Thesis Abstract

<p> </p><p>Health care<br>workers, particularly nurses are at risk of infection because they constantly<br>come into contact with infected tissues, fluid, blood and blood products. By<br>complying with infection control measures a lot of infections can be prevented.<br>Some survey studies have been conducted in Nigeria on knowledge, perception<br>attitude and practice of infection control and they concluded that there was<br>inadequate adherence to infection control practices and this could be addressed<br>by organizing training and retraining programmes. This study therefore examined<br>the effects of a training programme in promoting infection control in two<br>teaching hospitals in Ogun State.</p><p>The study adopted<br>a pretest-posttest quasi experimental design. <br>The sample consisted of 87 participants. They were made up of<br>experimental group which consisted of 42 registered nurses from Babcock<br>University Teaching Hospital (BUTH). Ilishan-Remo, Ogun State. The control<br>group was 45 nurses from Olabisi Onabanjo University Teaching Hospital. The<br>training programme consisted of 4 modules on infection control. The programme<br>lasted 4 weeks. The instruments used for data collection were Knowledge about<br>Infection Control Questionnaire (r = 0.79); Perceptions about Infection Control<br>Questionnaire (r = 0.80); Attitudes towards Components of Infection Control<br>Questionnaire (r = 0.62); Practice of Infection Control Questionnaire (both<br>self-reported and observation checklist) (r =0.62). Four research questions<br>were answered and three hypotheses were tested at 0.05 alpha level. Data were<br>analysed using descriptive statistics and Students’ T-test.</p><p>Findings showed<br>that the mean age in the experimental group was 34.92 and SD 8.99 while the<br>control group was 47.43 and SD 6.60. The mean for years of experience in the<br>experimental group was 10.42 and SD 9.95 while in the control group was 21.89<br>and SD 8.72. On attitude, 30 participants (69.0%) had positive attitude in the<br>experimental group compared to 21 participants (46.7%) in the control group.<br>The mean difference was 4.02. On perception, 32 participants (76.0%) in the<br>post intervention had good perception compared to none in the control group.<br>The mean difference was 8.36. On knowledge, 26 participants (62.9%) in the post<br>intervention had high knowledge compared to none participant in the pre<br>intervention. The mean difference was 7.24. On infection risk reduction in the<br>intervention group, 28 participants (66.7%) have experienced sharp injury pre<br>intervention and none post intervention. Significant differences were found<br>between mean practice score of participants in the experimental and control (p =<br>0.001) and between self reported and observed practices (p = 0.000) but there<br>was no significant difference between the mean knowledge score in the<br>experimental and control group (p = 0.149).</p><p>The training<br>programme was effective in improving the level of knowledge, attitude,<br>perception and practice of infection control. Based on these findings, it is<br>recommended that there should be adequate provision of facilities for infection<br>control. Training and retraining should be organized for all nurses and other<br>categories of healthcare workers to promote adherence to infection control.</p><p><b>Keywords</b> Training, Knowledge, Attitude,<br>Perception, and Practice</p> <br><p></p>

Thesis Overview

<p> </p><p><b>INTRODUCTION</b></p><p><b>1.1 Background to the Study</b></p><p>Infection<br>control is an aspect of healthcare delivery that deals with the curtailment of<br>the spread of infection within the healthcare set-up, be it from<br>patient-to-patient, patient-to-staff, staff-to-patients or staff to staff.<br>According to World Health Organisation (WHO, 2011) the components of infection<br>prevention and control are as follows: organisation, technical guidelines,<br>human resources, surveillance, microbiology laboratory support, environment,<br>evaluation and links with public health and other services. Organisation<br>involves setting up a programme, formation of the infection control committee<br>and inter-professional team, which should include physicians, nurses,<br>microbiologists, epidemiologists, infection control specialists, information<br>specialists and others. The committee must have a good working relationship<br>with one another, because their work entails collaboration with other<br>departments, staff and programmes. Technical guidelines involve developing,<br>disseminating and implementing technical evidence-based information in<br>preventing the risks of infection. Human resources involve training and<br>re-training of health care personnel in preventing infections and the training<br>of infection control professionals. It guarantees a pool of adequate staff<br>responsible for infection prevention and control activities.</p><p>Surveillance<br>is the tracking of demonstrated or suspected spread of infection. It involves<br>the collection of data on epidemic and detection of outbreaks as well as the<br>assessment of level of compliance with infection control practices, response to<br>outbreaks and documentation of the situation of healthcare associated<br>infection. Surveillance is important in that it causes early detection,<br>identification, isolation and intervention, and results in effective infection<br>prevention. Microbiology laboratory supports generate data, standardised<br>laboratory techniques and promotes interaction between infection control<br>activities. The environment refers to the minimum requirements for infection<br>control. It includes water, ventilation, hand-hygiene equipment, placement of<br>patient as well as isolation facilities, sterile supply storage, building<br>conditions and renovation activities. Evaluation has to do with monitoring,<br>assessment and report of infection prevention and control outcomes, processing<br>and strategizing at national level and in healthcare facilities. It mirrors the<br>impact of the infection control programmes. Links with public health and other<br>services ensures proper coordination and collaboration between staff and<br>departments in the events of mandatory reporting and activities such as waste<br>management and sanitation, bio-safety, occupational health, patients and<br>consumer’s care and the quality of health care (Hebden, 2015; Stempliuk &amp;<br>Eremin, 2015; WHO, 2011).</p><p>There<br>are various sources of infections. Healthcare associated infections (HAI) are<br>infections that develop in the course of healthcare and results in aggravating<br>illnesses and may lead to deaths, extends the duration of hospital stay, and<br>calls for more interventions at an added cost to the one already expended by<br>the patient’s initial disease. Its occurrence is an indicator of the quality of<br>patient care, adverse event and an issue of patient safety. The sources<br>includes adverse drug events, surgical complications, microorganism isolates,<br>antimicrobial resistance, decreasing trends in intensive care units, exogenous<br>microorganisms such as bacteria, fungi, viruses, protozoan from other patients,<br>endogenous flora of the patients- residual bacteria residing on the patient’s<br>skin, mucous membrane, gastro intestinal tract, respiratory tract, inanimate<br>environmental surfaces, contaminated objects, patient room touch, surfaces,<br>equipment, medication, individual patient, medical equipment, devices, hospital<br>environment, contaminated drugs and foods and hospital flora in the healthcare<br>environment. Other sources include doctors’ white coats, nurses’ uniform,<br>hospital garments, privacy drapes, stethoscopes, bed rails, common hospital<br>surfaces, contaminated water, compromised immune system, negligence or poor<br>attitude of hospital staff, hands of health care workers. It could be from<br>patient to patient, patient to environment, staff to patient, renovation works<br>in the hospital (Hans, 2012; Stubblefield, 2014; WHO, 2011).</p><p>Healthcare<br>workers generally are at risk of infection, because they constantly come into<br>contact with infected materials such as tissues, fluid, blood and blood<br>products. There are several infection control measures aimed at controlling the<br>spread of infectious diseases, such as hepatitis B and C, Human immunodeficiency<br>virus (HIV) and other life threatening infections. Moreover, the hospital waste<br>itself is a potential source of infection hence the need for proper infection<br>control measures. It has been found that healthcare workers do not adhere<br>strictly to the various infection control measures, probably because they do<br>not recognise such, or they lack adequate knowledge, or could be due to poor<br>attitude towards infection control measures, including non-availability of<br>materials and equipment (Amoran &amp; Onwube, 2013).In a study conducted at the<br>Federal Medical Center (FMC), Gombe, in North Eastern Nigeria among nurses, it<br>was found that some respondents were not aware that standard precautions is<br>applied to all patients, and majority of the respondents have poor knowledge of<br>the components of standard precautions (Saidu, Habu, Kever, Dathini, Inuwa,<br>Maigari et al, 2015).</p><p>Standard<br>precautions are infection control measures that are put forward by the United<br>States Centre for Disease Prevention &amp; Control (CDC), in 1996. By complying<br>with standard precautions, a lot of infections can be avoided, such as<br>occupational exposure to pathogens. While some health workers are familiar with<br>the infection control measures, some are not. This may be due to lack of<br>awareness or knowledge and moreover, the attitude that some who are familiar<br>with the infection control measures, show towards practice is not encouraging.<br>When one considers the importance of adequate knowledge and practice of<br>infection control measures, by the healthcare workers, one cannot but think of<br>what to do to improve on that knowledge and practice. Jain, Dogra, Mishra,<br>Thakur and Loomba (2012), in their study among doctors and nurses in a tertiary<br>care hospital, found that there is lack of knowledge and practice regarding<br>basic infection control measures. This deficit in knowledge can be improved<br>through educational intervention. Wasswa, Nalwadda, Buregyoya, Gitta, Anguzu<br>and Nuwama (2015), in their study on implementation of infection control in<br>health facilities in Uganda, found that with prior training on infection<br>control, the respondents were more likely to wash their hands. Level of<br>education and a prior nosocomial infection experience will have a role in the<br>practice of infection control measures. In-service training on infection<br>control measures will boost the practice of infection control measures.</p><p>Amoran<br>and Onwube (2013) found that inadequate workers’ knowledge on infection control<br>and environment related problems are crucial issues that need urgent attention.<br>According to Gebresilassie, Kumei, and Yemane (2014) in their study, “there is<br>suboptimal and inconsistent practice of standard precautions in the healthcare<br>setting that put patients and healthcare workers at significant risk of<br>acquiring infections”. They also emphasized the need for in-service training<br>for the healthcare workers on infection control. Adly, Amin and Abd El-aziz,<br>(2014) found that intervention influenced the compliance of nurses with<br>infection control measures, because of the knowledge gained during the<br>intervention or training programme. There is a standard of infection control<br>measures that can guarantee infection safety among health workers and patients.</p><p><b>&nbsp;1.2 Statement of the Problem</b></p><p>Healthcare<br>workers generally are at risk of infection. WHO (2006), reported that among the<br>35million health workers worldwide, about 3 million sustain percutaneous<br>exposures to the blood borne pathogens each year, including 2 million to<br>Hepatitis B virus (HBV), 0.9 million to Hepatitis C virus (HCV) and 170,000 to<br>Human Immunodeficiency virus (HIV). These injuries may result in 70,000 HBV;<br>15,000 HCV and 5,000 HIV infections. Nurses are at higher risk of being<br>infected with blood-borne pathogens from clinical blood exposure through<br>injuries with sharp instruments and needle-stick injuries if infection control<br>measures are not strictly followed. This is because they are usually the first<br>contact with a patient on arrival in the hospital and provide 24 hour patient<br>care. Studies have also shown evidence of clinical nurses becoming infected due<br>to occupational exposure (Centers for Disease Control &amp; Prevention,<br>2012). Abdulraheem, Amodu, Saka,<br>Bolarinwa &amp; Uthman (2012), in their study, among health workers in North<br>Eastern Nigerian found that the level of knowledge and implementation of<br>standard precautions is below standard to guarantee infection safety. They<br>concluded that there is still much to learn and implement when it comes to<br>infection control measures. </p><p>Furthermore,<br>in some health institutions, the researcher observed that some nurses do not<br>adhere to the components of standard precautions while providing nursing care.<br>For example, few nurses were observed not to wash their hand after removing<br>gloves and before commencing another procedure. In some of the wash hand basins<br>in the outpatient department, liquid soap is not available for health workers<br>and patients to wash their hands. When blood or body fluids are spilled on the<br>floor, the house keepers do not decontaminate with hypochlorite solution before<br>mopping with soap and water. The health institutions infection control units<br>are not well equipped to function effectively to ensure compliance to standard<br>precautions. It is in the light of the gaps that the researcher became<br>interested in planning a training programme on knowledge, perception, attitude<br>and practice of infection control for nurses at Babcock University Teaching<br>Hospital (BUTH), Ilisan-Remo, Ogun state.</p><p><b>1.3 Objective of the<br>Study</b></p><p>The<br>main objective of this study is to determine the effects of a training<br>programme on infection control among nurses. The specific objectives are to:</p><p>1. &nbsp; &nbsp; assess<br>the effectiveness of the training programme on knowledge of participants<br>about </p><p>infection control;</p><p>2. &nbsp; &nbsp; determine<br>the effectiveness of the training programme on perceptions of participants </p><p>about infection<br>control;</p><p>3. &nbsp; &nbsp; document<br>the effectiveness of the training programme on attitudes of participants &nbsp;</p><p>towards infection<br>control; &nbsp; </p><p>4. &nbsp;<br>implement a training programme on infection control;</p><p>5. &nbsp; determine the level of skills possessed and<br>practice of participants on infection control;</p><p>6. assess the effectiveness of a training<br>programme on infection risk reduction and</p><p>7. &nbsp; ascertain if there is any difference between<br>the self-reported practices and the actual &nbsp;</p><p>&nbsp; &nbsp; &nbsp; observed practices of infection control<br>in the experimental group. &nbsp; &nbsp;</p><p><b>1.4 Research Questions</b></p><p>This<br>study attempted to answer the following research questions:</p><p>1. &nbsp; &nbsp; What<br>are the effects of training programme on attitudes of participants?</p><p>2. &nbsp; &nbsp; What<br>are the effects of training programme on the perceptions of participants?</p><p>3. &nbsp; What are the effects of training programme on<br>the knowledge of participants?</p><p>4. &nbsp; What is the effect of the training programme<br>on infection risk reduction?</p><p><b>1.5 &nbsp;<br>Hypotheses</b></p><p>These<br>three hypotheses were tested at 0.05 level of significance:</p><p>Ho 1. &nbsp; &nbsp; &nbsp; &nbsp; There<br>is no significant difference in the mean knowledge score of infection control<br>between the experimental group and the control group.</p><p>Ho 2. &nbsp; &nbsp; &nbsp; &nbsp; There<br>is no significant difference in the mean practice score of infection control<br>between the experimental group and the control group. &nbsp; &nbsp;</p><p>Ho 3. &nbsp; &nbsp; &nbsp; &nbsp; There is no significant difference<br>between the self reported practice and observed practice of infection control<br>in the experimental group.</p><p><b>1.6 Scope of the Study</b></p><p>This<br>study focused on the knowledge, attitude, perception and practice of infection<br>control among nurses. Specific areas are; hand hygiene, use of personal<br>protective equipment (PPE), handling sharps/injection safety, cleaning and<br>disinfection as well as waste management. The independent variable is the<br>training package, and the dependent variables are the participants’ knowledge,<br>attitude, perception and practice.</p><p><b>1.7 Significance of the<br>Study</b></p><p>The<br>importance of the training programme to nurses, patients, hospital and society<br>cannot be over emphasized. The training programme may improve infection control<br>practices among nurses. The practices include: hand washing, donning and<br>removing PPE for example, gloves, gown, mask, eyewear, and injection safety.<br>The study may also improve the knowledge of nurses on the components of<br>standard precautions. Training and practicing standard precautions may lead to<br>a situation where nurses actually feel more protected from the risk of<br>exposures to HIV and Hepatitis, and are more likely to provide improved<br>“physical care”. Nurses also experience less fear and are less judgmental<br>towards patients, thus less likely to stigmatise or discriminate patients,<br>leading to improved “psychosocial or emotional care” when rendering care to<br>patients with highly infectious diseases. &nbsp;</p><p>In<br>the practice of standard precautions, all patients are assumed to be possible<br>sources of infection and must be handled professionally in that regard. The<br>importance of this programme to the hospital is that the patients that receive<br>care are not likely to have nosocomial infection. This may in turn allow the<br>hospital to have recognition which may attract more patronage by Ogun state<br>indigenes and beyond.</p><p>Adequate<br>infection control measures may have economic as well as political effect on the<br>society. However, the nurses will be conversant with what to do and how to do<br>it, in terms of preventing infection. For instance, Hepatitis kills more<br>quickly than HIV, if one is infected with either of the two, it will result in<br>severe economic loss for the individual and the family, and when this is<br>translated on to the national stage, it will be a great loss due to the<br>multiplier effect.</p><p><b>&nbsp;1.8 Justification for the Study</b></p><p>Knowledge<br>and practice of standard precautions has been shown to reduce the risk of<br>exposure to blood and body fluids (Chan, Molassiootis, Chan, Chan, Ho, Lai, et<br>al, 2002). Standard precautions are the basic level of infection control<br>precautions which are to be used, as a minimum in the care of all patients. It<br>is therefore necessary for nurses to have training and re-training programme on<br>standard precautions to improve their compliance.</p><p><b>1.9 Operational<br>Definition of Terms</b></p><p><b>Infection control: &nbsp;</b>This refers to an aspect<br>of healthcare delivery that deals with the curtailment of the spread of<br>infection within the healthcare set-up, be it from patient-to-patient,<br>patient-to-staff, staff-to-patients or staff to staff.</p><p><b>Nursing intervention</b>:<br>This refers to a training package that focuses on improving knowledge,<br>attitude, perception and practices of infection control. The areas of focus<br>include hand washing, PPE such as gowns, mask, goggles, and gloves. The<br>training also includes injection safety/handling sharps, cleaning<br>decontamination and sterilization, waste management as well as post exposure<br>prophylaxis (PEP).</p><p><b>Knowledge</b>:<br>This means facts, information and skills acquired through experience or<br>education on infection control.</p><p><b>Attitude</b>:<br>Internal mental disposition expressed towards infection control or feelings<br>expressed towards infection control.</p><p><b>Perception</b>:<br>This means conscious understanding of what infection control is all about or<br>meaning ascribed to infection control.</p><p><b>Practice</b>:<br>This refers to a regular repeated exercise in order to gain proficiency in<br>skills on the components of infection control. This includes hand hygiene, use<br>of personal protective equipment, injection safety/handling sharps, cleaning<br>decontamination and sterilization, waste management as well as PEP.</p><p><b>Effectiveness</b>:<br>This refers to the positive impact of a training programme on infection control<br>which may include increased level of participant’s knowledge and practice.</p><p><b>Nurses</b>:<br>These are registered nurses working at BUTH, Ilisan-Remo and Olabisi Onabanjo<br>University Teaching Hospital (OOUTH), Ogun state.</p><p><b>Promotion of Infection Control: </b>This means disseminating<br>information about infection control.</p> <br><p></p>