Knowledge And Perception Of Health Care Workers

Published Date: 02 Nov 2017

The care provided in a hospital should be curative and preventive. Curative aspect deals with the disease of the patient and preventive aspect deals with the prevention of nosocomial infection. An infection is considered as nosocomial, if it manifests 48 hours or more after hospital admission or within 30 days of discharge following inpatient care. (1) Hospitals are the major source of nosocomial infection. Ten to thirty percent of the patients admitted to hospitals in India acquire nosocomial infections as against only 5% in developed world. (2) Nosocomial infections are transmitted from one patient to another through the health care workers (HCWs) who do not practice control measures such as hand washing, use of gloves etc." In 1847 Ignaz Semmelwies, a Hungarian physician proposed the importance of Hand Washing for first time. (3) Hand hygiene, has been recognized as the most cost effective measure to prevent the spread of such infections and also is the first and foremost principle of Universal Safety Precaution. But there exists a gap between the knowledge and practice of HCWs who often forget to wash their hands before interacting with the patients. Such contaminated hands play an important role in transmitting infections.

HCWs are at an increased risk of needle stick injuries (NSI) due to the environment in which they work. HCWs are risk of acquiring 20 different pathogens by injury with sharp objects or needle sticks (4). On average HCWs acquire 30 NSI per 100 beds per year (5). The reporting of such infection is a critical step in initiating early prophylaxis.

The purpose of the study was to understand the level of knowledge and perception of HCWs towards hand hygiene and to know the prevalence of NSI and the factors associated with it.

MATERIALS AND METHODS

A cross sectional study was carried out in Basaveshwara Medical college Hospital and Research centre. The study was carried out for a period of 3 months from October 2012 to December 2012

After seeking permission from the concerned authorities, all the doctors, nurses and interns were contacted. All those who gave their consent were included in the study. A total of 275 employees who gave verbal consent were included. Thus 55 Doctors, 143 nurses and 77 interns constituted the study sample.

A pre designed and pretested questionnaire was administered to determine the knowledge and perception of hand hygiene and incidence of NSI. The questionnaire was divided into three sections. First section consisted of background information. Second about knowledge, perception and the hindrance factors associated with hand hygiene. Third section consisted of the details pertaining to the incidence of injury due to needle stick, sharp objects and the factors associated with it. Twenty five questions were used to assess the level of knowledge. Correct answer was given 1 mark and wrong zero, maximum being 25 and minimum being zero. The points were divided into 5 equal categories. Very poor knowledge was given to those who scored <5, 6 – 10 poor, 11 – 15 adequate, 16 – 20 good and >21 very good. For perception of hand hygiene and effectiveness of some measures to improve hand hygiene in the institution, the subjects were asked to grade on a scale of 1 to 5. Last part of the questionnaire consisted information regarding needle stick injuries, sharp objects and the factors associated with it.

The data thus obtained was compiled and analyzed in MS Excel. Chi square test was applied wherever necessary.

RESULTS

Among the 55 doctors, 77% were male and 23% female with mean age of 41.94+12.7 years. Fifty eight percent of the doctors had a very good knowledge of Hand Hygiene and 35% and 7% of them had good and adequate knowledge of hand hygiene. Among the nurses who constituted 52% of the sample, 76% of nurses had good knowledge, 19% had adequate and only 5% had very good knowledge of hand hygiene. Seventy percent of the interns had good knowledge and 14% and 16% of interns had adequate and very good knowledge respectively.

Fifty nine percent of the doctors, 58% of the nurses and 71% of the interns received formal education or training on hand hygiene. However the test showed no statistically significant difference between formal education received and level of knowledge on hand hygiene.

Mean years of experience of doctors was 11.9 + 10.25 yrs and nurses 3.8 + 1.82 yrs. There was statistical significance between the years of experience and level of knowledge, which means as the experience increases better, is the knowledge.

The whole of the nursing staff and the doctors were divided into two categories. One category consisted of doctors related to surgical field such as General surgery, ENT, Orthopedics etc and the nurses working under them. The other category consisted of them who were not related to surgical process directly such as those working in Dept of General Medicine, Dept of Pediatrics, Dept of Radiology etc and the nursing staff working under them. Casualty was included in surgical category. The test showed significant difference between the two categories (surgical and non-surgical) and knowledge of hand hygiene.

The participants were asked to grade the effectiveness of the hand hygiene on a 5 point Likert scale ranging from not effective to very effective. Ninety five percent of the respondents answered that hand hygiene is either effective or very effective to them. When asked about the effectiveness of hand hygiene towards hospital administration and to other hospital staff, 95% of them answered to be either effective or very effective. Whereas 1% answered that it is not effective to hospital administration or other hospital staff. Perception of hand hygiene towards patients was found to be either effective or very effective in 94% of the respondents.

A set of questions in the questionnaire were related to the perception of how effective a change could be made, to improve hand hygiene in institution. The responses were plotted on a 5 point Likert scale as mentioned above. Acceptable soap product made easily available was most effective measure and 7% of them were not sure of this. Hand hygiene would be increased if hand rubs are made easily available. Displaying of hand hygiene posters would not be effective according to the respondents. Regular education on hand hygiene would be very effective in improving the hand hygiene in the institution according to 94% of the respondents.

The respondents were asked about the factors responsible for poor adherence with hand hygiene. The most common reason was due to the lack of soap, towel or sinks followed by irritation and dryness of the skin and insufficient time. The uncommon reasons were skepticism, disagreement with the recommendations etc.

The incidence of needle stick injuries was found to be 50% in nurses, 31% in doctors and 25% in interns. When a statistical test was applied between the profession of HCWs and incidence of NSI it shows significant association.

Thirty four percent of the respondents said that recapping should be done immediately after giving injection. Out of which 14% were nurses, 12% were interns and 7% doctors. Fifty percent of the nurses had NSI in last 2 years with mean duration of 1.2 months back. The most common cause was during recapping. Incidence of NSI in doctors and interns was found to be 31% and 25% respectively, the most common cause again being recapping. As recapping was the most common cause of NSI, a test was applied to know the association. But there was no significant association.

Incidence of injury with sharps was found to be 11%. The highest incidence was observed among doctors which was 63% followed by the nursing staff 21% and interns 16%. A test was applied to know the association between the incidence of injuries with the sharps and the profession of the HCWs. However the test showed no statistically significant difference.

DISCUSSION

The knowledge scores ranged from adequate to very good in doctors, nurses and interns in this study. In a study conducted in Pakistan by Anwar et al (6) found that 17% of the physicians were aware of WHO recommendations of hand hygiene. They had also found that the hand hygiene was not practiced due to lack of sinks, soap, water and disposable towel. Similar findings were found in our study also. The perceived barriers in our study were divided into three categories which were – lack of resources, attitude, and behavior of HCWs. Lack of resources (37%) was the main reason for poor adherence which included factors such as sinks not available, lack of soap, towel etc. This was followed by attitude (35%) which included factors such as skepticism, disagreement with recommendations, insufficient time etc. The last reason being related to behavior of HCWS (28%) which included factors such as forgetfulness, no role model etc. Another study conducted by Zimakoff et al (7) has shown the same factors as barriers for hand washing.

Our study concluded that the year of experience in the hospital significantly correlates with the level knowledge. A study conducted by JB Suchitra and N Lakshmi Devi. (8) concluded that years of experience significantly co related to increased knowledge which is similar to our study.

In an intervention study in Nigeria examined the impact of systematized education's impact on their knowledge, attitudes and compliance with universal precautions. The research revealed that a number of positive changes occurred over the period of the study with respect to knowledge about universal precautions. The conclusion emphasizes that it is very important for education about universal precaution to be incorporated within current undergraduate and in-service training programmes for nurses. (9) Another study conducted by JB Suchitra and N Lakshmi Devi (8) showed the same findings. But our results showed no statistical significant association. The reason may be the duration of time that had elapsed after receiving the education. People tend to forget things as the time passes and particularly those which they do not practice.

Optimal duration for performing hand rub is 1 min (10) and the knowledge about it was significantly lower in nurses. The test also showed statistical significant difference, which means that the nurses should be adequately explained about the hand rub which is effective than hand wash.

Our study suggests that the participants are aware of importance of hand hygiene, which are similar to the findings of Jumaa(11) and Yuan et al.(12) The factors identified by the participants for improving hand hygiene practices in their institution are hand rubs made easily available and regular hand hygiene education.

The prevalence rate of NSI in last two years was 38.9% which was similar to the study conducted by Bayapa Reddy N et al (13) and Haile D and Berhane Y in Northwest Ethiopia. (14) Regarding the cause of NSI it was found that most number of injuries i.e., 83% occurred due to injection needle and only 17% while suturing. The study conducted by Moges T and Takele T (15) in Awassa city southern Ethiopia found the same prevalence rate.

In a study conducted by Khurram S et al (16) in Rawalpindi, Pakistan showed that 43.3% of NSI occurred in those who work in surgical department followed by 23% who work in non surgical departments. Our study showed that 52% of the NSI occurred in those working in surgical department and 48% in those working in non surgical departments, the results of which are almost similar to the study conducted by Khurram S et al. (16) Most of the NSI occur during recapping of the needle (53.33%) which is similar to the study conducted by Nsubuga FM, Jaakkola MS in Mulago ,Uganda(17) and by Iram Manzoor et al. (18) But there was no association between recapping and NSI. The reason may be that the cause of NSI may be multifactorial. Other factors include the process while giving injection, taking syringe from others etc, contribute to a greater extent. These results are in contrast to a study carried out by

Zafar A et al (19) at Aga Khan Hospital, Pakistan which reported that more than half of the injuries (52.8%) occurred while drawing the blood samples i.e., the process while giving injection.

CONCLUSION

Hand hygiene is simple and play a vital role in preventing the hospital acquired infections. The knowledge and perception towards hand hygiene among health workers is of utmost important in achieving the quality patient care. The knowledge should be converted as practice to achieve the goal. A periodic and ongoing reorienting education program regarding Universal Precautions which includes hand hygiene, handling of the sharps and other protective measures is essential for preventing the hospital acquired infections. Role of mentors plays a role especially in the nursing staff and interns. However this research is not without limitations. Since it was cross sectional study of assessing the knowledge no reorienting education has been imparted on the health workers. However such studies help the hospital managements to reduce the burden of Hospital Acquired Infections.