CAVENDISH UNIVERSITY ZAMBIA

SCHOOL OF MEDICINE

DEPARTMENT OF NURSING AND MIDWIFERY

Nurses Compliance with Infection Prevention Guidelines at Levy Mwanawasa

University Teaching Hospital- Zambia

A research Dissertation Submitted in Partial Fulfilment for the Bachelor of Nursing and

midwifery Sciences at the Cavendish, Zambia

Mutinta Chimwembe

004-489

Research Supervisor: Mr. Mwalungali

2020

ii

CERTIFICATION

This is to certify that the work contained in the thesis entitled “Nurses Compliance With

Infection Prevention Guidelines at Levy Mwanawasa University Teaching Hospital”,

submitted by MUTINTA CHIMWEMBE (004-489) for the award of the Bachelor’s Degree

In Nursing And Midwifery is a record of bonafide research works carried out by her under my

direct supervision and guidance.

I considered that the thesis has reached the standards and fulfilling the requirements of the rules

and regulations relating to the nature of the degree. The contents embodied in the thesis have

not been submitted for the award of any other degree or diploma in this or any other univers ity.

NAME OF SUPERVISOR SIGNATURE DATE

…………………………….. …………………….. …………………………..

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DECLARATION

I, MUTINTA CHIMWEMBE, do declare that this Dissertation hereby submitted in partial

fulfilment for the award of a BACHELOR’S DEGREE IN NURSING AND

MIDWIFERY represents my own work and that it has never been previously submitted for a

degree at the Cavendish University or any other University or institution of higher learning.

NAME OF STUDENT SIGNATUARE DATE

……………………….. ……………….. ……………….

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DEDICATION (OPTIONAL)

This research work is dedicated to my husband, MR AGREY CHISOKO, my children

MONICA MWAPE, NORAH MWAPE, LIKEZO CHISOKO and last though not the least

my parents MR AND MRS CHIMWEMBE.

Thank you.

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ACKNOWLEDGEMENTS

I would like to express my deepest appreciation to all those who provided me the possibility to

complete this report. I give a special gratitude to my final year project supervisor Mr

Mwalungali, whose contribution in stimulating suggestions and encouragement helped me to

coordinate my project especially in writing the report.

Befitting also is that I thank the lecturers at the school of Medicine at Cavendish University for

their Contribution in moulding me in my profession. Their input proved to be very helpful

when writing the report. Furthermore, I would like to acknowledge with much appreciation the

crucial role of all the academic staff at Cavendish University, particularly my Tutor and Course

Coordinator Miss Mwiinga.

Last but not the least, many thanks go to my Director Dr. Njekwa and colleagues from

institution.

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ABSTRACT

Brief Background: The occurrence of hospital infections among nurses within health facilit ies

is a serious health problem. There is insufficient information regarding the matter, particula r ly

with a specific focus on examining factors that influence nurses' compliance to Infection

Prevention Guidelines. The aim of the study was to determine factors that influence nurses'

compliance with infection prevention guideline at Levy Mwanawasa University Teaching

Hospital.

Procedure: The population of the study included all nurses at Levy Mwanawasa Teaching

Hospital. A sample size of 50 participants was used after participants were selected at random

from the site study. Questionnaires were administered on fifty (50) participants that took part

in the research study.

Results: The study investigated the work related infections risks on nurses who were

participants that took part in the research study. The study showed that majority participants,

43 (86%) in the study had heard of hospital-acquired infection and prevalence rate of 30%

Hospital Acquired Infections was reported. On nurses’ information on infection prevention

guidelines, study results showed that half participants25 (50%) participants cited hand

washing as most effective method to prevent infections and participants considered of all

unsterile needles/sharps to be contaminated.

The research study investigated Factors That Influence Compliance/Non-Compliance to IP,

and majority participant agreed poor working environment, poor knowledge about prevention

of nosocomial infection, lack of water for hand washing and other material resources and lack

of equipment influence compliance/non-compliance to IP Guidelines. On measures to put in

place for nurses regarding infection, the study participants agreed increasing awareness of

hospital acquired, hygiene education, hand washing is an effective measure toward infect ion

control and satisfactory knowledge level as measures of infection control.

Recommendations: The research study recommends increasing awareness of hospital

acquired infections among healthcare nurses a measure towards infections control and

emphasizing hand washing as an effective measure toward infection control.

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TABLE OF CONTENTS

CERTIFICATION…………………………………………………………………………….ii

DECLARATION……………………….……………………….……………………………iii

DEDICATION (OPTIONAL)………………………………………………..………………iv

ACKNOWLEDGEMENTS……………………………………………………………..……v

ABSTRACT……………………………………………………………………..……………vi

LIST OF TABLES…………………………………………………………………………..xii

LIST OF FIGURES……………………………………………………..…………………..xiii

LIST OF ACRONYMS/ABBREVIATIONS……………………………………………….ivx

CHAPTER 1 - INTRODUCTION

1.1 Background of the Study…………………………………………………………………..1

1.2 Statement of the Problem………………………………………………………………….5

1.3 Study Justification……………………………………………………………..…………..6

1.4 Research Questions…………………………………………………………………….….7

1.5 The Main Objective……………………………………………………………….……….7

1.5.1 Specific Objectives………………………………………………………………...…….7

1.6 Research Methodology……………………………...……………………………………..7

1.7 Significance of the Study…………………………………………………………...……..8

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1.7 Scope and Location of the Research………………………………………………………8

CHAPTER 2 - LITERATURE REVIEW

2.1 Introduction………………………………………………………………………………..9

2.2 Nosocomial infection………………………………………………………………….…..9

2.3 Global Perspective ………………………………………………………………...……..10

2.4 African Perspective………………………………………………………………………11

2.5 Zambian Perspective………………………………………………………………..……13

2.6 Infection Control Measures………………………………………………………………14

CHAPTER 3 - RESEARCH METHODOLOGY

3.1 Introduction…………………………………………………………………………...….18

3.2 Research Design………………………………………………………………………….18

3.3 Study Site…………………………………………………………………………...……19

3.4 Study Population……...………………………………………………………………….19

3.5 Target Population……………………………………………………………………...…19

3.5.1 Sample Size Determination and Sampling Method……………………….…………19

3.6 Inclusion and Exclusion Criteria…………………………………………………….…..21

3.6.1 Inclusion criteria………………………………………………………………………..21

3.6.2 Exclusion criteria…………………………………………………………………….…22

3.7 Data Collection Tools and Techniques…………………………………………………..22

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3.8 Data Analysis……………………………………………………………………...……..24

3.9 Ethical Issues/Concerns…………………………………………………………………..24

CHAPTER 4 - DATA PRESENTATION AND INTERPRETATION

4.1 Introduction………………………………………………………………………………25

4.2 Characteristic of Respondents………………………………………………...………….25

4.3 Work related infections risks on nurses……………………………………………….…27

4.4 Nurses Information on IPG……………………………………………………………....30

4.5 Factors That Influence Compliance/Non-Compliance to IP Guidelines………..………..33

4.6 Measures That Can Be Put in Place for Nurses Regarding IP…………………..……….35

CHAPTER 5 - DISCUSSION OF FINDINGS AND ANALYSIS

4.1 Introduction………………………………………………………………………………39

4.2 Work related infections risks on nurses……………………………………….…………39

4.3 Nurses Information on IPG……………………………………………………..………..41

4.4 Factors That Influence Compliance/Non-Compliance to IP Guidelines…………..……..42

4.5 Measures That Can Be Put in Place for Nurses Regarding IP…………………………...43

CHAPTER 6 - CONCLUSIONS AND RECOMMENDATIONS

6.1 Introduction……………………………………………………………………...……….46

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5.2 Conclusions………………………………………………………………………...…….46

5.3 Recommendations………………………………………………………………..………48

References……………………………………………………………………………………49

APPENDIX I – Informed Consent……………………………………………………….......53

APPENDIX II – Questionnaire……………………………………………..………………..54

APPENDIX III - Gantt chart For Proposed Study……………….……………….…………61

APPENDIX IV - Research Budget…………………………………………….………….....62

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LIST OF TABLES

Table 4.3.1 Distribution of participants if they ever heard of hospital-acquired

infection………………………………………………………………………………………22

Table 4.3.2 Distribution of participants on whether they ever experienced hospital-acquired

infection…………………………………………………………………………………...….28

Table 4.3.3 Distribution of responses on whether participants ever sustained a used needle

stick injury ………………………………………………………………………………...…28

Table 4.3.4 Distribution of responses on participants if ever splashed by patient's blood,

vomit or other bodily fluids…………………………………………………………………..29

Table 4.3.5 Distribution of responses on whether participants consider all patients

contagious…………………………………………………………………………………….29

Table 4.4.2 Distribution of responses on consideration of all unsterile needles/sharps to be

contaminated…………………………………………………………………………………31

Table 4.4.3 Distribution of responses on whether participants knew about nosocomial

infection monitoring program in your hospital……………………………...…….…………31

Table 4.4.4 Distribution of responses whether participants knew where infectious wastes

from patients are disposed of…………………………………………………………...…….32

Table 4.5.1 Distribution of responses on whether poor working environment influence

compliance/non-compliance to IP Guidelines…………………………………………….….33

Table 4.5.2 distribution of responses on whether poor knowledge about prevention of

nosocomial infection influence compliance/non-compliance to IP Guidelines……………...34

Table 4.5.3 Distribution of responses on whether lack of water for hand washing and other

material resources infection influence compliance/non-compliance to IP Guidelines………34

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Table 4.5.4 Distribution of responses on whether lack of equipment influence compliance/non-

compliance to IP Guidelines……………………………………………….35

Table 4.6.1 Distribution of responses on whether increasing awareness of hospital acquired

infections among healthcare nurses a measure towards infections control………………..…35

Table 4.6.2 Distribution of responses on whether hygiene education is a good measure for

infection control…………………………………………………………………………...…36

Table 4.6.3 Distribution of responses on whether hand washing is an effective measure toward

infection control……………………………………………………………………...37

Table 4.6.4 Distribution of responses on whether satisfactory knowledge level is an ideal

measure of infection control………………………………………………………………….37

Table 4.6.5 Distribution of responses on whether nurse training sessions regarding infect ion

can mitigate infection control…………………………………………………………..…….38

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LIST OF FIGURES

Figure 4.2.1 Distribution of Participants by Gender…………………………………………25

Figure 4.2.2 Distribution of Participants by Age……………………………...……………..26

Figure 4.2.3 Distribution of Participants by years of experience………….…………………26

Figure 4.2.4 Distribtion of participant by level of education…………………………..…….27

Figure 4.4.1 Distribution of responses on single most effective method to prevent

infections…………………………………………………………………………..…………30

Figure 4.4.6 Distribution of responses on how often participants wash apron/nurse

uniform……………………………………………………………………………...………..32

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LIST OF ACRONYMS/ABBREVIATIONS

CBoH - Central Board of Health

HAIs - Health Acquired Infections

HCAI - Healthcare Associated Infections

HCWs - Health Care Workers

HICC - Hospital Infection Control Committee

ICU – Intensive Care Unit

IP - Infection Prevention

IPGs - Infection Prevention Guidelines

LMUTH - Levy Mwanawasa University Teaching Hospital

MoH - Ministry of Health

Nis - Nosocomial Infections

PPEs - Personal Protective Equipment

SSI - Surgical Site Infections

UTI - Urinary Tract Infections

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CHAPTER 1

INTRODUCTION

1.1 Background of The Study: The Chapter provides an overview of the research study aimed

at determining factors that influence nurses' compliance with Infection Prevention Guidelines

at Levy Mwanawasa University Teaching Hospital in Lusaka. The Chapter is divided into some

themes, which include background of the study, statement of the problem, research objectives

and research questions, significance of the study and the study scope and location of the study.

The Government of Zambia through the Ministry of Health and its cooperating partners

developed Zambia Infection Prevention Guidelines in 2003. This was after a realization that

infection prevention was a critical component of quality health care. High compliance with

infection prevention and control guidelines was associated with inclusion of Guidelines in the

Curricular.

What is important is high knowledge of infection prevention/hospital acquired infections,

positive attitude towards infection prevention and availability of materials for infect ion

prevention. The concept of Nosocomial Infection (NI) or hospital-acquired infection or Health-

care-associated infection has become a great concern. Nejad et al. (2011) referred to

nosocomial infection (NI), or hospital-acquired infection or Health-care-associated infect ion

(HCAI) in reference to infection that is acquired during the process of care and not manifes ted

at the time of admission to a hospital or other health-care facility.

The general intention of medical treatment is save life, and never to cause any transmission of

diseases. WHO (2008) also acknowledged that that medical treatment is intended to save life

and improve health. Against the highlighted, all health workers have a responsibility to prevent

transmission of health-care associated infections. Adherence to safe injection practices and

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related infection control is part of that the core responsibility. The ultimate results should be

the desire to protect patients and all front line health workers against transmission of diseases.

Compliance with Standard Precautions, which includes a set of guidelines that can protect

health care professionals from being exposed to microorganisms, is regrettably low among

nurses. Additionally, high rates of exposure to microorganisms among nurses via several

modes, such as needle sticks, hands contamination with blood, exposure to air-transmit ted

microorganisms occur on daily basis. It is an inevitable risk all health workers are exposed to.

The study conducted by Vaz et al (2010) established that numerous studies document the

pivotal role of Health Care Workers’ hands in the propagation of micro-organisms within the

healthcare environment and ultimately to patients. The study revealed that those organisms are

capable of surviving on Health Care Workers’ hands for at least several minutes following

contamination.

Thus, if hand hygiene practices are suboptimal, microbial colonization is more easily

established and/or direct transmission to patients in direct contact with the patient may not

occur. Hand hygiene is the leading measure for preventing the spread of antimicrob ia l

resistance and reducing Healthcare-Associated Infections (HCAIs). Regrettably, healthcare

worker compliance with optimal practices remains low in most settings.

Standard precautions are a set of guidelines designed to reduce the risk of acquiring

occupational infection from both known and unexpected sources in the health care setting.

Richards et al. (2009) stated that these infection prevention guidelines and precautions are

intended to protect health care workers from percutaneous injuries and prevent transmission of

nosocomial infection that can be applied to care of all patients in all health care settings

regardless of the suspected or confirmed presence of an infectious agent.

3

Nurses' strict adherences constitute an important factor in determining the rate of hospital

associated infections. The Compliance of nurses with the standard precautions of infect ion

control has been recognized as being an efficient means to prevent and control healthcare -

associated infections. Such measures not only protect the pediatric patients, but also the nurses

and the environment. Several studies indicated that better knowledge of standard precautions

among healthcare workers was one of the predictors’ of better compliance.

The study conducted by Vaz et al. (2010) further reported that reported factors that contribute

to non-compliance with the standard precautions include lack of understanding and knowledge

among healthcare workers on how to properly use protective barriers, lack of time, lack of

resources and lack of proper training.

The cornerstone of efforts to reduce infection in the critical pediatric departments is an effective

infection prevention and control program to improve the nurses’ compliance with standard

precautions of infection control. Therefore, education has been identified both nationally and

internationally that as a part of any overall strategy for infection prevention and control in

health care settings. Vaz et al (2010) pointed out that interventional measures have been

proposed as a key strategy to minimize exposure of nurses and patients to infection with the

implementation of standard precautions as one of the strategies.

WHO (2008) observed that infection prevention essentially implies to prevention and control

of healthcare-associated infection. It addresses factors related to the spread of infections within

the healthcare setting whether patient-to-patient, from patients to staff and from staff to

patients, or among-staff, including prevention (via hand hygiene/hand washing,

cleaning/disinfection/sterilization, vaccination, surveillance), monitoring/investigation of

demonstrated or suspected spread of infection within a particular health-care setting. In many

studies, compliance with standard precautions among healthcare workers was reported to be

4

inadequate. Nurses may acquire an infection during the provision of nursing care because of

occupational exposure to microorganisms.

The study conducted by Katowa (2007) found that Hospital Acquired Infections (HAIs) are

still a major problem in Zambia as demonstrated by the increase in post-operation wound

infections among patients with Caesarian Section which has been 30%. This could be attributed

to ineffective use of Infection Prevention (IP) and control practices and guidelines. Against the

highlighted, there is dire need to highlight some key areas of focus such as hospital stay, IP,

resistance levels, universal precautions, training and procurement.

Unfortunately, HAIs put an added financial strain on the health system. This is due to prolonged

patient hospitalization, use of expensive drugs and provision of other services such as

laboratory and X-Ray services. The Central Board of Health developed some guidelines and

noted that that HAI cause patients to stay unnecessarily longer days in hospitals and yet this

can be avoided simply by adhering to the stipulated and cheaper infection and control methods

and practices.

On average, this state of affair increases a patient’s hospital stay by 7-10 days, with organ/space

and deep incision accounting for the longest stays and highest cost. The Zambia Infection

Prevention Guidelines, (2003) standard infection precautions and guidelines are internationa lly

approved measures which prevent health care providers from either infecting their patients or

acquiring hospital infections whilst rendering care.

These measures include washing hands with soap and water or using an antiseptic hand rub

before and after attending to a patient, covering all cuts and bruises which offer entry ports for

HIV and not recapping needles and syringes. Others comprises wearing of barriers such as

gloves, gowns, masks and protective eye shields, bending or manipulating used needles and

other sharp instruments and decontaminating all reusable instruments.

5

Ofili and Sogbeson (2013) observed that IP Guidelines were recommended in West Africa and

that they were to be strictly adhered to as outlined in the nursing curriculum because they found

out that most nurses had inadequate knowledge of IP practices which led to poor utilization of

IP Guidelines.

It is important also to note that standard guidelines and precaution with regard to control and

prevention of infection require that health care workers assume for instance, the blood and

body substances of all patients are potential sources of infection, regardless of the diagnosis,

or presumed infectious status. Additional precautions are needed for diseases transmitted by

air, droplets and contact.

1.2 Statement of the Problem: There have been a lot of good interventions by the Zambian

Government through the Ministry of Health and various cooperating partners such as to reduce

infections caused by exposure to care providers such as nurses. Interventions have been

developed and implemented through Infection Prevention (IP) Guidelines with the aim of

reducing infections caused by exposure to the care providers as well as patients. Alas,

infections have at times been experienced.

Despite developing and implementing the IP Guidelines, the prevalence and infections among

nurses still seems to be high in most hospitals and health centres. This year, a number of health

practitioners that included nurses were reported to have been infected with COVID-19, at

isolation centres that included Levy Mwanawasa University Teaching Hospital.

There is no ample research that has investigated factors causing the state of affairs particula r ly

among nurses. Munganga (2007) in a study done at Kitwe Central Hospital only determined

the knowledge, attitude and practice of medical doctors on infection prevention, which revealed

that all the respondents had heard of IP. Libetwa (1997) in her dissertation entitled knowledge,

Attitude and Practices of Midwives on Infection Control in Maternity Units in Lusaka Urban

6

Clinics also revealed some inconsistence and incorrect use of IP materials as indicated by

12.5% of midwives who wore gloves throughout the shift and 17.5% who wore 3-4 pairs of

gloves. The study never examined causal factors.

The study conducted by Libetwa (1997) only revealed some lack of knowledge in the

utilization of personal protective materials such as double gloving for health workers

performing deliveries and those assisting with surgical procedures. This means occurrence of

infections among nurses within health facilities is a serious health problem which needs to be

addressed, with inadequate and absence of a thorough study available.

To address the problem, there is need to have ample evidence about the current situation and

factors at play. From the literature viewed, there is insufficient information regarding the

matter, particularly with a specific focus on examining factors that influence nurses'

compliance to Infection Prevention Guidelines. Based on the highlighted, it was important to

determine the factors that influence nurses' compliance with Infection Prevention Guidelines.

1.3 Study Justification: The world is now faced with numerous infectious diseases. This calls

for interventions that can deal with hospital infections. Hospital settings are of public interest

and they must safe in the most possible way for members of staff and indeed the patients who

are always hosted there and their visitors. The safety of all stakeholders depends matters

pertaining to issues of Infection Prevention (IP) Guidelines. Those are having potential of

reducing infections caused by exposure to the care providers as well as patients. Research such

as one determining Nurses compliance to Infection Prevention Guidelines at Levy Mwanawasa

University Teaching Hospital is fundamentally important.

1.4 Research Questions: The following were research questions on which the study was

based:

7

• What are work-related infection risks on nurses at LMUTH?

• Is there any information on IP Guidelines and compliance among nurses at LMUTH?

• Are any factors that influence compliance/non-compliance to IP Guidelines at

LMUTH?

• What measures can be put in place for nurses and other healthcare workers regarding

IP at LMUTH?

1.5 The Main Objective: The main objective of this study was to determine Nurses

compliance to Infection Prevention Guidelines at Levy Mwanawasa University Teaching

Hospital.

1.5.1 Specific Objectives: The following were specific objectives of the study:

• To determine work-related infection risks on nurses at LMUTH.

• To assess nurses’ information on IP Guidelines and compliance among nurses at

LMUTH.

• To identify factors that influence compliance/non-compliance to IP Guidelines at

LMUTH.

• To recommend measures that can be put in place for nurses and other healthcare

workers regarding IP at LMUTH.

1.6 Research Methodology: The research study was conducted through a primary in the field

using a questionnaire. All participants were selected at random from participants. The research

adopted all possible research methodologies as oulined in chapter three of the research report.

8

1.7 Significance of the Study: Although there have been many seminars, presentations and

workshops regarding IP Guidelines, HAI seems to be a continuing problem in a number of

health facilities in Zambia. Not so many studies have been done in the country regarding HAIs .

Statistics and information regarding compliance levels or costs associated with nosocomia l

infections in Zambia is scanty, thereby justifying the essence of the study. This information

which the study reveals is necessary for informing policy and decision-makers.

The information which the research study brings out can be used to deal with factors leading

to nurse’s non-compliance to Infection Prevention Guidelines in health facilities. Just like any

other research study, findings of the study will contribute to available body of knowledge by

adding to literature on the subject which other academicians can utilise for future references.

Similarly, the recommendations which the research study suggests can be used to provide

answers to the problems at hand.

1.7 Scope and Location of the Research: The scope of the study should essentially be clear

in order for the study to remain focused and be exhaustive. The study remained dedicated by

determining only the factors that influence nurses' compliance with Infection Prevention

Guidelines at Levy Mwanawasa University Teaching Hospital in Lusaka. The study confined

itself to determining work-related infection risks on nurses, assessing nurses’ information on

IP Guidelines and compliance, identifying factors that influence compliance/non-compliance

to IP Guidelines and recommending measures that can be put in place for nurses and other

healthcare workers regarding IP at Levy Mwanawasa University Teaching Hospital.

CHAPTER 2

LITERATURE REVIEW

9

2.1 Introduction: This Chapter reviews literature relevant to the research problem concerning

and establishing factors that lead to Non-Adherence to Anti-Retroviral Therapy among HIV

infected adults: A case study of Chilenje First Level Hospital. The literature review is presented

using some Themes. Among other Themes, Global, Sub-Saharan and Local (National)

perspectives have been highlighted in the Chapter.

2.2 Nosocomial Infections: The problem of transmissions of infection of diseases from

patients to nurses is not a new phenomenon. This is known as nosocomial infection (NI) or

hospital-acquired infection or Health-care-associated infection (HCAI). Researchers Nejad et

al defined hospital-acquired infection to refer to infections that are acquired during the process

of care and not manifested at the time of admission to a hospital or other health-care facility.

Nosocomial infections are acquired during hospitalization.

The research study conducted by Mukwato et al. (2008) that observed that the infect ion

prevention guidelines specifies the infection prevention principles which are considers every

person infectious.

WHO (2008) estimated that the risk of health care-associated infection is 2 to 20 times higher

in developing countries compared to developed countries and 5% - 10% of patients admitted

to hospitals in developed countries acquire these infections. Siegel et al. (2007) observed that

the mode of transmission may vary by type of organism as some types of organism may be

transmitted by more than one route.

Research conducted by Siegel et al. (2007) also explained the complex inter-relationship

between a potential host and an infectious agent that produces infection. Transmission of

infectious agents within a health care setting requires three agents. These include a reservoir,

susceptible host and a mode of transmission. Patients, health care workers and visitors are

susceptible host in the hospital environment. The complex inter-relationship between a

potential host and infectious agent produces infection.

10

It is a standard consensus that compliance on the part of medical staff with standard precautions

has been documented as an efficient and effective procedure to preclude and control health

care-associated infections. In their study, Siegel et al. (2007) also similarly acknowledged that

compliance on the part of health care workers with standard precautions has been recognized

as an efficient and effective means to prevent and control health care-associated infections in

patients and health workers.

2.3 Global Perspective: Research on health workers knowledge, attitude and compliance with

infection control guidelines has been conducted globally. There are several studies which have

been conducted in various parts at the international level. Literature reviewed focuses on

studies conducted elsewhere in relations to infection control guidelines.

The research study conducted by Lynch (1997) acknowledged that nosocomial infections rates

range from 1% in Europe and America to more than 40% in some parts of Asia, Latin America

and Sub-Saharan Africa.

Literature reviewed cited a research study by Stein et al. (2003) where a survey of doctors’ and

nurses’ knowledge, attitude and compliance with infection control guidelines in Birmingham

teaching hospitals was conducted. The results of this study indicated that overall knowledge

regarding blood-borne virus transmission from an infected patient after needles stick injury

was low. The study by Stein et al. (2003) recommended that education, monitoring, improved

availability of resources and disciplinary measures for poor compliance are required to improve

infection control practices in hospitals.

Similar studies have been conducted in China where a focus on nurses and physic ians

concentrated on. A cross-sectional study was conducted in Hong Kong by Tai et al. (2009)

among nurses and physicians who provided direct patient care in four hospitals. The study

concentrated on perceptions of the importance and impact of health care associated infect ions

11

and hand hygiene. Among the respondents in the study, a total of 60% of the nurses and 46%

of the physicians acknowledged that over 75% of healthcare-associated infections could be

prevented by hand hygiene.

Research has also been conducted to investigate the role of hand hygiene in health care and its

association with infection prevention. In Switzerland, Allesranziandpittet (2009) conducted a

research to investigate the role of hand hygiene in health care, associated with infect ion

prevention. The research study revealed that factors influencing hand hygiene compliance, the

impact of hand hygiene promotion on healthcare-associated pathogen, cross-transmission and

infection rates and challenging issues related to the universal adoption of alcohol-based hand

rub as a critical system change for successful promotion.

2.4 African Perspective: The problem of hospital infections is not alien to the African

continents. Research conducted by Emori and Gaynes (1993) reported that the most frequent

nosocomial infections occurring in developing countries are Surgical Site Infections (SSI),

urinary tract infections and lower respiratory tract infections such as pneumonia.

Several diseases have been reported in the African continent, and some have been recorded to

have been transferred from patients to health workers including nurses. A typical example to

demonstrate the above refer to the outbreaks of Ebola virus. Such is a common pandemic on

the African continent whose effects have been significantly felt. From the above highlighted,

infection prevention is becoming more and more important in people’s lives.

Several studies have been conducted to pertaining to the issues of infection controls and safe

methods of handling patients. Research indicates that Ebola is not only a disease that has been

reported to be transmitted to health workers.

12

In a study conducted by Wyatt (1997), quoting Udeze in a study entitled' reducing and replacing

injections to assess medical Doctors knowledge on administering unsafe injections to their

patients, a report on the Ebola virus epidemic in Zaire, hospitals were described as epidemic

amplifiers. It was found that 72 out of 103 primary cases in Yambuku Mission Hospital were

caused by unsterile injections administered by the doctors. During the epidemic, the risk of

getting Ebola virus infection from a single injection was greater than 90%.

Another study that was conducted in Sierra Leone by Wyatt (1997) indicated that that Lassa

fever is transmitted by injections. In another study done in Nigeria, Wyatt (1997) quoting

Udeze, it was concluded that at least 1 in every 40 multiple dose injection treatments ended

with an injection abscess.

In another study was conducted by Nsubuga and Jaakkola (2005) in Uganda was entitled

“Needle stick injuries among nurses in Sub-Sahara Africa at Mulango National Referral

Hospital’. The study that was composed of 526 nurses and midwives indicated that 57% of the

nurses and midwives had experienced at least one needle stick injury in the last six months.

Analysis showed that the most important risk factor for needle stick injuries was lack of

training, long working hours more than forty (40) hours week, recapping needles and not using

gloves when handling needles. The study indicated that lack of knowledge, long working hours,

working habits and little experience were the predictors for such injuries. The study showe d

here that the health care practitioner slacked knowledge on the dangers of needle stick injur ies.

A research also conducted in Egypt, in relations to nosocomial respiratory infections. Ahmed

at al. (2000) also conducted a study regarding nosocomial respiratory infections and nurses’

performance related to infection control measures. The research study was conducted in

artificially ventilated patients in Egypt to assess nurses ‘practices regarding daily care

13

activities, ventilator decontamination, and use of universal infection control measures and the

maintenance of the patients care environment.

The study revealed a high incidence of nosocomial respiratory infections. Also, it was revealed

that pseudomonas was the causative agents in more than one fourth of the cases. Moreover,

nurses’ infection control practices were inadequate.

2.5 Zambian Perspective: A number of studies focusing on infection prevention have been

done in Zambia. A study was conducted by Mukwato (2008) at Ronald Ross General Hospital

in Mufulira on the Copperbelt Province. This study was done to determine the level of health-

care workers’ compliance with Infection Prevention Guidelines and identify factors that

influence compliance at Ronald Ross General Hospital, Mufulira District.

The study revealed that, high compliance was associated with inclusion of Guidelines in the

Curricular, high knowledge of infection prevention/hospital acquired infections, positive

attitude towards infection prevention and availability of materials for infection prevention. The

study further reviewed varied levels of compliance on different components of infect ion

prevention. The highest level of compliance (100%) was with single use of needles and

syringes while the lowest (35.1%) was with decontamination of needles and syringes with 0.5%

chlorine solution prior to disposal.

Compliance with hand hygiene was moderate (61%). The study findings of the study above

suggested a need for inclusion of Infection Prevention Guidelines in the health workers

curricular, provision of in-service training in infection prevention protocols and improvements

in the supply of materials for infection prevention.

Another study conducted by Munganga (2007) in Kitwe Central Hospital to determine the

knowledge, attitude and practice of medical doctors on infection prevention, revealed that all

14

the respondents 100% had heard of IP. This indicated that the Medical Doctors had some basic

knowledge on IP practices. On attitude the study revealed that majority had negative attitude

towards IP practices while 26% had positive attitude towards IP practices.

On practice the study showed that 56% of the respondents had sustained needle stick injur ies

and out of 28 respondents who had sustained needle stick injuries 44% carried out the correct

action while 12% of the respondents did not know what to do. All the above studies indicate

that knowledge and proper utilization of IPGs is the key to reducing HAIs and injuries to the

patient as well as the care giver.

Libetwa (1997) in her dissertation entitled knowledge, Attitude and Practices of Midwives on

Infection Control in Maternity Units in Lusaka Urban Clinics, revealed some inconsistence and

incorrect use of IP materials as indicated by 12.5% of midwives who wore gloves throughout

the shift and 17.5% who wore 3-4 pairs of gloves. This shows lack of knowledge in the

utilization of personal protective materials as WHO (1985) only recommends double gloving

for health workers performing deliveries and those assisting with surgical procedures.

2.6 Infection Control Measures: Bouallègue et al. (2013) observed that many infect ion

control measures, such as appropriate hand hygiene and the correct application of basic

precautions during invasive procedures are simple and of low-cost, but require staff

accountability and behavioral change, in addition to improving staff education, reporting and

surveillance systems. Cole (2007) also submitted that to utilize these precautions, the human

element plays some important role in increasing or decreasing the chances of catching HCAI.

Therefore, Hugonnet et al. (2007) rightly observed that adequate nursing staff is necessary

because a higher patient-to nurse ratio increases the risk of nosocomial infection.

Agaral and Thomas (2003) also conducted a descriptive study on the level of knowledge and

practice of prevention of hospital acquired infections among trained nurses in surgical wards

15

and the factors that hinder this practice. The findings revealed that 98% of the respondents have

heard about nosocomial infections while 2% have not. About 78% of the respondents practice

prevention of hospital acquired infections while 22% do not. About 94% of the respondents

expressed that they have hindrances to the practice of prevention of nosocomial infections.

The study by Agaral and Thomas (2003) found that hindrances include poor working

environment among 26%, poor knowledge about prevention of nosocomial infection was 10%,

and lack of water for hand washing and other material resources 58%. The Study reveals that

majority of the trained nurses in surgical wards have knowledge about the prevention of

nosocomial infections but not all practice it due to lack of equipment and poor working

environment

A study conducted by Talaat and Shamia (2010) was also conducted to assess the knowledge

of health team in relation to infection control measures as well as their level of practice in the

application of infection control measures at the endoscopy units in El-KasrEl-Ani Hospital.

The New Kasr El-Ani Teaching Hospital (French), and the Internal Medicine Hospital, all

hospitals are affiliated to Cairo University. The study recommended an educational program

for the endoscopy staff about infection and infection control measures application for the

protection of staff and patients.

Picheansathian et al. (2008) also conducted a quasi-experimental study among nursing

personnel to identify the impact of a promotion program on hand hygiene practices and its

effect on hospital acquired infection rates in a neonatal intensive care unit of a univers ity

hospital in Thailand. The study reveals that after implementing a hand hygiene promotion

program, compliance with hand hygiene among nursing personnel improved significantly from

6.3% before the program to 81.2%, 7 months after the program. All participants agreed that

promotion program implemented in this project motivated them to practice better hand hygiene.

16

The study conducted by Picheansathian et al. (2008) across three hospitals showed a significant

drop in the rates of Surgical Site Infections (SSI) and hospital-acquired Urinary Tract Infection

(UTI) by increasing the awareness of hospital acquired infections among healthcare workers.

An education program for the healthcare workers in three different hospitals was included in

the study. This showed a significant reduction rate of 8.1% for SSI (P < 0.001) and 3.9% for

hospital-acquired UTI (P < 0.001). This reveals that linking of prevention efforts and

continuous monitored infection rates are thus necessitated.

Researchers Barbara and Josephine (2014) conducted an observational study among health care

worker’s including nurses to determine the hand hygiene practices. The intervention consisted

of problem-based and task orientated hand hygiene education, enhancement of minimal

handling protocol and clustering of nursing care, liberal provision of alcohol-based hand

antiseptic, improvement in hand hygiene facilities, on-going regular hand hygiene audit, and

implementation of health care– associated infection surveillance.

The observational study by researchers Barbara and Josephine (2014) was repeated 6 months

after the completion of the intervention program, which extended over 1-year period. The study

reveals that there was improvement in most aspects of hand-washing technique in the post

intervention stage and the health care–associated infection rate decreased from 11.3 to 6.2 per

1000 patient-days and it emphasize the need for a problem-based and task-orientated education

program that can improve hand hygiene compliance.

A recent descriptive study conducted by Eskander et al. (2013) assessed critical nurses’

knowledge and evaluate their practice regarding infection control standard precautions. The

study revealed that approximately two thirds (63.6%) of the studied sample had unsatisfac tory

knowledge level, more than half (57.1%) of the studied sample had satisfactory performance

level.

17

Mahmud and Abdul Sahib (2011) conducted a descriptive study on nurses who worked at

surgical wards Azady Teaching Hospital in Kirkuk city to assess the practices of nurses towards

standard precautions. The study revealed that the majority (91.9%) of the nurses did not get

training sessions regarding infection control and (83.4%) of them had not participated

continuous learning about infection control. According to the level of practices towards

standard precautions, it has revealed that poor practices of standard precautions by surgica l

wards nurses had shown in surgical wards.

18

CHAPTER 3

RESEARCH METHODOLOGY

3.1 Introduction: This Chapter of the research study presents the research methods such as

the research design, sources of data, sample size, sampling methods as well as methods of data

collection, reliability of data, validity of data and ethics that were used in this study.

3.2 Research Design: A qualitative study was conducted. The study design chosen depends

on the type of problem, the knowledge already available about the problem and the resources

available for the study. Basavanthappa (2007) indicated that the basic purpose of the research

design is to provide answers to research questions. A research design is a plan, structure and

strategy of investigation used for answering the research questions.

Robson (1993) explained that a research design is the set of methods and procedures used in

collecting and analysing measures of the variables specified in the research problem. The

design of a study defines the study type. Similarly Robson (1993) also observed that research

design is the framework that has been created to find answers to research questions.

The research study was non-experimental designs, where the research was undertaken in an

uncontrolled and natural setting. This study collected qualitative data from participants. The

basis for the use of this method was hinged on the premise that all the data was to be based on

qualitative judgments. All qualitative data collected was described and manipula ted

numerically.

This allowed for in-depth understanding of the issues so that there would be an explanation of

the ‘what’ and ‘why’ interrogative questions in the study. The method would help to get in-

depth information around the phenomenon of early marriage in the communities and the

19

general description of the factors that influence nurses' compliance with Infection Prevention

Guidelines at Levy Mwanawasa University Teaching Hospital in Lusaka.

3.3 Study Site: The research study was conducted at Levy Mwanawasa University Teaching

Hospital in Lusaka. The health institution is located in Lusaka District of Lusaka province in

the Republic of Zambia.

3.4 Study Population: The study population of interest is an important consideration for a

person undertaking a research study. Basavanthappa (2007) explained that the study population

is the total group of individuals (people) or things meeting the designated interest to the

researcher. Polit and Hungler (2007) refers to target population as the entire population in

which the researcher is interested in and to which he/she would like to generalize the results of

the study.

Study population is fundamental when undertaking a research study. The study population

included all the nurses at Levy Mwanawasa Teaching Hospital. This population includes all

nurses who are working at the health facilities in all departments.

3.5 Target Population: The target population consisted health workers at Levy Mwanawasa

Teaching Hospital. The population of interest consisted of all the three hundred and sixty five

(365) nurses.

3.5.1 Sample Size Determination and Sampling Method: According to Polit and Hungler

(2007), a sample size is a specific number (small part) of the population selected in such a way

that the individuals in the sample represent as near as possible the characteristics of the

population. It is commended in research that a sample size greater than thirty (30) is large

enough to be used for a research study.

A total sample of fifty (50) participants was used during the research study. Fifty (50) nurses

were selected from the health facility. The sample size was arrived at only after selection

20

reached saturation level. This was a point where no new responses could be obtained from the

participants that would give different results.

Fifty (50) questionnaire schedules were returned. Data saturation refers to the quality and

quantity of information in a qualitative study. Guest, Bunce and Johnson (2006) observed that

data saturation is a point when no new information or themes are observed in the data. In the

research study, as many participants as possible were engaged until the researcher was satisfied

that all themes were exhausted.

The total number of fifty (50) nurses was arrived at as it was enough to generalize the findings

of the research to the entire population. This sample (100≥ 30) was large enough to justify

generalization of the findings to the entire population of Lusaka District. It is common practice

to use a sample in any research study for the purpose of convenience and timeliness. Webster

(1985) defined a sample as a finite part of a statistical population whose properties are studied

to gain information about the whole. The sample in the study consisted of randomly selected

nurses.

The researcher employed convenience sampling. Kothari (2004) defined convenience sampling

as method used when population elements are selected for inclusion in the sample based on the

ease of access. This method is appropriate for use since the study is constrained with resources.

A convenient sample was used to select participants of the research study because it appeared

to be the most easier way of sampling in this setting.

The research conducted a pilot study before the actual study was conducted. The pilot study

ensured reliability. Polit and Hungler (2007) described reliability as the degree of consistency

or accuracy with which an instrument measures the attribute it is designed to measure. In this

respect, reliability was ensured since the research instruments were pre tested on independent

respondents.

21

Validity of Data: The pilot studies also ensure validity, which Polit and Hungler (2007) defined

as the degree to which an instrument measures what it is intended to measure. Validity was

upheld by avoiding selection bias of respondents by using probability method of selection of

questions to ensure randomization, making questions simple, concise, clearly constructed to

avoid ambiguity and brief so that the respondents were not be bored as this could affect their

responses.

In addition, the researcher avoided administering the research instrument to respondents when

she was tired as fatigue could also negatively affect the test effect. The researcher ensured that

the same questions were asked to each respondent in the same sequence. Validity is concerned

with the extent to which research findings can be generalized beyond the sample size of the

study. Validity is important in research as it influences the significance of the study. In this

study, validity was upheld by ensuring that researcher detached herself from the study by being

objective during data collection and analysis so that the study findings would be a true

reflection of what the respondents said.

3.6 Inclusion and Exclusion Criteria: Establishing inclusion and exclusion criteria for study

participants is a standard, required practice when designing high-quality research protocols.

Stanley (2007) explained that inclusion and exclusion criteria define who can be included or

excluded to the study sample of a research being conducted.

3.6.1 Inclusion criteria: Inclusion criteria are defined as the key features of the target

population that the investigators used to answer their research question (s). Typical inclus ion

criteria include demographic and geographic characteristics. Therefore, inclusion criteria are

attributes of subjects that are essential for their selection to participate in the study under

investigation. In the study, only participants who were member of staff were considered in the

research study. Work experience exceeding five years and age more than 30 was considered

for participants.

22

3.6.2 Exclusion criteria: In contrast, exclusion criteria are defined as features of the potential

study participants who meet the inclusion criteria but present with additional characterist ics

that could interfere with the success of the study or increase their risk for an unfavourab le

outcome.

Common exclusion criteria include characteristics of eligible individuals that make them highly

likely to be lost to follow-up, miss scheduled appointments to collect data, provide inaccurate

data, and have characteristics that could highly bring some bias to the results of the research

study, or increase their risk for adverse events most relevant in studies testing interventions. In

this particular study, health workers who are not nurses were excluded from participating in

the study. Stanley (2007) also observed that exclusion criteria refer to responses of subjects

that require their removal as subjects.

3.7 Data Collection Tools and Techniques: A questionnaire was used to collect data from

study participants.

Primary data was collected from participants that were engaged during the study. This form of

data was collected using a set of questionnaires administered to participants. This data was also

used in the analysis of findings.

This research study used a set of questionnaires. Data was collected using a structured

questionnaire which consisted of closed ended questions and no open ended questions. Open-

ended question asked the respondent to formulate their own answers, and hence they were not

used. On the other hand, closed-ended question required the respondent to pick an answer from

a given number of options.

Questionnaires have an advantage of taking it to a wider audience as compared to interviews,

but have a disadvantage of not being possible to customize it to individuals as it is possible

with other methods of data collection. One type of questionnaire was used for all participants

23

in the study. Questionnaires were administered to the 50 respondents who included nurses from

health facility where the study was being conducted.

The study used a questionnaire to collect information because of some advantages it offers.

Nicholas (2005) explained that a questionnaire was adopted because it makes it easy to answer

from a respondent point of view in that the enumerator would be available to clarify if the

question is not clear and would help the researcher to analyse data in a systematic way.

Data collection tool was pre-tested before the actual field study was undertaken. Pre-testing

was conducted on randomly selected participants of nurses drawn from Lusaka district. This

was because the population of these participants had similar characteristics to the population

of the main study.

The main purpose of pre-testing was to determine whether the questionnaire enlisted the

correctly measured results and also to identify any technical jargon that would affect the flow

of information from respondents during data collection. Pre-testing, therefore, helped to

ascertain whether adjustments were to be made to the questionnaire. No adjustments were

performed on the questionnaire.

3.8 Data Analysis: Descriptive statistics was used to analyse data collected using the

questionnaire. Descriptive data was analysed using measures of central tendency. Categorical,

data was analysed using median, mode and interquartile range. Continuous data variables were

analysed using mean, standard deviation and standard error of the mean.

Data from the questionnaires were be subjected to content analysis. This involved a careful

examination of the responses given by the study participants in order to identify major themes.

The major themes were then integrated into the text of the main report, which was written in

Microsoft word together with the output from Microsoft Office Excel from the data.

24

The Statistical Package for Social Sciences (SPSS) was software to easily and automatica l ly

convert data into statistical charts such as percentages and tables.

3.9 Ethical Issues/Concerns: The study ensured that the research ethics are taken into

consideration throughout the research process. On the respondent’s side, the researcher made

make sure that participants are informed of the main purpose of the study before engaging them

into the study.

Participation was based on voluntary basis upon signing a consent form.

Consent was obtained from the potential respondents.

Respondents were also guaranteed of privacy and confidentiality of data.

There was no recording of names or any personal identification during data collection.

Furthermore, the researcher watches over the research methodology for conducting the study

throughout the research studies. This means that there was no doctoring or alteration of the

research findings aimed at satisfying (suit) the researcher’s views.

25

CHAPTER 4

DATA PRESENTATION AND INTERPRETATION

4.1 Introduction: This Chapter presents the analysis of data obtained from the fields, after the

questionnaire was administered to respondents that participated in the study. The Chapter

essentially shows answers from participants in a study determine factors that influence nurses'

compliance with Infection Prevention Guidelines at Levy Mwanawasa University Teaching

Hospital in Lusaka.

4.2 Characteristic of Respondents: This section of the study demonstrated the bio data of

participants that participated in the research study. Various respondents were selected to fill

the questionnaire from target group. A total of forty (40) questionnaires were successfully

administered. The respondents who were selected were nurses from Levy Mwanawasa

University Teaching Hospital.

Figure 4.2.1 Distribution of Participants by Gender

Figure 4.2.1 shows the distribution of participants by gender. The figure shows that there were

12 (24%) male nurses’ participants and 38 (72%) female nurses participants in the research

study.

12

38

0

5

10

15

20

25

30

35

40

Male Female

PARTICIPANTS

GENDER

26

Figure 4.2.2 Distribution of Participants by Age

Figure 4.2.2 shows the distribution of participants by age. The figures shows that there were

no participants who were aged between 15 – 20 years, 21 – 25 years, 26 – 30 years, 31 – 35

years, 36 – 40 years, 41 – 46 years, 47 - - 51 years and above 51 years.

Figure 4.2.3 Distribution of Participants by years of experience

Figure 4.2.3 indicates the distribution of participants by years of experience. The study shows

that 2 (4%) participants served less than one year, 5 (10%) participants served between 1 – 2

years, 11 (22%) participants served between 3 – 5 years, 13 (26%) participants served between

6 – 9 years, 11 (22%) participants served between and 8 (16%) participants served above 15

years.

02

79 9

12

9

20

2

4

6

8

10

12

14

15 - 20 21 - 25 26 - 30 31 - 35 36 - 40 41 –46 47- 51 Above 51

PARTICIPANTS

AGE

4%

10%

22%

26%

22%

16%

Less than 1 year

Between 1 - 2

years

Between 3 - 5

years

Between 6 - 9

years

Between 9 -15

years

27

Figure 4.2.4 Distribution of Participants by level of education.

Figure 4.2.4 shows the distribution of Participants by years of experience. The study indicates

that there were 10 (20%) participants who were certificate holders, (26) 52% participants who

were diploma holders, 10 (20%) participants who were B. Sc. In Nursing Holders and 4 (8%)

master degrees holders.

Ever heard of hospital-acquired infection Frequency Percentages

Yes 43 86%

No 5 10%

Not sure 2 4%

Total 50 100%

4.3 Work related infections risks on nurses: The study also investigated work rel

Table 4.3.1 Distribution of participants if they ever heard of hospital-acquired infection

20%

52%

20%

8%

Certificate

Diplomas

B.Sc. in Nursing

Masters

28

Table 4.3.1 shows the distribution of participants if they ever heard of hospital-acquired

infection. The table shows that there were 43 (86%) that agreed, and 5 (10%) that disagreed

and 2 (4%) that were unsure.

Ever experienced hospital-acquired infection Frequency Percentages

Yes 15 30%

No 17 34%

Not sure 18 36%

Total 50 100%

Table 4.3.2 Distribution of participants on whether they ever experienced hospital-

acquired infection

Table 4.3.2 shows the distribution of participants on whether they ever experienced hospital-

acquired infection. The table shows that 15 (30%) participants experienced hospital-acquired

infection, 17 (34%) never experienced hospital-acquired infection, and 18 (36%) were not sure

if they ever experienced hospital-acquired infection.

Ever sustained a used needle stick injury Frequency Percentages

Yes 29 58%

No 21 42%

Not sure 0 0%

Total 50 100%

29

Table 4.3.3 Distribution of responses on whether participants ever sustained a used needle

stick injury

Table 4.3.3 shows the distributions of responses on whether participants ever sustained a used

needle stick injury. The table shows that 29 (58%) agreed, 21 (42%) disagreed and 0 (0) were

unsure.

If ever splashed by patient's blood, vomit or other bodily

fluids

Participants Percentage

Yes 36 72%

No 12 24%

Not sure 2 4%

Total 50 100%

Table 4.3.4 Distribution of responses on participants if ever splashed by patient's blood,

vomit or other bodily fluids

Table 4.3.4 shows the distribution of responses from participants if ever splashed by patient's

blood, vomit or other bodily fluids. The table indicates that 36 (72%) agreed, 12 (24%)

disagreed and 2 (4%).

whether participants consider all patients contagious frequency Percentage

Yes 23 46%

No 18 36%

Not sure 9 18%

Total 50 100

30

Table 4.3.5 Distribution of responses on whether participants consider all patients

contagious

Table 4.3.5 Distribution of responses on whether participants consider all patients contagious.

The table shows that 23 (56%) participants agreed, 18 (36%) disagreed and 9 (18%) were

unsure.

4.4 Nurses Information on IPG: One of the objectives of the research study was to investiga te

nurses’ information on infection prevention guidelines.

Figure 4.4.1 Distribution of responses on single most effective method to prevent

infections

Figure 4.4.1 shows the distribution of responses on single most effective method to prevent

infections. The figures shows that 25 (50%) participants cited hand washing, 12 (24%) cited

wearing PPEs, 8 (16%) cited education and 5 (10%) were unsure.

64%17%

12%

7%

Hand

washing

Wearing

PPEs

Education

Not sure

31

Consideration of all unsterile needles/sharps to be

contaminated

Frequency Percentage

Yes 23 46%

No 18 36%

Not sure 9 18%

Total 50 100%

Table 4.4.2 Distribution of responses on consideration of all unsterile needles/sharps to

be contaminated

Table 4.4.2 shows the distribution of responses on consideration of all unsterile needles/sharps

to be contaminated. The table indicate that 23 (46%) agreed, 18 (36%) disagreed and 9 (18%)

were unsure.

whether participants knew about nosocomial

infection monitoring program

Frequency Percentage

Yes 30 60%

No 15 30%

Not sure 5 10%

Total 50 100%

Table 4.4.3 Distribution of responses on whether participants knew about nosocomial

infection monitoring program in your hospital

32

Table 4.4.3 shows the distribution of responses on whether participants knew about nosocomia l

infection monitoring program in your hospital. The table indicates that 30 (60%) agreed, 15

(30%) disagreed and 5 (10%) were unsure.

Frequency Percentages

Yes 30 60%

No 15 30%

Not sure 5 10%

Total 50 100%

Table 4.4.4: Distribution of responses on whether knew where infectious wastes from

patients are disposed of

Table 4.4.4 shows the distribution of responses on whether knew where infectious wastes from

patients are disposed of. The table indicates that 30 (60%) agreed, 15 (30%) disagreed and 5

(10%) were unsure.

31

8 9 20

10

20

30

40

Daily 3 times a week2 times a week Weekly

PARTICIPANTS

FREQUENCY

33

Figure 4.4.6 Distribution of responses on how often participants wash apron/nurse

uniform

Figure 4.4.6 shows the distribution of responses on how often participants wash apron/nurse

uniform. The figure shows that 31 (62%) participants washed daily, 8 (16%) washed three

times a week, 9 (18%) participants washed 2 times a week, and 2 (4%) participants washed

weekly.

4.5 Factors That Influence Compliance/Non-Compliance To IP Guidelines: The study also

investigated Factors That Influence Compliance/Non-Compliance To IP Guidelines at Levy

Mwanawasa University teaching Hospital.

whether poor working environment influence

compliance/non-compliance to IP Guidelines

Frequency Percentage

Yes 30 60%

No 15 30%

Not sure 5 10%

Total 50 100%

Table 4.5.1 Distribution of responses on whether poor working environment influence

compliance/non-compliance to IP Guidelines

Table 4.5.1 shows the distribution of responses on whether poor working environment

influence compliance/non-compliance to IP Guidelines. The table indicated that that 30 (60%)

agreed, 15 (30%) disagreed and 5 (10%) were unsure.

34

poor knowledge about prevention of nosocomial infection

influence compliance/non-compliance to IP Guidelines

Frequency Percentages

Yes 36 72%

No 10 20%

Not sure 4 10%

Total 50 100%

Table 4.5.2 distribution of responses on whether poor knowledge about prevention of

nosocomial infection influence compliance/non-compliance to IP Guidelines

Table 4.5.2 shows the distribution of responses on whether poor knowledge about prevention

of nosocomial infection influence compliance/non-compliance to IP Guidelines. The table

shows that 36 (72%) agreed, 10 (20%) participants disagreed and 4 (8%) were unsure.

If lack of water for hand washing & other material

resources influence compliance/non-compliance

Frequency

Percentages

Yes 38 76%

No 10 20%

Not sure 2 4%

Total 50 100%

Table 4.5.3 Distribution of responses on whether lack of water for hand washing and

other material resources infection influence compliance/non-compliance to IP Guidelines

35

Table 4.5.3 shows a distribution of responses on whether lack of water for hand washing and

other material resources infection influence compliance/non-compliance to IP Guidelines. The

table shows that 38 (77%) agreed, 10 (20%) disagreed and 2 (4%) were unsure.

Whether of lack of equipment influence

compliance/non-compliance to IP Guidelines?

Frequency Percentages

Yes 40 80%

No 8 16%

Not sure 2 4%

Total 50 100%

Table 4.5.4 Distribution of responses on whether lack of equipment influence

compliance/non-compliance to IP Guidelines

Table 4.5.4 shows the distribution of responses of responses on whether lack of equipment

influence compliance/non-compliance to IP Guidelines. The table indicates that there were 40

(80%) participants that agreed, 8 (16%) disagreed and 2 (4%) were unsure.

36

4.6 Measures That Can Be Put in Place for Nurses Regarding IP: The study also

investigated measures that can be put in place for nurses regarding infection protection at Levy

Mwanawasa University Teaching Hospital.

If increasing awareness of hospital acquired

infections is a measure towards infections control

Frequency Percentages

Yes 42 84%

No 8 16%

Not sure 0 0%

Total 50 100%

Table 4.6.1 Distribution of responses on whether increasing awareness of hospital

acquired infections among healthcare nurses a measure towards infections control

Table 4.6.1 shows the distribution of responses on whether increasing awareness of hospital

acquired infections among healthcare nurses a measure towards infections control. The table

shows that 42 (84%) participants agreed, 8 (16%) participants disagreed and 0 (0%) were

unsure.

37

whether hygiene education is a good measure for

infection control

Frequency Percentages

Yes 40 80%

No 10 20%

Not sure 0 0%

Total 50 100%

Table 4.6.2 Distribution of responses on whether hygiene education is a good measure for

infection control

Table 4.6.2 shows the distribution of responses on whether hygiene education is a good

measure for infection control. The table shows that 40 (80%) participants agreed and 0 (0%)

were unsure.

Whether hand washing is an effective measure

toward infection control

Frequency Percentage

Yes 45 90%

No 5 10%

Not sure 0 0%

Total 50 100%

Table 4.6.3 Distribution of responses on whether hand washing is an effective measure

toward infection control

38

Table 4.6.3 shows distribution of responses on whether hand washing is an effective measure

toward infection control. The table shows that 45 (90%) participants agreed, 5 (10%) disagreed

and 0 (0%) were unsure.

Whether satisfactory knowledge level is an ideal

measure of infection control

Frequency Percentages

Yes 41 82%

No 8 16%

Not sure 1 2%

Total 50 100%

Table 4.6.4 Distribution of responses on whether satisfactory knowledge level is an ideal

measure of infection control

Table 4.6.4 shows the distribution of responses on whether satisfactory knowledge level is an

ideal measure of infection control. The table indicates that 42 (82%) participants agreed, 8

(16%) participants disagreed and 1 (2%) was unsure.

39

Whether nurse training sessions regarding

infection can mitigate infection control.

Frequency Percentages

Yes 40 80%

No 8 16%

Not sure 2 4%

Total 50 100%

Table 4.6.5 Distribution of responses on whether nurse training sessions regarding

infection can mitigate infection control.

Table 4.6.5 shows the distribution of responses on whether nurse training sessions regarding

infection can mitigate infection control. The table shows that 40 (80%) agreed, 8 (16%)

disagreed and 2 (4%) were unsure.

40

CHAPTER 5

DISCUSSION OF FINDINGS AND ANALYSIS

5.1 Introduction: This Chapter discusses the findings and analysis of data obtained from the

fields. All the questionnaires which were administered to respondents that participated in the

study were returned. This means the study received a 100% response from participants in the

study.

The Chapter fundamentally discusses the finding based on answers from participants and

literature reviewed in a study determines factors that influence nurses' compliance with

Infection Prevention Guidelines at Levy Mwanawasa University Teaching Hospital in Lusaka.

5.2 Work related infections risks on nurses: The first objective of the study investigated the

work related infections risks on nurses who were participants that took part in the research

study.

Table 4.3.1 in the previous chapter showed the distribution of participants if they ever heard of

hospital-acquired infection. The table shows that there were 43 (86%) that agreed, and 5 (10%)

that disagreed and 2 (4%) that were unsure. The study showed that majority participants, 43

(86%) in the study had heard of hospital-acquired infection. In the same vein, research study

by Mukweto et al. (2008) also found that majority (95%) of the subjects indicated that they had

heard about Hospital Acquired Infection (HAI), with (86%) having heard of Universa l

Precautions (UP) or Infection Prevention (IP) guidelines.

Tai et al. (2009) found that among nurses and physicians who provided direct patient care in

four hospitals, a total of 60% of the nurses and 46% of the physicians acknowledged that over

75% of healthcare-associated infections.

Table 4.3.2 shows the distribution of participants on whether they ever experienced hospital-

acquired infection. The table shows that 15 (30%) participants experienced hospital-acquired

41

infection, 17 (34%) never experienced hospital-acquired infection, and 18 (36%) were not sure

if they ever experienced hospital-acquired infection. The research study reported prevalence

rate of 30%. This finding is consistent with the finding of Katowa (2007) found that Hospital

Acquired Infections (HAIs) are still a major problem in Zambia as demonstrated by the increase

in post-operation wound infections among patients with Caesarian Section which has been at

30% rate.

Table 4.3.3 shows the distributions of responses on whether participants ever sustained a used

needle stick injury. The table shows that 29 (58) % agreed, 21 (42%) disagreed and 0 (0) were

unsure. Majority participants, 29 (58) % agreed ever sustained a used needle stick injury.

Similarly, the study conducted by Nsubuga and Jaakkola (2005) in Uganda also found that

nurses and midwives had experienced at least one needle stick injury in the last six months.

Table 4.3.4 shows the distribution of responses from participants if ever splashed by patient's

blood, vomit or other bodily fluids. The table indicates that 36 (72%) agreed, 12 (24%)

disagreed and 2 (4%). Results of the study show that majority participants 36 (72%), were ever

splashed by patient's blood, vomit or other bodily fluids.

Table 4.3.5 Distribution of responses on whether participants consider all patients contagious.

The table shows that 23 (56%) participants agreed, 18 (36%) disagreed and 9 (18%) were

unsure. Majority participants 23 (56%) agreed on considering all patients contagious. This

finding is consistent with the study conducted by Mukwato et al. (2008) that observed that the

infection prevention guidelines specifies the infection prevention principles which are

considers every person infectious.

5.3 Nurses Information on IPG: The second objective of the research study investiga te

nurses’ information on infection prevention guidelines at Levy Mwanawasa Univers ity

Teaching hospital.

42

Figure 4.4.1 shows the distribution of responses on single most effective method to prevent

infections. The figures shows that 25 (50%) participants cited hand washing, 12 (24%) cited

wearing PPEs, 8 (16%) cited education and 5 (10%) were unsure. Majority participants25

(50%) participants cited hand washing as a single most effective method to prevent infections.

The study by Agaral and Thomas (2003) similarly found that hindrances about prevention of

nosocomial infection included lack of water for hand washing.

Table 4.4.2 shows the distribution of responses on consideration of all unsterile needles/sharps

to be contaminated. The table indicate that 23 (46%) agreed, 18 (36%) disagreed and 9 (18%)

were unsure. Majority participants 23 (46%) in the research study agreed consideration of all

unsterile needles/sharps to be contaminated. Similarly, the study conducted by Wyatt (1997)

found that administering unsafe injections to their patients on the Ebola virus epidemic in Zaire

hospitals were described as epidemic amplifiers. The study found that 72 out of 103 primary

cases in Yambuku Mission Hospital were caused by unsterile injections administered by the

doctors.

Table 4.3.3 shows the distribution of responses on whether participants knew about nosocomia l

infection monitoring program in your hospital. The table indicates that 30 (60%) agreed, 15

(30%) disagreed and 5 (10%) were unsure. Majority participants 30 (60%) knew about

nosocomial infection monitoring program in your hospital. Similarly, the study by Stein et al.

(2003) recommended monitoring as required to improve infection control practices in

hospitals.

Table 4.4.5 shows the distribution of responses on whether knew where infectious wastes from

patients are disposed of. The table indicates that 30 (60%) agreed, 15 (30%) disagreed and 5

(10%) were unsure. Majority participants, 30 (60%) agreed they had knowledge on where

infectious wastes from patients are disposed of. The study by Mukwato (2008) simila r ly

43

observed that infection prevention guidelines specify the infection prevention principles which

are included disposing contaminated instruments and contaminated wastes thoroughly and

properly.

Figure 4.4.6 shows the distribution of responses on how often participants wash apron/nurse

uniform. The figure shows that 31 (62%) participants washed daily, 8 (16%) washed three

times a week, 9 (18%) participants washed 2 times a week, and 2 (4%) participants washed

weekly. The study found that majority participants 31 (62%) participants washed daily.

5.4 Factors That Influence Compliance/Non-Compliance to IP Guidelines: In line with the

third objective of the study, the research study also investigated Factors That Influence

Compliance/Non-Compliance to IP Guidelines at Levy Mwanawasa University Teaching

Hospital.

Table 4.5.1 shows the distribution of responses on whether poor working environment

influence compliance/non-compliance to IP Guidelines. The table indicated that that 30 (60%)

agreed, 15 (30%) disagreed and 5 (10%) were unsure. Majority participant (60%) agreed poor

working environment influences compliance/non-compliance to IP Guidelines. This finding

agrees with the findings of the study conducted by Agaral and Thomas (2003) that found that

hindrances include poor working environment.

Table 4.5.2 shows the distribution of responses on whether poor knowledge about prevention

of nosocomial infection influence compliance/non-compliance to IP Guidelines. Majority

participants in the study 36 (72%) agreed poor knowledge about prevention of nosocomia l

infection influence compliance/non-compliance to IP Guidelines. Similarly, Agaral and

Thomas (2003) found that hindrances included poor knowledge about prevention of

nosocomial infection.

44

Table 4.5.3 shows a distribution of responses on whether lack of water for hand washing and

other material resources infection influence compliance/non-compliance to IP Guidelines. The

table shows that 38 (77%) agreed, 10 (20%) disagreed and 2 (4%) were unsure. Majority

participants 38 (77%) agreed lack of water for hand washing and other material resources

infection influence compliance/non-compliance to IP Guidelines. Similarly, Agaral and

Thomas (2003) found that hindrances include lack of water for hand washing and other material

resources.

Table 4.5.4 shows the distribution of responses of responses on whether lack of equipment

influence compliance/non-compliance to IP Guidelines. The table indicates that there were 40

(80%) participants that agreed, 8 (16%) disagreed and 2 (4%) were unsure. The study found

that majority participants, 40 (80%) agreed lack of equipment influence compliance/non-

compliance to IP Guidelines. The study by Agaral and Thomas (2003) found that hindrances

include lack of other material resources. The study revealed that majority of the trained nurses

in surgical wards have knowledge about the prevention of nosocomial infections but not all

practice it due to lack of equipment and poor working environment.

5.5 Measures That Can Be Put in Place for Nurses Regarding IP: In line with the objectives

of the study, the research study also investigated measures that can be put in place for nurses

regarding infection protection at Levy Mwanawasa University Teaching Hospital.

Table 4.6.1 shows the distribution of responses on whether increasing awareness of hospital

acquired infections among healthcare nurses a measure towards infections control. The table

shows that 42 (84%) participants agreed, 8 (16%) participants disagreed and 0 (0%) were

unsure. Majority participants 42 (84%) participants agreed increasing awareness of hospital

acquired infections among healthcare nurses a measure towards infections control. Simila r ly,

Picheansathian et al. (2008) reported a significant drop in the rates of Surgical Site Infections

45

(SSI) and hospital-acquired Urinary Tract Infection (UTI) by increasing the awareness of

hospital acquired infections among healthcare workers.

Table 4.6.2 shows the distribution of responses on whether hygiene education is a good

measure for infection control. The table shows that 40 (80%) participants agreed and 0 (0%)

were unsure. The study found that 40 (80%) participants agreed that hygiene education is a

good measure for infection control. Similarly, the study by Barbara and Josephine (2014)

conducted found that hygiene education.

Table 4.6.3 shows distribution of responses on whether hand washing is an effective measure

toward infection control. The table shows that 45 (90%) participants agreed, 5 (10%) disagreed

and 0 (0%) were unsure. Majority participants 45 (90%) agreed that hand washing is an

effective measure toward infection control. This finding is consistent with the study conducted

by WHO (2008) report that observed that infection prevention essentially implies to prevention

and control of healthcare-associated infection including hand washing.

Table 4.6.4 shows the distribution of responses on whether satisfactory knowledge level is an

ideal measure of infection control. The table indicates that 42 (82%) participants agreed, 8

(16%) participants disagreed and 1 (2%) was unsure. The study found that majority participants

42 (82%) suggested satisfactory knowledge level as an ideal measure of infection control. This

finding is in tandem with the findings of the study conducted by that Mukwato (2008) that

observed that high knowledge of infection prevention/hospital acquired infections was an

important for infection prevention.

Table 4.6.5 shows the distribution of responses on whether nurse training sessions regarding

can mitigate infection control. The table shows that 40 (80%) agreed, 8 (16%) disagreed and 2

(4%) were unsure. The study found that majority participants, 40 (80%) found that nurses

training sessions can mitigate infection control. Similarly, a study conducted by Mukwato

46

(2008) recommended provision of in-service training in infection prevention protocols and

improvements infection prevention.

CHAPTER 6

CONCLUSION AND RECOMMENDATIONS

6.1 Introduction: The previous Chapter discussed findings of the study based on the data that

was collected and presented in Chapter four. This final Chapter of the study essentially presents

47

the conclusion drawn from the results of the research study and the researcher makes

recommendations based on the findings.

The study broadly thought to determine factors that influence nurses' compliance with Infection

Prevention Guidelines at Levy Mwanawasa University Teaching Hospital in Lusaka. To

remain focused the study though to determine work-related infection risks on nurses, assess

nurses’ information on IP Guidelines and compliance among nurses, identify factors that

influence compliance/non-compliance to IP Guidelines and recommend measures that can be

put in place for nurses and other healthcare workers regarding IP at Levy Mwanawasa

University Teaching Hospital.

6.2 Conclusion: The first objective of the study investigated the work related infections risks

on nurses who were participants that took part in the research study. The study showed that

majority participants, 43 (86%) in the study had heard of hospital-acquired infection. The

research study reported prevalence rate of 30% regarding Hospital Acquired Infections.

Majority participants, 29 (58) % agreed ever sustained a used needle stick injury. Results of

the study show that majority participants 36 (72%), were ever splashed by patient's blood,

vomit or other bodily fluids. Majority participants 23 (56%) agreed on considering all patients

contagious.

The second objective of the research study investigated nurses’ information on infect ion

prevention guidelines at Levy Mwanawasa University Teaching hospital. Results of the

research study showed that majority participants25 (50%) participants cited hand washing as a

single most effective method to prevent infections. Results of the study also showed that

majority participants 23 (46%) in the research study agreed consideration of all unsterile

needles/sharps to be contaminated. Majority participants 30 (60%) knew about nosocomia l

infection monitoring program in your hospital.

48

Table 4.4.5 shows the distribution of responses on whether knew where infectious wastes from

patients are disposed of. The table indicates that 30 (60%) agreed, 15 (30%) disagreed and 5

(10%) were unsure. Majority participants, 30 (60%) agreed they had knowledge on where

infectious wastes from patients are disposed of. The study by Mukwato (2008) simila r ly

observed that infection prevention guidelines specify the infection prevention principles which

are included disposing contaminated instruments and contaminated wastes thoroughly and

properly.

In line with the third objective of the study, the research study investigated Factors That

Influence Compliance/Non-Compliance to IP Guidelines at Levy Mwanawasa Univers ity

Teaching Hospital. Majority participant (60%) agreed poor working environment influences

compliance/non-compliance to IP Guidelines. Results of the study also showed that majority

participants in the study 36 (72%) agreed poor knowledge about prevention of nosocomia l

infection influence compliance/non-compliance to IP Guidelines.

Furthermore, results of the research study indicated that majority participants 38 (77%) agreed

lack of water for hand washing and other material resources infection influence

compliance/non-compliance to IP Guidelines. The study found that majority participants, 40

(80%) agreed lack of equipment influence compliance/non-compliance to IP Guidelines.

The last objectives of the research study investigated measures that can be put in place for

nurses regarding infection protection at Levy Mwanawasa University Teaching Hospital.

Majority participants 42 (84%) participants agreed increasing awareness of hospital acquired

infections among healthcare nurses a measure towards infections control. Results of the

research study also found that 40 (80%) participants agreed that hygiene education is a good

measure for infection control. Results of the study also showed that majority participants 45

(90%) agreed that hand washing is an effective measure toward infection control. The study

49

found that majority participants 42 (82%) suggested satisfactory knowledge level as an ideal

measure of infection control. The study found that majority participants, 40 (80%) found that

nurses training sessions can mitigate infection control.

6.3 Recommendations: Based on the findings of the study, the study therefor recommends the

following:

Increasing awareness of hospital acquired infections among healthcare nurses a

measure towards infections control.

Consideration of all patients as potential

Increasing hygiene education as a measure for infection control.

Emphasizing hand washing as an effective measure toward infection control.

Increasing knowledge level among nurses as an ideal measure of infection control.

Increasing nurses training sessions with emphasis on mitigating infection control.

Disposing contaminated instruments and contaminated wastes thoroughly and properly.

Intensifying nosocomial infection monitoring program in hospital.

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surgical patients and associated risk factors-a prospective study. NJI. Sept; 107(3):625 – 620.

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Ahmed, N., Eshra, D. M., Nassar, B. M. and El-Shikh, A. A. (2000). Study of nosocomia l

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artificially ventilated patients. Journal of Egypt Public Health Assoc.; 75(1-2):199-217

Allegranzi B., Syed S. B., Ellis B. and Pittet D. (2011). Health-care-associated Infection in

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Allesranzi, B. and Pittet, D. (2009). Role of hand hygiene in healthcare associated infect ion

and prevention. Journalof hospital infection. Jan; 73: 305- 315.

Barbara C. and Josephine, L. (2004). Hand hygiene practices in a neonatal ICU. A multimoda l

intervention and impact on nosocomial infection. Paediatrics official journal of the American

academy of Paediatrics. Nov; 114(5):565- 571.

Basavantappa (2007). Nursing Research. New Delhi: Jaype Brothers Medical Publishers Ltd.

Bouallègue O, Naija W, Said H, Nouria A, Jaidane N, Dhidah L, and Boujaafar N, (2013):

Incidence of ICUacquired nosocomial infections in University Hospital of Sahloul (Sousse-

Tunisia). Antimicrobial Resistance and Infection Control 2(1): P233.

Cole, M. (2007). Infection control: worlds apart primary and secondary care. British journal of

community nursing 12(7): 301,303-306.

Emori, T. J. and Gaynes, R. P. (1993). An overview of nosocomial infections, including the

role of microbiology laboratory. Clin Microbiol Rev 6(4):428-442.

Eskander H., Morsy W., Elfeky H. (2013) Intensive Care Nurses’ Knowledge & Practices

regarding Infection Control Standard Precautions at a Selected Egyptian Cancer Hospital.

Journal of Education and Practice; 4 (19):160- 174

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Guest, G., Bunce, A. and Johnson, L. (2006). How Many Interviews Are Enough?: An

Experiment with Data Saturation and Variability. Sage Journals. 18(1): 59-82.

Katowa, P., Mukwato, Ngoma, C. M. and Maimbolwa, M. (2007). Compliance with Infection

Prevention Guidelines by Health Care Workers at Ronald Ross General Hospital Muful ira

District. Medical Journal of Zambia, 35(3): 110-116.

Katowa, P., Mukwato, Ngoma, C .M. and Maimbolwa, M. (2007). Compliance with Infection

Prevention Guidelines by Health Care Workers at Ronald Ross General Hospital Mufulira

District. Medical Journal of Zambia, 35(3): 110-116.

Kothari C, R (2004), Research Methodology. Jaipur: New Age International Publishers.

Libetwa, C. M. (1997). Knowledge, Attitude and Practices of Midwives on Infection Control

in Maternity Units in Lusaka Urban Clinics. University of Zambia.

Libetwa, C. M. (1997). Knowledge, Attitude and Practices of Midwives on Infection Control

in Maternity Units in Lusaka Urban Clinics. University of Zambia.

Lynch, P. (1997). Infection prevention with limited Resources. ETNA communications :

Chicago.

Mahmud N. and Abdul Sahib S. (2011). Assessment of Nurses' Practices Toward Infection

Control Standardized Precautions in Azady Teaching Hospital in the City of Kirkuk. Iraqi

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APPENDIX I – INFORMED CONSENT

Introduction: This is to inform you that I am a student at Cavendish University mandated to

conduct a study. The main objective of the proposed study determined factors that influence

54

nurses' compliance with Infection Prevention Guidelines at Levy Mwanawasa University

Teaching Hospital in Lusaka.

You have been selected as a study participant and a plea is being extended to you now, to read

through/listen to the information contained in this document with the aim of giving your

consent on whether you will agree to participate in the study.

Your part in the study: If you agree, a researcher will take some part of your time which will

be approximately 15 – 20 minutes.

Risks in participating in the study: There is a chance that things we discuss may make you

feel uncomfortable. You may refuse to answer any question at any time.

Confidentiality: The researcher will talk with you in a private place. He/she will not ask you

your name instead he/she will give you a number. Research study papers will be kept in a

secure place. Neither your name nor number will appear anywhere in the study report.

Compensation: Joining the study is on a voluntary basis. There is no compensation availab le

for study participants.

Leaving the study: You are free to leave the study anytime. However, we will highly

appreciate your co-operation during the study period which will last between 15 to 20 minutes.

Declaration: I have read/listened to the information contained in this document and clearly

understood it. I therefore agree to participate in the study.

Signature: ………………………… Date:………………………

APPENDIX II - NURSES QUESTIONNAIRE

Dear Respondent,

My name is Mutinta a Fourth year student at Cavendish University. You have been randomly

selected to take in this study by filling in this questionnaire. This questionnaire is purely

55

designed for academic purpose and it is part of my Degree in nursing and midwifery at

Cavendish University.

“The Aim of the Study is to Determine Factors That Influence Nurses' Compliance with

Infection Prevention Guideline: A Case Study of Levy Mwanawasa University Teaching

Hospital.”

You are kindly requested to provide answers to these questions as honestly and precisely as

possible. Responses to these questions will be treated confidentially. Do not write your name

on this questionnaire. Please answer all the questions.

(Mark with an “X” or tick (√) in the appropriate code selected)

Section A: Bio Data

1. Gender

Male

Female

2. Age

15-20 years

21-25 years

26-30 years

31 - 35 years

36 - 40 years

41 – 46 years

47 – 51 years

56

Above 51 years

3. Duration in services

Less than 1 year

Between 1 - 2 years

Between 3 - 5 years

Between 6 - 9 years

Between 6-10 years

Above 10 years

4. Level of education

Certificate

Diploma s

B.Sc. in Nursing

Masters

Section B: Work related infections risks on nurses.

5. Have you ever heard of hospital-acquired infection?

Yes

No

Not sure

6. Have you ever experienced hospital-acquired infection?

Yes

57

No

Not sure

7. Have you ever sustained a used needle stick injury?

Yes

No

Not sure

8. Have ever been splashed by patient's blood, vomit or other bodily fluids?

Yes

No

Not sure

9. Do you consider all patients contagious?

Yes

No

Not sure

Section C: Nurses Information on IPG.

10. Which is the single most effective method to prevent infections?

Hand washing

Wearing PPEs

Education

Not sure

58

11. Do you consider all unsterile needles/sharps to be contaminated?

Yes

No

Not sure

12. Do you know about nosocomial infection monitoring program in your hospital?

Yes

No

Not sure

13. Do you know where infectious wastes from patients are disposed of?

Yes

No

Not sure

14. How often do you wash your apron/nurse uniform?

Daily

3 times a week

2 times a week

Weekly

Section D: Factors That Influence Compliance/Non-Compliance To IP Guidelines

15. Does poor working environment influence compliance/non-compliance to IP

Guidelines?

59

Yes

No

Not sure

16. Does poor knowledge about prevention of nosocomial infection influence

compliance/non-compliance to IP Guidelines?

Yes

No

Not sure

17. Do lack of water for hand washing and other material resources infection influence

compliance/non-compliance to IP Guidelines?

Yes

No

Not sure

18. Does lack of equipment influence compliance/non-compliance to IP Guidelines?

Yes

No

Not sure

Section E: Measures That Can Be Put in Place for Nurses Regarding IP

19. Does increasing the awareness of hospital acquired infections among healthcare

nurses a measure towards infections control?

60

Yes

No

Not sure

20. Does hygiene education is a good measure for infection control?

Yes

No

Not sure

21. Does hand washing is an effective measure toward infection control?

Yes

No

Not sure

22. Does satisfactory knowledge level is an ideal measure of infection control?

Yes

No

Not sure

23. Does thing nurse training sessions regarding infection can mitigate infection control.

Yes

No

Not sure

61

APPENDIX III - GANTT CHART SHOWING TIME FRAME

62

APPENDIX IV - RESEARCH BUDGET

NO

V20

19

NOV

2019

DEC

2019

DEC

2019

JAN

2020

FEB

2020

MA

R202

0

AUG

2020

TASKS TO BE

PERFORMED

Activity

Consultation with Stakeholders

to Identify Research Topic

Meetings, Money for Transport

Identification of Research Problem

Meetings

Research Design and Methodology

Formulation of Interviews and Questionnaires

Presentation of the Prposal

Testing of the Questionnaire on a Pilot Sample

Modification of the Questionnaire for production of the Final Questionnaire

Data Collection

Submission of the Proposal

Conduction Interviews

Implementation of Questionnaire

Written Sources Such Journal, Books Internet

Reporting of Findings

Typing, Editing and Printing

Submission of Report

63

ACTIVITY DESCRIPTION OF

EXPENDITURE

QTY UNIT

COST(ZMK)

TOTAL

COST

(ZMK)

Consultation with Stakeholders to Identify Research Topic

(Meeting)

Refreshments Transport

10 10

20 30

200 300

Identification of Research Problem (Meetings)

Refreshments Transport

10 10

100 100

400 250

Research Design Formulation Questionnaires and focus group discussion questions

Typing and printing

20 5 100

Testing of the Questionnaire on a Pilot

Sample Transport during

distribution of pilot questionnaire

20

50

500

Modification of the Questionnaire for

production of the Final Questionnaire.

Typing and printing

50 5 250

100

Written sources such journal, books at the Library/internet

200

Documentation of

Findings

Typing, Printing and

binding.

300

Communication Airtime and transport 250

Grand Total K2, 850