A Study on Knowledge and Practice of Nursing Staff Towards Infection Control Measures

7/29/2019 A Study on Knowledge and Practice of Nursing Staff Towards Infection Control Measures

1/17

A Study on

Knowledge and

Practice of NursingStaff towards

Infection Control

Measures


2/17

Introduction

Hospital Acquired Infection (HAI) is a major health

problem today. Although it is difficult to assess

the exact incidence of hospital acquired infections


3/17

in our hospitals, ample evidence exists to indicate

the magnitude of HAI and related problems.

Most often it is observed that the patient comes to

the hospital for treatment of a particular ailment

but has acquired infection prolonging his hospital

stay sometimes leading to septicemia, multi

system organ failure and death.

HAI not only prolongs the hospital stay of patients

but also increases bed occupancy and therefore

puts extra burden on already strained hospital

resources.

However, HAI cannot be eradicated entirely

because of the fact that whenever more than one

patient is taken care of in one place, they are

vulnerable to catch infections from each other.

A well organized infection control programme can

prevent 25-50% of HAI as stated by the "Hospital

Infection Society of India".

It also known that patients in high dependency

areas such as intensive care units (ICUs) are 5-10

times more likely to acquire HAI because of their

compromised defence mechanisms.


4/17

HAI are not only the problem of the patients but

also patient's families, hospital staff and the

community. Thus hospital acquired infectioncontrol is of prime importance in any hospital

offering comprehensive health care.

Nurses being in direct contact with the patients

round the clock and performing various nursing

procedures and assisting physicians and surgeons

in various procedures, play an important role inpreventing and controlling HAI.

Therefore, the need for a high degree of

awareness, knowledge and skill in nursing practice

is essential to prevent hospital acquired

infections.

Hence, it was felt that there is a need to assess

the existing knowledge and practice of nursing

staff towards infection control measures at

Lokmanya Tilak General Municipal Hospital with a

view to identify the areas of knowledge and

practice deficit and to strengthen those areas by

establishing appropriate measures.


5/17

Materials and methods

A study of exploratory nature was conducted

during the internship period (Jan-Feb) at

Lokmanya Tilak General Municipal Hospital.

Subjects for study were registered staff nurses

working in orthopedic, medical, surgical

obstetrics & gynecology, pediatric, EMS &

Trauma wards and Intensive Care Unit and

Operation Theater

Subjects were selected by systematic random

sampling.

Sample size n=70 (i.e. 70 staff nurses responses

were collected either by direct interview or

questionnaire submitted to them)

Questionnaire comprising of 3 sections

pertaining to working unit & experience data,

knowledge and practice with a set of 48questions was developed and pilot tested before

the final observations were made.

Limitations


6/17

The study had limitations in that it was restricted to

selected wards and practice could not be assessed by

direct observation because of the time factor, so

responses were made in the form of questionnaire

and practice was thus assessed.

Sample questionnaire

Knowledge and Practice of Nursing

Staff towards Infection Control

Measures

WARD or UNIT :

WORK EXPERIENCE:

UNDERGONE ANY TRAINING (SHORT TERM COURSES, SERVICE

EDUCATION, OR CME):Yes/No:

(please tick in the appropriate box)

Sl.No.

Knowledge of Items AGREE DISAGREENOT AWARE

OF

1. Hospital acquired infections are the result of cross infection

2.The single most important measure for preventing HAI ishand washing

3. The common causative organism of UTI is E. Coli

4. HAI's are transmitted through body fluids, Medical care


7/17

provider and reusable equipment

5. Immunization v/s universal precaution

6. Haemoglobin less than 11 gm % is not a sign of infection.

7.Patients receiving immunosuppressive therapy are more

susceptible to HAI

8.Hypo chloride solution has to be changed every day andwhat is the concentration please do mention.

9.Sterilisation is a process of killing of microorganismincluding spores

10.Items such as nebulisers and disposable pulse oximeterprobes can be used for the same patient unless cleaned.

11.Is it essential to change the mask used between patientexamination or procedure?

12. Sterile technique is not necessary for nasogastric feeding.

13.The most important factor involved in hand washing isfriction

14.Checklist completed during central venous and pulmonaryartery catheter insertion

15. Moisture enhances the trans-mission of micro- organisms.

16. Boiling is the only method of sterilisation.

17.Chemical disinfection is the best method of sterilisingsurgical instruments

18. If a person doesn't show sign and symptoms of disease, hecan't transfer a disease.

19.Alcohol hand rubs provide an effective and convenientalternative to hand washing with sanitizer.

20. URTI & UTI's are one of the most common forms of HAI

Sl.

No.Practice YES NO

1.

Multi-patient use equipment such as commodes, beds,pressure relieving mattresses and blood pressure cuffs,requires decontamination after each episode of use by apatient?

2.Do you display notices which describe the precautionsneeded if a patient is in isolation?

3.Sterile water and sterile saline labelled when opened andreplaced every24 hours?

4 Do u label specimen collected in presence of patient?


8/17

5The glucose meter is cleaned and disinfected after everyuse.

6If a patient on precautions is leaving the unit to go to x-ray,do you inform the transporter about the precautions?

7

Do you perform hand hygiene in following situations: before patient contact

before contact with a susceptible patient site(such as an invasive device or wound)

before an aseptic task

after exposure to body fluids

after glove removal

after patient contact

after contact with the patients immediateenvironment.

8The negative air pressure is checked every day either bylooking at the pressure gauge or performing the tissuetest?

9 Sharps containers are replaced when the filled two third?

10

Do you ensure that any spillage is disinfected properly,taking into account the surface where the incidenthappened for example on a hard surface in a hospital

Do you use hypo chloride solution in such case?

11

Do you perform decontamination of items like as nebulisers

and disposable pulse ox meter probes in hand washingsinks?

12Do you report any staff sharps injuries in line with localreporting procedures/policies?

13 Unused sterile articles are re autoclaved?

14 Wearing gloves is a must during administration of injection?

15 Do staff members receive infection control training?

16Do you remove gloves before moving to next task orpatient?

17 Microbiological waste is discarded in yellow bag?

18 In your unit, staff's finger swabs for c/s are regularly sent?

Score for each correct answer is 5

points


9/17

Sample Characteristics

Presently, the staff nurses working at Lokmanya

Tilak General Municipal Hospital has completed

General Nursing and midwifery Courses.

In the study sample, the total 70 staff nurses

were graduates. None of the subjects were post -

graduate.

The majority i.e. 60% of the subjects had work

experience of 20-30 years, 20% had work

experience of 10-20 years and 16% had work

experience of 30-40 years; rest; rest 4% had

experience ranging from 05-10 years.


10/17

90% of staff nurses have undergone training

such as in service education, short term courses

and training programmes & very few around 10%

have undergone continuing medical education

Frequency and percentage of response to items pertaining to

knowledge on infection control measures (n=70)

Sl.No.

Knowledge of Items

Frequencyof

correctResponse

%of correctResponses

1.Hospital acquired infections are the result of crossinfection

65 92

2.The single most important measure for preventing HAI ishand washing

68 98

3. The common causative organism of of UTI is E. Coli 58 82

4.HAI's are transmitted through body fluids, Medical careprovider and reusable equipment

60 85

5. Immunization v/s universal precaution 65 92

6. Haemoglobin less than 11 gm % is not a sign of infection. 40 57

7.Patients receiving immunosuppressive therapy are moresusceptible to HAI

70 100

8.Hypo chloride solution has to be changed every day andwhat is the concentration please do mention.

70 100


11/17

9.Sterilisation is a process of killing of microorganismincluding spores

70 100

10.Items such as nebulisers and disposable pulse oximeterprobes can be used for the same patient unless cleaned.

50 71

11. Is it essential to change the mask used between patientexamination or procedure? 58 82

12.Sterile technique is not necessary for nasogastricfeeding.

60 85

13.The most important factor involved in hand washing isfriction

62 88

14.Checklist completed during central venous andpulmonary artery catheter insertion

68 97

15.Moisture enhances the trans-mission of micro-organisms.

65 92

16. Boiling is the only method of sterilisation. 70 100

17.Chemical disinfection is the best method of sterilisingsurgical instruments

60 85

18.If a person doesn't show sign and symptoms of disease,he can't transfer a disease.

70 100

19.Alcohol hand rubs provide an effective and convenientalternative to hand washing with sanitizer.

40 57

20. URTI & UTI's are one of the most common forms of HAI 70 100

Frequency and percentage of response to items

pertaining to practice on infection control measures.

(N=70)

Sl.No.

Practice

Frequencyof

correctResponse

%OfcorrectResponse

1.

Multi-patient use equipment such as commodes, beds,pressure relieving mattresses and blood pressure cuffs,

requires decontamination after each episode of use by apatient?

70 100

2.Do you display notices which describe the precautionsneeded if a patient is in isolation?

50 71

3.Sterile water and sterile saline labelled when opened andreplaced every24 hours?

64 91

4 Do u label specimen collected in presence of patient? 56 80

5The glucose meter is cleaned and disinfected after everyuse.

60 85

6 If a patient on precautions is leaving the unit to go to x-ray, 70 100


12/17

do you inform the transporter about the precautions?

7

Do you perform hand hygiene in following situations:

before patient contact

before contact with a susceptible patient site

(such as an invasive device or wound) before an aseptic task

after exposure to body fluids

after glove removal

after patient contact

after contact with the patients immediateenvironment.

70 100

8The negative air pressure is checked every day either bylooking at the pressure gauge or performing the tissue test?

40 57

9 Sharps containers are replaced when the filled two third? 70 100

10

Do you ensure that any spillage is disinfected properly,taking into account the surface where the incident happened for example on a hard surface in a hospital

Do you use hypo chloride solution in such case?

70 100

11Do you perform decontamination of items like as nebulisersand disposable pulse ox meter probes in hand washingsinks?

70 100

12Do you report any staff sharps injuries in line with localreporting procedures/policies?

70 100

13 Unused sterile articles are re autoclaved? 60 85

14 Wearing gloves is a must during administration of injection? 70 100

15 Do staff members receive infection control training? 70 100

16Do you remove gloves before moving to next task orpatient? 62 88

17 Microbiological waste is discarded in yellow bag? 65 92

18 In your unit, staff's finger swabs for c/s are regularly sent? 70 100

Interpretation of above data


13/17

Average frequency of correct responses of

knowledge about HAI of staff nurses

working at the hospital was 62.

Mean knowledge about HAI of staff nurses

working at the hospital was 88%.

Average frequency of correct responsestowards practice about HAI of staff nurses

working at hospital was 64.

Mean practice of staff nurses regardinginfection control measures is 86%.

Knowledge and practice of staff

nurses in relation to years of

experience

Years ofexperience

Average scoretowards

knowledge

Average scoretowards practice


14/17

0-10 years 70 7010-20 years 80 7520-30 years 85 8030-40 years 80 80

CATEGORY 1: 0-10 YEARS




CONCLUSION AND

SUGGESTIONS

On the basis of the above study and findings, it

can be said that there exists a positive

relationship between knowledge and practice.

This indicates that with improved knowledge, we


15/17

can also improve the practice, which should be

of major concern in the present day health care

scenario.

In service education, refresher courses and

training programmes on infection control

measures should be systematically planned and

regularly conducted for staff nurses so as to

keep staff nurses up to date on the topic.

Training should include:

practical hand washing sessions/use of alcohol

hand sanitizer

aseptic technique

the importance of environmental/equipment

cleaning and whose responsibility

who to go to for advice/ more information

trust infection and prevention policies

what you can do to help yourself, your

colleagues and your patients (uniform, hair,

general, hygiene).

Continuous vigilance, assessment and

supervision of various levels of workers will help

to start a multidimensional attack on the

problem of HAI.


16/17

Nursing staff should actively take part in the

maintenance of cleanliness of the hospital which

is very poor presently.

Nursing staff should be given the extra

responsibility for the inspection of the area

outside their ward or unit since these areas are

currently more vulnerable and are prone to

spread Infection.

Nurses can do a great deal to allay fears by

communicating effectively, without breaking

confidentiality. For example, nurses should:

provide information leaflets for patients,

visitors and staff

provide notices which describe the precautions

needed

talk to patients about how they can help

themselves

include support staff in team meetings during

outbreaks

tell the patient how their care might be affected

by a HAI and how long precautions will beneeded

ensure that other staff understand the actions

Continuous surveillance of HAI and notification

to the concerned authorities is essential and the

formulation of regulations should be effectively


17/17

performed, so as to be able to take appropriate

measures in time.

Documents

A Study on Knowledge and Practice of Nursing Staff Towards Infection Control Measures