CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Standard precautions constitute the primary strategy for nosocomial infection control in the hospital. It is applicable to all patients receiving care irrespective of their diagnosis or presumed infection status and covers blood, body fluids, secretions, excretions, non intact skin and mucous membrane (Sobayo, 2015). Pratt, Pellowe, Wilson and Loveday, (2015), also defined standard precautions as a measure that incorporate both universal precaution – designed to prevent transmission of blood-borne infections and body substance isolation designed to reduce the risk of transmission from other body substance. It is designed to protect both health care staff and patients from the risk of cross infection. It has been estimated that the prevalence of hospital acquired infections in tertiary hospitals in Nigeria is 2.6 percent (Ige, Adesanmi and Asuzu, 2016). The challenge of achieving significant improvement in patient care is one of the task facing health care providers. A large number of people continue to be successfully cared for and treated in health facilities, however errors and other forms of harm occur (Knight and Bodsworth, 2014). It is pertinent to mention here that little resources are required to implement standard precautions. Hand washing as simple as it is, reduces the spread of diseases by removing bacteria, viruses, other micro-organisms and chemicals that could have caused harm or diseases from hands (Suzzame, Brenda, Hinkle and Cheever, 2014). The attitude of some health workers towards hand washing, if improved can help reduce the transmission of micro-organisms. According to Sobayo (2015), patient may develop urinary tract infection due to improper care of urethral catheter, wound infection due to poor operative technique, use of improperly sterilized instrument and inadequate care of wound, phlebitis and septicaemia due to improper handling of intravenous infusion administration. All these are unnecessary infections and lead to extra cost to hospital and the patients.
Failure to comply with policies and procedures that support the reduction of hospital acquired infections (HAIs) is a recognized and complex problem that maybecontributing to the current trend in the world (Damina, 2016). Research has identified varying degree of noncompliance with standard precaution. According to Centre for Disease Control (2013), limited knowledge, lack of facilities and poor working environment are commonly cited as barriers to compliance. WHO (2013) opined that the risk of professional exposure to viruses is compounded by restricted size of staff in many health units, the lack of basic protective equipment, cleaning materials and deficit knowledge contributed to poor compliance.
For more than two decades after the Centre for Disease Prevention and Control first, and subsequent documents were released, refined and mandated to be used for training and practice by all health personnel as a primary strategy to reduce the risk of transmission of micro-organisms, anecdotal observation in some units/wards of Federal Medical Centre Edo State showed poor/inconsistent hand washing, selective use of protective equipment such as gloves, eye goggles, apron and poor disposal of sharp consumables by health care providers. These practices posed high risks for the transmission of infections to the patients as well as the care providers. The resultant infection prolongs the patient’s period of hospitalization, affects attention to family matters and additional financial burden which is sometimes difficult to meet up by many patients. The health workers are exposed to blood and other body fluids which lead to infections such as HIV and Hepatitis B following poor compliance to standard precaution.
1.2 Statement of Problem
The practice of standard precautions is being widely promoted to protect healthcare workers (HCWs) from occupational exposure to body fluids and consequent risk of infection with blood-borne pathogens. HCWs are potentially exposed to blood-borne and other infections through contact with body fluids while performing their duties. HCWs frequently provide care to patients whose HBV, HIV and hepatitis C virus (HCV) status is unknown, and individuals may be asymptomatic for months to years while being infectious. The occupational health of the health care workforce of about 35 million people globally, representing about 12 percent of the working population, has been neglected (Wilburn and Eijkemans, 2014). About three million HCWs worldwide receive percutaneous exposure to blood-borne pathogens each year. These injuries may result in 15,000 HCV, 70,000 HBV and 500 HIV infections, and more than 90 percent of these infections occur in developing countries. Worldwide, about 40 percent of HBV and HCV infections and 2.5 percent of HIV infections in HCWs are attributable to occupational sharps exposures, which are mainly preventable (WHO 2013). The health consequences of these infections are enormous. For instance, about 60–85 percent of HCV infections result in chronic liver disease and a risk for liver cirrhosis and liver cancer (CDC 2013).
The Occupational Safety and Health Administration (2012) estimates that 5.6 million HCWs worldwide, who handle sharp devices, are at risk of occupational exposure to blood-borne pathogens. Needle stick injuries were shown to be the commonest (75.6percent) mechanism for occupational exposure in a Nigerian teaching hospital (Orji, Fasubaa and Onwudiegwu, 2014). These injuries are usually under-reported for so many reasons, which include stigma that could be associated with an eventual infection with HIV in the affected HCW. There is no immunization for HIV and HCV, thus the most effective prevention is through regular practice of the standard precautions. hence the need to assess the knowledge and attitude of nurses towards standard precautions in Health centres in Esan West local Government Area.
1.3 Objective of the Study
The aim of the study is to determine the knowledge and attitude of nurses towards standard precautions in health care centers in Esan West Local Government Area of Edo State.
1.3.1 Specific Objectives of the Study
The specific objectives of the study are to;
- Assess the knowledge of standard precautions among nurses in health care centers in Esan West Local Government Area.
- Determine the attitude of nurses towards the utilization of standard precautions.
1.4 Research Question
- What are the level of knowledge of nurses towards the utilization of standard precautions in health care centres in Esan West Local Government Area?
- What are the attitude of nurses towards the utilization of standard precautions in health care centres in Esan West Local Government Area?
1.5 Significance of Study
This study examines the knowledge and attitude of nurses towards the utilization of standard precautions in Health care centers in Ekpoma, Esan West Local Government Area of Edo State. Findings from the study will be used by the Health and human Services Secretariat (HHSS) of the Edo State, the hospital management, and other stakeholders in planning and targeting appropriate measures/interventions to improve compliance to standard precautions among health care workers. The nurses will be the ultimate beneficiary of interventions that will be based on findings from the study.
1.6 Scope of Study
The research was carried out among nurses working in Health care centers in Ekpoma, Esan West Local Government Area of Edo State, Nigeria.
1.7 Hypotheses (HO)
There are no significant difference in the knowledge of nurses towards the utilization of standard precautions in health care centres in Esan West Local Government Area.
1.8 Operational Definition of Terms
Knowledge: Facts, information, and skills acquired through experience or education; the theoretical or practical understanding of a subject.
Attitude: A way of thinking or feeling about something
Standard precautions: The Centers for Disease Control and Prevention defines standard precautions as a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered.
Nurses: Nurses are persons whose jobs are to take care of the sick or injured people, usually in a hospital (Oxford Learners Dictionary 2012).
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