A Study to Assess The Knowledge and Practice among Nurse on Infection Control Measures in Pediatric Unit at Pondicherry Institute of Medical Science, Puducherry

 

Vigy Elizebth Cherian^1*, Rose Rajesh²

¹Assistant Professor, Sharda University, Greater Noida, NCR Delhi India

²Nursing Superintendent, Pondicherry Institute of Medical Sciences, Puducherry

 

ABSTRACT:

Health can be neither be demanded nor given, it can be neither be bought, nor sold; but the circumstances and services that are prerequisite to health can certainly be demanded and received as a right¹. Objectives1. To assess the level of knowledge on infection control measures among nurses². To assess the level of practice on infection control measures among nurses³. To correlate the knowledge and practice on infection control measures among nurses⁴. To associate the knowledge and practice of nurses with selected demographic variables. Conceptual framework for the study has been based on the “Ludwig von Bertalanffy general system theory⁹. Research design used for the study is descriptive design⁸. The convenience sampling technique has been used to choose the sample⁸. Pilot study was conducted in pediatric ICU Pondicherry Institute of Medical Science. The Population for this study consisted of 60 nurses the study was conducted in Pediatric Units Pondicherry Institute of Medical Science. The tools used for data collection were demographic variables, structured questionnaire to assess the knowledge and Observational checklist for practice. Results: The knowledge level of nurses as assessed with questionnaire. Among the 60 nurses, only 23.3% had adequate knowledge. The rest (78%) did not have adequate knowledge and for the practice of nurses (57%) of the nurses had adequate practice. Few (43%) did not have adequate practice. The correlation showed there is a weak negative significant correlation between knowledge and practice among nurses on infection control measures. The chi- square test revealed that at p<0.05there is association between knowledge of nurses and classes attended on infection control within one month and there is association between practice of nurses to their current area of experience. Conclusion The knowledge level of nurses as assessed with questionnaire. Among the 60 nurses, only 23.3% had adequate knowledge. The rest 78% did not have adequate knowledge. The practice of nurses observed on infection control measures 57% of the nurses had adequate practice. Few 43% did not have adequate practice.

 

 

INTRODUCTION:

A hospital is a health care institution providing treatment to clients by experienced staff and specialized equipment. It is an institution where sick or injured people are given care⁴. Among the infections hospital acquired infections are among the leading causes of death. Worldwide it is estimated that almost 10% of the hospitalized patients acquire at least one Health Care Associated Infections². The prevalence of HealthCare Associated Infections in developing countries can become as high as 30-50%. They cause significant morbidity among clients who receive health care. Prevention of hospital acquired infections is therefore cost effective and achievable even when resources are limited⁵.

 

Neonatal nosocomial infections are an important cause of neonatal morbidity⁵. In USA (2012) it has been reported that hospital acquired infection among neonates ranges from 0.9% to 7%. In United Kingdom it is reported that approximately 70% of infants are discharged were nosocomial infection rate of 0.9% to 1.1%. These studies emphasis the importance on strict adherence to aseptic protocols in neonatal units to bring down infection rates⁶.

 

The recent report in India by center for disease control and prevention (CDC) (2011) the neonatal infection rate is 44/1000 live birth³. The reported incidence of nosocomial sepsis in neonates from India ranges from 1.5% to 37%. Thus infection in the neonatal intensive care unit is a problem in the developing and developed countries⁷.

 

WHO (2011) outlined that 4% to 16% of all hospitalized patients acquire nosocomial infections. It further states that high income countries had 7.6% of hospital acquired infection rates. Thus there is a prevalence of health care acquired infections ranging from 5.7% to 19.1%³.

 

The analysis of Indian hospital data shows that one of the reasons for increased mortality and morbidity rate is infection. Infections prolong the stay of child in the neonatal unit as a result additional complications and risk of survival results in increased neonatal mortality rate¹⁰. The health for all by 2025 AD has specified that, itis the responsibility of each health care provider, to control and prevent neonatal infection especially in neonatal intensive care unit, where care specialized is rendered to the citizens of tomorrow².

 

OBJECTIVES:

1.    To assess the level of knowledge on infection control measures among nurses.

2.    To assess the level of practice on infection control measures among nurses.

3.    To correlate the knowledge and practice on infection control measures among nurses.

4.    To associate the knowledge and practice of nurses with selected demographic variables

 

MATERIALS AND METHODS:

Research approach-exploratory⁸

Research design-non experimental research design⁸

Setting of the study-paediatric units, Pondicherry institute of medical sciences, puducherr

Population-nurses working in pims

Sample–nurses working in paediatric units

Sample size-60

Sampling techniques-Convenience Sampling⁸

 

Criteria for sample selection

Inclusion criteria:

1.    Nurses with General Nursing and Midwifery certificate and with BSc degree

2.    Both male and female nurses

 

Exclusion criteria:

1.    Auxillary nurses and midwives

2.    Student nurses undergoing post-graduation training

 

DEVELOPMENT AND DESCRIPTION OF TOOL:

The tool was constructed after an extensive literature review. The tool consists of two parts.

 

Part I: Structured questionnaire. It consists of 2 sections

Section 1: Demographic variables of the nurses.

It includes name, age, gender, education, years of experience, current area of experience, and details of attended class on infection control.

Section 2: Multiple choice questions on knowledge.

There were 20 questions on infection control. Each question has 3 responses, with one correct answer.

 

Part II: Checklist to observe the nurses by participant observation.

The commonly done procedures on which infection control measures were observed were namely collection of blood, surgical dressing, and insertion of IV cannula

 

VALIDITY OF TOOL:

Content validity was sought from experts in Pediatric nursing and Nursing research. All the items in the questionnaire and checklists was found to be relevant.

 

ETHICAL CONSIDERATIONS:

·      Formal permission was obtained from dean college of nursing at Pondicherry institute of medical sciences

·      Written consent was obtained from the institutional review board

·      Consents from the participants were obtained

 

 

 

 

PILOT STUDY:

·        The pilot study of the present study was conducted among 6 nurses who were working in pediatrics unit, at Pondicherry institute of medical sciences, puducherry at 23/09/13 to 29/09/13.

·        The investigator obtained written permission from the concerned hospital authority prior to the study. Subjects were chosen by convenience sampling technique. The investigator introduced her to the subjects and the purpose of the study was explained. Written consent was taken from the subjects those who participated in the study. Instructions were given and on the first 23/09/13 structured knowledge questionnaire was administered. All the items in the tool were understood by the participants. There were no changes made in the content of the tool and checklist after the pilot study.

 

RELIABILITY OF THE TOOL:

Reliability of the tool was checked by test retest method during the pilot study. At the cronbach’s alpha calculated as r=0.8 was found to be reliable.

 

DATA COLLECTION PROCEDURE:                                                                

The data collection period was from 7/10/13 to 16/10//13. Written permission was obtained from the administrator, Head of Pediatric Department, Dean college of nursing, Nursing Superintendents and the sister in charge of the areas namely Pediatric medical ward, Pediatric surgical ward, and special ward, Pediatric Intensive Care Unit, Neonatal Intensive Care Unit and Pediatric Out Patient Department.

 

The nurses were gathered in a class room. They were made to sit. Purpose of the study was explained to them. Confidentiality was assured. Self-administered structured questionnaire was given to assess the knowledge of the nurses. Time limit of 30minutes was given to complete the questions. After 30minutes questionnaire were checked for completeness.

 

Practice was observed using a checklist. The commonly done and assessed procedures by nurses were collection of blood, surgical dressing and starting IV line. With the guidance of experts, statistician and based on the investigators observation. It was decided to observe each nurse for her practice on infection control measures. The investigator observed the procedure of nurses by participatory observation. Each nurse was assessed for three procedures that performed in the clinical area. The areas were categorized into four and each area was observed for one week. The timing consist of 8am to 8pm. For the morning shift 4 staffs and for the evening shift also 4 staffs on duty.

 

 

 

 

DATA ANALYSIS:

The data was analyzed using both descriptive and inferential statistics, compute the data, master data sheet was prepared.

 

The Knowledge and Practice among Nurses on Infection Control Measures of Pediatric Unit was calculated using mean and standard deviation.

 

Inferential statistics namely chi square, “t” test and Pearson’s ‘r’ was used for correlation and association⁹.

 

MAJOR FINDIGS OF THE STUDY AND DISCUSSION:

The data are organized and presented in the following 5 tables

Section I: Frequency and percentage distribution of demographic variables among study population

Section II: Level of knowledge and practice among nurses working in pediatric unit

Section III: Correlation between knowledge and practice among nurse

Section IV: Association of knowledge of nurses with their selected demographic variables.

Section V: Association of practice of nurses with their selected demographic variables

 

SECTION I DISTRIBUTION OF NURSES BASED ON THEIR DEMOGRAPHIC VARIABLES:

Table 1show most of the nurse (70%) were ≤25 years of age. Majority of them (77%) were with BSc Nursing degree. Majority (73%) of nurses had less than 2years of experience. Few (48%) were working in immediate newborn care area. Among 60 nurses (25%) were educated from Pondicherry institute of medical sciences. Most of them (63%)had attended classes on infection control measures within the last one month.

 

SECTION II: Knowledge of Nurses on Infection Control Measures

 

The above figure shows the knowledge level of nurses as assessed with questionnaire. Among the 60 nurses, only 23.3% had adequate knowledge. The rest 78% did not have adequate knowledge.

 

 

 

SECTION II: PRACTICE OF NURSES ON INFECTION CONTROL MEASURES

 

The figure 3 represents the practice of nurses observed on infection control measures (57%) of the nurses had adequate practice. Few (43%) did not have adequate practice.

SECTION III: CORRELATION OF KNOWLEDGE AND PRACTICE OF NURSES ON INFECTION CONTROL MEASURES n=60

Variables	r value	p value
Knowledge Practice	-0.318	0.013

 

The table 4 shows the correlation of knowledge and practice of the nurses on infection control measures. Pearson correlation test r value is-0.318 and p value is .013 shows, weak negative significant correlation between knowledge and practice among nurses on infection control measures.

 

 

SCETION IV: ASSOCIATION OF KNOWLEDGE AMONG NURSES TO SELECTED DEMOGRAPHIC VARIABLES n=60

S.No	Demographic variables	level of knowledge				X2	p value
		Adequate knowledge (>70-100%)		Inadequate knowledge (<70%)
		F	%	f	%
1	Age in years a)<25years b)≥25years	11 3	26 17	31 15	74 83	0.73	0.69
2	Educational status a)GNM b)BSc/PBBSc	2 12	15 26	11 35	85 74	2.23	0.32
3	Years of experience a)<2years b)>2years	11 3	25 19	33 13	75 81	0.25	0.87
4	Current area of experience a) Immediate Newborn care b) Pediatric ICU c) Pediatric ward/Pediatric OPD	7 5 2	24 31 13	22 11 13	76 69 87	1.47	0.83
5	Institution studied a) Government b) PIMS c) Other private institution	0 6 8	0 40 20	4 9 33	100 60 81	6.96	0.13
6	Attended classes on infection control within 1 month a) Yes b) No	12 2	32 9	26 20	68 91	5.6	0.06S

 

SECTION V: ASSOCIATION OF PRACTICE AMONG NURSES TO SELECTED DEMOGRAPHIC VARIABLES  n=60

 

S.No	Demographic variables	Practice				X2	p value
		Adequate practice (>50%)		Inadequate practice (=<50%)
		F	%	f	%
1	Age in years a)<25years b)>=25years	26 8	62 44	16 10	38 56	1.56	0.21
2	Educational status a)GNM b)BSc/PBBSc	8 26	62 55	5 21	39 45	0.16	0.68
3	Years of experience a)<2years b)>2years	25 9	57 56	19 7	43 44	0.00	0.96
4	Current area of experience a) Immediate Newborn care b) Pediatric ICU c) Pediatric ward/Pediatric OPD	19 4 11	66 25 73	10 12 4	35 75 27	9.15	0.01S
5	Institution studied a) Government b) PIMS c) Other private institution	2 8 24	50 53 59	2 7 17	50 47 42	0.19	0.90
6	Attended classes on infection control within 1 month a) Yes b) No	18 16	47 73	20 6	53 27	3.64	0.03

This table represents the association between knowledge of nurses and their selected demographic variables. The chi- square test revealed that at p<0.05there is association between knowledge of nurses and classes attended on infection control within one month. The other demographic variables namely age, educational status, years of experience, current area of experience and institution studied did not have association to the knowledge level.

 

The table 6 represents the association between practice of nurses and their selected demographic variables.

 

 

The chi-square test revealed that at p<0.05, there is association between practice of nurses to their current area of experience.

 

The other demographic variables namely age, educational status, years of experience, institution studied and attended classes on infection control within one month did not have association to the practice.

 

RECOMMENDATIONS:

1.    A Similar studies can be undertaken to assess the practices of ward attendants regarding infections control.

2.    A similar study can be done on the need of the hour is to check the knowledge as well as practices of nurses towards compliance of infection control practices in government including municipal hospitals.

 

IMPLICATIONS:

The findings of the study have implication in nursing profession. The implications have been written on the following heading nursing service, nursing administration, nursing education and nursing research.

 

Implication to nursing service:

1.    The result of the study will help the nurses to enlighten their knowledge on importance of infection control measures

2.    The nurses have responsibility in educating the younger generation regarding infection control measures

 

Implication to nursing education:

1.    In service education to be provided to the nursing personnel at various levels to improve their knowledge on infection control measures.

2.    The nurse educator should update their knowledge on infection control measures.

 

Implications in nursing administration:

1.    The nursing administration should take active part in policy making related to developing protocol, procedures related to infection control measures.

2.    Extensive use of mass media propaganda can help in the promotion of infection control.

3.    Nurse administrator should initiate awareness program in hospitals with active support of available resources.

 

Implications in nursing research:

1.    The study can be published in journals to disseminate knowledge regarding infection control measures.

2.    The findings of the study serve as basis for the nursing professionals and the students to conduct further studies in different aspect of infection control measures.

 

CONCLUSION:

The conclusion drawn from the findings of the study are,

The knowledge level of nurses as assessed with questionnaire. Among the 60 nurses, only few of them had adequate knowledge. The rest did not have adequate knowledge. For the practice of nurses observed on infection control measures had adequate practice. Rest of them did not have adequate practice. Teaching given to nurses on infection control measures will improves their knowledge. This study emphasized that learning module will serve for a quick reference and enables the nurse to be more awareness about infection.

 

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Received on 29.03.2018        Modified on 27.06.2018

Accepted on 12.07.2018      ©A&V Publications All right reserved