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

Introduction

Hospital Acquired Infection (HAI) is a major health problem today. Although it is difficult to assess the exact incidence of hospital acquired infections

in our hospitals, ample evidence exists to indicate the magnitude of HAI and related problems.

Most often it is observed that the patient comes to the hospital for treatment of a particular ailment but has acquired infection prolonging his hospital stay sometimes leading to septicemia, multi system organ failure and death.

HAI not only prolongs the hospital stay of patients but also increases bed occupancy and therefore puts extra burden on already strained hospital resources.

However, HAI cannot be eradicated entirely because of the fact that whenever more than one patient is taken care of in one place, they are vulnerable to catch infections from each other.

A well organized infection control programme can prevent 25-50% of HAI as stated by the "Hospital Infection Society of India".

It also known that patients in high dependency areas such as intensive care units (ICUs) are 5-10 times more likely to acquire HAI because of their compromised defence mechanisms.

 HAI are not only the problem of the patients but also patient's families, hospital staff and the community. Thus hospital acquired infection control is of prime importance in any hospital offering comprehensive health care.

Nurses being in direct contact with the patients round the clock and performing various nursing procedures and assisting physicians and surgeons in various procedures, play an important role in preventing and controlling HAI.

Therefore, the need for a high degree of awareness, knowledge and skill in nursing practice is essential to prevent hospital acquired infections.

Hence, it was felt that there is a need to assess the existing knowledge and practice of nursing staff towards infection control measures at Lokmanya Tilak General Municipal Hospital with a view to identify the areas of knowledge and practice deficit and to strengthen those areas by establishing appropriate measures.

Materials and methods

A study of exploratory nature was conducted during the internship period (Jan-Feb) at Lokmanya Tilak General Municipal Hospital.

Subjects for study were registered staff nurses working in orthopedic, medical, surgical obstetrics & gynecology, pediatric, EMS & Trauma wards and Intensive Care Unit and Operation Theater

Subjects were selected by systematic random sampling.

Sample size n=70 (i.e. 70 staff nurses responses were collected either by direct interview or questionnaire submitted to them)

Questionnaire comprising of 3 sections pertaining to working unit & experience data, knowledge and practice with a set of 48 questions was developed and pilot tested before the final observations were made.

Limitations

The study had limitations in that it was restricted to selected wards and practice could not be assessed by direct observation because of the time factor, so responses were made in the form of questionnaire and practice was thus assessed.

Sample questionnaire Knowledge and Practice of Nursing Staff towards Infection Control Measures

WARD or UNIT :

WORK EXPERIENCE:

UNDERGONE ANY TRAINING (SHORT TERM COURSES, SERVICE EDUCATION, OR CME):Yes/No:

(please tick in the appropriate box)

Sl. Knowledge of Items No. 1. Hospital acquired infections are the result of cross infection The single most important measure for preventing HAI is 2. hand washing 3. The common causative organism of UTI is E. Coli 4. HAI's are transmitted through body fluids, Medical care

AGREE DISAGREE

NOT AWARE OF

5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

provider and reusable equipment Immunization v/s universal precaution Haemoglobin less than 11 gm % is not a sign of infection. Patients receiving immunosuppressive therapy are more susceptible to HAI Hypo chloride solution has to be changed every day and what is the concentration please do mention. Sterilisation is a process of killing of microorganism including spores Items such as nebulisers and disposable pulse oximeter probes can be used for the same patient unless cleaned. Is it essential to change the mask used between patient examination or procedure? Sterile technique is not necessary for nasogastric feeding. The most important factor involved in hand washing is friction Checklist completed during central venous and pulmonary artery catheter insertion Moisture enhances the trans-mission of micro- organisms. Boiling is the only method of sterilisation. Chemical disinfection is the best method of sterilising surgical instruments If a person doesn't show sign and symptoms of disease, he can't transfer a disease. Alcohol hand rubs provide an effective and convenient alternative to hand washing with sanitizer. URTI & UTI's are one of the most common forms of HAI

Sl. No. 1.

Practice Multi-patient use equipment such as commodes, beds, pressure relieving mattresses and blood pressure cuffs, requires decontamination after each episode of use by a patient? Do you display notices which describe the precautions needed if a patient is in isolation? Sterile water and sterile saline labelled when opened and replaced every24 hours? Do u label specimen collected in presence of patient?

YES

NO

2. 3. 4

5 6

The glucose meter is cleaned and disinfected after every use. If a patient on precautions is leaving the unit to go to x-ray, do you inform the transporter about the precautions? Do you perform hand hygiene in following situations: before patient contact before contact with a susceptible patient site (such as an invasive device or wound) before an aseptic task after exposure to body fluids after glove removal after patient contact after contact with the patients immediate environment. The negative air pressure is checked every day either by looking at the pressure gauge or performing the tissue test? Sharps containers are replaced when the filled two third? Do you ensure that any spillage is disinfected properly, taking into account the surface where the incident happened for example on a hard surface in a hospital Do you use hypo chloride solution in such case? Do you perform decontamination of items like as nebulisers and disposable pulse ox meter probes in hand washing sinks? Do you report any staff sharps injuries in line with local reporting procedures/policies? Unused sterile articles are re autoclaved? Wearing gloves is a must during administration of injection? Do staff members receive infection control training? Do you remove gloves before moving to next task or patient? Microbiological waste is discarded in yellow bag? In your unit, staff's finger swabs for c/s are regularly sent?

8 9

10

11 12 13 14 15 16 17 18

Score for each correct answer is 5 points

Sample Characteristics

Presently, the staff nurses working at Lokmanya Tilak General Municipal Hospital has completed General Nursing and midwifery Courses.

In the study sample, the total 70 staff nurses were graduates. None of the subjects were post graduate.

The majority i.e. 60% of the subjects had work experience of 20-30 years, 20% had work experience of 10-20 years and 16% had work experience of 30-40 years; rest; rest 4% had experience ranging from 05-10 years.

90% of staff nurses have undergone training such as in service education, short term courses and training programmes & very few around 10% have undergone continuing medical education

Frequency and percentage of response to items pertaining to knowledge on infection control measures (n=70) Sl. No. 1. 2. 3. 4. 5. 6. 7. 8. Frequency % of of correct correct Responses Response 65 68 58 60 65 40 70 70 92 98 82 85 92 57 100 100

Knowledge of Items Hospital acquired infections are the result of cross infection The single most important measure for preventing HAI is hand washing The common causative organism of of UTI is E. Coli HAI's are transmitted through body fluids, Medical care provider and reusable equipment Immunization v/s universal precaution Haemoglobin less than 11 gm % is not a sign of infection. Patients receiving immunosuppressive therapy are more susceptible to HAI Hypo chloride solution has to be changed every day and what is the concentration please do mention.

9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20.

Sterilisation is a process of killing of microorganism including spores Items such as nebulisers and disposable pulse oximeter probes can be used for the same patient unless cleaned. Is it essential to change the mask used between patient examination or procedure? Sterile technique is not necessary for nasogastric feeding. The most important factor involved in hand washing is friction Checklist completed during central venous and pulmonary artery catheter insertion Moisture enhances the trans-mission of microorganisms. Boiling is the only method of sterilisation. Chemical disinfection is the best method of sterilising surgical instruments If a person doesn't show sign and symptoms of disease, he can't transfer a disease. Alcohol hand rubs provide an effective and convenient alternative to hand washing with sanitizer. URTI & UTI's are one of the most common forms of HAI

70 50 58 60 62 68 65 70 60 70 40 70

100 71 82 85 88 97 92 100 85 100 57 100

Frequency and percentage of response to items pertaining to practice on infection control measures. (N=70)
Sl. No. Frequency of correct Response 70
% Of correct Response

Practice Multi-patient use equipment such as commodes, beds, pressure relieving mattresses and blood pressure cuffs, requires decontamination after each episode of use by a patient? Do you display notices which describe the precautions needed if a patient is in isolation? Sterile water and sterile saline labelled when opened and replaced every24 hours? Do u label specimen collected in presence of patient? The glucose meter is cleaned and disinfected after every use. If a patient on precautions is leaving the unit to go to x-ray,

1.

100

2. 3. 4 5 6

50 64 56 60 70

71 91 80 85 100

do you inform the transporter about the precautions? Do you perform hand hygiene in following situations: before patient contact before contact with a susceptible patient site (such as an invasive device or wound) before an aseptic task after exposure to body fluids after glove removal after patient contact after contact with the patients immediate environment. The negative air pressure is checked every day either by looking at the pressure gauge or performing the tissue test? Sharps containers are replaced when the filled two third? Do you ensure that any spillage is disinfected properly, taking into account the surface where the incident happened for example on a hard surface in a hospital Do you use hypo chloride solution in such case? Do you perform decontamination of items like as nebulisers and disposable pulse ox meter probes in hand washing sinks? Do you report any staff sharps injuries in line with local reporting procedures/policies? Unused sterile articles are re autoclaved? Wearing gloves is a must during administration of injection? Do staff members receive infection control training? Do you remove gloves before moving to next task or patient? Microbiological waste is discarded in yellow bag? In your unit, staff's finger swabs for c/s are regularly sent?

70

100

8 9

40 70

57 100

10

70

100

11 12 13 14 15 16 17 18

70 70 60 70 70 62 65 70

100 100 85 100 100 88 92 100

Interpretation of above data

Average frequency of correct responses of knowledge about HAI of staff nurses working at the hospital was 62.

Mean knowledge about HAI of staff nurses working at the hospital was 88%.

Average frequency of correct responses towards practice about HAI of staff nurses working at hospital was 64.

Mean practice of staff nurses regarding infection control measures is 86%.

Knowledge and practice of staff nurses in relation to years of experience

Years of experience Average score towards knowledge Average score towards practice

0-10 years 10-20 years 20-30 years 30-40 years

70 80 85 80

70 75 80 80

CATEGORY 1: 0-10 YEARS CATEGORY 2: 10-20 YEARS CATEGORY 3: 20-30 YEARS CATEGORY 4: 30-40 YEARS

CONCLUSION AND SUGGESTIONS

On the basis of the above study and findings, it can be said that there exists a positive relationship between knowledge and practice. This indicates that with improved knowledge, we

can also improve the practice, which should be of major concern in the present day health care scenario.

In service education, refresher courses and training programmes on infection control measures should be systematically planned and regularly conducted for staff nurses so as to keep staff nurses up to date on the topic.

Training should include: practical hand washing sessions/use of alcohol hand sanitizer aseptic technique the importance of environmental/equipment cleaning and whose responsibility who to go to for advice/ more information trust infection and prevention policies what you can do to help yourself, your colleagues and your patients (uniform, hair, general, hygiene).

Continuous vigilance, assessment and supervision of various levels of workers will help to start a multidimensional attack on the problem of HAI.

 Nursing staff should actively take part in the maintenance of cleanliness of the hospital which is very poor presently.

Nursing staff should be given the extra responsibility for the inspection of the area outside their ward or unit since these areas are currently more vulnerable and are prone to spread Infection.

Nurses can do a great deal to allay fears by communicating effectively, without breaking confidentiality. For example, nurses should: provide information leaflets for patients, visitors and staff provide notices which describe the precautions needed talk to patients about how they can help themselves include support staff in team meetings during outbreaks tell the patient how their care might be affected by a HAI and how long precautions will be needed ensure that other staff understand the actions

Continuous surveillance of HAI and notification to the concerned authorities is essential and the formulation of regulations should be effectively

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