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Journal of the Academy of Hospital Administration

Knowledge and Practice of Nursing Staff Towards Infection Control Measures in a Tertiary Care Hospital

Author(s): Aarti Vij*, Swapna.N. Williamson**, Shakti Gupta***

Vol. 13, No. 2 (2001-07 - 2001-12)

Key Messages:

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.

Abstract

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

Introduction

Hospital Acquired Infection (HAI) is a major health problem today. It has received the attention of the Government of India and thus the Rao committee, (1968) and the Sharad Kumar Committees 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.

Materials and methods

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.

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.

Observation and Discussion

Sample Characteristics

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.

Table 1: Mean distribution of knowledge and practice of staff nurses in relation to professional qualification.

Professional
qualification
Mean
Knowledge
Mean
Practice
Diploma 14.09 9.24
Graduation 15.60 9.53
Post Graduation -- --

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.

Table 2: Knowledge and practice of staff nurses in relation to years of experience

(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
0-5 years 18 12
6-10 years 19 13
11-15 years 16 12
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.

Table 3: Frequency and percentage of items pertaining to knowledge on infection control measures.

Sl.
No.
Knowledge of Items Frequency of
correct Response
Percentage
of correct
Responses
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%.

Table 4: Frequency and percentage of reponse to items pertaining to practice on infection control measures. (N=50)

Sl.
No.
Practice Frequency of
correct Response
Percentage
of correct
Responses
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%

Table 5: Spearman's coefficient of correlation between knowledge and practice level of staff nurses.

Variable Observation Mean Std. Deviation
Knowledge (X) 50 14.62 2.71
Practice (Y) 50 9.34 1.85

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.

Conclusion

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.

Reference

  1. Rao's Committee (1968): Report of the Review committee on Delhi hospitals. New Delhi. Government of India Press.
  2. Sharad Kumar's committee (1976): Report of the group on hospital infections, Delhi.
  3. Beaumont, E. (1997), Technology Score Care. Focus on Infection Control, American Journal of Nursing. 97 (12), 51.54.
  4. Bowell, B. (1992). Protecting the patient at risk, Nursing times 88 (3), 32-35.
  5. Gardiner, A. et al (1995) Knowledge of disinfection and Motivation, Infection Control Supplement, Nursing Times 91 (20), 59-66
  6. Gould, D.J. (1994), The Significance of Hand drying in the prevention of infection, Nursing Times, 90 (47), 33-35.
  7. Lawrence, Thomson, H et al (1992), Hard - surface disinfectants, Infection Control Supplement, Nursing Times 88 (34), 63-70.
  8. Hawker- Jl, A survey of the implementation of health services guidelines an arrangements of infection controls in health trusts in the West Midlands. Dis-Public-Health 1999 Jan; 2 (1):54-8.
  9. Ortona, L (1987), A study on the incidence of post operative infections and surgical sepsis in a university hospital, Infection Control Journal 8 (8), 320-324.
  10. Rostein, C et al (1998) Nosocomial infection rates at an oncology centre, Infection Control and Hospital Eqidemology 16(3), 141-147.
  11. Ward, Courtenay M. et al (1997), Auditing infection. Infection Control Supplement, Nursing Times 93 (29), 71-78.

* Assistant Professor, Hospital Admn., AIIMS
** Lecturer, College of Nursing, AIIMS
> *** Addl. Professor, Deptt. of Hosp. Admn., AIIMS

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