ABSTRACT

Standard precautions are a set of guidelines that aim to protect health care workers from infections from blood, body fluids secretions, excretions except sweat, non-intact skin, and mucous membranes while providing care to patients. However, compliance to the standard precautions is often low in low-income countries in spite of the greater risk of infection. This study examined the knowledge and practice of standard precautions among health care workers in Federal Teaching Hospital, Ido-Ekiti, Ekiti State. A quantitative descriptive survey was conducted with 57 doctors and 131 nurses using a structured questionnaire. Findings show suboptimal knowledge and practice of the standard precautions among the health care workers. Knowledge of post-exposure prophylaxis for HIV was low as well as hepatitis B immunization among the respondents. A lack or irregular supply of essential materials, such as personal protective equipment, was the main reason the respondents did not comply to the precautions. This report recommends the development and implementation of a comprehensive infection prevention and control program in hospitals in order to ensure compliance to the standard precautions by health care workers.

CHAPTER ONE

INTRODUCTION

This chapter  reviews in brief, Health Care Associated Infections (HAI), elements required for transmission of infectious agent within a health care setting (chain of infection, sources of infection, susceptible host, mode of transmission, portal of entry and portal of exit), HAI among health-care workers, Universal Precautions (UP), Body Substances Isolation (BSI) and Standard Precautions (SP).

 

1.1 BACKGROUND OF THE STUDY

Health Care Workers (HCWs) are potentially exposed to blood and body fluid in the course of their work which put them in an escalating risk of acquiring blood borne infections such as HIV, Hepatitis B and C Nazir & Kadiri, 2014). Exposure to BBF can occur through a percutaneous injury (needle stick injury, sharp injury) or  mucocutaneous  incident  like  BBF  splash  during patient care (Kotwal & Taneja, 2012). It is of utmost importance to consistently use Blood and body  fluid (BBF) precautions for all patients regardless of their blood borne infection status. This practice of blood and body fluid precautions to all patients is referred to as Standard Precautions (SPs) (Okechukwu & Modteshi, 2012). The term “Standard precautions” is replaced by “universal precautions’’, as it also includes any kind of body fluid. Standard precautions are defined as single set of precautions used for all patient care regardless of their HBV, HCV & HIV status (Nazir & Kadiri, 2014).

 

It is difficult and expensive to test all patients for all pathogens before giving care specially in resource limited setups. The level of precautions to be used depends on the nature of procedure being done but not on serological status of patient. Standard precautions apply to all potentially infectious specimens such as vaginal secretions, semen, amniotic, peritoneal, cerebrospinal and pericardial fluids; but not to seat, urine, stool and sputum (unless these specimens are mixed with blood (Okechukwu & Modteshi, 2012). Standard precautions include: Hand hygiene, Use of personal protective equipment like gloves, gowns, masks, Safe injection practices, Safe handling of potentially contaminated equipment or surfaces in the environment, Respiratory hygiene/ cough etiquette (Reda, Fisseha, Mengistie & Vandeweerd, 2010). Despite the awareness campaign, the knowledge regarding SPs among HCWs in developing country is inadequate and their safety is at high risk (Sodhi,  Shrivastava,  Arya  & Kumar, 2013). The infectious agent is transmitted to nurses mainly via droplet: direct contact or contact with inanimate contaminated objects by infectious material. The risk of transmission of infectious agents would increase if infection control practice and standard precautions were not applied (WHO, 2013).

In 1983, Centre for Disease Control disseminated a document called (Guidelines for Isolation Precautions in Hospitals). This document included a section about precautions that must be taken when dealing with blood and body fluid of suspected patient infected by blood-borne pathogen (CDC, 2014). In 1985, in response to HIV /AIDS epidemic(CDC, 2014), CDC developed precautions to be applied to all patients irrespective of their blood-borne infection status. They were called universal precautions. These precautions are defined as a set of precautions devised to prevent, and minimize accidental transmission of all known blood-borne pathogens including HIV, hepatitis B virus, and hepatitis C virus to/from health care personnel when providing first aid or other health care services (Vaz etal., 2010). These universal precautions can also be defined as 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” (Bidira, Woldie & Nemera, 2014). These precautions apply to blood, body fluid containing visible blood, semen, cerebrospinal, synovial, pleural, peritoneal and amniotic fluid but don’t apply to feces, nasal secretion, sputum, sweat, tears, urine and vomits unless blood appears (Vaz et al., 2010). This study determine the knowledge, attitude and practice of standard precautions among health care workers in Federal Teaching Hospital, Ido-Ekiti, Ekiti state.

 

1.2 STATEMENT OF PROBLEM

Compliance to standard precautions is low in public secondary health facilities, especially in resource-limited settings, thus exposing Health care workers to the risk of infection. Occupational safety of Health care workers is often neglected in low-income countries in spite of the greater risk of infection due to higher disease prevalence, low level awareness of the risks associated with occupational exposure to blood, inadequate supply of personal protective equipment (PPE), and limited organizational support for safe practices (Sagoe-Moses, Pearson, Perry &Jagger 2001: 538–41). Blood and other body fluids from patients are becoming increasingly hazardous to those who provide care for them. There is therefore a need for adequate measures to ensure compliance to standard precautions and reduce the risk of infection among Health care workers (Bamigboye & Adesanya 2015).

This study examines the knowledge and practice of standard precautions among two categories of health care workers (doctors and nurses) in Federal Teaching Hospital, Ido-ekiti. It also examines the factors promoting or inhibiting the practice. Findings from the study will be used by  the health sector,  hospital management, and other stakeholders in planning and targeting appropriate measures/interventions to improve compliance to standard precautions among health care workers in Ekiti state and Nigeria at large. The health care workers will be the ultimate beneficiary of interventions that will be based on findings from the study.

1.3 RESEARCH QUESTIONS

1. What is the knowledge of standard precautions among health care workers in Federal Teaching Hospital, Ido-ekiti?
2. What is the practice of standard precautions among health care workers in Federal Teaching Hospital, Ido-ekiti?
3. What are the factors affecting the practice of standard precautions among health care workers in Federal Teaching Hospital, Ido-ekiti?

1.4 OBJECTIVES OF THE STUDY

The research objectives are to:

1. Toassess the knowledge of standard precautions among health care workers in Federal Teaching Hospital, Ido-Ekiti;
2. Todetermine the practice of standard precautions among health care workers in Federal Teaching Hospital, Ido-Ekiti;
3. Toidentify factors affecting the practice of standard precautions among health care workers in Federal Teaching Hospital, Ido-Ekiti.

 

1.5 SIGNIFICANCE OF THE STUDY

This study examines the knowledge and practice of standard precautions among two categories of health care workers (doctors and nurses) in federal teaching hospital, Ido-ekiti. It also examines the factors promoting or inhibiting the practice. Findings from the study will be used by government health parastatal, health sectors, the hospital management, and other stakeholders in planning and targeting appropriate measures/interventions to improve compliance to standard precautions among health care workers in Ekiti state and Nigeria at large . The health care workers will be the ultimate beneficiary of interventions that will be based on findings from the study.

1.6 SCOPE OF STUDY

The study will be to examine the knowledge, attitude and practice of standard precautions among health care workers with particular reference to federal teaching hospital, IdoEkiti, State. The study will focus on standard precaution among two major health practioners; Doctors and Nurses in the sample area.

1.7 OPERATIONAL DEFINITION OF TERMS

• Knowledge: The Oxford Advanced Learners Dictionary (2001) 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: Practice is the usual or expected way of doing something in a particular organization or situation (Oxford, 2001). In this study, practice refers to the extent that health care workers implement recommended strategies of standard precautions.

 

• 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. It is based on the assumption that every person is infected or colonized with an organism that could be transmitted in the healthcare setting and thus health care workers need to apply infection control practices during the delivery of health care.The same definition/assumption applies in this study.

 

• Nurses: Nurses are persons whose jobs are to take care of the sick or injured people, usually in a hospital (Oxford Learners Dictionary 2001). In this study, nurses refer to registered nurses and nurse/midwives working in public secondary health facilities in FCT.

 

• Doctors: A doctor is a person who has been trained in medical science and whose job is to treat ill or injured people (Oxford 2001). In this study, doctors refer to graduates of medical schools working as medical practitioners in public secondary health facilities in FCT.

 

• Occupational exposure: Occupational exposure is defined by the Occupational Safety and Health Administration (OSHA) of US Department of Labour as reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee’s duties. The same definition applies in this study.

 

• Blood-borne infections: OSHA defines blood-borne infections as infections from pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, HBV and HIV. In this study, blood-borneinfections are infections from pathogenic microorganisms that are present in human blood, are capable of causing disease in human, and are predominantly transmitted via blood and blood contact.