|
| |
 |
|
| ORIGINAL ARTICLE |
|
| Year : 2020 | Volume
: 8
| Issue : 2 | Page : 66-70 |
|
Prevention and Control Measures toward Hospital-Acquired Infections among Patients, Relatives, and Health Professionals in Tertiary Health-care System
Denmo Otele1, Samuel J Bunu2, Baralet Sambo1
1 Department of Medical Surgical Nursing, Faculty of Nursing, College of Health Sciences, Niger Delta University, Bayelsa State, Nigeria
2 Department of Pharmaceutical and Medicinal Chemistry, Faculty of Pharmacy, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria
| Date of Submission | 08-Jul-2020 |
| Date of Decision | 24-Sep-2020 |
| Date of Acceptance | 01-Oct-2020 |
| Date of Web Publication | 12-Jan-2021 |
Correspondence Address:
Dr. Samuel J Bunu
Department of Pharmaceutical and Medicinal Chemistry, Faculty of Pharmacy, Niger Delta University, Wilberforce Island, Bayelsa State
Nigeria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JIHS.JIHS_25_20
Background: Nurses, as well as other health workers, have an important role to play toward preventing hospital-acquired infections (HAIs) among the patients and themselves. The most important and basic techniques in the prevention and control of infection transmission are hand washing. Objectives: The study was aimed to investigate measures utilized by health-care professionals, in the prevention and control of nosocomial infections in the selected health facility. Materials and Methods: A descriptive questionnaire was designed and used to identify and describe the measures and role of health-care professionals in the prevention and control of HAI in the Federal Medical Centre, Yenagoa. One hundred and fifteen nurses were selected at random among the health facilities to partake in the survey. Results: Respondents had good knowledge on the transmission and prevention of HAIs and that universal precaution must be employed in all aspects of patient care. All nurses strongly agreed that gloves do not transmit pathogens that cause HAIs and 88.7% of the respondents strongly disagreed that over diluted solutions are effective in decontamination as long as instruments are soaked for long periods, nurses that participated in the survey demonstrates a very good attitude towards the prevention of nosocomial infections. Some showed that personal protective equipment reduced their efficiency during procedures. Conclusion: Nosocomial infections complicate patient care and prolong the stay of patients in hospitals. The provision of safe care through the acquired knowledge and demonstration of a positive attitude will promote the preventive measures and subsequent incidence of HAIs.
Keywords: Health care, hospital-acquired, nosocomial infections, nurse
How to cite this article:
Otele D, Bunu SJ, Sambo B. Prevention and Control Measures toward Hospital-Acquired Infections among Patients, Relatives, and Health Professionals in Tertiary Health-care System. J Integr Health Sci 2020;8:66-70 |
How to cite this URL:
Otele D, Bunu SJ, Sambo B. Prevention and Control Measures toward Hospital-Acquired Infections among Patients, Relatives, and Health Professionals in Tertiary Health-care System. J Integr Health Sci [serial online] 2020 [cited 2023 Jun 5];8:66-70. Available from: https://www.jihs.in/text.asp?2020/8/2/66/306717 |
| Introduction | |  |
Hospital-acquired or nosocomial infections are infections occurring 48 h or more after hospital admission or within 30 days after discharge.[1] They have been recognized as a problem affecting the quality of health care and the principal source of unwanted health-care outcomes. Within the realm of patient safety, these infections have serious impacts such as increased hospital stay, increased costs of health care, economic hardship to individuals and their families and even deaths are among the many negative outcomes.[2] Nosocomial infections in developing countries are difficult to manage because they are complex health challenges with idiosyncratic causes. Controlling nosocomial infections is not just by encouraging proper hand hygiene in areas where soap and clean water may not be readily available, nor providing health equipment to health-care professionals that are not trained to properly use them.[3] In Nigeria, the rate of hospital-acquired infections (HAIs) was reported to be 2.7% at Ife (Osun state), 3.8% Lagos, and 4.2% from Ilorin (Kwara state), respectively.[4]
Centre for Disease Control and Prevention published a further version in 1999 of their guidance that introduced a two-tier system of precaution. The first tier is known as a standard precaution that should be used for patients regardless of the diagnosis of infection status and it is a synthesis of standard precaution of universal precautions and body substance isolation.[5] The second tier is a transmission-based precaution, to be taken in addition to standard precaution when a patient is suspected of being infected with a transmissible pathogen by air droplets or contacts with dry skin or contaminated surface. Bloodstream nosocomial infection was reported to be the main cause of death and suggested that all hospitals should have an antimicrobial committee. As nosocomial infections develop they present with both signs and symptoms such as chills, fever, headache, also present with enlargement and tenderness of lymph nodes due to the increase in vascular permeability of blood vessels.[6]
Yakoe & Classen, 2008; reported that 9 out of 100 inpatients usually acquires nosocomial infections and over 300,000 inpatients in a year acquire one or more nosocomial infection. The causes of nosocomial infections might be endogenous or exogenous.[7] Some endogenous infections are caused by organisms present as part of the normal flora of the patient, while exogenous infections are acquired through exposure to the hospital environment personnel, or medical devices.[8] Nosocomial infection is caused by some pathogens such as bacteria, viruses, and fungal parasites.[9] Nosocomial infections can be acquired through flora from the health-care environment. Frequently occurring nosocomial infections include urinary tract, surgical site, pneumonia, and bacteremia infection.[10]
Factors influencing the development of nosocomial infections range from the virulence of the organism and the amount of the invading microorganism responsible for the infection.[11] Health-care workers are at risk of exposure to body fluids which has led to several infections with blood-borne viruses including hepatitis B, C, and human-immune deficiency virus. Needle-stick injury is the most common form of injury from occupational exposure to blood that often results in the transmission of infection.[12] Healthcare-associated infections are a serious challenge in the health-care delivery system and a common cause of morbidity and mortality among hospitalized patients, patients' relatives, and health-care professionals.[13]
Some perceived challenges facing healthcare workers in the prevention and control of nosocomial infections including unavailability of equipment,[14] the negative influence of personal protective equipment (PPE), patients discomfort, lack of time management, provision of nursing care to children, influences on nurses appearance, psychological factors, and physicians influence.[15] Some standard precautionary measures used in the prevention and control of nosocomial infection include good hand hygiene, proper use of PPE, masking, and separation of a person with respiratory symptoms.[16],[17],[18],[19],[20],[21] Nosocomial infections are major global challenges in the health-care delivery system, not just to the health professionals but also to patients and relatives. Hence, we aimed to investigate the incidence and measures utilized in the prevention and control of nosocomial infection by health-care professionals in selected hospitals in Bayelsa state, Nigeria (West African country).
| Materials and Methods | | |
Study design and setting
A descriptive questionnaire was designed and used to identify and describe the measures and role of health-care professionals in the prevention and control of nosocomial infection in selected health-care delivery system. A total of 115 nurses were drawn at random (sampling technique) among the health facilities to participate in the survey. The study was conducted in the Federal Medical Centre, Yenagoa, Bayelsa state using a standard questionnaire instrument. The questionnaire was validated by a senior nurse in the Faculty of Nursing, Niger Delta University, Wilberforce Island, Bayelsa State, and administered at their point of duty, the aims and objectives of the survey clearly explained to the participant and same was retrieved after filling.
Target population, sample size, and data analysis
The study population consists of professional nurses in all the wards. With the target population of 140 nurses, nurses were selected based on their relative closeness and passionate nature of duty toward the patients. A sample of 140 questionnaires was given out but only 115 were returned. Study inclusion and exclusion criteria include trained professional nurses with Bachelor of Nursing Science, Registered Nurse, Registered Midwife, or Public Health (PH) Nurse, working in the selected health facility that was willing to participate in the survey. The questionnaires were administered through direct interactions with the nurses and the same was retrieved after filling. Generated data were analyzed using SPSS statistical software version 23.0, International Business Machine (IBM) corporation, 2015. Chicago, USA. and Microsoft Excel spreadsheet using frequency, percentage tables, and figures. The study was approved by the research and ethical committee of the Faculty of Nursing, College of Health Sciences, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria, and the consent of the respondent was also sought before questionnaire administration.
| Results | | |
Data obtained from the survey are presented in [Figure 1] and frequency [Table 1] and [Table 2]. Following their responses, there was no statistical significance on measures used in the prevention and control and practice of preventive measures of nosocomial infection at P value 0.30, 0.30, and Pearson Chi-square of 112, 60, respectively. Statistical analysis was performed at a P ≤ 0.05. | Figure 1: Sociodemographic data (n = 115). NO: Nursing officer, SNO: Senior Nursing Officer, PNO: Principal Nursing Officer, ACNO: Assistant Chief Nursing Officer, CNO: Chief Nursing Officer, RN: Registered Nurse, RM: Registered Midwife, BNSc: Bachelor of Nursing Science
Click here to view |
 | Table 1: Measures used in the prevention and control of nosocomial infections (n=115)
Click here to view |
 | Table 2: Practice of preventive measures of nosocomial infections (n=115)
Click here to view |
| Discussion | | |
Nosocomial infections are the leading cause of most hospital admission among patient relatives and healthcare professionals. In this survey, 80% of the respondents were female while 20% were male. Majority of the participants (41.7%) were between the ages of 30–39 years old, 31.7% were 40–49 years, 10% were 20–29 years, and 16.7% were above 50 years, respectively, as shown in [Figure 1].
All the respondents had adequate knowledge regarding the transmission and prevention of HAIs. Specifically, 91.3% of the respondent strongly agreed that hand washing techniques are a requirement of standard precaution, also some of the participants were on the assertion that HAIs can be prevented through universal precautions such as hand hygiene, the use of PPE (such as disposable and surgical gloves, facial masks, and eyewear), respiratory hygiene/cough etiquette, sharps safety (engineering and work practice controls), safe injection practices (an aseptic technique for parenteral medications), sterilizing instruments and medical devices and clean and disinfect environmental surfaces among others.[22]
On the other hand, 86.1% of the respondents strongly agreed that universal precaution must be employed in all aspects of patient care. About 82.6% of respondents believe that fomites spread HAIs. On the aspect of possible transmission modes, 100% respondents strongly agreed with the propositions that gloves do not transmit pathogens that cause HAIs and 88.7% of the respondents strongly disagreed with the assertion that over diluted solutions are effective in decontamination as long as instruments are soaked for long periods, almost all the respondent strongly agreed that majority of HAIs result from invasive procedures. In addition, 100% of the respondent strongly agreed that the instrument must be washed decontaminated, and autoclaved after each use, all respondents strongly agreed that every patient is at risk of HAIs, as shown in [Table 1]. The results of this study show that nurses have adequate knowledge of HAIs, and their preventive methods. The findings are in agreement with Kleivens et al., who reported that nurses have high levels of knowledge about HAI and their prevention. The parallel reports from the studies imply that there might be a need for continuous training of nurses on HIAs and their prevention to improve their knowledge and attitude.[15]
Nurses that participated in the survey demonstrate a very good attitude towards the prevention of nosocomial infections. All participants (100%) claimed they use universal precautionary measures in caring for their patients. 86.7% of them agreed that carrying out standard precautions was not time-consuming. 6.7% of the Nurses felt that heavy workload was interfering with observing standard precautions, while 93.3% felt a heavy patient load was not a deterrent to their utilizing standard precautions. Only 10% showed that PPE reduced their efficiency during procedures, while 90% felt differently. All respondents (100%) claimed they always use aseptic techniques during sterile procedures and also standard protocol is maintained when disposing of sharps, solid materials, and body fluids [Table 2]. Some epidemiological evidence indicates that Acinetobacter baumanii, Escherichia More Details coli, Staphylococcus aureus, and Pseudomonas aeruginosa, are the principal nosocomial pathogens.[23] Out of the total number of nurses who participated in the study, majority demonstrated a positive attitude towed the prevention of HAI. This finding is in line with results Chan and Day (2005) that nurses have positive attitudes and are likely to adhere to the standard and universal precautions geared towards preventing HAIs. With this knowledge and other public health awareness, such as malnutrition management [24], Nurses can actively support in the prevention of nosocomial infections.
The findings portend good practice of prevention of HAIs. Since the nurses are knowledgeable and enthusiastic about HAIs prevention, it would be instructive for nurse managers to encourage other nurses to imbibe the attitude of prevention. This will make nursing care qualitative and patient recovery will improve. This study is to investigate nursing measures utilized for the prevention and control of nosocomial infection by nurses in Bayelsa state. The findings from the study reveal that the respondents are quite knowledgeable about HAIs and preventive measures. It was also found that the participants have a positive attitude about the prevention of HAIs.
| Conclusion | | |
Nosocomial infections complicate patient care and prolong the stay of patients in hospitals and as well contribute to global morbidity and mortality rates. It is therefore important that safe nursing care practice through preventive measures in the form of standard precautions be adequately utilized. The provision of safe care through the acquired knowledge and demonstration of a positive attitude will promote the preventive measures and subsequent occurrence of HAIs. Nurse managers should organize programs that will increase the knowledge base of nurses, patients' relatives, and other health-care professionals regarding HAIs and the use of PPE, as this would minimize the prevalence of HAIs globally.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | |
| 2. | |
| 3. | Petersen MH, Holm MO, Pedersen SS, Lassen AT, Pedersen C. Incidence and Prevalence of Hospital-Acquired Infections in a Cohort of Patients Admitted to the Medical Department; 2010. Available from: https://pubmed.ncbi.nlm.nih.gov/21055371/. [Last Accessed on 08 August, 2019].  |
| 4. | Sharma BK, George S. Role of knowledge in practicing universal precaution among staff nurses. Int J Med Sci Res Pract 2014;1:44-49. |
| 5. | Center for Disease Control and Prevention. Hospital-acquired Infection. Nurses' Role in Prevention; 2014. |
| 6. | Allegranzi B, Pittel D. Preventing infection acquired during the health care delivery. Lancet 2008;373:1719-20. |
| 7. | Yakoe DS, Classen D. Improving patient safety flowage infection control. A new healthcare imperative. Infect Control Hosp Epidemiol 2008;29 Suppl 1:S3-11. |
| 8. | |
| 9. | |
| 10. | Demir F. A survey on prevention of surgical infection in operating theatres worldviews. Evud Bases Nurs 2009;6;102-13. |
| 11. | Zhang Y, Du, M., Johnston, J.M. et al. Incidence of healthcare-associated infections in a tertiary hospital in Beijing, China: results from a real-time surveillance system. Anti microb Resist Infect Control, 2019; 8: 145. https://doi.org/10.1186/s13756-019-0582-7. |
| 12. | Chan MF, Ho A, Day MC. Investigating attitude and practice pattern of operating room staff towards standard and transmission-based precognition result of a cluster analysis. J Clin Nurs 2005;17;1051-62. |
| 13. | |
| 14. | Devnani M, Kumar R, Sharma RK, Gupta AK. A survey offhand washing facilities in the outpatient department of a tertiary care teaching hospital in India. J Infect Dev Countries 2011;5;1114-8. |
| 15. | Kleivens RM, Edwards JR, Richards CL Jr. Estimating healthcare-associated infection and deaths in the US hospitals. Public Health 2017;122:160-6. |
| 16. | Sydnor ER, Perl TM. Hospital epidemiology and infection control in acute-care settings. Clin Microbiol Rev 2011;24:141-73. |
| 17. | Roa A. Role of Nursing in Infection Prevention and Control, Medical, and Health Care Workers in the Developing World; 2013. |
| 18. | WHO. Hospital-Acquired Infection: A Systematic Review. World Health Organization; 2009. |
| 19. | Gould DJ, Moralejo D, Drey N, Chudleign JH. Interventions to improve hand hygiene compliance with inpatient care. Cochrane Database Syst Rev 2010; Sep 8;(9):CD005186. |
| 20. | Hassan ZI, Afolaranmi TO, Nathanel OO, Yushau AA, Tangkat TE, Chomo DJ and Chirdan OO. Knowledge of Transmission and Prevention of Nosocomial Infections: Primary Health Care workers' perspective in Plateau State North Central Nigeria. International Journal of Biomedical Research. 2017;8:148-53. |
| 21. | STATA Corporation. State Statistical Software Release to College Station. TX, USA: STATA Corporation; 2007. |
| 22. | |
| 23. | Donkor ES. Nosocomial pathogens: An in-depth analysis of the vectorial potential of cockroaches. Trop Med Infect Dis 2019;4:14. |
| 24. | |
[Figure 1]
[Table 1], [Table 2]
|
Search Pubmed for