nosocomial infection treatment, measures for nosocomial infections, nurses’ knowledge of nosocomial infections, nursing measures utilized for the prevention of nosocomial infections and conceptual framework.
Etiology of Nosocomial Infections
Numerous epidemiological studies have documented that nosocomial infections are commonly caused by pathogens such as bacteria, fungi, parasites and viruses transmitted from one patient to another through indirect or direct contact (Edwards, Peterson, Mu, Banerjee, Allen-Bridson, Morrell, Dudeck, Pollock & Horan, 2009). The most common pathogens are the bacteria. In 1938, it was established that bacteria recovered from the human body could be divided into two categories: the resident flora (microbiota), or transient flora. 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 non-intact skin. The most dominant species of resident microbiota is Staphylococcus epidermis. 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 (Hayden et al., 2006). The transmission of transient bacteria depends on the number of microorganisms on the surface, toxins produced during colonization, skin moisture, and the transmission ofpathogens by healthcare workers (Abbo, Navon.venezia, Hammer-Muntoz, Krichali, Siegman-Igra, & Carmeli, 2005). The most common types of transient bacteria implicatedin nosocomialinfections are the Staphylococcus aureus, Escherichia coli, {3eta-hemolytic Streptococci, Serratia mercescens, Klebsiellapneumonia, Pseudomonas aeruginosa, Enterobacter species and Clostridium difficile. The affected bodysystems depend on the virulence ofthe pathogens and the body system affected. Some ofthe bacteria become highly resistant to multiple classes of antimicrobial agentsincluding antibiotics such as Methicillin and Vancomycin(Hayden et al., 2006). The resistance of bacteria to antimicrobial agents requires prescription of more potent and expensive classes of antibiotics and they contribute to extended hospital stay days, and ultimate increased cost of healthcare (Scott II, 2009).
The causative agents of nosocomial infections are commonly present in hospitals and other healthcare facilities and may be transmitted from one source to susceptible hosts by more than one route. For example, some of the pathogens are transmitted by “direct contact between the healthcare workers and patients or by “indirect contact with environmental surfaces and inanimate objects, or by air. The most common method of transmission of nosocomial infections from an infected patient to a susceptible patient, often via the contaminated hands of healthcare workers, is “direct contact” (De Oliveira, White, Leschinsky, Beecham, Vogt, Moolenaar, Perz & Safranek, 2005).
CHAPTER THREE
RESEARCH METHOD
This chapter focuses on the research design, research setting, research population, sample and sampling technique, instrument for data collection, method of data collection, procedure for data analysis and ethical consideration
Research Setting
The study was conducted in University of Calabar Teaching Hospital (UCTH), situated in Calabar Municipality and was founded in the year 1979. It is a tertiary health care facility located in the South-eastern area of Calabar.
The UCTH serves as clinical area for teaching medical, nursing, medical laboratory science, radiography and other health related students. It also provides specialist clinical services as well as promotion of scientific knowledge through research. At the apex of administration is the Chief Medical Director. There are several departments in the hospital which include Medical, Nursing, Pharmacy, Medical Laboratory and Medical Records Departments. The hospital runs 24 hours service and offer preventive and curative health care services.
The hospital is also made up of twenty-five (25) wards and units, with 392 bed complements and 118 cots, amongst which are Casualty Ward; Diarrhoea Treatment and Training Unit (DTTU); Eye Ward; Ear, Nose and Throat (ENT) Ward; Male Medical Ward; Male Surgical Ward; Female Medical Ward; Female Surgical Ward; Paediatric Medical Ward; Paediatric Surgical Ward; Male Orthopaedic Ward; Female Orthopaedic Ward; Cardiothoracic Ward; Intensive Care Unit (ICU); Gynaecological Ward; Ante-natal Ward; Post-natal Ward; Labour Ward; Special Care Baby Unit (SCBU); and Sick Baby Unit (SBU). The Nursing services department has at its apex the Assistant Director of Nursing Services (ADNS) with 580 nurses.
The labour ward of University of Calabar Teaching Hospital (UCTH), Calabar has eight (8) Chief Nursing Officers (C.N.O.), four (4) Assistant Chief Nursing Officer (A.C.N.O.), two (2) Principal Nursing Officers (P.N.O.), two (2) Senior Nursing Officers (S.N.O.), three (3) Nursing Officer I (N.O.I), six (6) Nursing Officer II (N.O.II) and eight (8) Health Assistant (H.A.).
Research Design
A descriptive study was used to investigate nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar.
CHAPTER FOUR
DATA ANALYSIS AND RESULT PRESENTATION
This chapter focuses on the results of the findings emanated from the study. The data are presented according to the research questions of the study.
Socio-demographic data
The results in table 1 showed the socio-demographic data of the respondents.
Age: The results of the socio-demographic data indicates that 25(73.53%) were between 25-29 years of age, 5(14.71%) were between 30-34years and4(11.76%) were between 35-39 years.
Gender: The results in Table 1 revealed that all 34 respondents were females.
Professional qualification: Out of the 34 respondents used for this study, 26(76.47%) had obtained RN/RM professional qualification while 8(23.53%) had obtained B.N.Sc. professional qualification.
CHAPTER FIVE
DISCUSSION OF FINDINGS
Introduction
This chapter deals with the discussion of findings in relation to the purpose of the study which was to investigate nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar.
Nurses’ knowledge of nosocomial infections
From the findings of this study it was revealed that majority of the respondents, possessed good knowledge of nosocomial infections (94.12%) while minority possessed poor knowledge of nosocomial infections (5.88%). This supportsthe study carried ofSherwood (2008)who documented that a solid background knowledge of epidemiology and micro-organisms would empower nurses with sufficient confidence to question practices and depend on their own ability to make informed decisions. This is not in line with the study of Saka & Adebara(2011) who discovered that poor knowledge on infection prevention was observed, disinfectants such as 0.5% chlorine solution was most commonly used in private hospitals even though the practice of aseptic hand washing was good.
Nursing measures utilized for the prevention of nosocomial infections
From the findings of this study, it showed that the nursing measures used for the prevention of nosocomial infections by nurses in UCTH, Calabar are as follows; gloves, hand washing (hand hygiene), gowns and eye protection devices such as goggles. This does not supports the study of Ogunsola & Adesiji (2008), where they documented that most wards in Nigerian hospitals lack adequate facilities for effective hand hygiene and use the bucket and bowl method as an alternative to running water. This findings does not support the work of Nazarko (2009), who discovered that nurses often fail to practice hand hygiene because they are busy and they feel hand hygiene takes up precious time. This findings support the work of Saka & Adebara (2011), who carried out a study on prevention of nosocomial infections in the new born: the practice of private health facilities in rural communities of Nigeria and discovered that only 29.4% of the hospital health care providers wore protective rubber gloves. This is inline with the study of MaryRocha, Adenicia & Janaina (2010), who conducted a study to evaluate the practice of hand washing, and discovered that there exist the use of gloves and the handling and disposal of needle sticks and other sharp objects among nurses.
Research Hypothesis
There is no significant relationship between the level of knowledge of nosocomial infection and nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar.
The results of the Chi-square test revealed that that there is a significant relationship between the level of knowledge of nosocomial infection and nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar. This findings is in line with the findings of Sherwood (2008) who suggested that a solid background knowledge of epidemiology and micro-organisms would empower nurses with sufficient confidence to question practices and depend on their own ability to make informed decisions.
Summary
The purpose of the study was to investigate nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar. A descriptive stud design was used with a well-structured questionnaire. Data was collected from 34 nurses working in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar.
Majority of the respondents possessed good knowledge of nosocomial infections (94.12%). The findings in this study also revealed that the nursing measures used for the prevention of nosocomial infections by nurses in UCTH, Calabar are as follows; gloves, hand washing (hand hygiene), gowns and eye protection devices such as goggles. The study revealed a significant relationship between the level of knowledge of nosocomial infection and nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar.
Conclusion
Based on the research findings, it was concluded that when nurses possess good knowledge of nosocomial infections it will always result in the good practice of nursing measures used for the prevention of nosocomial infections such as; gloves, hand washing (hand hygiene), gowns and eye protection devices such as goggles.
Implication to nursing
The study has the following implications in nursing practices
- This research work will motivate many more researchers of this nature in the nearest future as many would desire to find out the current trends of present years.
- By the results and findings in this work, nurses will seek measures to prevent the transmission of nosocomial infections from nurses to patient or patient to patient.
- This research will also stimulate consciousness and continuous practice of the measures for the prevention of nosocomial infections among nurses.
Recommendation
Based on the findings, the following recommendations were made;
- Adequate information should be provided on nosocomial infections in hospitals and health centres for both nurses and patients.
- Efforts should be made to sustain the practice of nursing measures for the prevention and treatment of nosocomial treatments among nurses.
- Supportive programmes by government for health workers in rural and urban areas for awareness on nosocomial infections should be considered.
REFERENCES
- Abbo, A., Navon.venezia, S., Hammer-Muntoz, O. Krichali, T., Siegman-Igra, Y.& Carmeli, Y. (2005). Multidrug-resistant Acinetobacter baumanii. Emerging Infectious Diseases, 11 (1), 22-29.
- Abubakar S. (2007). Implementing infection control programme in Kano, Northern Nigeria. Presented at the: 8th Congress of the International Federation of Infection Control, 18–27 October 2007, Budapest, Hungary.
- Adenicia,C., Janaina,V. & MaryRocha, C. (2010). Standard Precautions: Knowledge and practice among nursing and medical students in a teaching hospital in Brazil, International Journal of Infection Control,6(1 ):20-22.
- Akyol, A.D. (2007). ‘Hand hygiene among nurses in Turkey: opinions and practices’, Journal of Clinical Nursing 16, 431-437.
- Allegranzi, B. & Pittet, D. (2008). Preventing infections acquired during health-care delivery. Lancet;372:1719–20. doi:10.1016/S0140-6736(08)61715-8 PMID:19013310.
- Aly, H., Herson, V., Duncan, A, Herr, J., Bender, J., Patel, K., & EI-Mohandes, AA.E. (2005). Is bloodstream infection preventable among premature infants? A tale of two cities. Pediatrics, 115(6), 1513-518.
- Anderson, J., Kaye, S., Chen, F., Schmader, E., Choi, Y., Sloan, R, & Sexton, J.D (2009). Clinical and financial outcomes due to Methicillin Resistant Staphylococcus aureus surgical site infection: A multi-center matched-outcomes study. PloS ONE, 4(12), 1- 8.
- Atif ML, Bezzaoucha A, Mesbah S, Djellato S, Boubechou N, Bellouni R. (2006). Evolution of nosocomial infection prevalence in an Algeria university hospital (2001 to 2005). Med Mal Infect 2006;36:423–8. French. doi:10.1016/j.medmal.2006.05.002 PMID:16876975.
