ABSTRACT

Health care
workers, particularly nurses are at risk of infection because they constantly
come into contact with infected tissues, fluid, blood and blood products. By
complying with infection control measures a lot of infections can be prevented.
Some survey studies have been conducted in Nigeria on knowledge, perception
attitude and practice of infection control and they concluded that there was
inadequate adherence to infection control practices and this could be addressed
by organizing training and retraining programmes. This study therefore examined
the effects of a training programme in promoting infection control in two
teaching hospitals in Ogun State.

The study adopted
a pretest-posttest quasi experimental design. 
The sample consisted of 87 participants. They were made up of
experimental group which consisted of 42 registered nurses from Babcock
University Teaching Hospital (BUTH). Ilishan-Remo, Ogun State. The control
group was 45 nurses from Olabisi Onabanjo University Teaching Hospital. The
training programme consisted of 4 modules on infection control. The programme
lasted 4 weeks. The instruments used for data collection were Knowledge about
Infection Control Questionnaire (r = 0.79); Perceptions about Infection Control
Questionnaire (r = 0.80); Attitudes towards Components of Infection Control
Questionnaire (r = 0.62); Practice of Infection Control Questionnaire (both
self-reported and observation checklist) (r =0.62). Four research questions
were answered and three hypotheses were tested at 0.05 alpha level. Data were
analysed using descriptive statistics and Students’ T-test.

Findings showed
that the mean age in the experimental group was 34.92 and SD 8.99 while the
control group was 47.43 and SD 6.60. The mean for years of experience in the
experimental group was 10.42 and SD 9.95 while in the control group was 21.89
and SD 8.72. On attitude, 30 participants (69.0%) had positive attitude in the
experimental group compared to 21 participants (46.7%) in the control group.
The mean difference was 4.02. On perception, 32 participants (76.0%) in the
post intervention had good perception compared to none in the control group.
The mean difference was 8.36. On knowledge, 26 participants (62.9%) in the post
intervention had high knowledge compared to none participant in the pre
intervention. The mean difference was 7.24. On infection risk reduction in the
intervention group, 28 participants (66.7%) have experienced sharp injury pre
intervention and none post intervention. Significant differences were found
between mean practice score of participants in the experimental and control (p =
0.001) and between self reported and observed practices (p = 0.000) but there
was no significant difference between the mean knowledge score in the
experimental and control group (p = 0.149).

The training
programme was effective in improving the level of knowledge, attitude,
perception and practice of infection control. Based on these findings, it is
recommended that there should be adequate provision of facilities for infection
control. Training and retraining should be organized for all nurses and other
categories of healthcare workers to promote adherence to infection control.

Keywords: Training, Knowledge, Attitude,
Perception, and Practice

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Infection
control is an aspect of healthcare delivery that deals with the curtailment of
the spread of infection within the healthcare set-up, be it from
patient-to-patient, patient-to-staff, staff-to-patients or staff to staff.
According to World Health Organisation (WHO, 2011) the components of infection
prevention and control are as follows: organisation, technical guidelines,
human resources, surveillance, microbiology laboratory support, environment,
evaluation and links with public health and other services. Organisation
involves setting up a programme, formation of the infection control committee
and inter-professional team, which should include physicians, nurses,
microbiologists, epidemiologists, infection control specialists, information
specialists and others. The committee must have a good working relationship
with one another, because their work entails collaboration with other
departments, staff and programmes. Technical guidelines involve developing,
disseminating and implementing technical evidence-based information in
preventing the risks of infection. Human resources involve training and
re-training of health care personnel in preventing infections and the training
of infection control professionals. It guarantees a pool of adequate staff
responsible for infection prevention and control activities.

Surveillance
is the tracking of demonstrated or suspected spread of infection. It involves
the collection of data on epidemic and detection of outbreaks as well as the
assessment of level of compliance with infection control practices, response to
outbreaks and documentation of the situation of healthcare associated
infection. Surveillance is important in that it causes early detection,
identification, isolation and intervention, and results in effective infection
prevention. Microbiology laboratory supports generate data, standardised
laboratory techniques and promotes interaction between infection control
activities. The environment refers to the minimum requirements for infection
control. It includes water, ventilation, hand-hygiene equipment, placement of
patient as well as isolation facilities, sterile supply storage, building
conditions and renovation activities. Evaluation has to do with monitoring,
assessment and report of infection prevention and control outcomes, processing
and strategizing at national level and in healthcare facilities. It mirrors the
impact of the infection control programmes. Links with public health and other
services ensures proper coordination and collaboration between staff and
departments in the events of mandatory reporting and activities such as waste
management and sanitation, bio-safety, occupational health, patients and
consumer’s care and the quality of health care (Hebden, 2015; Stempliuk &
Eremin, 2015; WHO, 2011).

There
are various sources of infections. Healthcare associated infections (HAI) are
infections that develop in the course of healthcare and results in aggravating
illnesses and may lead to deaths, extends the duration of hospital stay, and
calls for more interventions at an added cost to the one already expended by
the patient’s initial disease. Its occurrence is an indicator of the quality of
patient care, adverse event and an issue of patient safety. The sources
includes adverse drug events, surgical complications, microorganism isolates,
antimicrobial resistance, decreasing trends in intensive care units, exogenous
microorganisms such as bacteria, fungi, viruses, protozoan from other patients,
endogenous flora of the patients- residual bacteria residing on the patient’s
skin, mucous membrane, gastro intestinal tract, respiratory tract, inanimate
environmental surfaces, contaminated objects, patient room touch, surfaces,
equipment, medication, individual patient, medical equipment, devices, hospital
environment, contaminated drugs and foods and hospital flora in the healthcare
environment. Other sources include doctors’ white coats, nurses’ uniform,
hospital garments, privacy drapes, stethoscopes, bed rails, common hospital
surfaces, contaminated water, compromised immune system, negligence or poor
attitude of hospital staff, hands of health care workers. It could be from
patient to patient, patient to environment, staff to patient, renovation works
in the hospital (Hans, 2012; Stubblefield, 2014; WHO, 2011).

Healthcare
workers generally are at risk of infection, because they constantly come into
contact with infected materials such as tissues, fluid, blood and blood
products. There are several infection control measures aimed at controlling the
spread of infectious diseases, such as hepatitis B and C, Human immunodeficiency
virus (HIV) and other life threatening infections. Moreover, the hospital waste
itself is a potential source of infection hence the need for proper infection
control measures. It has been found that healthcare workers do not adhere
strictly to the various infection control measures, probably because they do
not recognise such, or they lack adequate knowledge, or could be due to poor
attitude towards infection control measures, including non-availability of
materials and equipment (Amoran & Onwube, 2013).In a study conducted at the
Federal Medical Center (FMC), Gombe, in North Eastern Nigeria among nurses, it
was found that some respondents were not aware that standard precautions is
applied to all patients, and majority of the respondents have poor knowledge of
the components of standard precautions (Saidu, Habu, Kever, Dathini, Inuwa,
Maigari et al, 2015).

Standard
precautions are infection control measures that are put forward by the United
States Centre for Disease Prevention & Control (CDC), in 1996. By complying
with standard precautions, a lot of infections can be avoided, such as
occupational exposure to pathogens. While some health workers are familiar with
the infection control measures, some are not. This may be due to lack of
awareness or knowledge and moreover, the attitude that some who are familiar
with the infection control measures, show towards practice is not encouraging.
When one considers the importance of adequate knowledge and practice of
infection control measures, by the healthcare workers, one cannot but think of
what to do to improve on that knowledge and practice. Jain, Dogra, Mishra,
Thakur and Loomba (2012), in their study among doctors and nurses in a tertiary
care hospital, found that there is lack of knowledge and practice regarding
basic infection control measures. This deficit in knowledge can be improved
through educational intervention. Wasswa, Nalwadda, Buregyoya, Gitta, Anguzu
and Nuwama (2015), in their study on implementation of infection control in
health facilities in Uganda, found that with prior training on infection
control, the respondents were more likely to wash their hands. Level of
education and a prior nosocomial infection experience will have a role in the
practice of infection control measures. In-service training on infection
control measures will boost the practice of infection control measures.

Amoran
and Onwube (2013) found that inadequate workers’ knowledge on infection control
and environment related problems are crucial issues that need urgent attention.
According to Gebresilassie, Kumei, and Yemane (2014) in their study, “there is
suboptimal and inconsistent practice of standard precautions in the healthcare
setting that put patients and healthcare workers at significant risk of
acquiring infections”. They also emphasized the need for in-service training
for the healthcare workers on infection control. Adly, Amin and Abd El-aziz,
(2014) found that intervention influenced the compliance of nurses with
infection control measures, because of the knowledge gained during the
intervention or training programme. There is a standard of infection control
measures that can guarantee infection safety among health workers and patients.

 1.2 Statement of the Problem

Healthcare
workers generally are at risk of infection. WHO (2006), reported that among the
35million health workers worldwide, about 3 million sustain percutaneous
exposures to the blood borne pathogens each year, including 2 million to
Hepatitis B virus (HBV), 0.9 million to Hepatitis C virus (HCV) and 170,000 to
Human Immunodeficiency virus (HIV). These injuries may result in 70,000 HBV;
15,000 HCV and 5,000 HIV infections. Nurses are at higher risk of being
infected with blood-borne pathogens from clinical blood exposure through
injuries with sharp instruments and needle-stick injuries if infection control
measures are not strictly followed. This is because they are usually the first
contact with a patient on arrival in the hospital and provide 24 hour patient
care. Studies have also shown evidence of clinical nurses becoming infected due
to occupational exposure (Centers for Disease Control & Prevention,
2012).  Abdulraheem, Amodu, Saka,
Bolarinwa & Uthman (2012), in their study, among health workers in North
Eastern Nigerian found that the level of knowledge and implementation of
standard precautions is below standard to guarantee infection safety. They
concluded that there is still much to learn and implement when it comes to
infection control measures. 

Furthermore,
in some health institutions, the researcher observed that some nurses do not
adhere to the components of standard precautions while providing nursing care.
For example, few nurses were observed not to wash their hand after removing
gloves and before commencing another procedure. In some of the wash hand basins
in the outpatient department, liquid soap is not available for health workers
and patients to wash their hands. When blood or body fluids are spilled on the
floor, the house keepers do not decontaminate with hypochlorite solution before
mopping with soap and water. The health institutions infection control units
are not well equipped to function effectively to ensure compliance to standard
precautions. It is in the light of the gaps that the researcher became
interested in planning a training programme on knowledge, perception, attitude
and practice of infection control for nurses at Babcock University Teaching
Hospital (BUTH), Ilisan-Remo, Ogun state.

1.3 Objective of the
Study

The
main objective of this study is to determine the effects of a training
programme on infection control among nurses. The specific objectives are to:

1.      assess
the effectiveness of the training programme on knowledge of participants
about 

infection control;

2.      determine
the effectiveness of the training programme on perceptions of participants 

about infection
control;

3.      document
the effectiveness of the training programme on attitudes of participants  

towards infection
control;   

4.  
implement a training programme on infection control;

5.   determine the level of skills possessed and
practice of participants on infection control;

6.  assess the effectiveness of a training
programme on infection risk reduction and

7.   ascertain if there is any difference between
the self-reported practices and the actual  

      observed practices of infection control
in the experimental group.     

1.4 Research Questions

This
study attempted to answer the following research questions:

1.      What
are the effects of training programme on attitudes of participants?

2.      What
are the effects of training programme on the perceptions of participants?

3.   What are the effects of training programme on
the knowledge of participants?

4.   What is the effect of the training programme
on infection risk reduction?

1.5  
Hypotheses

These
three hypotheses were tested at 0.05 level of significance:

Ho 1.         There
is no significant difference in the mean knowledge score of infection control
between the experimental group and the control group.

Ho 2.         There
is no significant difference in the mean practice score of infection control
between the experimental group and the control group.    

Ho 3.         There is no significant difference
between the self reported practice and observed practice of infection control
in the experimental group.

1.6 Scope of the Study

This
study focused on the knowledge, attitude, perception and practice of infection
control among nurses. Specific areas are; hand hygiene, use of personal
protective equipment (PPE), handling sharps/injection safety, cleaning and
disinfection as well as waste management. The independent variable is the
training package, and the dependent variables are the participants’ knowledge,
attitude, perception and practice.

1.7 Significance of the
Study

The
importance of the training programme to nurses, patients, hospital and society
cannot be over emphasized. The training programme may improve infection control
practices among nurses. The practices include: hand washing, donning and
removing PPE for example, gloves, gown, mask, eyewear, and injection safety.
The study may also improve the knowledge of nurses on the components of
standard precautions. Training and practicing standard precautions may lead to
a situation where nurses actually feel more protected from the risk of
exposures to HIV and Hepatitis, and are more likely to provide improved
“physical care”. Nurses also experience less fear and are less judgmental
towards patients, thus less likely to stigmatise or discriminate patients,
leading to improved “psychosocial or emotional care” when rendering care to
patients with highly infectious diseases.  

In
the practice of standard precautions, all patients are assumed to be possible
sources of infection and must be handled professionally in that regard. The
importance of this programme to the hospital is that the patients that receive
care are not likely to have nosocomial infection. This may in turn allow the
hospital to have recognition which may attract more patronage by Ogun state
indigenes and beyond.

Adequate
infection control measures may have economic as well as political effect on the
society. However, the nurses will be conversant with what to do and how to do
it, in terms of preventing infection. For instance, Hepatitis kills more
quickly than HIV, if one is infected with either of the two, it will result in
severe economic loss for the individual and the family, and when this is
translated on to the national stage, it will be a great loss due to the
multiplier effect.

 1.8 Justification for the Study

Knowledge
and practice of standard precautions has been shown to reduce the risk of
exposure to blood and body fluids (Chan, Molassiootis, Chan, Chan, Ho, Lai, et
al, 2002). Standard precautions are the basic level of infection control
precautions which are to be used, as a minimum in the care of all patients. It
is therefore necessary for nurses to have training and re-training programme on
standard precautions to improve their compliance.

1.9 Operational
Definition of Terms

Infection control:  This refers to an aspect
of healthcare delivery that deals with the curtailment of the spread of
infection within the healthcare set-up, be it from patient-to-patient,
patient-to-staff, staff-to-patients or staff to staff.

Nursing intervention:
This refers to a training package that focuses on improving knowledge,
attitude, perception and practices of infection control. The areas of focus
include hand washing, PPE such as gowns, mask, goggles, and gloves. The
training also includes injection safety/handling sharps, cleaning
decontamination and sterilization, waste management as well as post exposure
prophylaxis (PEP).

Knowledge:
This means facts, information and skills acquired through experience or
education on infection control.

Attitude:
Internal mental disposition expressed towards infection control or feelings
expressed towards infection control.

Perception:
This means conscious understanding of what infection control is all about or
meaning ascribed to infection control.

Practice:
This refers to a regular repeated exercise in order to gain proficiency in
skills on the components of infection control. This includes hand hygiene, use
of personal protective equipment, injection safety/handling sharps, cleaning
decontamination and sterilization, waste management as well as PEP.

Effectiveness:
This refers to the positive impact of a training programme on infection control
which may include increased level of participant’s knowledge and practice.

Nurses:
These are registered nurses working at BUTH, Ilisan-Remo and Olabisi Onabanjo
University Teaching Hospital (OOUTH), Ogun state.

Promotion of Infection Control: This means disseminating
information about infection control.

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