KNOWLEDGE, ATTITUDE AND PRACTICE OF STANDARD PRECAUTIONS AMONG HEALTH CARE WORKERS

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KNOWLEDGE, ATTITUDE AND PRACTICE OF STANDARD PRECAUTIONS AMONG HEALTH CARE WORKERS

ABSTRACT

Introduction

            Health care workers (HCWs) are at a high risk of needle stick injuries and blood borne pathogens, such as HIV, and Hepatitis B and C viruses, as they perform their clinical activities in the hospital3.  Standard precautions are a set of guidelines that aim to protect HCWs from infections from blood, body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes while providing care to patients.54  Compliance with universal precautions has been shown to reduce the risk of exposure to blood and body fluids.64

Aims and objectives

This study was aimed at assessing the level of knowledge, attitude and practice of standard precautions among HCWs in Central Hospital, Warri, Delta State, Nigeria.

Methodology

            The study was carried out between June and December, 2011 at Central Hospital, Warri, Delta State, Nigeria.  The respondents were doctors, trained nurses, laboratory scientists, laboratory technicians, health assistants and waste handlers.  They were selected through a stratified sampling technique.  The instrument was an interviewer administered 98-item semi-structured questionnaire that assessed the knowledge, attitude and practice of standard precautions.

Results

            A total of 200 respondents were studied.  The age of the respondents (in years) ranged from 22 – 60, with a mean age of 38.3   +   9.1.  The modal age was 30.  There were more females 144 (72.0%) than males 56 (28.0%).  The respondents with tertiary level 160 (80.0%)

 of education were more represented. Some 124 (62.0%) of all respondents had good knowledge of standard precautions, 140 (70.0%) had good attitude of standard precautions, and 138 (69.0%) had good practice of standard precautions. The higher the educational level, the higher the level of knowledge, attitude and practice of standard precautions. Some 87 (43.5%) reported always recapping needles after use, 52 (26.0%) always detach needles from syringes, 74 (37.0%) had needle stick injuries in the last one year. Compliance with non-recapping of needles by the HCWs was however good 113 (56.5%). A high percentage usually washed their hands after handling patients. A large proportion of respondents (80.0%) were not immunized, only (40.0%) had hepatitis B virus vaccine.

Conclusion

The level of knowledge attitude and practice of standard precautions was influenced by certain variables such as age, sex, occupation, level of education.  In this study, there is need to increase awareness and further improve on compliance with standard precautions in this present day scourge of HIV pandemic .It is recommended that staffs should be trained regularly on standard precautions, hepatitis B virus immunization should be made compulsory, though free, needle recapping should be prohibited, unsafe and unwarranted use of injections should be minimized and a PEP protocol should be in place with a well-known designated PEP focal person.

KEY WORDS

Standard precautions, knowledge, attitude, practice, blood-borne infection, needle stick injury, health care workers, compliance.

 

 

 

TABLE OF CONTENTS

Title page                                            -                       -                       -                       i

Declaration                                          -                       -                       -                       ii

Certification                                        -                       -                       -                       iii

Dedication                                          -                       -                       -                       iv

Acknowledgement                              -                       -                       -                       v

Abstract                                              -                       -                       -                       vi

Key words                                          -                       -                       -                       vii

Table of contents                                -                       -                       -                       viii

List of tables                                       -                       -                       -                       ix

List of figures                                     -                       -                       -                       xi

Definition of terms                             -                       -                       -                       xii

CHAPTER ONE:     Introduction                            -                       -                       1

CHAPTER TWO:    Literature review                     -                       -                       14

CHAPTER THREE:               Methodology                       -                       -                       43

CHAPTER FOUR:    Results                                  -                       -                       55

CHAPTER FIVE:    Discussion                               -                       -                       88

CHAPTER SIX:       Conclusion and recommendations                  -                       97

References                                          -                       -                       -                       101

Appendix:       (Questionnaire, letter from ethical committee and score-

schedules for Knowledge, Attitude and Practice of Standard Precautions)              -                       -                        -                       111                 

 

 

 

 

LIST OF TABLES

Table 4.1:        Socio-demographic characteristics of respondents showing age group, sex, marital status, religion.

Table 4.2:        Socio-demographic characteristics of respondents showing ethnicity, educational level, occupation, years of service.

Table 4.3:        Occupation of respondents by sex distribution.

Table 4.4:        Source of information on standard precaution.

Table 4.5:        Diseases transmitted by needle stick injury.

Table 4.6:        Facilities methods of disease prevention.

Table 4.7:        Attitude towards standard precaution.

Table 4.8:        Attitude following needle stick injuries.

Table 4.9:        Willingness to perform the procedures on HIV positive patients.

Table. 4.10:     Ways to protect self if managing HIV positive patients.

Table 4.11:      Frequency of needle stick injuries in the last one year.

Tale 4.12:        Practice following spill of blood and body fluids.

Table 4.13:      Injection safety practices.

Table 4.14:      Methods of needle disposal.

Table 4.15:      Methods of handling used reusable instruments.

Table 4.16:      Duration of been immunized with HBV immunization.

Table 4.17:      Scores for knowledge, attitude and practice towards standard precautions.

Table 4.18:      Knowledge of standard precautions and socio-demographic variables of respondents.

Table 4.19:      Attitude towards standard precautions and socio-demographic variables of respondents.

Table 4.20:    Practice of standard precautions and socio-demographic variables of respondents.

Table 4.21:      Knowledge, attitude and practice of standard precautions and ever had needle stick injury.

Table 4.22:       Ever had needle stick injuries and recapping of needles after use.

Table 4.23:       Ever had needle stick injuries and detaching of needles after use.

 


LIST OF FIGURES

Figure 4.1:       Respondents who have heard of standard precautions.

Figure 4.2:       Knowledge of HIV immune status of respondents.

Figure 4.3:       Prevalence of needle stick injuries.

Figure 4.4        Respondents immunized against HBV infection.

 

 

 

 


 DEFINITION OF TERMS

Attitude:         Way of feeling, thinking or behaviour.  In this study, the same definition/assumption applies.

Blood-borne infections : Occupation Safety and Health Administration (OSHA) defines blood-borne infections as infections from pathogenic micro-organisms that are present in human blood and can cause diseases in humans.  These pathogens include, but not limited to HBV, and HIV.  In this study, the same definition applies.

Compliance:   Practice of obeying rules or request made by people in authority.  In this study, it is the extent, to which the HCWs obey or implement the definitions and recommendations of standard precaution laid down by the Centres for Disease Control (CDC).

Knowledge:    The Oxford Advanced Learner’s Dictionary (2001:658) defines knowledge as the information, understanding and skills that one gains through education or experience.  It also defines knowledge as the state of knowing about a particular fact or situation.  In this study, knowledge refers to the awareness of basic principles of standard precautions.

Practice:         Is the usual or expected way of doing something in a particular organization or situation.  In this study, practice refers to the extent that the HCWs implement or comply with recommended strategies of standard precautions.

Safety (sharps) container or box:  A puncture/liquid proof container designed to hold used sharps safety during collection, disposal and destruction.

Sharps injury:   An injury, which occurs when a sharp object penetrates the skin or mucous membranes.

Standard precautions: Care taken in advance to avoid a risk.  In this study, it is an approach to infection control to treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other blood borne pathogens, by use of barrier equipment like hand gloves, face masks, gowns, boots.




CHAPTER ONE

1.1   INTRODUCTION

            Infection is one of the most important problems in health care services worldwide.  It constitutes one of the most important causes of morbidity and mortality associated with clinical, diagnostic and therapeutic procedures.1,2

            Health care workers (HCWs) are at a high risk of needle stick injuries and blood-borne pathogens as they perform their clinical activities in a hospital.3  They are exposed to blood borne pathogens, such as human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) viruses, from sharp injuries and contacts with blood and other body fluids.4,5  According to a WHO estimate, in the year 2002, sharp injuries resulted in 16,000 hepatitis C Virus, 66,000 hepatitis B virus and 10,000 HIV infections in health care workers worldwide.6  There is no immunization for HIV and hepatitis C.7  It becomes important to prevent infection by preventing exposure.  Recapping, disassembly, and inappropriate disposal increase the risk of needle stick injury.8,9  The incidence rate of these causative factors is higher in developing countries for the higher rate of injection with previously used syringes.10  Developing countries where the prevalence of HIV-infected patients is very high, record the highest needle stick injuries too.10  Needle stick injuries were also reported as the most common occupational health hazard in a Nigerian teaching hospital.11  The World Health Organization (WHO) estimates that about 2.5% of HIV cases among HCWs and 40% of hepatitis B and C cases among HCWs are the result of these exposures.12  Irrational and  unsafe injection practices are rife in developing countries.13  The practice of recapping needles has been identified as a contributor to incidence of needle stick injuries among HCWs.5, 14 It is believed that only one out of three needle stick injuries are reported in the US, while these injuries virtually go undocumented in many developing countries.15  Unsafe injections and the consequent transmission of blood borne pathogens are suspected to occur routinely in the developing world.16  It was estimated that each person in developing countries receives an average of 1.5 infections per annum. 16, 19 About 90-95% of injections are therapeutic, while 5-10% is given for immunization.17 It has been shown that between 70% and 99% of these injections are unnecessary, while at least 50% are unsafe in 14 of 19 countries in five developing world regions with data. 17, 18, 19, 20.

            Hauri et al of the Department of Essential Health Technologies, WHO estimates 3.4 injections per person per year in developing countries.16, 18  In Nigeria, the annual mean was found to be 4.9 injections per year.21  Injection over use and unsafe practices account for a substantial burden of death and disability worldwide.16  Eighteen studies reported a convincing link between unsafe injections and the transmission of hepatitis B and C., HIV, Ebola and Lassa virus infections and malaria.19  Injuries from sharp devices have been associated with the transmission of more than 40 pathogens, including HBV, HCV, HIV, haemorrhagic fevers, malaria and tetanus, thereby increasing the risk and burden of infectious diseases.22, 23, 24, 25  Contaminated sharps such as needles, lancets, scalpels, broken glass, specimen tubes and other instruments, can transmit blood borne pathogens such as HIV, Hepatitis B (HBV) and Hepatitis C viruses (HCV).26  The circumstances leading to needle stick injuries depend partly on the type and design of the device and certain work practices.27  Also, the level of risk depends on the number of patients with that infection in the health care facility and the precautions the health care workers observe while dealing with these patients.27  It is documented that 10 – 25% injuries occurred while recapping a used needle.5  The recapping of needles has been prohibited under the Occupation Safety and Health Administration (OSHA) blood-borne pathogen standard.28

            A data combined from more than 20 prospective studies worldwide of health care workers exposed to HIV infected blood through percutaneous injury revealed an average transmission rate of 0.3% per injury,4, 15, 27, 29 and after a mucous membrane exposure approximately 0.09.30  The commonest mode of transmission of HIV –contaminated blood to health care workers is via needle stick injury.27  The greater the size and depth of the blood inoculation, the greater the risk.4  Transmission through the conjunctiva and open lesions in the skin can also occur when in contact with HIV containing fluids.4

            An increasing number and variety of needle devices with safety features are now available.  Needleless or protracted needle I.V. systems have decreased the incidence of needle – stick injuries by 62% - 88%.31Some of these injection devices are; Auto-disable syringe, manually retractable, automatically retractable, standard disposable and needle remover.31

            The World Health Organization defines a safe injection as one that is given using appropriate equipment, does not harm the recipient, does not expose the provider to any waste that is dangerous to the community.32 A safe injection is only given when there is no other suitable alternative. Developing countries, especially those in sub-Saharan Africa, that account for the highest prevalence of HIV-infected patients in the world also report the highest incidences of occupational exposure.12, 25, 33  HCV and HBV infections are generally considered endemic in sub-Saharan Africa.33

            Occupational safety of HCWs is often neglected in low-income countries in spite of the greater risks associated with occupational exposure to blood, inadequate supply of personal protective equipment (PPE), and limited organizational support for safe practices.33

KNOWLEDGE, ATTITUDE AND PRACTICE OF STANDARD PRECAUTIONS AMONG HEALTH CARE WORKERS

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Health care workers (HCWs) are at a high risk of needle stick injuries and blood borne pathogens, such as HIV, and Hepatitis B and C viruses, as they perform their clinical activities in the hospital3. Standard precautions are a set of guidelines that aim to protect HCWs from infections from blood, body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes while providing care to patients.54 Compliance with universal precautions has been shown to reduce the risk of exposure to blood and body fluids.64.. health and kinetics project topics

KNOWLEDGE, ATTITUDE AND PRACTICE OF STANDARD PRECAUTIONS AMONG HEALTH CARE WORKERS

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  • CHAPTERS : 1 - 5
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