Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Nosocomial infections (NIs), also known as a hospital-acquired infection, are defined as infections which are acquired after 48 h of patient admission. Such infections are neither present nor incubating prior to a patient’s admission to a given hospital. NIs represent a universally serious health problem and a major concern for the safety of both patients and the health care providers [1,2,3,4]. Although the incidence rate for nosocomial infection vary from country to country, at any given time, almost seven patients from developed countries to ten patients from developing countries out of each100 patients admitted to hospitals gain at least one kind of nosocomial infections [5]. In Yemen, data regarding NIs are few, but the prevalence rate of NIs, specifically surgical site infection, is high from time to time as it accounted for 8% in 2002 [6] and 34% in 2013 [7].Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

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NIs have significant consequences on patients, their families, and the community as a whole. The most common consequences of NIs are increased morbidity, mortality, and length of hospitalization [4, 8]. Such consequences contribute substantially to raise both the direct and indirect cost of the health care services, which result in additional costs to treat infected cases. Hence, such issue wastes the available resources which are not already enough, especially in developing countries [9].Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Nurses are responsible for providing medications, dressing, sterilization, and disinfection. They are involved in more contact with patients than other health care workers (HCWs). Therefore, they are more exposed to various NIs [10]. Hence, nurses play a vital role in transmitting NIs, and their compliance with infection control measures seems to be necessary for preventing and controlling NIs [11]. Accordingly, they should be aware of how to prevent transmission of NIs and be knowledgeable of its potential risk to patients, other staff, and as visitors.

Although there are many previous cross-sectional studies which revealed that the levels of nurses’ knowledge and practices are relatively poor and insufficient [12,13,14,15], to the researcher’s best of knowledge, so far, no study has been conducted in Yemen which is the context of the current study. Therefore, this study aimed to identify gaps in nurses’ knowledge and practices regarding NI control measures in order to improve the current training courses and enhance future good practice.Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Methods
Aim
This study aims to answer the following research questions:

1.
What is the current level of knowledge of nurses regarding infection control measures?

2.
What is the current level of practices of nurses regarding infection control measures?

Study design
A descriptive, cross-sectional design was used in this study.

Study setting
This study was carried out in two private hospitals in Sana’a, the capital city of Yemen. The study covered a period from April 2016 to May 2016. All nurses who were working in the selected private hospitals and involved in a direct contact with patients were invited to participate in this study.

Subjects
A non-probability (purposive) sampling technique was used to select the study participants. A total of 100 nurses participated in this study and responded to the study questionnaire. However, only 85 questionnaires were filled completely and included in the final analysis.Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Study instrument
A structured questionnaire was developed based on the World Health Organization (WHO) infection control guidelines [9]. The final questionnaire comprised 45 items related to knowledge and practice regarding NI control measures. It is divided into the following three sections:

Section 1 is related to the demographic information of the participants: age, gender, level of education, current position and duration of working, course training on NI control, and working experience in NI control measures.Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Section 2 is related to knowledge and is divided into these two parts:

1.
Knowledge of preventive measures of person-to-person transmission, which includes hand hygiene (5 items), personal protective equipment (5 items), and safe injection practices (4 items)

2.
Knowledge of preventive measures of transmission from hospital environment, which involves routine hospital cleaning (4 items), safe waste handling and disposal (4 items), reprocessing of patient care equipment (4 items), and safe linen handling (4 items)

Section 3 is related to practices on NI control measures, and it consists of 15 items. This section is also subdivided into two parts: precautions to prevent NIs (9 items) and actual actions to prevent NIs (6 items).

Scoring system
The 30 items related to knowledge were assessed with “Correct,” “Incorrect,” and “I don’t know” options, while the practices was assessed using 15 scenario-based items with “Yes,” “No,” and “I don’t know” options. The reverse statement was corrected first and then a 0 score was given for each “incorrect” or “I don’t know” response; 1 score was given for each correct response. The maximum and minimum scores for each section vary based on the number of items in each section. Correct answers were calculated to obtain total scores for different infection control practices. A score of less than 50% was considered poor, 50–79% fair, and 80% and above was considered as good [16].Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Validity and reliability
Content validity was obtained by three experts in infection control and prevention at hospitals and academic institutions. Their comments regarding the tool layout and format, relevance, accuracy, consistency, and scoring system were taken in consideration. Reliability of the tool items was tested using alpha Cronbach (α) test: section 2 of the tool = 0.81 and section 3 = 0.79 which considered acceptable.

The responses were recorded and analyzed using the statistical software (IBMSPSS), version 22.0. Descriptive statistics was applied (percent and number). A p value of ≤ 0.05 was taken as statistically significant.Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Data collection
The questionnaire was distributed during the study period of April to May 2016. In-ward nurses from both hospitals were invited during regularly scheduled educational meetings to fill the questionnaire and had to return it back at the same time to avoid any non-response bias. A total of 100 questionnaire were distributed, 50 in each hospital. Only 85 out of the 100 distributed questionnaires were completed, and therefore, they were used in the final analysis.Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Ethics
Permission for this study was obtained from the Ethics Committee of both selected private hospitals (University of Science and Technology and Saudi German Hospital Sana’a). A written consent was also obtained from all eligible nurses before data collection.

Results
Response rate
Out of 100 distributed questionnaires, 85 questionnaires were filled completely and included in the final analysis, thus making up a response rate of 85%.

Nosocomial infection also known as Hospital Acquired Infections (HAI) is a localized or systemic infection acquired in a hospital or any other health care facility by a patient admitted for a reason other than the pathology present during admission. It may also include an infection acquired in a healthcare facility that may manifest 48 hours after the patient’s admission into the health care facility or discharge (Hildron, Edwards, Patel, Horan, Sievert, Pollock & Fridkin, 2008). Epidemiological studies report that nosocomial infections are caused by pervasive pathogens such as bacteria (Lepelletier, Perron, Bizouarn, Caillon, Drugeon, Michaud & Duveau, 2005), viruses (De-Oliveira, White, Leschinsky, Beecham, Vogt, Moolenaar, Perz & Safranek, 2005) and fungi present in air, surfaces or equipment. The pathogens are not present or incubating prior to the patient’s admission into healthcare facility and are most likely transmitted by direct person-to-person contact during invasive medical procedures (Anderson, Kaye, Chen, Schmader, Choi, Sloan & Sexton, 2009). Some of the pathogens are highly resistant to antimicrobial agents, andthis necessitates the prescription of more potent and costly antimicrobial agents (Mulvey & Simor,2009).Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Nosocomial infections are prevalent nationally and internationally; and occur in patients of all age groups: neonates (Aly, Herson, Duncan, Herr, Bender, Patel & EI-Mohandes, 2005), immuno-compromised adults and the elderly (Lepelletier, Perron, Bizouarn, Caillon, Drugeon, Michaud& Duveau, 2005). The most frequent types of nosocomial infections are those associated with the urinary tract, surgical wounds, respiratory tract and blood stream (Lo, 2008). It is a serious global public health issue, causing the suffering of 1.4 million people across the world at any given time (WHO, 2007).Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Nosocomial infection in developing countries is difficult to address because it is such a complex problem with diverse underlying causes. International non-governmental organizations (INGOs) and inter-governmental organizations such as United Nations agencies add a unique perspective to the push for infection control measures in hospitals in the developing world. However, these organizations have not been able to address all facets of the problem such as infrastructure, leadership and individual health care worker behavior. Nosocomial infection control is not simply a matter of encouraging hand hygiene in settings where clean water and soap may not be consistently available. Nor is infection control a matter of providing supplies to health care workers who are not trained to use them properly (WHO, 2010).Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

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The burden of HAI is already substantial in developed countries, where it affects from 5% to 15% of hospitalized patients in regular wards and as many as 50% or more of patients in intensive care units (ICUs) (WHO, 2009). In developing countries, the magnitude of the problem remains underestimated or even unknown largely because HAI diagnosis is complex and surveillance activities to guide interventions require expertise and resources (Allegranzi & Pittet, 2008). Surveillance systems exist in some developed countries and provide regular reports on national trends of endemic HAI (Pittet, Allegranzi, Sax, Bertinato, Concia & Cookson, 2005) such as the National Healthcare Safety Network of the United States of America or the German hospital infection surveillance system. This is not the case in most developing countries (WHO, 2010) because of social and health-care system deficiencies that are aggravated by economic problems. Additionally, overcrowding and understaffing in hospitals result in inadequate infection control practices, and a lack of infection control policies, guidelines and trained professionals also adds to the extent of the problem.Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Hospital-wide HAI prevalence varied between 2.5% and 14.8% in Algeria (Vincent, Rello, Marshall, Silva, Anzueto & Martin, 2009), Burkina Faso (DiA, Ka, Dieng, Diagne, Dia & Fortes, 2008), Senegal and the United Republic of Tanzania (Atif, Bezzaoucha, Mesbah, Djellato, Boubechou & Bellouni, 2006). Overall HAI cumulative incidence in surgical wards ranged from 5.7% to 45.8% in studies conducted in Ethiopia (Messele, Woldemedhin, Demissie, Mamo & Geyid, 2009) and Nigeria (Kesah, Egri-Okwaji, Iroh & Odugbemi, 2009). The latter reported an incidence as high as 45.8% and an incidence density equal to 26.8 infections per 1000 patient-days in paediatric surgical patients (Kesah, Brewer, Yingrengreung & Fairchild, 2009). In a study conducted in the surgical wards of two Ethiopian hospitals, the overall cumulative incidence of patients affected by HAI was 6.2% and 5.7% (Messele, Grottolo, Renzi, Paganelli, Sapelli, Zerbini & Nardi, 2009). In a study from Nigeria, the implementation of an infection control programme in a teaching hospital succeeded in reducing the rate of HAI from 5.8% in 2003 to 2.8% in 2006 (Abubakar, 2007).Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

In Nigeria, nosocomial infection rate of 2.7 % was reported from Ife, while 3.8 % from Lagos and 4.2 % from Ilorin (Odimayo, Nwabuisi & Adegboro, 2008). The cause of nosocomial infections might be endogenous or exogenous. Endogenous infections are caused by organism present as part of the normal flora of the patient, while exogenous infections are acquired through exposure to the hospital environment, hospital personnel or medical devices (Medubi, Akande & Osagbemi, 2006). Nosocomial infection rates vary substantially by body site, by type of hospital and by the infection control capabilities of the institution. The proportion of infections at each site is also considerably different in each of the major hospital services and by level of patient risk (Taiwo, Onile & Akanbi, 2005).This is exemplified by surgical site infections (SSIs) which are most common in general survey, whereas urinary tract infections and blood stream infections are most frequent in medical services and nurseries. Rates of nosocomial infection vary by surgical subspecialty, low in ophthalmology and high in general surgery. The differences are largely due to variations in exposure to high risk devices or procedures (Tolu, 2007).Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Urinary tract infections (UTI) represent the most common (34%) type of nosocomial infections. Indwelling catheters cause the majority while others are caused by genito urinary procedures (Tolu, 2007). Surgical wound infections represent 17% nosocomial infection and are the second most common hospital acquired infections. The classification of wound infections is based on the degree of bacterial contamination, including clean, clean contaminated and contaminated. Co-morbid and contamination of the surgical site contribute to the infection rate. The risk factors for surgical wound infections include age, obesity, concurrent infection and prolonged hospitalizations. The origin of the bacterial agent is dependent on direct inoculation from a host’s flora, cross-contamination, the surgeon’s hands, air-borne contamination and devices such as drains and catheters (Odimayo, Nwabuisi& Adegboro, 2008). Lower respiratory infection (LRI) or pneumonia represents 13 % of nosocomial infections (Taiwo, Onile & Akanbi II, 2005). This is the most dangerous of all nosocomial infections with acase fatality rate of 30%. It manifests in the intensive care unit or post-surgical recovery room. Endotracheal intubation and tracheostomy dry the lower respiratory tract mucous and provide entry for microbes.Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

This study therefore aims at investigating nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar, Cross River State, Nigeria.

1.2 Statement of Problems

Nosocomial infections have been recognized as a problem affecting the quality of health care and a principal source of adverse healthcare outcomes. Within the realm of patient safety, these infections have serious impact such as increased hospital stay days, increased costs of healthcare, economic hardship to patients and their families and even deaths, are among the many negative outcomes (Anderson, Kaye, Chen, Schmader, Choi, Sloan & Sexton, 2009). Further more, it was noted that Doctors and Midwives were not observing strict Aseptic measures. It is with the above information the researcher carried out this study to investigate nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar.Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

1.3 Purpose of Study

The purpose of this study is to investigate nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar.

1.4 Specific Objectives

i. To ascertain the level of knowledge of nosocomial infection among nurses in UCTH, Calabar.

ii. To identify the nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar.

1.5 Research Questions

i. How much do nurses in University of Calabar Teaching Hospital (UCTH), Calabar know about nosocomial infection?Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

ii. What nursing measures are utilized for the prevention of nosocomial infections in the labour ward of UCTH, Calabar?

1.6 Hypothesis

There is no significant relationship between thelevel of knowledge of nosocomial infection and nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar.

1.7 Scope of the Study

The study is focused on investigating the nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar. It will also look at the level of knowledge of nosocomial infections among nurses in UCTH, Calabar.

1.8 Significance of the Study

The findings of this study will be of significance to the following categories of people;

Health Workers: They will find this study to be an important tool for counselling patients suffering from nosocomial infections.Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Nurses And Midwives: The findings in this study will aid nurses and midwives with deciding the most suitable infection preventive measure for a particular individual at a particular time. The findings in this study will also provide nurses and midwives with more insight on nosocomial infections, which will help them give comprehensive health talks on it treatment and prevention.

Researchers: The findings in this study will also serve as a resource material to researchers who wish to embark on related researches in the nearest future.

1.9 Limitation of the Study

The limitation encountered by the researcher was inability to distribute the questionnaire to all the nurses in Calabar at the early stage of the research. This was due to the three shift-duties of nurses (morning, evening and night) in all the various hospitals in Calabar. However, the researcher overcame it by distributing questionnaire during the morning and evening shift, face to face, whereby she collected completed filled questionnaire at the spot.

1.10 Operational Definition of Terms

The key terms in this research were defined as follows:

Nosocomial: This simply is a disease originating in a hospital.Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay

Infections: This is referred to the process of infecting or the state of being infected bacteria or fungi that generates to a disease while being admitted in the hospital.

Nurse: This simply means a person trained to care for people diagnosed of nosocomial infection.

Prevention: This is simply the act of stopping nosocomial infection from happening or occurring.

Measure: This refers to a means of achieving a purpose of preventing the occurrence of nosocomial infections in labour ward Measures Utilized For Prevention of NOsocomial Infection In The Labour Ward Essay