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CHAPTER : 1

INTRODUCTION

Hospital Acquired Infection (HAI) is a major health problem today. It has

received the attention of the Government of India and thus the Rao committee,

(1968) and the Sharad Kumar Committees (1976) were set up to investigate the

problem of hospital infections in depth. Although it is difficult to assess the exact

incidence of hospital acquired infections 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 acquires

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 orgainsed infection control programme

can prevent 25-50% of HAI as stated by the "Hospital Infection Society of India".

The literature also reveals 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 defense mechanisms. HAI are not only the problem of the patients

but also patient families, hospital staff and the community. Thus hospital acquired

infection control is of prime importance in any hospital offering comprehensive

health care. Nurses being in direct contact with the patients round the clock and


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performing various nursing procedures and assisting physicians and surgeons in

various procedures, play an important role in preventing 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 Hospital Acquired Infections at Samaritan tertiary care teaching hospital

with a view to identify the areas of knowledge and practice deficit and to

strengthen those areas by establishing appropriate measures. Hospital Associated

Infections (HAI) have been the bane of hospitals since time immemorial. Despite

rapid advances in medical science in therapeutics, diagnostics and a better

understanding of the disease process, the problem of HAI persists throughout the

world. The incidence, type and magnitude of HAI varies from hospital to hospital;

it is estimated to be around 10% of hospital admissions. Given the prevailing

conditions in the hospitals in developing countries, this is likely to increase. Hence,

there is an urgent need to set up systematic control measures.

Nursing is a profession of art and science that involves interaction with theclient equipped with a touch of care. Unlike the other jobs, it opts to give care to

those who are sick with a sense of desire to promote wellness and provide

treatment. As promoters of health, nurses teach, give care, and treat patients who

are physically, emotionally, mentally and socially sick and ill. It is a profession

that offers the individual the chance to touch other peoples lives and be sensitive

to them.

Nurses are the heart and hands of the team and they are sensitive to the

needs of the client that enables them to have a good nurse-client relationship by

being more empathetic as well as rendering services in a hands-on manner. This

would mean constant contact and exposure with the various nosocomial infections


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present in the hospital setting. It is the duty and responsibility of the nurse to

strictly comply and adhere to the hospitals preventive measures against

nosocomial infections and other infectious diseases. Furthermore, nurses as health

care workers and have should be aware of the ways to slow or prevent the

transmission of infectious diseases and be knowledgeable of its potential risk to the

client and hospital staff.

The study aims to identify the ways of preventing nosocomial infections in

Samaritan hospital as well as the different kinds of preventive measures that are

implemented and foreseen as an effective way in breaking down the chain of

infection.

This study would serve as a baseline guide for further development and

growth of nursing care and enhance the preventive strategies used to minimize

nosocomial infection from the patient or client, hospital setting, and care giver

itself.


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1.PROFILE OF

SAMARITAN HOSPITAL PAZHANGANAD

1.1 INTRODUCTION

Samaritan hospital Pazhanganad is the biggest unit of action in the medical

field managed by the congregation of the Sisters of the Destitute. This hospital acts

as a nerve centre for all the socio medical activities of the congregation and as a

referral centres for the many small medical units located in the peripheral villages.

Samaritan hospital Pazhanganad is a 350 bedded multispecialty hospital

having all departments such as Department of Cardiology, Department of General

Medicine, Department of Ophthalmology, Department of General Surgery, etc.

with a medical staff of around 40 physicians and 200 health care employees.

Samaritan hospital offers a wide range of services unequalled by hospitals of

comparable size in the region. Currently the hospital has 17 full fledged medical

and surgical departments with 27 consultants and 12 resident medical officers. As

most of the doctors, nurses and technicians reside in the campus itself their service

is available round the clock. More than 50 medically or technically qualified

religious sisters do voluntary services in the hospital.


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The hospital runs clinics for the poor and the needy where medicines and

treatment are given free of cost to all irrespective of their religious convictions. In

addition, teams of doctors and nurses conduct medical and health camps and

immunization programs in the villages routinely. The school of nursing visit homes

collects vital information on the health status of the villagers and educates them,

especially expectant mothers, on health, hygiene and child care.

1.2 LOCATION

The hospital is located in village Kizhakambalam, 10 KM, from

Alwaye, on the Alwaye Thripunithura road and about 25 KM from Cochin.

Public transport facility to reach the hospital is available from Alwaye, Cochin,

perumbavoor and Thripunithura.

1.3 HISTORY

Samaritan hospital was started back in 1962 as a small dispensary

handling minor medical needs of the rural community in the nearby village. In

1969 the dispensary was upgraded to a 70 bedded hospital providing basic medical

services and in the course of the last 33 years it was developed into a 350 bedded

general hospital catering to the health needs of the rural poor.

1.4VISION AND MISSION

The mission of the hospital is the care of the destitute and the sick

irrespective of their religious convictions.


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The sisters began their ministry by setting up homes for the destitute, the

aged and the sick.

The congregation also operates homes for the dying and the terminally ill

and for the rehabilitation of the mental and physically challenged.

1.5. OBJECTIVES OF SAMARITAN HOSPITAL.

1. To make quality health services available, affordable and accessible to all,

especially in the underserved areas.

2. To promote health education, training and research.

3. To manage, maintain and develop Samaritan Hospital and any other hospital

or dispensary as a charitable organization and on a non-profit basis in the true

spirit of Christian services, ideals and principles.

4. To co-operate and collaborate with the government and other agencies to make

health care accessible to all.

5. To encourage multi dimensional programs on promotion of health and

prevention of diseases in communities.

1.6 STRATEGIES

1. Effective collaboration with the government, national, and international

agencies for accessing vaccines and medicines and for participation in the various

diseases control programs will be encouraged.

2. Patients and families will be counseled and enabled to comply with treatment

regimens and prevention methods to control the transmission of diseases.


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3. Patients with HIV/AIDS, Tuberculosis, Leprosy and other debilitating diseases

will be admitted and treated in the health care institutions with provision for

treatment, including surgery.

4. The health care institutions will conduct awareness programs against smoking,

alcohol and drug abuse.

5. The institution will encourage their staff and students to have a multi

disciplinary approach to health care.

1.7 ORGANIZATIONAL STRUCTURE

Organization structure may be considered as the anatomy of theorganization, which provides the foundation within which the organization

functions. Organization structure is believed to affect the behaviour of its

members. As Hall (1977) noted, this belief is based on a simple observation.

Buildings have halls, stairways, entries, exits, walls and roofs. The specific

structure of a building is a major determinant of the activities of people within it.

Similarly behaviour in an organization is influenced by the organizational

structure, though not as apparent as that of building.

The influence is assumed to be pervasive. Organization as Hall noted has

2 basic functions each of which is likely to affect individual behaviour or


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organization performance. Structures are designed to minimize or at least regulate

the influence of individuals.

The organizational chart is given below:


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1.8 LEVELS OF AUTHORITY

The top level management of Samaritan Hospital includes the Governingboard, director, administrator and elected members from congregation they are the

major decision making bodies.

The middle level management includes principle of school of nursing,

nursing superintendent, principal of school of medical lab training, Public relation

officer, Chief Medical officer, Accounts, department heads and finance officer.

The lower level management includes ward in charge.

1.9 CLINICAL DEPARTMENTS

Samaritan Hospital is a multispecialty having a lot of departments such as;

1.9.1 GENERAL MEDICINE OP

This department was first to be started when the hospital started functioningin 1969.The general medicine is the part of the O.P. No emergency cases come on

their own. In the ground floor O.P services of diagnostic or therapeutic nature are

taken care of. The O.P is situated near to the Reception.

Facilities:

ICU with ventilator and monitoring facilities.

Lung function analyzer

1.9.2 CARDIOLOGY


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Started in 1974, this is one of the first department of cardiology in the state

of Kerala. The unit serves as a referral centres for many peripheral hospital.

Facilities:

Computerized stress testing (TMT).

Echocardiography with color flow mapping.

Stress echocardiography.

24 hrs ambulatory ECG monitoring and analysis.

Temporary pacing.

Ventilator.

Pulse oximetry.

Full- fledged unit with 12 bedded air conditioned intensive coronary care unit

(ICCU).

1.9.3 DEPARTMENT OF PEDIATRIC MEDICINE

This department is recognized by UNICEF as one of the baby friendly

resource hospitals in Kerala.

Facilities:

Multi parameter monitoring.

1.9.4 DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

It is one of the first and busiest departments of the hospital.


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Facil ities:

Fetal cardiac monitor

Ultra sound scanning.

1.9.5 DEPARTMENT OF GENERAL SURGERY

This department handles all types of adult and paediatric surgical problems.

Facilities:

Upper GI endoscopy.

Laparoscopy.

Bronchoscope.

Cryosurgery.

1.9.6 DEPARTMENT OF ENT SURGERY

This department undertakes all types of ENT surgeries including video

monitored endoscopic sinus surgeries (FESS).

Facilities:

Impedance audiometric.

Operating microscope.

1.9.7 DEPARTMENT OF OPHTHALMOLOGY


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Well equipped for treating cataract, glaucoma, squint, etc.

Facilities:

Computerized refactometry.

A-scan

Operating microscope.

1.9.8 DEPARTMENT OF ORTHOPEDIC SURGERY

This department handles all types of muscular-skeletal injuries and poly

trauma cases. The unit also handles surgical procedures like joint replacement,

limb length correction and arthroscopic surgery.

Facilities:

C arm image intensifier.

Diagnostic arthroscopy.

1.9.9 DEPARTMENT OF UROLOGY

Procedures like TURP and surgical procedures for kidney tumors stones, etc.

are routinely undertaken.

Facilities:

Endoscope and Laparoscope.

Ultrasound lithotripsy.

1.9.10 DEPARTMENT OF NEPHROLOGY


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It consist modern facility for diagnosis and treatment of kidney diseases.

Facilities for renal biopsy, radiological and ultra son logical investigation exist.

Facilities

State of the art dialysis machine.

Multi parameter monitoring

1.9.11 DEPARTMENT OF NEUROPSYCHIATRY

A wide spectrum of psychiatric problems like psychoses, alcohol and drug

dependence, and childhood and adolescent psychological disorders are treated.

1.9.12 DEPARTMENT OF DERMATOLOGY

It is another important department of the hospital. This department

deals with skin and its diseases.

1.9.13 DEPARTMENT OF DENTISTRY

This department is functioning since 1969. This department deal with dental

problems.

1.9.14 DEPARTMENT OF ANESTHESIOLOGY

It handles over 2500 major surgeries every year.

Facilities:


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Patient Monitoring equipment.

Defibrillator.

Pulse oximeter.

Capnography

1.9.15 DEPARTMENT OF EMERGENCY MEDICINE (CASUALTY)

It is the first place of contact in emergency. Its a 4 bedde d casualty.

Emergency cases are first entered into this department. The hospital has a 24 hours

trauma and accident care unit. They provide comprehensive emergency medicalservices to patients with severe illness or suffering from traumatic injuries. A

trauma center often requires complex multi disciplinary treatment including

surgery to give the victims the best possible chance for survival and recovery.

Trauma is a life threatening occurrence either accidental or intentional that causes

injuries. The cases in trauma are motor vehicle accidents, falls, assaults etc..

1.10 SUPPORTIVE DEPARTMENTS

1.10.1 RADIOLOGY

This department has the facilities like C.T scan, ultra sound scan, X-

ray, ECG, etc.

1.10.2 PHARMACY

It is common for outpatient and inpatient. All the medicines are

arranged in alphabetic order. IP and OP have separate pharmacy.

1.10.3 LABORATORY


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A laboratory or lab is a facility that provides controlled conditions in which

scientific research equipments and measurement may be performed. The lab is

divided into collecting and testing area. The machines used are sodium potassium

analyzer, semi auto analyzer, haemogram for platelets, WBC count taking. Elisa

reader, flame photometer, calorimeter, microscope, centrifuge, Hot air oven,

incubator, autoclave. In the collection lab, only extraction of blood sputum or urine

and likewise takes place. They have a fully automatic lab.

1.10.4 BLOOD BANK

The unit provides 24 hrs service and having 3 bed capacities.

1.10.5 DEPARTMENT OF PATHOLOGY

It is one single department whose quality of services is

paramount for the overall performance of this hospital. It plays the following role.

As a vital aid to diagnosis.

Establishing the cause of death through autopsy reports.

Education, training and research activities.

Validation of diagnosis through tissue studies.

Early detection and prevention of diseases in asymptomatic cases.

1.10.6 I.C.U


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An intensive care unit, intensive therapy unit or intensive treatment unit is a

specialized department used in many hospitals that provide intensives care

medicines. There are specialty intensive cares that take care of special needs or

areas as dictated by the needs of each hospital. Samaritan hospital has specialized

I.C.U, Neonatal I.C.U, Cardiac I.C.U, Pediatric I.C.U, Medical Intensive Care

Unit. Common equipment in I.C.U includes mechanical ventilator to assist

breathing, cardiac monitors, equipments for constant monitoring of bodily

functions feeding tubes, nasogastric tubes, suction pumps, drains and catheters and

wide array of drugs to prevent secondary infections.

1.10.7 PHYSIOTHERAPY

The physiotherapy often known as physical therapy provides

Treatment to improve large muscle mobility and to prevent or limit

permanent disability.

Treatments include exercise, massage, hydrotherapy, ultra sound,

electrical, stimulation, and heat application.

The department is concerned with identifying maximizing prevention, treatment,

habilitation and rehabilitation. It encompasses physical/ emotional, psychological

and social well being.

1.10.8 ADMINISTRATIVE DEPARTMENT

The general administration is done by the administrator. His

responsibilities are:

Ensures that physical facilities and equipment are adequately available and

functioning properly to support good and speedy patient care.


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Ensures proper up keep and confidentiality of medical records and patient

documentation.

Promotes positive image of the hospital and develops good public relations

with the government, official agencies, vendors and public at large.

1.10.9 PUBLIC RELATION DEPARTMENT

The primary function of a public relation officer is to act as mediator

between the organization and the public. The hospital has a public relations officer

who manages and supervises the following public relations functions of the

hospital:

Responsible to improve the internal and external public relations of the

hospital.

To develop and maintain good relation with the government organization

departments, etc.

To look to the patients problems, complaints and suggest ways and meansto solve them.

To prepare press report.

1.10.10 ENQUIRY

The enquiry is common for OP and IP there are 2 staff in enquiry. The

enquiry provides 24 hrs facilities. There is a new registration counter forregistering new cases and old registration for previously existing cases.

1.10.11 BILLING SECTION


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Billing section is there for collecting cash. There four staff in this

section. IP & OP have separate billing.

1.10.12 HOUSEKEEPING DEPARTMENT

Housekeeping services also called environmental services are of

paramount importance in providing a safe pleasant orderly and functional

environment for both patients and hospital personnels.

It takes care of cleaning, sterilizing and concerns itself with changing linen,

handling waste and keeping premises clean.

1.10.13 AMBULANCE MORTUARY

There are 2 ambulances on the run and a mortuary with freezers that can

accommodate 6 bodies.

1.10.14 MEDICAL LIBRARY

It is a part of health care services department

1.10.15 CANTEEN

It provides quality food at a very subsidized rate and hygienic and

preparation of food. There about 8 staff in this department.

1.10.16 PURCHASE

The department has a purchase manager and an assistant purchase manager.

There are 2 purchase mainly general purchase & medical purchase (pharmacy).


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The general purchase include all day to day items from toilet soaps to furniture.

Whereas medical purchase includes drugs, medical equipments or laboratory items.

The goods are procured as needs arise. If the medical store for e.g.. Requires an

item a local purchase order (LPO) is issued addressed to the purchase manager.

Nobody except the P.M is entitled to buy the items. The head of each department

should sign and recommend the purchase after evaluating the needs. The stores

manager should have the discretion to choose the best. If an order is received he

should probe into it and check if the item exists, if it does is there a way to repair it

instead of buying new one. Often medical equipments are sent to the biomedical

engineer instead of buying a new one. In case of medical purchases medical

representatives from various companies meet the doctors and present their

products. The doctor gives intent to the medical representatives who go to the

purchase manager. The purchase manager then checks the rates and negotiates or

turns down the offer if they are procuring the product at a lower rate. He also

checks the credibility of the company.

CHAPTER :

2

REVIEW OF RELATED LITERATURE AND

STUDIES


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This chapter presents the literature, reading, and studies that are related to

the present study which is prevention of nosocomial infections as perceived by

staff nurses of Samaritan hospital Pazhanganad.

2.1 SOURCES OF INFECTION IN HOSPITAL

Bacteria and viruses are natural inhabitants of the environment, both in the

community and in the hospital. The majority of these organisms are not pathogens

and may even have a beneficial role to play in human body. The organisms in the

natural environment may provide a reservoir from which they may be passed to

other patients and cause infections. However, there are very many reservoirs; the

one from which infections arise is usually called the source. Identification of the

correct source is essential to arrest the spread from this source.

The sources of spread can be classified along the same lines as the types of

infection.

Spread from community-acquired infections to other patients in hospital can

be via:

The respiratory tract as in tuberculosis and respiratory viruses;

Infected blood as with viral hepatitis and HIV;

Faeces with salmonella, shigella, vibrio;

The air or skin scales as with chicken pox, herpes,

staphylococci,streptococci, and

Infected discharges such as pus.

Prevention of such spread requires interventions specific to the individual

infectious diseases.

Patients undergoing hospital treatment frequently become infected. These

infections arise from many different sources and are usually associated with


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operative or other invasive procedures carried out in operating theatres,

wards, X-ray departments and clinics.

The organisms come from many possible sources, such as:

The patients own resident flora the mouth, gastrointestinal tract,

vagina or the skin;

The resident microbial flora of health care workers and from other

patients on the ward;

Transient bacteria carried on the hands of health care workers from one

patient to another;

Contaminated instruments, dressings, needles, etc. used for invasive

procedures, and Infusions.

The wide variety of opportunities for acquisition of hospital pathogens

requires generalstandards of hospital practice to protect all patients. At the same

time, each risk group orprocedure may require specific measures related to

removing special sources of infection.

The general procedures include items such as:

Supply of adequately sterilized instruments and dressings;

Operating theatre design, discipline and procedures;

General application of aseptic techniques;

Good environment cleaning, safe food, effective laundry procedures and

waste disposal, and

Specific measures include items such as:

Standardized procedures for intubation, catheterization, venous access

investigative procedures and

Peri-operative surgical chemoprophylaxis.


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The groups at high risk of acquisition of infection due to diminished

defences require additional protection including hospital areas where there

are enhanced invasive procedures. The specific requirements of ICU, special

baby units, oncology departments and long-stay surgical wards need to be

documented and implemented. For neutropenic patients, special isolation

procedures providing a protective environment rather than containment

facility are necessary.

With such a complex series of events, it is necessary to apply a scientific

approach to the assessment of risks in order to establish priorities for infection

control. All hospital staff require information on control of hospital infection and

the particular role each group has to play in the process. The practicalities of the

situation have to be discussed with staff at all levels to ensure that they are capable

of carrying out the recommended procedures. Instructions are more readily

complied with if the procedures have been explained and are acceptable to the

surgeons, nurses, technicians and domestic staff who have to implement them.

2.2 PREVENTION OF HOSPITAL ASSOCIATED

INFECTIONS

2.2.1 STANDARD/UNIVERSAL PRECAUTIONS

With the onset of the AIDS pandemic, the concept of universal precautions

has been adopted i.e. precautions that should be practiced with all patients and

laboratory specimens regardless of diagnosis. It is presumed that every

patient/specimen could be potentially infected with blood borne pathogens such as

HIV, hepatitis B and C. Universal (Standard) precautions are applied to all patients

regardless of diagnosis, instead of universal testing.


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The main objective is to prevent exposure of staff and patients to blood and

body fluids. Body fluids considered to be potentially infected with blood-borne

pathogens are: semen, vaginal secretions, amniotic fluid, pericardial fluid, pleural

fluid, cerebrospinal fluid, synovial fluid or any body fluid that is visibly

contaminated with blood. Spills of blood or body fluids should be treated with

hypochlorite.

Universal precautions do not apply to the following unless they contain

visible blood: faeces, nasal secretions, sputum, tears, urine, vomitus, breast milk

and saliva. Since the above may have the potential to transmit other pathogens,

precautions should also be applied to all body secretions and excretions. Spills of

blood or body fluids should be treated with hypochlorite. Standard precautions also

apply to unfixed tissue and all pathological and laboratory specimens.

2.2.1.1. HAND DECONTAMINATION

The role of hands in the transmission of hospital infections has been well

demonstrated, and can be minimized with appropriate hand hygiene. Compliance

with hand washing, however, is frequently suboptimal. This is due to a variety of

reasons, including lack of appropriate accessible equipment, high patient to staff

ratios, allergies to hand washing products and insufficient knowledge of staff about

risks and procedures.

Hand washing is the single most important means of preventing the spread

of infection. Hands should be washed between patient contacts and after contact

with blood, body fluids, secretions, excretions and equipment or articles

contaminated by these.

For hand washing, the following facilities are required:


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Running water: large washbasins with hands free controls, which require

little maintenance and with anti-splash devices.

Products: dry soap or liquid antiseptic depending on the procedure.

Suitable material for drying of hands: disposable towels, reusable sterile

single use towels or roller towels which are suitably maintained.

For hand disinfection

The specific hand disinfectantsantiseptics recommended are: 2-4%

chlorhexidine, 5-7.5% povidone iodine, 1% triclosan or alcoholic rubs.

Alcoholic handrubs are not a substitute for hand washing, except for rapid

hand decontamination between patient contacts.

For surgical scrub (surgical care)

Training is needed in the current procedure for preparation of the hands

prior to surgical procedures.

Scrubbing of the hands for 3-5 minutes is sufficient. The recommended

antiseptics are 4% chlorhexidine or 7.5% povidone iodine.

Equipment and products are not equally accessible in all countries or health

care facilities. Flexibility in products and procedures, and sensitivity to local needs,

will improve compliance. In all cases, the best procedure possible should be

instituted.

Clothing

Staff can normally wear clean street clothes. In special areas such as burn or

intensive care units, uniform trousers and a short-sleeved gown are required for

men and women.

The working outfit must be made of a material easy to wash and decontaminate. If

possible, a clean outfit should be worn each day. An outfit must be changed after


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exposure to blood or if it becomes wet through excessive sweating or other fluid

exposure.

Shoes

In aseptic units and in operating rooms, staff must wear dedicated shoes, which

must be easy to clean. In other areas, change of footwear is unnecessary for

prevention of infection.

Caps

In aseptic units, operating rooms, or performing selected invasive procedures, staff

must wear caps or hoods which completely cover the hair.

Masks

Masks of cotton wool, gauze, or paper masks are ineffective. Paper masks with

synthetic material for filtration are an effective barrier against micro-organisms.

Masks are used in various situations and their requirements differ depending on the

purposes for which they are needed.

Patient protection:Staff wear masks to work in the operating room, to care

for immuno-compromised patients, to puncture body cavities. A surgical

deflector mask which directs aerosols away from the surgical site is

sufficient.

Staff protection: Staff must wear masks when caring for patients with

airborne infections, or when performing bronchoscopies or similar

examination. A high efficiency filter mask is recommended. Filter masks

remove organisms which might be inhaled. Patients with airborne infections

must use surgical deflector masks when outside their isolation room.

Gloves


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Gloves are used for:

Patient protection:Staff should wear sterile gloves for surgery, care for

immuno-compromised patients and invasive procedures which enter body cavities.

Non-sterile gloves should be worn for all patient contacts where hands are likely to

become contaminated, or for any mucous membrane contact. When performing

multiple procedures, the gloves should be decontaminated between patients. If

visibly soiled with blood, a fresh pair should be used.

Staff protection:Staff should wear non-sterile examination gloves to care

for patients with communicable disease transmitted by contact.

Hands must be washed when gloves are removed or changed.

Disposable gloves should not be reused.

The wearing of gloves, masks and other protective clothing is only necessary for

the tasks at hand and these items should be removed after the procedure.

2.2.1.2 SAFE INJECTION PRACTICES

To prevent transmission of infections between patients:

Unnecessary injections must be eliminated. Many medicines can be given

orally and this is preferred to parenteral administration.

Sterile needle and syringe should always be used. These should be

disposable, if possible.

Contamination of medications must be prevented by using single use vials.

Safe disposal practices in respect of metallic waste should be followed.

2.2.1.3 ADDITIONAL PRECAUTIONS FOR PREVENTION OF

TRANSMISSION OF INFECTION

In addition to standard precautions which are required for all patients in all

situations, special precautions need to be taken for patients suffering from certain

infections. These are based on the mode of transmission of these infections. The


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ICC should decide the policy for the individual hospital and procedures which are

feasible in its situation.

The following precautions are recommended:

2.2.1.3.1 RESPIRATORY PRECAUTIONS

For infections transmitted by the airborne route through small droplets less than 5

micron in size which can be dispersed over long distances e.g. tuberculosis.

The patient should be placed in a single room that ideally has good

ventilation and sunlight, negative air pressure and 6-12 air changes per hour.

If single room is not possible, patients should be in a cohort with other

patients with same infection. Doors should be kept closed. For additional respiratory protection, well-fitting filter masks should be

worn. Susceptible persons should not enter the room of patients having

measles or chickenpox whereas persons immune to measles or chicken pox

do not need to wear mask.

Transportation of patient should be done only when essential. Patient should

wear a mask during transportation.

2.2.1.3.2 CONTACT PRECAUTIONS

These precautions should be used in addition to standard precautions for patients

who are infected or colonized with important organisms that can be transmitted

directly by hand or skin contact or indirectly through fomites or environmental

surfaces in contact with the patient, such as gastrointestinal, respiratory,

conjunctival, skin and wound infections or colonization with multiresistant

bacteria.

The patient should preferably be placed in a single room. If that is not

possible, he/she should be placed with a cohort of patients having infection

with the identical micro-organism.

Clean, non-sterile gloves should be worn on entering the room or patients


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environment. Gloves must be removed after leaving the patients

environment and hands washed immediately.

A clean non-sterile gown should be worn on entering the patients room and

removed on leaving the room.

Sharing of patient care equipment between patients should be avoided. If

sharing is necessary, the equipment should be adequately cleaned and

disinfected before using on another patient.

Transportation of patient must be limited. If transport is necessary,

precautions must be taken to avoid contact with other patients and

contamination of the environment.

2.2.1.3.3 BLOOD/INOCULATION PRECAUTIONS

In addition to standard precautions, diseases transmitted through inoculation

or parenteral route such as hepatitis B, HIV/AIDS, malaria can be prevented by:

Rational Injection Practice: Unnecessary injections, suturing and blood

transfusions must be reduced.

Safe procedures for the handling and prevention of accidents with sharp

metallic waste should be ensured.

Recapping of needle should be avoided; if recapping is required, then well

established single-handed procedures should be used.

Metallic waste should always be disposed into a puncture resistant container.

Exposed sharp metallic waste should never be passed directly from one

person to another.

During exposure-prone procedures such as phlebotomy, the risk of injury

may be reduced by having maximum visibility and proper positioning of

the patient.

Fingers must be protected from injury by using forceps for holding suturing

needles.


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Overflow of sharp metallic waste disposal containers can be prevented by

sending the containers for disposal before they are completely filled.

2.3 ROUTES OF TRANSMISSION

Transmission of HAI can occur by one or more of the following modes:

2.3.1 AIRBORNE

Through small particles suspended in the air or large droplets expelled into the air

by coughing, sneezing, talking (aerosols), or by shedding of skin scales.

2 3 2 CONTACT

Through direct contact of hands or skin contact or indirectly through

environmental surfaces and other items which come in contact with the patient.2 3 3 INOCULATION OR PARENTERAL

Contaminated solutions, blood and body fluids can enter either through abrasions

or other skin lesions, through mucous membranes but not through intact skin.

2.3.4 FAECO-ORAL

Micro-organisms found in the intestines can be transmitted either directly through

contaminated food and water following unhygienic practices or indirectly.

2.3.5 MULTIPLE ROUTES

A disease may be transmitted by more than one mode e.g. respiratory viral

infections can be transmitted through airborne (droplet) as well as by physical

contact. Transmission-based precautionsare special precautions taken in addition

to standard precautions for known infections based on the mode of transmission of

the infection. Education is most important. Awareness programmes for staff,

visitors and patients must be established. Posters outlining the precautions should

be placed at appropriate locations. As the name implies, additional precautions

should be applied in addition to standard/universal precautions.


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2.4 RELEVANCE OF THE REVIEWED LITERATURE AND STUDIES

TO THE PRESENT STUDY

The researchers present study relates to the previously gathered and

reviewed literatures which show the relevance on the study about the knowledge

and practice of Hospital Acquired Infections as perceived by nurses of Samaritan

hospital

The present study conducted by the researchers used a descriptive method

such like other studies and made use of questionnaires that be given to the

respondents and to be answered while interviewing the respondents.


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CHAPTER :

3

METHODOLOGY

3.1. TITLE

A study on the knowledge and practice of nursing staff regarding Hospital

Acquired Infection in Samaritan Hospital Pazhanganad.

3.2. OBJECTIVE

3.2.1. GENERAL OBJECTIVE

To study the knowledge and practice of nursing staff regarding Hospital Acquired

Infection in Samaritan Hospital Pazhanganad

3.1.2. SPECIFIC OBJECTIVE

To assess the level of knowledge of nursing staff regarding Hospital

Acquired Infection in Samaritan Hospital Pazhanganad


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To assess the level of practice of nursing staff regarding Hospital Acquired

Infection in Samaritan Hospital Pazhanganad

To assess the relationship between knowledge and practice

3.3. THEORETICAL DEFINITIONS

3.3.1. KNOWLEDGE

Knowledge is facts, information, and skills acquired through experience or

education - oxford dictionary

3.3.2. PRACTICE

Practice means contemplation of rules and knowledge that lead to action - oxford

dictionary

3.3.3. NURSE

By International Council of Nurses (1965), The nurse is a person who has

completed a programme of basic nursing education and qualified and authorized in

her country to supply the most responsible services of nursing for the promotion of

health, prevention of illness and the care of the sick

3.3.4. HOSPITAL ACQUIRED INFECTION

Nosocomial infection is that which develops in the patients after more than 48

hours of hospitalization - World Health Organization

3.4. OPERATIONAL DEFINITIONS

3.4.1. KNOWLEDGE


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Any information gained or acquired by nursing staff in Samaritan hospital on

infection control measures

3.4.1.1. VERY GOOD LEVEL OF KNOWLEDGE

A score between 1 to 0.8is indicative of having very good level of knowledge

3.4.1.2. GOOD LEVEL OF KNOWLEDGE

A score between 0.8 to 0.6is indicative of having good level of knowledge

3.4.1.3. AVERAGE LEVEL OF KNOWLEDGE

A score between 0.6 to 0.4is indicative of having average level of knowledge

3.4.1.4. LOW LEVEL OF KNOWLEDGE

A score between 0.4 to 0.2 is indicative of having low level knowledge

3.4.1.5. VERY LOW LEVEL OF KNOWLEDGE

A score between 0.2 to 0is indicative of having very low of knowledge

3.4.2. PRACTICE

Adherence to rules and protocols to prevent Hospital Acquired Infection by nurses

in Samaritan hospital

3.4.2.1. GOOD LEVEL PRACTICE

A score between 2 to4 obtained in the survey is indicative of having Good level

of practice

3.4.2.2. BAD LEVEL PRACTICE


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A score between 0 to 2obtained in the survey is indicative of having Bad level of

practice

3.4.3. NURSE

The nurse is a person who has completed a programme of General nursing or

B.sc nursing and authorized by IMC\INC and is working in Samaritan hospital

from 1stOctober to 31stDecember 2013

3.4.4. HOSPITAL ACQUIRED INFECTION

Any infection acquired due to the hospitalisation in Samaritan hospital

3.5. RESEARCH DESIGN

Broadly the design of the study is descriptive in nature. The study is

concerned with describing the function and skills of nursing staff and find out the

knowledge and practice of nurses regarding hospital acquired infection. It tries to

portray accurately the characteristics of a particular situation, group or individual.

The study includes fact finding enquires of different kinds which is collected by

conducting personal interviews with the nurses of Samaritan hospital.

3.6. UNIVERSE

The universe of the study is the nursing staff from the period of 01 st

October to 31st December 2013 in Samaritan hospital Pazhanganad.

3.7. SOURCES OF DATA

3.7.1. PRIMARY SOURCE

The nursing staff where included in the sample for the survey.


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3.7.2. SECONDARY SOURCE

Booklets, brochures, books and journals regarding infection control

Hospital records

3.8. TOOLS OF DATA COLLECTION

3.8.1.STRUCTURED INTERVIEW

The questionnaire were prepared by the researcher with the help of review of

literature and the discussion with the experts .Structured interview schedule is

prepared to collect the data regarding the knowledge and practice of infectioncontrol . The interview schedule contains 35 questions in three parts. Part one

contains demographic factors. Part 2 contains questions on knowledge about the

infection control and part 3 contains questions on practice in infection control.

3.8.2. ADMINISTRATION OF INTERVIEW SCHEDULE

Personal interview was conducted in a structured way for collecting

information. The interview schedule was administered to the respondents by the

researcher himself. The researcher, after establishing good rapport with the

respondent and after explaining the objectives and method of the study, holding

one copy of the interview schedule in hand presented each question so that the

respondents may freely respond to each one. Each responses was asked very

careful and extra cautions not to present any leading question so that the responses

might be free from bias.Acopy of the Questionnaire is attached as appendix I.

Reasons for selecting interview schedule

Interview method has got several merits over the other methods of data

collection. The chief merits of the interview method are:


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It is one of the most commonly used method

Samples can be controlled more effectively as there arises no difficulty of

the missing returns; non responses generally remains very low

The attention or the concentration of the respondents can be very well

seeked and thereby collect more appropriate answers and thereby avoiding

the biases,

In the interview it is possible to clarify the doubt regarding the nature of

enquiry or meaning of any statement or question or any tem used, as the

interviewer is personally present and takes note of the reponses himself in

the schedule.

3.9. SAMPLING

3.9.1. STRATIFIED RANDOM SAMPLING

The sampling method used was stratified random sampling. Total nursing staff

of hospital was stratified in to 8 strata namely Medical Ward, Cardiac Ward,

Surgical Ward, Gynaecology, Paediatrics Casualty, Operation Theatre and

Dialysis Unit. 35% of the nurses from each strata were included in the study. If

35% of the total nurses in any strata were less than 5, a minimum of 5 nurses were

included in the study. The nurses were selected randomly from each strata.

3.10. SAMPLE SIZE

Table 1: The table showing sample size

Departments

No of staff

Sample size

Medical ward

23

8


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Cardiac ward 20 7

Surgical ward 17 6

Gynaecology

9

5

Paediatrics ward

9

5

Casualty 23 8

Operation Theatre 17 6

Dialysis unit

5

5

123

50

3.11. PROCESSING AND ANALYSIS OF DATA

3.11.1. EDITING


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The questionnaires were scrutinized to assure that the data were accurate.

There were no incomplete questionnaires.

3.11.2. CODING

The questions regarding gender and marital status had two options each and

was coded as A and B

The questions regarding age and experience of work have three options andwas coded as A, B, and C.

3.11.3. CLASSIFICATION

In this study the questionnaire is divided in to three parts. First part deals

with demographic factors and the second part includes questions are based

on the knowledge, and third part deals practice.

3.11.4. TABULATION

The following tables were developed by finding the simple averages:

The result will be tabulated as follows:

Total average score

Demographic Factors wise Average Score

Gender wise average score

Age wise average score

Experience wise average score


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Education wise average score

Marital status wise average score

Department wise average score

Comparative analysis between knowledge and practice level of staff nurse

3.12. PILOT STUDY

A pilot study was conducted in the first 25 day to assess the feasibility of the

tool. first we scheduled in questionnaire method for data collection but personel

bias will occured in questionnaire method, we rescheduled questionnaire method to

interview method for data collection.

3.13. CALCULATION OF THE RESPONSES

Those who gave more than two correct answers to the questions

concerned, were given one mark and those who gave less than two answers were

given 0.5 mark. In the case of knowledge questionnaire, question numbers

1,3,4,5,7,8,9,10,16 and 18 had 2 or more answers. In the case of knowledge

questionnaire, question number 2 ,6,11,12,13,14,15,17 had only one correct

answer, those who gave correct answers were given one mark each for each correct

answers. For wrong and no answer, a score of zero were given.

The reponse to the practice questionnaire were 5 options, such as never , rarely, sometimes , often and always and they were assigned numerical value of

0,1,2,3,4 respectively

Assessment of knowledge:


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A score between 0 - 0.2 : very poor level knowledge

A score between 0.2 - 0.4 : poor level knowledge

A score between 0.4 - 0.6 : average level knowledge

A score between 0.6 - 0.8 : good level knowledge

A score between 0.8 - 1 :Very good level knowledge

Assessment of practice

A score between 0 to 2: bad level practice

A score between 2 to 4: good level practice

3.14 ANALYSIS AND INTERPRETATION

3.14.1. ANALYSIS

The question wise average score is calculated by dividing the total score of

each individual question by total number of samples.

Total average scores is calculated by dividing total score with samples no:

and again the answer divided by no: of questions

Variable wise average score is calculated by dividing total score of each

variable with samples no: and again the answer divided by no: of questions

of that variable.

Demographic factor wise average score is obtained by dividing the total

score of respondents corresponding to each factor in a variable with no: of

respondents of that factor and No. of questions.

Correlation between knowledge and practice of nursing staff regarding

infection control


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Karl pearsons coefficient of correlation = n xy(xy)

nx2- (x)2n y2- (y)2

Where x= sample wise average scores of knowledge of nursing staff ,

y= sample wise average scores of practice of nursing staff ,

n= number of samples.

3.14.2. INTERPRETATION

The data as per the tables were interpreted by the researcher and accordingly the

report was prepared. The correlation values were interpreted according to thetable given in appendix-II.

3.15. REPORT WRITING

The report is divided into five chapters. First chapter deals with introduction

and profile of the hospital. The second chapter presents the Review of

Literature. Third chapter deals with the Methodology. The fourth chapter deals

with analysis and interpretation of the data. The fifth chapter deals with the

findings and suggestion and conclusion.

3.16. TIME BUDGET

Institution and topic selection : 5 days

Tool preparation : 10 days

Pilot Study : 25 day


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Data collection : 50 days

Processing and analysis : 30 days

Report writing : 10 days

3.17. LIMITATION OF STUDY

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 interview and practice was thus assessed.


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CHAPTER 4

ANALYSIS AND INTERPRETATIONS OF THE

SURVEY

4.1. INTRODUCTION

In this chapter the researcher analyzes the data collected during the

survey on knowledge and practice of nursing staff regarding the hospital acquired

infections at Samaritan Hospital, Pazhanganad. After analysis, the interpretations

are also given.

4.2 . OVER ALL KNOWLEDGE AND PRACTICE OF NURSING

STAFF REGARDING HOSPITAL ACQUIRED INFECTION

Table 2: showing total average score

KNOWLEDGE PRACTICE

Total

score

Avge.

ScoreRemarks

Total

score

Avge.

ScoreRemarks

696.5 .69

good level

of

knowledge

2938 .29

Good

level of

practice

INTERPRETATION


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The overall study shows that all the employees possess good level of knowledge

and Good level of practice with respect to hospital acquired infections, in the

Samaritan Hospital, Pazhanganad.

4.3. ANALYSIS OF KNOWLEDGE AND PRACTICE

The collected data are analysed on the basis of questions , respondents and

demographic factor wise. The analysed data are given below.

4.3.1. QUESTION WISE AVERAGE SCORE IN KNOWLEDGE AND

PRACTICE.

4.3.1.1.QUESTION WISE AVERAGE SCORE IN KNOWLEDGE

TABLE: 3showing question wise average score

Q.NO Questions

Totalscore

No ofRespondents

Average

Remark

1

Hospital acquired

infection is the resultof cross infection.

17

50

.4

Poor level

of

knowledge

2

Hand washing is the

simplest and most

important practice

33

50

.7

Good level

of

knowledge

3

Body fluids like

blood need universal

precaution. 45

50

.9

Very good

level of

knowledge


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4 Nosocomialinfection can be

prevented by the

techniques like handwashing,

42 50 .8

Good level

of

knowledge

5 Universalprecautions were

initially developed

specifically toprevent the

transmission of

hepatitis B virus andHIV

14.5

50

.3

Poor level

of

knowledge

6

The number of

people occupied theroom, the amount of

activity and the rateof air exchange will

influence the numberof organism present

in the room

47 50 .9

Very good

level of

knowledge

7 Roots by whichinfections can be

transmitted areDroplets route,

Contact route,

Environmental route,

Intravenous route

43

50

.87

Very good

level of

knowledge

8 The high risk areasof the hospital

32 50 .64

Good level

of

knowledge

9

The patient factors

influencingtransmission of

diseases are Extremeage.

27.5 50 .55

Avg. Level

of


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Knowledge

10 HAI's transmittedthrough Body fluid,

Staff hands,

Reusable equipment31

50

.62

Good level

of

knowledge

11

Immediate action

should be taken in

case of direct blood

contact with HIVpatient

41

50

.82

Very good

level of

knowledge

12 Vaccines should betaken for health

workers

41.5

50

.83

Very good

level ofknowledge

13

After use of gloves

for a patient itshould be disposed

off

41

50

.82

Very good

level of

knowledge

14 HAI is also knownas nosocomial

infection 43

50

.86

Very good

level ofknowledge

15

The factor which

enhances the trans-mission of micro-

organisms ismoisture

15 50 .3

Poor level

of

knowledge

16 The method for

sterilization areHeat, Irradiation,Filtration, chemical,

low temp

25

50

.5

Avg. Level

of

Knowledge

17 Alcohol is aneffective disinfectant

34 50 .7 Good level


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for local skin. of

knowledge

18 The most common

forms of HAI areUrinary tract,surgicalwounds

,respiratory tract

33.5

50

.7

Good level

of

knowledge

19

The Colour coding

methods which isused for hospital

waste storage are

45 50 .9

Very good

level of

knowledge

20

Isolation is

important ininfection control

45 50 .9

Very good

level of

knowledge

INTERPRETATION

The questions regarding universal precautions, air exchange in the room, roots of

infections, first aid for direct blood contact of HIV, types of Vaccines, use of

gloves, basic information about HAI, colour methods of hospital waste, and the

important of isolation, the respondents have very good level of knowledge.

The questions regarding hand washing, preventions technique for HAI, high

risk areas of the hospital, HAI transmission route , the importance of alcohol and

common forms of HAI received good level of knowledge


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Towards the questions like cause for hospital acquired infection and factors

enchancing the transmission of micro organisms the respondents have poor level of

knowledge.

4.3.1.2 QUESTIONS WISE AVERAGE SCORE IN PRACTICE

TABLE: 4 showing question wise average score in practice

Q.

NO

Questions

Total

score

No of

Respondents

Average

Remark

1 Isolate the patients onimmuno suppressive drugs to

prevent HAI. 154 50 3

Good

level of

practice

2

We must follow sterile

technique for all the process.

158

50

3.1

Good

level of

practice

3

Universal precautions are

followed for the patients with

hiv and hepatitis band c.

112

50

2.3

Good

level of

practice


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4 Soap, water or any other

disinfectants should be used

for hand washing practice.

174

50

3.5

Good

level of

practice

5

Tissue paper or any othermaterials should used afterhand washing for drying.

131

50

2.6

Good

level of

practice

6 Use distilled water innebulizer.

92 50 1.8

Bad

level of

practice

7

Whether you are use needle

destroyers to destroy needles. 95 50 1.9Bad

level of

practice

8

Wash hands before & after

patient examination.

168

50

3.4

Good

level of

practice

9

Wear gloves in gastric lavage

procedure 167

50

3.4

Good

level of

practice

10

Reautoclave the unused

sterile articles after a

specified period 166 50 3.3

Good

level of

practice

11 Wear gloves for i/v injection

42 50 .84

Bad

level of

practice

12

Follow hand washing

procedure after removing180 50 3.6

Good

level of


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gloves practice

13 Swabs from the departmentshould sent for culture

138 50 2.8

Good

level of

practice

14 Fumigate or through wash the

isolation room should be doneafter patient departure

164

50

3.3

Good

level of

practice

15

Use preventive measures,

while taking injections and

blood.113

50

2.3

Good

level of

practice

16

Follow the color coding for

disposing the waste safely inyour department

191 50 3.8

Good

level of

practice

17 We should maintain a cleanclinical environment .

162 50 3.2

Good

level of

practice

18 Wear mask and cap whiledoing any procedures.

169

50

3.4

Good

level of

practice

19

Vaccines should be taken

compulsory in health sectoras a preventive method. 170 50 3.4

Good

level of

practice

20

Biomedical waste should

taken out of the department at

regular intervals192 50 3.8

Good

level of

practice


52/67

INTERPRETATION

The questions regarding isolating the patients, sterile technique, universal

precautions, disinfectants, using tissue paper, hand washing before & after patient

examination, use of gloves, reautocalve of unused sterile articles after a specified

period, hand washing procedure, fumigating, preventive measures during the time

of injections, color coding for disposing the waste, clean environment, personnel

protective equipments, vaccines taken , and the time of biomedical waste removal

from the department, shows Good level of practice.

The analysis of the questions for using distilled water in nebulizer, use of

needle destroyers and the use of gloves shows Bad level of practice.

4.3.2.DEMOGRAPHIC WISE AVERAGE SCORE

4.3.2.1. GENDER WISE AVERAGE SCORE IN KNOWLEDGE AND

PRACTICE

TABLE: 5showing gender wise average score knowledge and practice

Sl

.n

o

factor No of

responden

t

No of

question

s

Knowledge Practice

averag

e

remark

averag

e

remar

k

1

male

3

20

.7

good level Good


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of

knowledg

e

2.8 level of

practic

e

2

Femal

e47

20

.7

Good

level of

knowledg

e

2.9

Good

level of

practic

e

INTERPRETATION

Thistable shows no difference for males and females towards the knowledge

and practice. The males and females shows good level of knowledge and Good

level of practice towards Hospital Acquired Infections.

4.3.2.2. MARITAL STATUS WISE AVERAGE SCORE IN

KNOWLEDGE AND PRACTICE

TABLE: 6 showing marital status wise average score knowledge and practice

Sl

.nofactor

No of

respondent

No of

questions

Knowledge Practice

Average remark average Remark


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1 Married 20 20 .72

good level

of

knowledge

3

Good

level of

practice

2 single 30 20 .7

Good level

of

knowledge

2.9

Good

level of

practice

INTERPRETATION

The study shows no difference for married and unmarried employees regarding

the knowledge and practice of Hospital Acquired Infections.

4.3.2.3. AGE WISE AVERAGE SCORE IN KNOWLEDGE AND

PRACTICE

TABLE: 7 showing age wise average score in knowledge and practice

Sl factor No of No of Knowledge Practice


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.no respondent questions average remark average Remark

1 Grp;Less

than 25

28

20

.7

good level

of

knowledge

2.9

Good

level of

practice

2 Grp;25 to

35 17 20 .7

good level

of

knowledge

2.9

Good

level of

practice

3 Grp;above

35 5 20 .68

good level

of

knowledge

2.9

Good

level of

practice

INTERPRETATION

From the above table its clear that age difference does not influence the

knowledge and practice to Hospital Acquired Infections. All nursing staff shows

good level of knowledge and Good level of practice towards Hospital Acquired

Infections.

4.3.2.4. EDUCATION WISE AVERAGE SCORE IN KNOWLEDGE

AND PRACTICE

TABLE: 8 showing education wise average score in knowledge and practice


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Sl

.nofactor

No of

respondent

No of

questions

Knowledge Practice

average remark average remark

1

Grp; G N

M 10 20 .7

good level

of

knowledge

2.9

Good

level of

practice

2 Grp; B .Sc

39 20 .7

good level

of

knowledge

2.9

Good

level of

practice

3 Grp;

M.Ssc

1

20

.68

good level

ofknowledge

2.9

Good

level ofpractice

INTERPRETATION

From the above table it is evident that the employees educational qualification

difference does not influence the knowledge and practice of nursing staff

towards Hospital Acquired Infections .

4.3.2.5. EXPERIENCE WISE AVERAGE SCORE IN KNOWLEDGE

AND PRACTICE

TABLE: 9 showing experience wise average score in knowledge and practice


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Sl

.nofactor

No of

respondent

No of

questions

Knowledge Practice

Average Remark average remark

1 Grp;1-3

24 20 .7

Good level

of

knowledge

3

Good

level of

practice

2 Grp;3-6

4 20 .75

Good level

of

knowledge

2.8

Good

level of

practice

3 Grp;above

6 22 20 .69

Good level

of

knowledge

2.8

Good

level of

practice

INTERPRETATION

From the above table its clear that staff of all group shows Good level of practice

and good level of knowledge in Hospital Acquired Infections .

4.3.3. DEPARTMENT WISE AVERAGE SCORE IN KNOWLEDGE

AND PRACTICE

TABLE:10 showing department wise average score in knowledge and practice

Sl factor No of No of Knowledge Practice


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.no respondent questions average Remark average remark

1Emergency

department

8 20 .72

Good level

of

knowledge

3.2

Good

level of

practice

2operation

theatre6 20 .7

Good levelof

knowledge

2.9Good

level of

practice

3 Dialysis 5 20 .77

Good level

of

knowledge

3

Good

level of

practice

4. Medical ward 8 20 .60

Good level

of

knowledge

2.9

Good

level of

practice

5.

Cardiac

7

20

.68

Good level

of

knowledge

2.8

Good

level of

practice

6.

Surgical

6

20

.66

Good level

of

knowledge

3.2

Good

level of

practice

7.Gynaecology

department5 20 .61

Good level

of

knowledge

2.8

Good

level of

practice

8.

paediatric

5

20

.57

Average

level ofknowledge

2.7

Good

level ofpractice

INTERPRETATION

Respondents in paediatric department shows average knowledge and

Good level of practice . Respondents in all other departments shows good level of

knowledge and Good level of practice .

4.4. CORRELATION ANALYSIS OF KNOWLEDGE AND PRACTICE

OF NURSING STAFF TOWARDS HOSPITAL ACQUIRED

INFECTIONS


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TABLE : 11showing sample wise average score knowledge and practice of

nursing staff towards hospital acquired infections.

X

(knowledge)

Y

(Practice)

X2

Y2

XY

.8 3.3 0.64 10.89 2.64

.6

3.7

0.36

13.69

2.22

.8

3.1

0.64

9.61

2.48

.6 3.4 0.36 11.56 2.04

.85

3.1

0.7225

9.61

2.635

.78

3.2

0.6084

10.24

2.496

.65 2.7 0.4225 7.29 1.755

.7 2.7 0.49 7.29 1.89

.83 2.6 0.6889 6.76 2.158

.6

2.6

0.36

6.76

1.56

.73 3.3 0.5329 10.89 2.409

.7 3.1 0.49 9.61 2.17

.73

3.1

0.5329

9.61

2.263

.6

2.8

0.36

7.84

1.68

.5 2.1 0.25 4.41 1.05

.83 3.3 0.6889 10.89 2.739

.7

3.4

0.49

11.56

2.38

.68

2.8

0.4624

7.84

1.904

.56 2.6 0.3136 6.76 1.456

.8

2.8

0.64

7.84

2.24

.78

3.4

0.6084

11.56

2.652


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.68 3.3 0.4624 10.89 2.244

.45 2.9 0.2025 8.41 1.305

.6

3

0.36

9

1.8

.65

2.7

0.4225

7.29

1.755

.68 2.9 0.4624 8.41 1.972

.73 3.5 0.5329 12.25 2.555

.83

3.2

0.6889

10.24

2.656

.75

3.3

0.5625

10.89

2.475

.58 3 0.3364 9 1.74

.75

3

0.5625

9

2.25

.8

3.5

0.64

12.25

2.8

.68

2.9

0.4624

8.41

1.972

.65 3.4 0.4225 11.56 2.21

.8 2.8 0.64 7.84 2.24

.75

2.4

0.5625

5.76

1.8

.68 2.3 0.4624 5.29 1.564

.58 2.6 0.3364 6.76 1.508

.5

2.1

0.25

4.41

1.05

.6

3.5

0.36

12.25

2.1

.68

3.5

0.4624

12.25

2.38

.7 3 0.49 9 2.1

.75

3.3

0.5625

10.89

2.475

.6

2.8

0.36

7.84

1.68

.83 2.6 0.6889 6.76 2.158

.85 3.3 0.7225 10.89 2.805

.5

2.1

0.25

4.41

1.05


61/67


62/67

= 31.95

103.101

Co- efficient of correlation = .3099

INTERPRETATION

The analysis shows that knowledge and practice of nursing staff

regarding Hospital Acquired Infection have low positive co-relation. Hence the

relationship between them is definite.


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CHAPTER 5

FINDINGS AND SUGGESTIONS

5.1 FINDINGS

Towards the questions that cause of Hospital Acquired Infection, and

factor enhances the transmission of micro organisms the nurses shown

poor level knowledge.

In this study shows that there is no difference between males and females

regarding knowledge and practice.

The study shows that, nurse have good level knowledge and practice

towards hospital acquired infection.

Level of practice regarding the use of distilled water in nebulizer, use of

needle destroyers and the use of gloves is bad.

From the study its clear that age difference does not influence the

knowledge and practice.

The study shows no difference in the knowledge and practice of married

and unmarried employees towards Hospital acquired infection.


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Study reveals that educational qualification of nurses do not influence

their knowledge and practice towards Hospital Acquired Infections .

The study states that experience of the staff do not affect the Good level

of practice and good level of knowledge in Hospital Acquired Infections.

The overall study shows that all the employees shows good level of

knowledge and Good level of practice towards Hospital Acquired

Infections.

5.2 SUGGESTIONS

The knowledge of nurse regarding hospital acquired infections, universal

precucations, and transmission of micro organsms can be improved by

conducting seminars, workshops etc..

There should be strict supervision on nurse regarding whether they are

following the aseptic and preventive techniques like the use of distilled

water in nebulizer, use of needle destroyer and use of gloves for i/v

injection.

Specific educational efforts should be carried out to increase the information

to the health care team on the risks and concerns of treating HIV positive


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patients or the AIDS patient and to increase the confidence of the

practitioner to treat these patients.

An assessment of knowledge of infection control procedures and infectious

diseases should be carried out for all newly-hired professional staff and the

formal courses should be provided based on the pre-course results.


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CONCLUSION

On the basis of the above study and findings, it can be said that there exists a

low positive relationship between knowledge and practice. Both are directly

proportional to each other. This indicates that with improved knowledge, we 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 Hospital

Acquired Infections should be systematically planned and regularly conducted for

staff nurses so as to keep staff nurses up to date on the topic.

Continuous surveillance of HAI in vulnerable areas and notification to the

concerned authorities is essential and the formulation of regulations should be

effectively performed, so as to be able to take appropriate measures in time.

Continuous vigilance, assessment and supervision of clinical performance of

various levels of workers will help to start a multidimensional attack on the

problem of HAI.


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BIBLIOGRAPHY

Kothari C.R. , Researcher Methodology ,New Age International (P)

limited Publishers ,Newdelhi,2007.

C .M. Francis and Mario C D Souza ,Hospital Administration ,Jaypee

Brothers ,Medical Publishers (p) LTD.Newdelhi.3rdedition

World Health Organization, Guidelines for Prevention and control of

Hospital Associated Infections, Regional Office for South-East Asia New

Delhi ,SEA-HLM-343 January 2002

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