Knowledge, Attitude and Practice of Standard Precautions Among Health Care Workers in Lagos State
CHAPTER ONE
Objective of the study
The main objective of this study is to investigate the Knowledge, Attitude and Practice of Standard Precautions Among Health Care Workers in Lagos state, specifically the study aims to:
- Determine the demographic distribution the HCWs in HCWs in Federal Medical Centre, Ebute-Metta
- Investigate the knowledge of standard precautions among HCWs in Federal Medical Centre, Ebute-Metta
- Examine the attitude of HCWs towards standard precautions in Federal Medical Centre, Ebute-Metta
- Investigate the practice of standard precautions among HCWs in Federal Medical Centre Ebute-Metta
CHAPTER TWO
REVIEW OF LITERATURE
The following keywords were used as the topic thrust for the review:
* Standard precautions
* Knowledge of standard precautions
* Practice of standard precautions
Standard Precautions
Historical Background
The CDC first published a document in 1983 entitled ‘Guidelines for Isolation Precautions in Hospital’, which contained a section on precautions for blood and body fluids. The section recommended preventive measures to be taken when a patient is known or suspected to be infected with blood-borne pathogens (Garner, Simmons & Williams 1983: A8-8). In 1987, CDC published ‘Recommendations for Prevention of HIV Transmission in Healthcare Settings’. In contrast to the 1983 guidelines, the Recommendations suggested that precautions be consistently used for all patients regardless of their blood-borne infection status. This extension became known as the Universal Precautions and it was defined by CDC (1996) as a set of precautions designed to prevent the transmission of HIV, HBV and other blood-borne pathogens when providing first aid or health care. Under the universal precautions, blood and certain body fluids of all patients were considered potentially infectious for HIV, HBV and other blood-borne pathogens. Thus, universal precautions replaced and eliminated the need for the isolation category “blood and body fluid precautions” in the 1983 CDC Guidelines for Isolation Precautions in Hospitals.
Universal precautions was applicable to blood, other body fluids containing visible blood, semen, vaginal secretions, tissues, and the cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids. However, the universal precautions did not apply to feaces, nasal secretions, sputum, sweat, tears, urine, and vomitus unless they contained visible blood. It did not also apply to saliva except when visibly contaminated with blood or in the dental setting where blood contamination of saliva is predictable (CDC 1996). Universal precautions recommended the use of protective barriers such as gloves, gowns, aprons, masks, or protective eyewear, which can reduce the risk of exposure of the health care worker’s skin or mucous membranes to potentially infective materials. It recommended that all health care workers take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices.
However, additional precautions were needed for diseases transmitted by air and droplet contacts in order to protect health care workers from occupationally acquired pulmonary tuberculosis, severe acute respiratory syndrome (SARS), and, recently, human influenza.
CHAPTER THREE
RESEARCH METHODOLOGY
INTRODUCTION
In this chapter, we described the research procedure for this study. A research methodology is a research process adopted or employed to systematically and scientifically present the results of a study to the research audience viz. a vis, the study beneficiaries.
Study setting
The study was carried out at Federal Medical Centre Ebute-Metta Lagos State, Nigeria. Federal Medical Centre Ebute-Metta was established in 1964. It started out as the Department of Health Services of the Nigerian Railway Corporation. It was created exclusively to cater for the health needs of NRC staff and their families.
During the Nigerian Civil War, It became an annex of the Lagos University Teaching Hospital for the treatment of wounded soldiers.
On May 26th 2004, the Federal Executive Council (FEC) approved the upgrading of the Nigerian Railway Hospital to a Federal Medical Centre and on 31st January 2005, the hospital was formally handed over to the Federal Ministry of Health as a Tertiary Healthcare Institution and designated as Federal Medical Centre, Ebute-Metta, Lagos.
It is a training institution for Resident doctors and House Officers in Anaesthesia, Family Medicine, Obstetrics and Gynaecology and Surgery.
RESEARCH DESIGN
Research designs are perceived to be an overall strategy adopted by the researcher whereby different components of the study are integrated in a logical manner to effectively address a research problem. In this study, the researcher employed the survey research design. This is due to the nature of the study whereby the opinion and views of people are sampled. According to Singleton & Straits, (2009), Survey research can use quantitative research strategies (e.g., using questionnaires with numerically rated items), qualitative research strategies (e.g., using open-ended questions), or both strategies (i.e., mixed methods). As it is often used to describe and explore human behaviour, surveys are therefore frequently used in social and psychological research.
POPULATION OF THE STUDY
According to Udoyen (2019), a study population is a group of elements or individuals as the case may be, who share similar characteristics. These similar features can include location, gender, age, sex or specific interest. The emphasis on study population is that it constitute of individuals or elements that are homogeneous in description.
The population chosen for this study comprises nurses, health assistants and waste handlers in Federal Medical Centre, Ebute-Metta, Lagos State. All health care workers directly involved in the handling of patient’s blood, body fluids, needles, sharp objects and waste, and who have been in employment for at least 6 months, and were willing to participate in the study were included.
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
This chapter presents the analysis of data derived through the questionnaire and key informant interview administered on the respondents in the study area. The analysis and interpretation were derived from the findings of the study. The data analysis depicts the simple frequency and percentage of the respondents as well as interpretation of the information gathered. A total of two hundred (200) questionnaires were administered to respondents of which 200 were returned. The analysis of this study is based on the number returned.
CHAPTER FIVE
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
Introduction
This chapter summarizes the findings on the Knowledge, Attitude and Practice of Standard Precautions Among Health Care Workers in Lagos state, Federal Medical Centre, Ebute-Metta as case study. The chapter consists of summary of the study, conclusions, and recommendations.
Summary of the Study
In this study, our focus was on the Knowledge, Attitude and Practice of Standard Precautions Among Health Care Workers in Lagos state, Federal Medical Centre, Ebute-Metta as case study. The study is was specifically focused on examining the knowledge of standard precautions among HCWs in Federal Medical Centre, Ebute-Metta, the attitude of HCWs towards standard precautions in Federal Medical Centre, Ebute-Metta and investigating the practice of standard precautions among HCWs in Federal Medical Centre Ebute-Metta. Four research questions guided the study.
The study adopted the survey research design and randomly enrolled participants in the study. A total of 200 responses were validated from the enrolled participants where all respondent are healthe care workers in Federal Medical Centre, Ebute-Metta, Lagos State.
Discussion of findings
The study shows that majority of the respondents were aware of standard precaution as a form of universal precaution against infection. Furthermore, majority of the respondents demonstrated good knowledge, attitude and practice towards standard precaution. The study shows majority of the respondents were females, nursing profession and had served between 1-5 years as a health worker in the hospital. This finding is consistent to Tobin EA (2013)’s study in Edo State, South-South Nigeria; but slightly different from a study in Federal Teaching Hospital Gombe, Nigeria by Abdulraheem IS (2012) where the respondent were 6-10 years in service. Furthermore, the respondents demonstrated high awareness of standard precaution which is similar to the findings from previous studies.
The sources of information for standard precaution for most of the respondents were workshop and seminar which is similar to other study. This is not surprising as most of the health workers do attend various seminar and workshop for on the job training and retraining. In addition, more than half of the respondents demonstrated good knowledge of standard precaution. This finding is different from previous studies in Nigeria which found lower level of knowledge. The finding in this study was not surprising as the respondents demonstrated high awareness of standard precaution, however in some previous studies the high awareness did not necessarily translate to knowledge of standard precaution. The demonstration of knowledge in the study by the respondents goes to show that the respondents probably do attend seminars and workshops which is usually the avenue to learn new and best practices by medical practitioners.
Similarly, the respondents exhibited good attitude towards standard precaution by agreeing to go for medical check-up in case of a needle stick injury and wearing double hand gloves as a way of protecting oneself when managing HIV and HBV positive patients. This is in line with the findings from a previous study by Abdulraheem IS (2012). The appreciable knowledge of standard precaution can be said to probably have encouraged positive attitude towards standard precautions by the respondents. Furthermore, the respondents practiced standard precaution which is similar to previous studies in Nigeria. In terms of specific standard precaution practices there are some variations with previous studies. Some of the respondents affirmed they do not recap needle after use and detach needles from syringe after use which is similar to previous study where the respondents admitted not to or never recap needle after use. The prevalence of needle stick injuries from this study is similar to what was reported in Nigeria, Indonesia and other studies.
Conclusions
With respect to the analysis and the findings of this study, the following conclusions emerged;
Standard Precaution as a life saving measure is more relevant in the medical field because of the increasing number of people living with HIV/AIDS, Hepatitis and other infectious diseases worldwide. The study shows the knowledge, attitude and practice of standard precautions among health care workers in agos state, was fair as majority of the health care workers has good knowledge, attitude and practice of standard precautions respectively. However, majority of the Health Care Workers still recapped needles, while few detach needles from syringes. In addition, over half of the Health Care Workers had experienced needle stick injuries which should be a concern both to the management of the hospital and stakeholders as most of the health workers will be susceptible to infections. The effective knowledge, attitude and practice of standard precautions among Health Care Workers in Federal Medical Centre, Ebute Metta, are of absolute necessity because of the rising population of HIV-infected individuals in the study area and lack of immunization of some of the respondents against HBV. Therefore, both the management of the hospital, stakeholders at the state ministry of health and health workers union should strive to promote strict compliance to standard precautions in order to prevent infections from sharps, blood and body fluid pathogens.
Recommendation
Based on the findings the researcher recommends that;
- A comprehensive infection prevention and control (IPAC) program should be developed at all levels of healthcare in Nigeria, namely federal, state, local government and health facility levels.
- The government should established IPAC committees in the federal and state ministries of health and IPAC teams at the facility level.
- Knowledge of the standard precautions, including additional (transmission-based) precaution and infection control and prevention, should be improved among HCWs
- Health facility managers should ensure regular supply of personal protective equipment and other items required for IPAC in their facility.
- A clinician should be appointed as PEP focal person in each health facility and trained on how to handle cases of occupational exposure.
- Awareness of the importance of hepatitis B vaccination should be increased among HCWs.
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