Attitude And Practice Of Infection Control Among Midwives

Healthcare acquired infections (HCAIs) otherwise call nosocomial infection is associated with increased morbidity and mortality among hospitalized patients and predisposes healthcare workers (HCWs) to an increased risk of infections. The aim was to assess the levels of attitude, and practices of the healthcare professionals towards safety at General Hospital Eleme. An institution based cross-sectional study was conducted from February to June 2018. Proportional random sampling technique was used to include 282 study participants and data were collected using a structured self-administered questionnaire and analyzed using SPSS version 20. Among 282 study participants, 181 (64.2%), and 162 (57.4%) had favorable attitude, and adequate practice scores, respectively. More than half (55.3%) of the study participants were untrained. There was a high (26.6%) prevalence of needlestick injury; however, the use of post-exposure prophylaxis after potential exposures was very limited. Generally, the levels of attitude and practice scores among the study participants were low. Therefore, there should be adequate and consistent supply of personal protective devices and other materials used for infection prevention and control. In addition, there should be awareness raising mechanism, including the provision of job aids and periodic training. Further, comprehensive studies should be conducted by including different types and levels of health facilities.

ABBREVIATIONS

TABLE OF CONTENTS

COVER PAGE

TITLE PAGE

APPROVAL PAGE

DEDICATION

ACKNOWELDGEMENT

ABSTRACT

ABBREVIATIONS

CHAPTER ONE

• • INTRODUCTION

• • BACKGROUND OF THE PROJECT

• • PROBLEM STATEMENT

• • RESEARCH QUESTION

• • AIM OF THE RESEARCH

• • RESEARCH OBJECTIVES

• • LIMITATIONS

• • PROJECT ORGANISATION

CHAPTER TWO

2.0      LITERATURE REVIEW

• • OVERVIEW OF THE STUDY

• • OVERVIEW OF INFECTION PREVENTION AND CONTROL

• • METHODS OF INFECTION PREVENTION AND CONTROL

CHAPTER THREE

3.0      METHODOLOGY

• • STUDY AREA

• • SAMPLE SIZE, SAMPLING TECHNIQUE, AND ELIGIBILITY

• • DATA COLLECTION

• • METHODS OF MEASUREMENT AND ANALYSIS

• • ETHICAL CONSIDERATIONS

CHAPTER FOUR

• • RESULTS AND DISCUSSION

• • RESULT

• • DISCUSSION

CHAPTER FIVE

• • CONCLUSION

• • REFERENCES

CHAPTER ONE

1.0                                          INTRODUCTION

1.1                            BACKGROUND OF THE STUDY

Infection-related diseases are still the main cause of death in Nigeria, according to the 2013 health profile acquired by the World Health Organisation (WHO, 2013) statistics. The burden of disease in Nigeria  includes HIV, TB, Malaria, other infectious diseases and respiratory infections. Expansion of the infection prevention and control movements occur due to the increase in infection occurrences in the country. This increase in infection-related disease’s impact the increase health financing in Nigeria with a government contribution to health care of 57.5% above the figures budgeted for (WHO, 2014).

Infectious patients are admitted into hospitals and therefore hospitals have become common settings for transmission of diseases. In hospitals, infected patients are a source of infection transmission to other patients, health care workers and visitors (Sydnor & Perl, 2011). Nosocomial infection, also known as hospital-acquired infections is one of the leading causes of death and has much economic cost due to increased hospitalization and prognosis (WHO, 2015). According to WHO (2010), Hospital acquired infection is defined as an infection occurring in a patient during the process of care within a health care facility which was not present or incubating at the time of admission. These infections are those occurring more than 48 to 72 hours after admission and within ten days after hospital discharge (Collins 2008:2). Due to the admission of patients with different organisms, the hospital environment has become saturated with highly virulent organisms, namely: Staphylococcus aureus, Streptococcus pyogenic, Escherichia coli, Pseudomonas aureginosa and Hepatitis viruses that survive in a hospital. These organisms cause diseases ranging from minor skin infections to life-threatening conditions such as sepsis (Sydnor, & Perl, 2011).

The Nigeria Ministry of Health has indicated that Ebola virus disease epidemic is a public health risk as  neighbouring country are suffering from the diseases and therefore preparedness in infection prevention and control measures should be strengthened. Efficient knowledge, good attitude and best practices by nurses in infection prevention and control may contribute to decreasing in infection rate in the hospital.

The Nigeria policy on health has stipulates that the health care institution should provide a safe environment for the patients in their care. Hospital nurses form the backbone of infection prevention and control, therefore possibly, will either contribute to infection transmission or prevent and control infection. According to Damani (2012), the environment in which a patient is nursed must be planned to reduce the risk of transmission of infection. Infection prevention and control measures aim to protect the vulnerable people from acquiring an infection while receiving health care (Damani, 2012). Lack of knowledge, bad attitudes and poor practices amongst nurses in the prevention and control of infections can lead to hospital-acquired infections.

In clinical practice, the researcher has observed cases where nurses handle contaminated linen with bare hands, put needles in the patient’s mattress after giving injections, do not clean the stethoscope between patients and do not wash hands regularly in the clinical environment. Poor infection prevention and control practices among nurses increase the rates of hospital-acquired infections.

Hand hygiene is the single most important intervention to prevent transmission of infection and should be a quality standard in all health institutions. An attitude of not washing hands among individuals involved in the provision of health care can increase the rate of hospital-acquired infections. In a study that was conducted in India, where Nair, Hanumantappa, Hinemath,Siraj and Raghunath (2013:3) attitude and practices of hand hygiene among medical and nursing students at a tertiary health care centre, the majority of students had poor knowledge with regard to hand hygiene.

Lack of knowledge among nurses can increase the rate of hospital-acquired infections. This is supported by a study that was conducted in Zimbabwe by Tirivanhu, Ancia and Petronella (2014:73) who determined the barriers of infection prevention and control practices among nurses at the Bindura provincial hospital. The study revealed that the majority of nurses’ lack knowledge on infection control principles as only n= 14 (28%) of n= 50 (100%) nurses had excellent knowledge on infection control principles, n= 21 (42%) of n= 50 nurses did not utilize the infection control manuals. Infection control workshops were poorly organised as 68% of the nurses did not attend any workshop on infection prevention and control practices (Tirivanhu et al., 2014). Hayeh and Esena (2013:47) assessed the infection prevention and control (IPC) practices among health workers at Ridge Regional Hospital in Accra (Ghana). The study showed that knowledge in IPC practices among health care workers was moderate 51% (n= 204), as availability and access to material for IPC practices at the facility was 58% (n= 118) and overall compliance with IPC guidelines was 54% (n= 110).

The World Health Organisation (2016) has indicated that surgical site infections at this particular tertiary hospital in Nigeria are a research priority as there was an increase in wound infections of those people who had surgery at this hospital and this coincides with the researcher’s experiences and proposal. Therefore, this study determined the knowledge, attitude and practices of nurses in infection prevention and control within a tertiary hospital in Nigeria.

1.2                        STATEMENT OF THE PROBLEM

A research problem is an area of concern in which there is a gap in the knowledge base needed for midwives practice (Burns & Grove 2011:146). The researcher has observed that midwives do not apply infection prevention and control measures in the hospital setting which is required to ensure patient safety. Lack of attitude and practices in infection prevention and control contribute to high rates of hospital-acquired infections (Jain, Dogra, Mishra, Thaku and loomba, 2012 & Hayeh and Esena, 2013). Uncontrollable nosocomial infection contributes to prolonged stay, morbidity and mortality which put stress on health care economics of the country (Mishta, Banerjee & Gosain, 2014).

1.3                                 RESEARCH QUESTION

1. 1. What is the level of attitudes and practices of health care workers in infection prevention and control in General Hospital Eleme?

1. 1. Midwives, are they prone to infection as a result of their altitude and practice?

1.4                                 AIM OF THE RESEARCH

In order to address the research question, the aim of the study is to determine the knowledge, attitudes and practices of midwives regarding infection prevention and control in General Hospital Eleme in Rivers State of Nigeria.

1.5                                 RESEARCH OBJECTIVES

Based on the aim, the following objectives have been set for the study to determine:

1. 1. The knowledge of midwives in infection prevention and control in General Hospital Eleme.

1. 1. The attitude of midwives in infection prevention and control in General Hospital Eleme.

1. 1. The practices of midwives in infection prevention and control in General Hospital Eleme

1. 1. To make recommendations to the risk programme and policies in General Hospital Eleme

1.6                                            LIMITATIONS

Data obtained from the study participants through self-report were not cross-checked with their actual practices on the ground. Further, since the study was conducted in a single health facility, it could not be generalized at a national level.

1.7                                                         PROJECT ORGANISATION

The work is organized as follows: chapter one discuses the introductory part of the work, chapter two presents the literature review of the study, chapter three describes the methods applied, chapter four discusses the results of the work, chapter five summarizes the research outcomes and the recommendations.

CHAPTER TWO

2.0                                    LITERATURE REVIEW

2.1                                OVERVIEW OF THE STUDY

Workplace health and safety is a critical element in every organization particularly in the healthcare settings [Ogoina D, 2015]. Healthcare professionals (HCPs) may act as a mechanical vector for the transmission of nosocomial infections from patient to patient [Hilburn J, 2003]. Accidental exposure to body fluids can cause bloodborne infections particularly hepatitis B virus (HBV), human immunodeficiency virus (HIV), and hepatitis C virus (HCV) [Sabbah I, Sabbah H, Sabbah S, Akoum H, Droubi N, 2013]. Exposures may happen through needlestick or sharp injuries contaminated with infected body fluids or through contact with splashes [Sabbah I, Sabbah H, Sabbah S, Akoum H, Droubi N, 2013]. The risk of seroconversion after percutaneous exposure to infected blood is approximately 0.1–0.3% for HIV, 2% for HCV, and 6–60% for HBV [Sabbah I, Sabbah H, Sabbah S, Akoum H, Droubi N, 2013]. Safety practices help to protect healthcare workers, patients, and visitors from health hazards [Nazir A, ]. It includes the use of personal protective equipment (PPE) including gloves, gowns, eye goggles, aprons, masks [Kermode M, 2005], and through the provision of professional immunization programs [Vaz K, 2010]. With inadequate infection prevention practice, the risk of acquiring infections through exposure to body fluids is substantial [Vaz K, 2010].

Infection is one of the most important challenges in the healthcare facilities worldwide.