Systematically planned regular in service education programme, refresher courses and training for health personnel on infection control measures coupled with continuous surveillance of HAI would result in attaining highest standard of infection control practices.
A study to assess the knowledge and practice of staff nurses on infection control measures and the relationship between knowledge and practice was carried out in a super speciality teaching institute. Data revealed the mean knowledge and mean practice of staff nurses regarding infection control measures to be 73.1% and 62.7% respectively.
Keywords : HAI, knowledge and practice
Hospital Acquired Infection (HAI) is a major health problem today. It has received the attention of the Government of India and thus the Rao committee, (1968) and the Sharad Kumar Committees in (1976) were set up to investigate the problem of hospital infections in depth. Although it is difficult to assess the exact incidence of hospital acquired infections in our hospitals, ample evidence exists to indicate the magnitude of HAI and related problems. Most often it is observed that the patient comes to the hospital for treatment of a particular ailment but 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 orgainsed infection control programme can prevent 25-50% of HAI as stated by the "Hospital Infection Society of India". The literature also reveals that patients in high dependency areas such as intensive care units (ICUs) are 5-10 times more likely to acquire HAI because of their compromised 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 AIIMS hospital (tertiary care teaching hospital) with a view to identify the areas of knowledge and practice deficit and to strengthen those areas by establishing appropriate measures.
The objectives of the study were: To assess the level of knowledge and practice of staff nurses on infection control measures and to find out the relationship between knowledge and practice.
A descriptive study of exploratory nature was conducted in June-July 1999 at Main Hospital, AIIMS. Subjects for study were registered staff nurses working in medical, surgical wards and Intensive Care Unit. Subjects were selected by systematic random sampling. Questionnaire comprising of 3 sections pertaining to personal data, knowledge and practice with a set of 35 questions was developed and pilot tested before the final observations were made.
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.
Presently, the staff nurses working at AIIMS hospital have either completed General Nursing and midwifery Courses or B.Sc. (Hons.) Nursing Course.
In the study sample, out of the total of 50 staff nurses, 66% were diploma nurses and 34% of them were graduates. None of the subjects were post - graduate.
The majority i.e. 70% of the subjects had experience of 0-5 years and 24% had work experience of 6-10 years; rest; rest 6% had experience ranging from 11-16 years.
60% of staff nurses had not received continuing education whereas 40% had undergone training such as in service education, short term courses, and training programmes.
Based on the mean distribution data, the (15.60) graduate nurses were found to possess more knowledge and practice than diploma nurses (14.09). This strongly suggests that the graduate nurses are better equipped with knowledge with regards to prevention and control of HAI.
The mean distribution data further reveals that graduate nurses practice level (9.53) is higher than diploma nurses (9.24).
From the above data, it could be observed that there exists a positive relationship between knowledge and practice. Thus, the persons with requisite knowledge will be the better performers in their professional practice in preventing and controlling HAI.
(It was surprising to note that nursing staff having more than 10 years of experience showed a decline in their level of knowledge and practice of prevention control of HAI than with the freshly recruited nurses.)
|Years of experience||Knowledge||Practice|
|Above 16 years||10||10|
This observation establishes the need for in service continuing education on HAI for the health professional who are responsible for direct patient care. Hawker (1999) conducted a survey on the implementation of Health service guidelines on arrangements for infection control in health trusts reported that a good hospital infection control programme can reduce hospital acquired infection, which causes considerable morbidity, mortality and cost.
|Knowledge of Items||Frequency of
|1.||Hospital acquired infections are the result of self infection, cross infection & environmental infection||20||40|
|2.||The single most important measure for preventing HAI is hand washing||43||86|
|3.||The common causative organism of of UTI is E. Coli||37||74|
|4.||HAI's are transmitted through body fluids, staff hands and reusable equipment||45||90|
|5.||Immunization is not a universal precaution||44||88|
|6.||Haemoglobin less than 11 gm % is not a sign of infection.||48||96|
|7.||Patients receiving immunosuppressive therapy are more susceptible to HAI||44||88|
|8.||In case of UTI, bacterial count of 10 CFU/ml of Urine c/s is significant||22||44|
|9.||Sterilisation is a process of killing of microorganism including spores||43||86|
|10.||Glutehyde is to be changed every 28 days||45||90|
|11.||More than 15 CFU organisms are grown in an agar plate||9||18|
|12.||Sterile technique is not necessary for naso gastric feeding.||41||82|
|13.||The most important factor involved in hand washing is friction||24||48|
|14.||HAI is synonymous to nosocomial infection||39||78|
|15.||Moisture enhances the trans-mission of micro- organisms||48||96|
|16.||Boiling is a method of sterilisation||16||32|
|17.||Chemical disinfection is the best method of sterilising surgical instruments||38||76|
|18.||If a person doesn't show sign and symptoms of disease, he can't transfer a disease||49||98|
|19.||Alcohol is an effective disinfectant when rubbed in skin.||39||78|
|20.||UTI's are one of the most common forms of HAI||37||74|
Mean knowledge about HAI of staff nurses working at the hospital was 73.1%.
|1.||2 % activated glueraldehyde is to be changed every 28 days||29||58|
|2.||To prevent HAI it is essential to isolate the patients on Immuno suppressive drugs||16||32|
|3.||Sterile technique is necessary to be followed except in naso-gastric feeding||47||94|
|4.||Universal precautions are to be followd for all patients.||38||76|
|5.||Handwashing should be practiced with soap and water||49||98|
|6.||After hand washing tissue paper drying is preferable||31||62|
|7.||The solution used in humidifiers is distilled water||35||70|
|8.||Disposable needles should be discarded in the needle distroyers||35||70|
|9.||Polar bleach is used for disinfecting blood spilled on the floor||43||86|
|10.||Proper hand washing practice should be above the elbow||3||6|
|11.||It's necessary to wear gloves in gastric lavage||21||70|
|12.||Unused sterile articles must be reautoclaved||21||42|
|13.||Wearing gloves is a must for I/V injection||41||82|
|14.||Following a procedure, after removing gloves, hand washing is not necessary||41||82|
|15.||In your unit, staff's finger swabs for c/s are regularly sent||3||6|
Above data reveals that the mean practice of staff nurses regarding infection control measures is 62.7%
Spearman's coefficient of correlation: 0.2381
This indicates that there exists a linear relation (correlation) between knowledge and practice. Though the mean knowledge of staff nurses regarding infection control measures is 73.1%, and the mean practice is 62.27% it is imperative that to attain highest standard of infection control practices which would in turn lead to a reduction in the incidence of hospital acquired infection depends greatly on the level of knowledge.
On the basis of the above study and findings, it can be said that there exists a positive relationship between knowledge and practice. Both are directly proportional to each other. This indicates that with improved knowledge, we can also improve the practice, which should be of major concern in the present day health care scenario.
In service education, refresher courses and training programmes on 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.
Continuous surveillance of HAI in vulnerable areas and notification to the concerned authorities is essential and the formulation of regulations should be effectively performed, so as to be able to take appropriate measures in time.
Continuous vigilance, assessment and supervision of clinical performance of various levels of workers will help to start a multidimensional attack on the problem of HAI.
* Assistant Professor, Hospital Admn., AIIMS
** Lecturer, College of Nursing, AIIMS
> *** Addl. Professor, Deptt. of Hosp. Admn., AIIMS