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CHAPTER : 1
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 (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 acquires
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 defense mechanisms. HAI are not only the problem of the patients
but also patient 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
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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 Hospital Acquired Infections at Samaritan 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. Hospital Associated
Infections (HAI) have been the bane of hospitals since time immemorial. Despite
rapid advances in medical science in therapeutics, diagnostics and a better
understanding of the disease process, the problem of HAI persists throughout the
world. The incidence, type and magnitude of HAI varies from hospital to hospital;
it is estimated to be around 10% of hospital admissions. Given the prevailing
conditions in the hospitals in developing countries, this is likely to increase. Hence,
there is an urgent need to set up systematic control measures.
Nursing is a profession of art and science that involves interaction with theclient equipped with a touch of care. Unlike the other jobs, it opts to give care to
those who are sick with a sense of desire to promote wellness and provide
treatment. As promoters of health, nurses teach, give care, and treat patients who
are physically, emotionally, mentally and socially sick and ill. It is a profession
that offers the individual the chance to touch other peoples lives and be sensitive
to them.
Nurses are the heart and hands of the team and they are sensitive to the
needs of the client that enables them to have a good nurse-client relationship by
being more empathetic as well as rendering services in a hands-on manner. This
would mean constant contact and exposure with the various nosocomial infections
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present in the hospital setting. It is the duty and responsibility of the nurse to
strictly comply and adhere to the hospitals preventive measures against
nosocomial infections and other infectious diseases. Furthermore, nurses as health
care workers and have should be aware of the ways to slow or prevent the
transmission of infectious diseases and be knowledgeable of its potential risk to the
client and hospital staff.
The study aims to identify the ways of preventing nosocomial infections in
Samaritan hospital as well as the different kinds of preventive measures that are
implemented and foreseen as an effective way in breaking down the chain of
infection.
This study would serve as a baseline guide for further development and
growth of nursing care and enhance the preventive strategies used to minimize
nosocomial infection from the patient or client, hospital setting, and care giver
itself.
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1.PROFILE OF
SAMARITAN HOSPITAL PAZHANGANAD
1.1 INTRODUCTION
Samaritan hospital Pazhanganad is the biggest unit of action in the medical
field managed by the congregation of the Sisters of the Destitute. This hospital acts
as a nerve centre for all the socio medical activities of the congregation and as a
referral centres for the many small medical units located in the peripheral villages.
Samaritan hospital Pazhanganad is a 350 bedded multispecialty hospital
having all departments such as Department of Cardiology, Department of General
Medicine, Department of Ophthalmology, Department of General Surgery, etc.
with a medical staff of around 40 physicians and 200 health care employees.
Samaritan hospital offers a wide range of services unequalled by hospitals of
comparable size in the region. Currently the hospital has 17 full fledged medical
and surgical departments with 27 consultants and 12 resident medical officers. As
most of the doctors, nurses and technicians reside in the campus itself their service
is available round the clock. More than 50 medically or technically qualified
religious sisters do voluntary services in the hospital.
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The hospital runs clinics for the poor and the needy where medicines and
treatment are given free of cost to all irrespective of their religious convictions. In
addition, teams of doctors and nurses conduct medical and health camps and
immunization programs in the villages routinely. The school of nursing visit homes
collects vital information on the health status of the villagers and educates them,
especially expectant mothers, on health, hygiene and child care.
1.2 LOCATION
The hospital is located in village Kizhakambalam, 10 KM, from
Alwaye, on the Alwaye Thripunithura road and about 25 KM from Cochin.
Public transport facility to reach the hospital is available from Alwaye, Cochin,
perumbavoor and Thripunithura.
1.3 HISTORY
Samaritan hospital was started back in 1962 as a small dispensary
handling minor medical needs of the rural community in the nearby village. In
1969 the dispensary was upgraded to a 70 bedded hospital providing basic medical
services and in the course of the last 33 years it was developed into a 350 bedded
general hospital catering to the health needs of the rural poor.
1.4VISION AND MISSION
The mission of the hospital is the care of the destitute and the sick
irrespective of their religious convictions.
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The sisters began their ministry by setting up homes for the destitute, the
aged and the sick.
The congregation also operates homes for the dying and the terminally ill
and for the rehabilitation of the mental and physically challenged.
1.5. OBJECTIVES OF SAMARITAN HOSPITAL.
1. To make quality health services available, affordable and accessible to all,
especially in the underserved areas.
2. To promote health education, training and research.
3. To manage, maintain and develop Samaritan Hospital and any other hospital
or dispensary as a charitable organization and on a non-profit basis in the true
spirit of Christian services, ideals and principles.
4. To co-operate and collaborate with the government and other agencies to make
health care accessible to all.
5. To encourage multi dimensional programs on promotion of health and
prevention of diseases in communities.
1.6 STRATEGIES
1. Effective collaboration with the government, national, and international
agencies for accessing vaccines and medicines and for participation in the various
diseases control programs will be encouraged.
2. Patients and families will be counseled and enabled to comply with treatment
regimens and prevention methods to control the transmission of diseases.
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3. Patients with HIV/AIDS, Tuberculosis, Leprosy and other debilitating diseases
will be admitted and treated in the health care institutions with provision for
treatment, including surgery.
4. The health care institutions will conduct awareness programs against smoking,
alcohol and drug abuse.
5. The institution will encourage their staff and students to have a multi
disciplinary approach to health care.
1.7 ORGANIZATIONAL STRUCTURE
Organization structure may be considered as the anatomy of theorganization, which provides the foundation within which the organization
functions. Organization structure is believed to affect the behaviour of its
members. As Hall (1977) noted, this belief is based on a simple observation.
Buildings have halls, stairways, entries, exits, walls and roofs. The specific
structure of a building is a major determinant of the activities of people within it.
Similarly behaviour in an organization is influenced by the organizational
structure, though not as apparent as that of building.
The influence is assumed to be pervasive. Organization as Hall noted has
2 basic functions each of which is likely to affect individual behaviour or
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organization performance. Structures are designed to minimize or at least regulate
the influence of individuals.
The organizational chart is given below:
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1.8 LEVELS OF AUTHORITY
The top level management of Samaritan Hospital includes the Governingboard, director, administrator and elected members from congregation they are the
major decision making bodies.
The middle level management includes principle of school of nursing,
nursing superintendent, principal of school of medical lab training, Public relation
officer, Chief Medical officer, Accounts, department heads and finance officer.
The lower level management includes ward in charge.
1.9 CLINICAL DEPARTMENTS
Samaritan Hospital is a multispecialty having a lot of departments such as;
1.9.1 GENERAL MEDICINE OP
This department was first to be started when the hospital started functioningin 1969.The general medicine is the part of the O.P. No emergency cases come on
their own. In the ground floor O.P services of diagnostic or therapeutic nature are
taken care of. The O.P is situated near to the Reception.
Facilities:
ICU with ventilator and monitoring facilities.
Lung function analyzer
1.9.2 CARDIOLOGY
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Started in 1974, this is one of the first department of cardiology in the state
of Kerala. The unit serves as a referral centres for many peripheral hospital.
Facilities:
Computerized stress testing (TMT).
Echocardiography with color flow mapping.
Stress echocardiography.
24 hrs ambulatory ECG monitoring and analysis.
Temporary pacing.
Ventilator.
Pulse oximetry.
Full- fledged unit with 12 bedded air conditioned intensive coronary care unit
(ICCU).
1.9.3 DEPARTMENT OF PEDIATRIC MEDICINE
This department is recognized by UNICEF as one of the baby friendly
resource hospitals in Kerala.
Facilities:
Multi parameter monitoring.
1.9.4 DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
It is one of the first and busiest departments of the hospital.
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Facil ities:
Fetal cardiac monitor
Ultra sound scanning.
1.9.5 DEPARTMENT OF GENERAL SURGERY
This department handles all types of adult and paediatric surgical problems.
Facilities:
Upper GI endoscopy.
Laparoscopy.
Bronchoscope.
Cryosurgery.
1.9.6 DEPARTMENT OF ENT SURGERY
This department undertakes all types of ENT surgeries including video
monitored endoscopic sinus surgeries (FESS).
Facilities:
Impedance audiometric.
Operating microscope.
1.9.7 DEPARTMENT OF OPHTHALMOLOGY
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Well equipped for treating cataract, glaucoma, squint, etc.
Facilities:
Computerized refactometry.
A-scan
Operating microscope.
1.9.8 DEPARTMENT OF ORTHOPEDIC SURGERY
This department handles all types of muscular-skeletal injuries and poly
trauma cases. The unit also handles surgical procedures like joint replacement,
limb length correction and arthroscopic surgery.
Facilities:
C arm image intensifier.
Diagnostic arthroscopy.
1.9.9 DEPARTMENT OF UROLOGY
Procedures like TURP and surgical procedures for kidney tumors stones, etc.
are routinely undertaken.
Facilities:
Endoscope and Laparoscope.
Ultrasound lithotripsy.
1.9.10 DEPARTMENT OF NEPHROLOGY
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It consist modern facility for diagnosis and treatment of kidney diseases.
Facilities for renal biopsy, radiological and ultra son logical investigation exist.
Facilities
State of the art dialysis machine.
Multi parameter monitoring
1.9.11 DEPARTMENT OF NEUROPSYCHIATRY
A wide spectrum of psychiatric problems like psychoses, alcohol and drug
dependence, and childhood and adolescent psychological disorders are treated.
1.9.12 DEPARTMENT OF DERMATOLOGY
It is another important department of the hospital. This department
deals with skin and its diseases.
1.9.13 DEPARTMENT OF DENTISTRY
This department is functioning since 1969. This department deal with dental
problems.
1.9.14 DEPARTMENT OF ANESTHESIOLOGY
It handles over 2500 major surgeries every year.
Facilities:
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Patient Monitoring equipment.
Defibrillator.
Pulse oximeter.
Capnography
1.9.15 DEPARTMENT OF EMERGENCY MEDICINE (CASUALTY)
It is the first place of contact in emergency. Its a 4 bedde d casualty.
Emergency cases are first entered into this department. The hospital has a 24 hours
trauma and accident care unit. They provide comprehensive emergency medicalservices to patients with severe illness or suffering from traumatic injuries. A
trauma center often requires complex multi disciplinary treatment including
surgery to give the victims the best possible chance for survival and recovery.
Trauma is a life threatening occurrence either accidental or intentional that causes
injuries. The cases in trauma are motor vehicle accidents, falls, assaults etc..
1.10 SUPPORTIVE DEPARTMENTS
1.10.1 RADIOLOGY
This department has the facilities like C.T scan, ultra sound scan, X-
ray, ECG, etc.
1.10.2 PHARMACY
It is common for outpatient and inpatient. All the medicines are
arranged in alphabetic order. IP and OP have separate pharmacy.
1.10.3 LABORATORY
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A laboratory or lab is a facility that provides controlled conditions in which
scientific research equipments and measurement may be performed. The lab is
divided into collecting and testing area. The machines used are sodium potassium
analyzer, semi auto analyzer, haemogram for platelets, WBC count taking. Elisa
reader, flame photometer, calorimeter, microscope, centrifuge, Hot air oven,
incubator, autoclave. In the collection lab, only extraction of blood sputum or urine
and likewise takes place. They have a fully automatic lab.
1.10.4 BLOOD BANK
The unit provides 24 hrs service and having 3 bed capacities.
1.10.5 DEPARTMENT OF PATHOLOGY
It is one single department whose quality of services is
paramount for the overall performance of this hospital. It plays the following role.
As a vital aid to diagnosis.
Establishing the cause of death through autopsy reports.
Education, training and research activities.
Validation of diagnosis through tissue studies.
Early detection and prevention of diseases in asymptomatic cases.
1.10.6 I.C.U
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An intensive care unit, intensive therapy unit or intensive treatment unit is a
specialized department used in many hospitals that provide intensives care
medicines. There are specialty intensive cares that take care of special needs or
areas as dictated by the needs of each hospital. Samaritan hospital has specialized
I.C.U, Neonatal I.C.U, Cardiac I.C.U, Pediatric I.C.U, Medical Intensive Care
Unit. Common equipment in I.C.U includes mechanical ventilator to assist
breathing, cardiac monitors, equipments for constant monitoring of bodily
functions feeding tubes, nasogastric tubes, suction pumps, drains and catheters and
wide array of drugs to prevent secondary infections.
1.10.7 PHYSIOTHERAPY
The physiotherapy often known as physical therapy provides
Treatment to improve large muscle mobility and to prevent or limit
permanent disability.
Treatments include exercise, massage, hydrotherapy, ultra sound,
electrical, stimulation, and heat application.
The department is concerned with identifying maximizing prevention, treatment,
habilitation and rehabilitation. It encompasses physical/ emotional, psychological
and social well being.
1.10.8 ADMINISTRATIVE DEPARTMENT
The general administration is done by the administrator. His
responsibilities are:
Ensures that physical facilities and equipment are adequately available and
functioning properly to support good and speedy patient care.
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Ensures proper up keep and confidentiality of medical records and patient
documentation.
Promotes positive image of the hospital and develops good public relations
with the government, official agencies, vendors and public at large.
1.10.9 PUBLIC RELATION DEPARTMENT
The primary function of a public relation officer is to act as mediator
between the organization and the public. The hospital has a public relations officer
who manages and supervises the following public relations functions of the
hospital:
Responsible to improve the internal and external public relations of the
hospital.
To develop and maintain good relation with the government organization
departments, etc.
To look to the patients problems, complaints and suggest ways and meansto solve them.
To prepare press report.
1.10.10 ENQUIRY
The enquiry is common for OP and IP there are 2 staff in enquiry. The
enquiry provides 24 hrs facilities. There is a new registration counter forregistering new cases and old registration for previously existing cases.
1.10.11 BILLING SECTION
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Billing section is there for collecting cash. There four staff in this
section. IP & OP have separate billing.
1.10.12 HOUSEKEEPING DEPARTMENT
Housekeeping services also called environmental services are of
paramount importance in providing a safe pleasant orderly and functional
environment for both patients and hospital personnels.
It takes care of cleaning, sterilizing and concerns itself with changing linen,
handling waste and keeping premises clean.
1.10.13 AMBULANCE MORTUARY
There are 2 ambulances on the run and a mortuary with freezers that can
accommodate 6 bodies.
1.10.14 MEDICAL LIBRARY
It is a part of health care services department
1.10.15 CANTEEN
It provides quality food at a very subsidized rate and hygienic and
preparation of food. There about 8 staff in this department.
1.10.16 PURCHASE
The department has a purchase manager and an assistant purchase manager.
There are 2 purchase mainly general purchase & medical purchase (pharmacy).
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The general purchase include all day to day items from toilet soaps to furniture.
Whereas medical purchase includes drugs, medical equipments or laboratory items.
The goods are procured as needs arise. If the medical store for e.g.. Requires an
item a local purchase order (LPO) is issued addressed to the purchase manager.
Nobody except the P.M is entitled to buy the items. The head of each department
should sign and recommend the purchase after evaluating the needs. The stores
manager should have the discretion to choose the best. If an order is received he
should probe into it and check if the item exists, if it does is there a way to repair it
instead of buying new one. Often medical equipments are sent to the biomedical
engineer instead of buying a new one. In case of medical purchases medical
representatives from various companies meet the doctors and present their
products. The doctor gives intent to the medical representatives who go to the
purchase manager. The purchase manager then checks the rates and negotiates or
turns down the offer if they are procuring the product at a lower rate. He also
checks the credibility of the company.
CHAPTER :
2
REVIEW OF RELATED LITERATURE AND
STUDIES
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This chapter presents the literature, reading, and studies that are related to
the present study which is prevention of nosocomial infections as perceived by
staff nurses of Samaritan hospital Pazhanganad.
2.1 SOURCES OF INFECTION IN HOSPITAL
Bacteria and viruses are natural inhabitants of the environment, both in the
community and in the hospital. The majority of these organisms are not pathogens
and may even have a beneficial role to play in human body. The organisms in the
natural environment may provide a reservoir from which they may be passed to
other patients and cause infections. However, there are very many reservoirs; the
one from which infections arise is usually called the source. Identification of the
correct source is essential to arrest the spread from this source.
The sources of spread can be classified along the same lines as the types of
infection.
Spread from community-acquired infections to other patients in hospital can
be via:
The respiratory tract as in tuberculosis and respiratory viruses;
Infected blood as with viral hepatitis and HIV;
Faeces with salmonella, shigella, vibrio;
The air or skin scales as with chicken pox, herpes,
staphylococci,streptococci, and
Infected discharges such as pus.
Prevention of such spread requires interventions specific to the individual
infectious diseases.
Patients undergoing hospital treatment frequently become infected. These
infections arise from many different sources and are usually associated with
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operative or other invasive procedures carried out in operating theatres,
wards, X-ray departments and clinics.
The organisms come from many possible sources, such as:
The patients own resident flora the mouth, gastrointestinal tract,
vagina or the skin;
The resident microbial flora of health care workers and from other
patients on the ward;
Transient bacteria carried on the hands of health care workers from one
patient to another;
Contaminated instruments, dressings, needles, etc. used for invasive
procedures, and Infusions.
The wide variety of opportunities for acquisition of hospital pathogens
requires generalstandards of hospital practice to protect all patients. At the same
time, each risk group orprocedure may require specific measures related to
removing special sources of infection.
The general procedures include items such as:
Supply of adequately sterilized instruments and dressings;
Operating theatre design, discipline and procedures;
General application of aseptic techniques;
Good environment cleaning, safe food, effective laundry procedures and
waste disposal, and
Specific measures include items such as:
Standardized procedures for intubation, catheterization, venous access
investigative procedures and
Peri-operative surgical chemoprophylaxis.
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The groups at high risk of acquisition of infection due to diminished
defences require additional protection including hospital areas where there
are enhanced invasive procedures. The specific requirements of ICU, special
baby units, oncology departments and long-stay surgical wards need to be
documented and implemented. For neutropenic patients, special isolation
procedures providing a protective environment rather than containment
facility are necessary.
With such a complex series of events, it is necessary to apply a scientific
approach to the assessment of risks in order to establish priorities for infection
control. All hospital staff require information on control of hospital infection and
the particular role each group has to play in the process. The practicalities of the
situation have to be discussed with staff at all levels to ensure that they are capable
of carrying out the recommended procedures. Instructions are more readily
complied with if the procedures have been explained and are acceptable to the
surgeons, nurses, technicians and domestic staff who have to implement them.
2.2 PREVENTION OF HOSPITAL ASSOCIATED
INFECTIONS
2.2.1 STANDARD/UNIVERSAL PRECAUTIONS
With the onset of the AIDS pandemic, the concept of universal precautions
has been adopted i.e. precautions that should be practiced with all patients and
laboratory specimens regardless of diagnosis. It is presumed that every
patient/specimen could be potentially infected with blood borne pathogens such as
HIV, hepatitis B and C. Universal (Standard) precautions are applied to all patients
regardless of diagnosis, instead of universal testing.
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The main objective is to prevent exposure of staff and patients to blood and
body fluids. Body fluids considered to be potentially infected with blood-borne
pathogens are: semen, vaginal secretions, amniotic fluid, pericardial fluid, pleural
fluid, cerebrospinal fluid, synovial fluid or any body fluid that is visibly
contaminated with blood. Spills of blood or body fluids should be treated with
hypochlorite.
Universal precautions do not apply to the following unless they contain
visible blood: faeces, nasal secretions, sputum, tears, urine, vomitus, breast milk
and saliva. Since the above may have the potential to transmit other pathogens,
precautions should also be applied to all body secretions and excretions. Spills of
blood or body fluids should be treated with hypochlorite. Standard precautions also
apply to unfixed tissue and all pathological and laboratory specimens.
2.2.1.1. HAND DECONTAMINATION
The role of hands in the transmission of hospital infections has been well
demonstrated, and can be minimized with appropriate hand hygiene. Compliance
with hand washing, however, is frequently suboptimal. This is due to a variety of
reasons, including lack of appropriate accessible equipment, high patient to staff
ratios, allergies to hand washing products and insufficient knowledge of staff about
risks and procedures.
Hand washing is the single most important means of preventing the spread
of infection. Hands should be washed between patient contacts and after contact
with blood, body fluids, secretions, excretions and equipment or articles
contaminated by these.
For hand washing, the following facilities are required:
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Running water: large washbasins with hands free controls, which require
little maintenance and with anti-splash devices.
Products: dry soap or liquid antiseptic depending on the procedure.
Suitable material for drying of hands: disposable towels, reusable sterile
single use towels or roller towels which are suitably maintained.
For hand disinfection
The specific hand disinfectantsantiseptics recommended are: 2-4%
chlorhexidine, 5-7.5% povidone iodine, 1% triclosan or alcoholic rubs.
Alcoholic handrubs are not a substitute for hand washing, except for rapid
hand decontamination between patient contacts.
For surgical scrub (surgical care)
Training is needed in the current procedure for preparation of the hands
prior to surgical procedures.
Scrubbing of the hands for 3-5 minutes is sufficient. The recommended
antiseptics are 4% chlorhexidine or 7.5% povidone iodine.
Equipment and products are not equally accessible in all countries or health
care facilities. Flexibility in products and procedures, and sensitivity to local needs,
will improve compliance. In all cases, the best procedure possible should be
instituted.
Clothing
Staff can normally wear clean street clothes. In special areas such as burn or
intensive care units, uniform trousers and a short-sleeved gown are required for
men and women.
The working outfit must be made of a material easy to wash and decontaminate. If
possible, a clean outfit should be worn each day. An outfit must be changed after
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exposure to blood or if it becomes wet through excessive sweating or other fluid
exposure.
Shoes
In aseptic units and in operating rooms, staff must wear dedicated shoes, which
must be easy to clean. In other areas, change of footwear is unnecessary for
prevention of infection.
Caps
In aseptic units, operating rooms, or performing selected invasive procedures, staff
must wear caps or hoods which completely cover the hair.
Masks
Masks of cotton wool, gauze, or paper masks are ineffective. Paper masks with
synthetic material for filtration are an effective barrier against micro-organisms.
Masks are used in various situations and their requirements differ depending on the
purposes for which they are needed.
Patient protection:Staff wear masks to work in the operating room, to care
for immuno-compromised patients, to puncture body cavities. A surgical
deflector mask which directs aerosols away from the surgical site is
sufficient.
Staff protection: Staff must wear masks when caring for patients with
airborne infections, or when performing bronchoscopies or similar
examination. A high efficiency filter mask is recommended. Filter masks
remove organisms which might be inhaled. Patients with airborne infections
must use surgical deflector masks when outside their isolation room.
Gloves
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Gloves are used for:
Patient protection:Staff should wear sterile gloves for surgery, care for
immuno-compromised patients and invasive procedures which enter body cavities.
Non-sterile gloves should be worn for all patient contacts where hands are likely to
become contaminated, or for any mucous membrane contact. When performing
multiple procedures, the gloves should be decontaminated between patients. If
visibly soiled with blood, a fresh pair should be used.
Staff protection:Staff should wear non-sterile examination gloves to care
for patients with communicable disease transmitted by contact.
Hands must be washed when gloves are removed or changed.
Disposable gloves should not be reused.
The wearing of gloves, masks and other protective clothing is only necessary for
the tasks at hand and these items should be removed after the procedure.
2.2.1.2 SAFE INJECTION PRACTICES
To prevent transmission of infections between patients:
Unnecessary injections must be eliminated. Many medicines can be given
orally and this is preferred to parenteral administration.
Sterile needle and syringe should always be used. These should be
disposable, if possible.
Contamination of medications must be prevented by using single use vials.
Safe disposal practices in respect of metallic waste should be followed.
2.2.1.3 ADDITIONAL PRECAUTIONS FOR PREVENTION OF
TRANSMISSION OF INFECTION
In addition to standard precautions which are required for all patients in all
situations, special precautions need to be taken for patients suffering from certain
infections. These are based on the mode of transmission of these infections. The
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ICC should decide the policy for the individual hospital and procedures which are
feasible in its situation.
The following precautions are recommended:
2.2.1.3.1 RESPIRATORY PRECAUTIONS
For infections transmitted by the airborne route through small droplets less than 5
micron in size which can be dispersed over long distances e.g. tuberculosis.
The patient should be placed in a single room that ideally has good
ventilation and sunlight, negative air pressure and 6-12 air changes per hour.
If single room is not possible, patients should be in a cohort with other
patients with same infection. Doors should be kept closed. For additional respiratory protection, well-fitting filter masks should be
worn. Susceptible persons should not enter the room of patients having
measles or chickenpox whereas persons immune to measles or chicken pox
do not need to wear mask.
Transportation of patient should be done only when essential. Patient should
wear a mask during transportation.
2.2.1.3.2 CONTACT PRECAUTIONS
These precautions should be used in addition to standard precautions for patients
who are infected or colonized with important organisms that can be transmitted
directly by hand or skin contact or indirectly through fomites or environmental
surfaces in contact with the patient, such as gastrointestinal, respiratory,
conjunctival, skin and wound infections or colonization with multiresistant
bacteria.
The patient should preferably be placed in a single room. If that is not
possible, he/she should be placed with a cohort of patients having infection
with the identical micro-organism.
Clean, non-sterile gloves should be worn on entering the room or patients
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environment. Gloves must be removed after leaving the patients
environment and hands washed immediately.
A clean non-sterile gown should be worn on entering the patients room and
removed on leaving the room.
Sharing of patient care equipment between patients should be avoided. If
sharing is necessary, the equipment should be adequately cleaned and
disinfected before using on another patient.
Transportation of patient must be limited. If transport is necessary,
precautions must be taken to avoid contact with other patients and
contamination of the environment.
2.2.1.3.3 BLOOD/INOCULATION PRECAUTIONS
In addition to standard precautions, diseases transmitted through inoculation
or parenteral route such as hepatitis B, HIV/AIDS, malaria can be prevented by:
Rational Injection Practice: Unnecessary injections, suturing and blood
transfusions must be reduced.
Safe procedures for the handling and prevention of accidents with sharp
metallic waste should be ensured.
Recapping of needle should be avoided; if recapping is required, then well
established single-handed procedures should be used.
Metallic waste should always be disposed into a puncture resistant container.
Exposed sharp metallic waste should never be passed directly from one
person to another.
During exposure-prone procedures such as phlebotomy, the risk of injury
may be reduced by having maximum visibility and proper positioning of
the patient.
Fingers must be protected from injury by using forceps for holding suturing
needles.
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Overflow of sharp metallic waste disposal containers can be prevented by
sending the containers for disposal before they are completely filled.
2.3 ROUTES OF TRANSMISSION
Transmission of HAI can occur by one or more of the following modes:
2.3.1 AIRBORNE
Through small particles suspended in the air or large droplets expelled into the air
by coughing, sneezing, talking (aerosols), or by shedding of skin scales.
2 3 2 CONTACT
Through direct contact of hands or skin contact or indirectly through
environmental surfaces and other items which come in contact with the patient.2 3 3 INOCULATION OR PARENTERAL
Contaminated solutions, blood and body fluids can enter either through abrasions
or other skin lesions, through mucous membranes but not through intact skin.
2.3.4 FAECO-ORAL
Micro-organisms found in the intestines can be transmitted either directly through
contaminated food and water following unhygienic practices or indirectly.
2.3.5 MULTIPLE ROUTES
A disease may be transmitted by more than one mode e.g. respiratory viral
infections can be transmitted through airborne (droplet) as well as by physical
contact. Transmission-based precautionsare special precautions taken in addition
to standard precautions for known infections based on the mode of transmission of
the infection. Education is most important. Awareness programmes for staff,
visitors and patients must be established. Posters outlining the precautions should
be placed at appropriate locations. As the name implies, additional precautions
should be applied in addition to standard/universal precautions.
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2.4 RELEVANCE OF THE REVIEWED LITERATURE AND STUDIES
TO THE PRESENT STUDY
The researchers present study relates to the previously gathered and
reviewed literatures which show the relevance on the study about the knowledge
and practice of Hospital Acquired Infections as perceived by nurses of Samaritan
hospital
The present study conducted by the researchers used a descriptive method
such like other studies and made use of questionnaires that be given to the
respondents and to be answered while interviewing the respondents.
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CHAPTER :
3
METHODOLOGY
3.1. TITLE
A study on the knowledge and practice of nursing staff regarding Hospital
Acquired Infection in Samaritan Hospital Pazhanganad.
3.2. OBJECTIVE
3.2.1. GENERAL OBJECTIVE
To study the knowledge and practice of nursing staff regarding Hospital Acquired
Infection in Samaritan Hospital Pazhanganad
3.1.2. SPECIFIC OBJECTIVE
To assess the level of knowledge of nursing staff regarding Hospital
Acquired Infection in Samaritan Hospital Pazhanganad
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To assess the level of practice of nursing staff regarding Hospital Acquired
Infection in Samaritan Hospital Pazhanganad
To assess the relationship between knowledge and practice
3.3. THEORETICAL DEFINITIONS
3.3.1. KNOWLEDGE
Knowledge is facts, information, and skills acquired through experience or
education - oxford dictionary
3.3.2. PRACTICE
Practice means contemplation of rules and knowledge that lead to action - oxford
dictionary
3.3.3. NURSE
By International Council of Nurses (1965), The nurse is a person who has
completed a programme of basic nursing education and qualified and authorized in
her country to supply the most responsible services of nursing for the promotion of
health, prevention of illness and the care of the sick
3.3.4. HOSPITAL ACQUIRED INFECTION
Nosocomial infection is that which develops in the patients after more than 48
hours of hospitalization - World Health Organization
3.4. OPERATIONAL DEFINITIONS
3.4.1. KNOWLEDGE
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Any information gained or acquired by nursing staff in Samaritan hospital on
infection control measures
3.4.1.1. VERY GOOD LEVEL OF KNOWLEDGE
A score between 1 to 0.8is indicative of having very good level of knowledge
3.4.1.2. GOOD LEVEL OF KNOWLEDGE
A score between 0.8 to 0.6is indicative of having good level of knowledge
3.4.1.3. AVERAGE LEVEL OF KNOWLEDGE
A score between 0.6 to 0.4is indicative of having average level of knowledge
3.4.1.4. LOW LEVEL OF KNOWLEDGE
A score between 0.4 to 0.2 is indicative of having low level knowledge
3.4.1.5. VERY LOW LEVEL OF KNOWLEDGE
A score between 0.2 to 0is indicative of having very low of knowledge
3.4.2. PRACTICE
Adherence to rules and protocols to prevent Hospital Acquired Infection by nurses
in Samaritan hospital
3.4.2.1. GOOD LEVEL PRACTICE
A score between 2 to4 obtained in the survey is indicative of having Good level
of practice
3.4.2.2. BAD LEVEL PRACTICE
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A score between 0 to 2obtained in the survey is indicative of having Bad level of
practice
3.4.3. NURSE
The nurse is a person who has completed a programme of General nursing or
B.sc nursing and authorized by IMC\INC and is working in Samaritan hospital
from 1stOctober to 31stDecember 2013
3.4.4. HOSPITAL ACQUIRED INFECTION
Any infection acquired due to the hospitalisation in Samaritan hospital
3.5. RESEARCH DESIGN
Broadly the design of the study is descriptive in nature. The study is
concerned with describing the function and skills of nursing staff and find out the
knowledge and practice of nurses regarding hospital acquired infection. It tries to
portray accurately the characteristics of a particular situation, group or individual.
The study includes fact finding enquires of different kinds which is collected by
conducting personal interviews with the nurses of Samaritan hospital.
3.6. UNIVERSE
The universe of the study is the nursing staff from the period of 01 st
October to 31st December 2013 in Samaritan hospital Pazhanganad.
3.7. SOURCES OF DATA
3.7.1. PRIMARY SOURCE
The nursing staff where included in the sample for the survey.
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3.7.2. SECONDARY SOURCE
Booklets, brochures, books and journals regarding infection control
Hospital records
3.8. TOOLS OF DATA COLLECTION
3.8.1.STRUCTURED INTERVIEW
The questionnaire were prepared by the researcher with the help of review of
literature and the discussion with the experts .Structured interview schedule is
prepared to collect the data regarding the knowledge and practice of infectioncontrol . The interview schedule contains 35 questions in three parts. Part one
contains demographic factors. Part 2 contains questions on knowledge about the
infection control and part 3 contains questions on practice in infection control.
3.8.2. ADMINISTRATION OF INTERVIEW SCHEDULE
Personal interview was conducted in a structured way for collecting
information. The interview schedule was administered to the respondents by the
researcher himself. The researcher, after establishing good rapport with the
respondent and after explaining the objectives and method of the study, holding
one copy of the interview schedule in hand presented each question so that the
respondents may freely respond to each one. Each responses was asked very
careful and extra cautions not to present any leading question so that the responses
might be free from bias.Acopy of the Questionnaire is attached as appendix I.
Reasons for selecting interview schedule
Interview method has got several merits over the other methods of data
collection. The chief merits of the interview method are:
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It is one of the most commonly used method
Samples can be controlled more effectively as there arises no difficulty of
the missing returns; non responses generally remains very low
The attention or the concentration of the respondents can be very well
seeked and thereby collect more appropriate answers and thereby avoiding
the biases,
In the interview it is possible to clarify the doubt regarding the nature of
enquiry or meaning of any statement or question or any tem used, as the
interviewer is personally present and takes note of the reponses himself in
the schedule.
3.9. SAMPLING
3.9.1. STRATIFIED RANDOM SAMPLING
The sampling method used was stratified random sampling. Total nursing staff
of hospital was stratified in to 8 strata namely Medical Ward, Cardiac Ward,
Surgical Ward, Gynaecology, Paediatrics Casualty, Operation Theatre and
Dialysis Unit. 35% of the nurses from each strata were included in the study. If
35% of the total nurses in any strata were less than 5, a minimum of 5 nurses were
included in the study. The nurses were selected randomly from each strata.
3.10. SAMPLE SIZE
Table 1: The table showing sample size
Departments
No of staff
Sample size
Medical ward
23
8
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Cardiac ward 20 7
Surgical ward 17 6
Gynaecology
9
5
Paediatrics ward
9
5
Casualty 23 8
Operation Theatre 17 6
Dialysis unit
5
5
123
50
3.11. PROCESSING AND ANALYSIS OF DATA
3.11.1. EDITING
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The questionnaires were scrutinized to assure that the data were accurate.
There were no incomplete questionnaires.
3.11.2. CODING
The questions regarding gender and marital status had two options each and
was coded as A and B
The questions regarding age and experience of work have three options andwas coded as A, B, and C.
3.11.3. CLASSIFICATION
In this study the questionnaire is divided in to three parts. First part deals
with demographic factors and the second part includes questions are based
on the knowledge, and third part deals practice.
3.11.4. TABULATION
The following tables were developed by finding the simple averages:
The result will be tabulated as follows:
Total average score
Demographic Factors wise Average Score
Gender wise average score
Age wise average score
Experience wise average score
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Education wise average score
Marital status wise average score
Department wise average score
Comparative analysis between knowledge and practice level of staff nurse
3.12. PILOT STUDY
A pilot study was conducted in the first 25 day to assess the feasibility of the
tool. first we scheduled in questionnaire method for data collection but personel
bias will occured in questionnaire method, we rescheduled questionnaire method to
interview method for data collection.
3.13. CALCULATION OF THE RESPONSES
Those who gave more than two correct answers to the questions
concerned, were given one mark and those who gave less than two answers were
given 0.5 mark. In the case of knowledge questionnaire, question numbers
1,3,4,5,7,8,9,10,16 and 18 had 2 or more answers. In the case of knowledge
questionnaire, question number 2 ,6,11,12,13,14,15,17 had only one correct
answer, those who gave correct answers were given one mark each for each correct
answers. For wrong and no answer, a score of zero were given.
The reponse to the practice questionnaire were 5 options, such as never , rarely, sometimes , often and always and they were assigned numerical value of
0,1,2,3,4 respectively
Assessment of knowledge:
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A score between 0 - 0.2 : very poor level knowledge
A score between 0.2 - 0.4 : poor level knowledge
A score between 0.4 - 0.6 : average level knowledge
A score between 0.6 - 0.8 : good level knowledge
A score between 0.8 - 1 :Very good level knowledge
Assessment of practice
A score between 0 to 2: bad level practice
A score between 2 to 4: good level practice
3.14 ANALYSIS AND INTERPRETATION
3.14.1. ANALYSIS
The question wise average score is calculated by dividing the total score of
each individual question by total number of samples.
Total average scores is calculated by dividing total score with samples no:
and again the answer divided by no: of questions
Variable wise average score is calculated by dividing total score of each
variable with samples no: and again the answer divided by no: of questions
of that variable.
Demographic factor wise average score is obtained by dividing the total
score of respondents corresponding to each factor in a variable with no: of
respondents of that factor and No. of questions.
Correlation between knowledge and practice of nursing staff regarding
infection control
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Karl pearsons coefficient of correlation = n xy(xy)
nx2- (x)2n y2- (y)2
Where x= sample wise average scores of knowledge of nursing staff ,
y= sample wise average scores of practice of nursing staff ,
n= number of samples.
3.14.2. INTERPRETATION
The data as per the tables were interpreted by the researcher and accordingly the
report was prepared. The correlation values were interpreted according to thetable given in appendix-II.
3.15. REPORT WRITING
The report is divided into five chapters. First chapter deals with introduction
and profile of the hospital. The second chapter presents the Review of
Literature. Third chapter deals with the Methodology. The fourth chapter deals
with analysis and interpretation of the data. The fifth chapter deals with the
findings and suggestion and conclusion.
3.16. TIME BUDGET
Institution and topic selection : 5 days
Tool preparation : 10 days
Pilot Study : 25 day
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Data collection : 50 days
Processing and analysis : 30 days
Report writing : 10 days
3.17. LIMITATION OF STUDY
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 interview and practice was thus assessed.
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CHAPTER 4
ANALYSIS AND INTERPRETATIONS OF THE
SURVEY
4.1. INTRODUCTION
In this chapter the researcher analyzes the data collected during the
survey on knowledge and practice of nursing staff regarding the hospital acquired
infections at Samaritan Hospital, Pazhanganad. After analysis, the interpretations
are also given.
4.2 . OVER ALL KNOWLEDGE AND PRACTICE OF NURSING
STAFF REGARDING HOSPITAL ACQUIRED INFECTION
Table 2: showing total average score
KNOWLEDGE PRACTICE
Total
score
Avge.
ScoreRemarks
Total
score
Avge.
ScoreRemarks
696.5 .69
good level
of
knowledge
2938 .29
Good
level of
practice
INTERPRETATION
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The overall study shows that all the employees possess good level of knowledge
and Good level of practice with respect to hospital acquired infections, in the
Samaritan Hospital, Pazhanganad.
4.3. ANALYSIS OF KNOWLEDGE AND PRACTICE
The collected data are analysed on the basis of questions , respondents and
demographic factor wise. The analysed data are given below.
4.3.1. QUESTION WISE AVERAGE SCORE IN KNOWLEDGE AND
PRACTICE.
4.3.1.1.QUESTION WISE AVERAGE SCORE IN KNOWLEDGE
TABLE: 3showing question wise average score
Q.NO Questions
Totalscore
No ofRespondents
Average
Remark
1
Hospital acquired
infection is the resultof cross infection.
17
50
.4
Poor level
of
knowledge
2
Hand washing is the
simplest and most
important practice
33
50
.7
Good level
of
knowledge
3
Body fluids like
blood need universal
precaution. 45
50
.9
Very good
level of
knowledge
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4 Nosocomialinfection can be
prevented by the
techniques like handwashing,
42 50 .8
Good level
of
knowledge
5 Universalprecautions were
initially developed
specifically toprevent the
transmission of
hepatitis B virus andHIV
14.5
50
.3
Poor level
of
knowledge
6
The number of
people occupied theroom, the amount of
activity and the rateof air exchange will
influence the numberof organism present
in the room
47 50 .9
Very good
level of
knowledge
7 Roots by whichinfections can be
transmitted areDroplets route,
Contact route,
Environmental route,
Intravenous route
43
50
.87
Very good
level of
knowledge
8 The high risk areasof the hospital
32 50 .64
Good level
of
knowledge
9
The patient factors
influencingtransmission of
diseases are Extremeage.
27.5 50 .55
Avg. Level
of
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Knowledge
10 HAI's transmittedthrough Body fluid,
Staff hands,
Reusable equipment31
50
.62
Good level
of
knowledge
11
Immediate action
should be taken in
case of direct blood
contact with HIVpatient
41
50
.82
Very good
level of
knowledge
12 Vaccines should betaken for health
workers
41.5
50
.83
Very good
level ofknowledge
13
After use of gloves
for a patient itshould be disposed
off
41
50
.82
Very good
level of
knowledge
14 HAI is also knownas nosocomial
infection 43
50
.86
Very good
level ofknowledge
15
The factor which
enhances the trans-mission of micro-
organisms ismoisture
15 50 .3
Poor level
of
knowledge
16 The method for
sterilization areHeat, Irradiation,Filtration, chemical,
low temp
25
50
.5
Avg. Level
of
Knowledge
17 Alcohol is aneffective disinfectant
34 50 .7 Good level
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for local skin. of
knowledge
18 The most common
forms of HAI areUrinary tract,surgicalwounds
,respiratory tract
33.5
50
.7
Good level
of
knowledge
19
The Colour coding
methods which isused for hospital
waste storage are
45 50 .9
Very good
level of
knowledge
20
Isolation is
important ininfection control
45 50 .9
Very good
level of
knowledge
INTERPRETATION
The questions regarding universal precautions, air exchange in the room, roots of
infections, first aid for direct blood contact of HIV, types of Vaccines, use of
gloves, basic information about HAI, colour methods of hospital waste, and the
important of isolation, the respondents have very good level of knowledge.
The questions regarding hand washing, preventions technique for HAI, high
risk areas of the hospital, HAI transmission route , the importance of alcohol and
common forms of HAI received good level of knowledge
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Towards the questions like cause for hospital acquired infection and factors
enchancing the transmission of micro organisms the respondents have poor level of
knowledge.
4.3.1.2 QUESTIONS WISE AVERAGE SCORE IN PRACTICE
TABLE: 4 showing question wise average score in practice
Q.
NO
Questions
Total
score
No of
Respondents
Average
Remark
1 Isolate the patients onimmuno suppressive drugs to
prevent HAI. 154 50 3
Good
level of
practice
2
We must follow sterile
technique for all the process.
158
50
3.1
Good
level of
practice
3
Universal precautions are
followed for the patients with
hiv and hepatitis band c.
112
50
2.3
Good
level of
practice
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4 Soap, water or any other
disinfectants should be used
for hand washing practice.
174
50
3.5
Good
level of
practice
5
Tissue paper or any othermaterials should used afterhand washing for drying.
131
50
2.6
Good
level of
practice
6 Use distilled water innebulizer.
92 50 1.8
Bad
level of
practice
7
Whether you are use needle
destroyers to destroy needles. 95 50 1.9Bad
level of
practice
8
Wash hands before & after
patient examination.
168
50
3.4
Good
level of
practice
9
Wear gloves in gastric lavage
procedure 167
50
3.4
Good
level of
practice
10
Reautoclave the unused
sterile articles after a
specified period 166 50 3.3
Good
level of
practice
11 Wear gloves for i/v injection
42 50 .84
Bad
level of
practice
12
Follow hand washing
procedure after removing180 50 3.6
Good
level of
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gloves practice
13 Swabs from the departmentshould sent for culture
138 50 2.8
Good
level of
practice
14 Fumigate or through wash the
isolation room should be doneafter patient departure
164
50
3.3
Good
level of
practice
15
Use preventive measures,
while taking injections and
blood.113
50
2.3
Good
level of
practice
16
Follow the color coding for
disposing the waste safely inyour department
191 50 3.8
Good
level of
practice
17 We should maintain a cleanclinical environment .
162 50 3.2
Good
level of
practice
18 Wear mask and cap whiledoing any procedures.
169
50
3.4
Good
level of
practice
19
Vaccines should be taken
compulsory in health sectoras a preventive method. 170 50 3.4
Good
level of
practice
20
Biomedical waste should
taken out of the department at
regular intervals192 50 3.8
Good
level of
practice
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INTERPRETATION
The questions regarding isolating the patients, sterile technique, universal
precautions, disinfectants, using tissue paper, hand washing before & after patient
examination, use of gloves, reautocalve of unused sterile articles after a specified
period, hand washing procedure, fumigating, preventive measures during the time
of injections, color coding for disposing the waste, clean environment, personnel
protective equipments, vaccines taken , and the time of biomedical waste removal
from the department, shows Good level of practice.
The analysis of the questions for using distilled water in nebulizer, use of
needle destroyers and the use of gloves shows Bad level of practice.
4.3.2.DEMOGRAPHIC WISE AVERAGE SCORE
4.3.2.1. GENDER WISE AVERAGE SCORE IN KNOWLEDGE AND
PRACTICE
TABLE: 5showing gender wise average score knowledge and practice
Sl
.n
o
factor No of
responden
t
No of
question
s
Knowledge Practice
averag
e
remark
averag
e
remar
k
1
male
3
20
.7
good level Good
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of
knowledg
e
2.8 level of
practic
e
2
Femal
e47
20
.7
Good
level of
knowledg
e
2.9
Good
level of
practic
e
INTERPRETATION
Thistable shows no difference for males and females towards the knowledge
and practice. The males and females shows good level of knowledge and Good
level of practice towards Hospital Acquired Infections.
4.3.2.2. MARITAL STATUS WISE AVERAGE SCORE IN
KNOWLEDGE AND PRACTICE
TABLE: 6 showing marital status wise average score knowledge and practice
Sl
.nofactor
No of
respondent
No of
questions
Knowledge Practice
Average remark average Remark
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1 Married 20 20 .72
good level
of
knowledge
3
Good
level of
practice
2 single 30 20 .7
Good level
of
knowledge
2.9
Good
level of
practice
INTERPRETATION
The study shows no difference for married and unmarried employees regarding
the knowledge and practice of Hospital Acquired Infections.
4.3.2.3. AGE WISE AVERAGE SCORE IN KNOWLEDGE AND
PRACTICE
TABLE: 7 showing age wise average score in knowledge and practice
Sl factor No of No of Knowledge Practice
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.no respondent questions average remark average Remark
1 Grp;Less
than 25
28
20
.7
good level
of
knowledge
2.9
Good
level of
practice
2 Grp;25 to
35 17 20 .7
good level
of
knowledge
2.9
Good
level of
practice
3 Grp;above
35 5 20 .68
good level
of
knowledge
2.9
Good
level of
practice
INTERPRETATION
From the above table its clear that age difference does not influence the
knowledge and practice to Hospital Acquired Infections. All nursing staff shows
good level of knowledge and Good level of practice towards Hospital Acquired
Infections.
4.3.2.4. EDUCATION WISE AVERAGE SCORE IN KNOWLEDGE
AND PRACTICE
TABLE: 8 showing education wise average score in knowledge and practice
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Sl
.nofactor
No of
respondent
No of
questions
Knowledge Practice
average remark average remark
1
Grp; G N
M 10 20 .7
good level
of
knowledge
2.9
Good
level of
practice
2 Grp; B .Sc
39 20 .7
good level
of
knowledge
2.9
Good
level of
practice
3 Grp;
M.Ssc
1
20
.68
good level
ofknowledge
2.9
Good
level ofpractice
INTERPRETATION
From the above table it is evident that the employees educational qualification
difference does not influence the knowledge and practice of nursing staff
towards Hospital Acquired Infections .
4.3.2.5. EXPERIENCE WISE AVERAGE SCORE IN KNOWLEDGE
AND PRACTICE
TABLE: 9 showing experience wise average score in knowledge and practice
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Sl
.nofactor
No of
respondent
No of
questions
Knowledge Practice
Average Remark average remark
1 Grp;1-3
24 20 .7
Good level
of
knowledge
3
Good
level of
practice
2 Grp;3-6
4 20 .75
Good level
of
knowledge
2.8
Good
level of
practice
3 Grp;above
6 22 20 .69
Good level
of
knowledge
2.8
Good
level of
practice
INTERPRETATION
From the above table its clear that staff of all group shows Good level of practice
and good level of knowledge in Hospital Acquired Infections .
4.3.3. DEPARTMENT WISE AVERAGE SCORE IN KNOWLEDGE
AND PRACTICE
TABLE:10 showing department wise average score in knowledge and practice
Sl factor No of No of Knowledge Practice
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.no respondent questions average Remark average remark
1Emergency
department
8 20 .72
Good level
of
knowledge
3.2
Good
level of
practice
2operation
theatre6 20 .7
Good levelof
knowledge
2.9Good
level of
practice
3 Dialysis 5 20 .77
Good level
of
knowledge
3
Good
level of
practice
4. Medical ward 8 20 .60
Good level
of
knowledge
2.9
Good
level of
practice
5.
Cardiac
7
20
.68
Good level
of
knowledge
2.8
Good
level of
practice
6.
Surgical
6
20
.66
Good level
of
knowledge
3.2
Good
level of
practice
7.Gynaecology
department5 20 .61
Good level
of
knowledge
2.8
Good
level of
practice
8.
paediatric
5
20
.57
Average
level ofknowledge
2.7
Good
level ofpractice
INTERPRETATION
Respondents in paediatric department shows average knowledge and
Good level of practice . Respondents in all other departments shows good level of
knowledge and Good level of practice .
4.4. CORRELATION ANALYSIS OF KNOWLEDGE AND PRACTICE
OF NURSING STAFF TOWARDS HOSPITAL ACQUIRED
INFECTIONS
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TABLE : 11showing sample wise average score knowledge and practice of
nursing staff towards hospital acquired infections.
X
(knowledge)
Y
(Practice)
X2
Y2
XY
.8 3.3 0.64 10.89 2.64
.6
3.7
0.36
13.69
2.22
.8
3.1
0.64
9.61
2.48
.6 3.4 0.36 11.56 2.04
.85
3.1
0.7225
9.61
2.635
.78
3.2
0.6084
10.24
2.496
.65 2.7 0.4225 7.29 1.755
.7 2.7 0.49 7.29 1.89
.83 2.6 0.6889 6.76 2.158
.6
2.6
0.36
6.76
1.56
.73 3.3 0.5329 10.89 2.409
.7 3.1 0.49 9.61 2.17
.73
3.1
0.5329
9.61
2.263
.6
2.8
0.36
7.84
1.68
.5 2.1 0.25 4.41 1.05
.83 3.3 0.6889 10.89 2.739
.7
3.4
0.49
11.56
2.38
.68
2.8
0.4624
7.84
1.904
.56 2.6 0.3136 6.76 1.456
.8
2.8
0.64
7.84
2.24
.78
3.4
0.6084
11.56
2.652
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.68 3.3 0.4624 10.89 2.244
.45 2.9 0.2025 8.41 1.305
.6
3
0.36
9
1.8
.65
2.7
0.4225
7.29
1.755
.68 2.9 0.4624 8.41 1.972
.73 3.5 0.5329 12.25 2.555
.83
3.2
0.6889
10.24
2.656
.75
3.3
0.5625
10.89
2.475
.58 3 0.3364 9 1.74
.75
3
0.5625
9
2.25
.8
3.5
0.64
12.25
2.8
.68
2.9
0.4624
8.41
1.972
.65 3.4 0.4225 11.56 2.21
.8 2.8 0.64 7.84 2.24
.75
2.4
0.5625
5.76
1.8
.68 2.3 0.4624 5.29 1.564
.58 2.6 0.3364 6.76 1.508
.5
2.1
0.25
4.41
1.05
.6
3.5
0.36
12.25
2.1
.68
3.5
0.4624
12.25
2.38
.7 3 0.49 9 2.1
.75
3.3
0.5625
10.89
2.475
.6
2.8
0.36
7.84
1.68
.83 2.6 0.6889 6.76 2.158
.85 3.3 0.7225 10.89 2.805
.5
2.1
0.25
4.41
1.05
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= 31.95
103.101
Co- efficient of correlation = .3099
INTERPRETATION
The analysis shows that knowledge and practice of nursing staff
regarding Hospital Acquired Infection have low positive co-relation. Hence the
relationship between them is definite.
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CHAPTER 5
FINDINGS AND SUGGESTIONS
5.1 FINDINGS
Towards the questions that cause of Hospital Acquired Infection, and
factor enhances the transmission of micro organisms the nurses shown
poor level knowledge.
In this study shows that there is no difference between males and females
regarding knowledge and practice.
The study shows that, nurse have good level knowledge and practice
towards hospital acquired infection.
Level of practice regarding the use of distilled water in nebulizer, use of
needle destroyers and the use of gloves is bad.
From the study its clear that age difference does not influence the
knowledge and practice.
The study shows no difference in the knowledge and practice of married
and unmarried employees towards Hospital acquired infection.
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Study reveals that educational qualification of nurses do not influence
their knowledge and practice towards Hospital Acquired Infections .
The study states that experience of the staff do not affect the Good level
of practice and good level of knowledge in Hospital Acquired Infections.
The overall study shows that all the employees shows good level of
knowledge and Good level of practice towards Hospital Acquired
Infections.
5.2 SUGGESTIONS
The knowledge of nurse regarding hospital acquired infections, universal
precucations, and transmission of micro organsms can be improved by
conducting seminars, workshops etc..
There should be strict supervision on nurse regarding whether they are
following the aseptic and preventive techniques like the use of distilled
water in nebulizer, use of needle destroyer and use of gloves for i/v
injection.
Specific educational efforts should be carried out to increase the information
to the health care team on the risks and concerns of treating HIV positive
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patients or the AIDS patient and to increase the confidence of the
practitioner to treat these patients.
An assessment of knowledge of infection control procedures and infectious
diseases should be carried out for all newly-hired professional staff and the
formal courses should be provided based on the pre-course results.
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CONCLUSION
On the basis of the above study and findings, it can be said that there exists a
low 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 Hospital
Acquired Infections 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.
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BIBLIOGRAPHY
Kothari C.R. , Researcher Methodology ,New Age International (P)
limited Publishers ,Newdelhi,2007.
C .M. Francis and Mario C D Souza ,Hospital Administration ,Jaypee
Brothers ,Medical Publishers (p) LTD.Newdelhi.3rdedition
World Health Organization, Guidelines for Prevention and control of
Hospital Associated Infections, Regional Office for South-East Asia New
Delhi ,SEA-HLM-343 January 2002