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“A STUDY TO ASSESS THE KNOWLEDGE OF STAFF NURSES
ON THE PRACTICE OF ASEPTIC TECHNIQUE DURING
LABOUR IN SELECTED HOSPITALS OF RAICHUR,
WITH A VIEW TO DEVELOP SELF
INSTRUCTIONAL
MODULE”
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
RAJKUMARI LAKSHMI DEVI
NAVODAYA COLLEGE OF NURSING, RAICHUR
DECEMBER 2010
RAJIV GANDHI UNIVERSTITY OF HEALTH SCIENCES,
BANGALORE,KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. Name of the candidate
And address
:
Ms.Rajkumari Lakshmi Devi
:
M.ScNursing (1st year)
Navodaya College of Nursing
Navodaya nagar
Mantralayam Road, Raichur
2. Name of the institution
:
Navodaya College of Nursing
3. Course of the study and
:
MSc Nursing (1st year)
:
Obstetrics and Gynaecological
Subject
Nursing
4. Date of admission
:
5. Title of the topic
:
15-07-2010
“A STUDY TO ASSESS THE KNOWLEDGE OF STAFF NURSES
ON THE PRACTICE OF ASEPTIC TECHNIQUE DURING
LABOUR IN SELECTED HOSPITALS OF RAICHUR,
WITH A VIEW TO DEVELOP SELF
INSTRUCTIONAL
MODULE”
6. BRIEF RESUME OF THE STUDY
6.1 NEED FOR THE STUDY
Aseptic technique is a set of specific practices and procedure performed
under carefully control condition with the goal of minimizing contamination by
pathogen.
Aseptic technique is employed to maximize and maintain asepsis, the
absence of pathogenic organisms, in the clinical setting. Aseptic technique can
be applied in any clinical setting. Pathogens may introduce infection through
contact with the environment, personal or equipment. All patient are potentially
vulnerable to infection, although certain situation further increase vulnerability,
such as extrinsic burns or immune disorders that disturb the body natural
defences.
Typical
situation
that
call
for
aseptic
measure
include
surgery,insertion of intravenous line,urinary catheter,drains and labour room
setting1.
According to WHO report (2008),In India it is reported that 5060%of all neonatal death occur within the first month of life due to poor aseptic
technique practising in the labour room. Of these more than half may die during
the first week of life2.
The concept of asepsis can be applied in any clinical setting. A key
element requiring careful attention is equipment or supplies Medical equipment
can be sterilise by chemical treatment,radiation,gas or heat. Personal can take
steps to ensure sterility by assessing that sterile packages are dry and intact and
checking sterility indicators such as dates or coloured tape that changes colour
when sterile3.
The universal precaution to control infection which applied by all
medical and para-medical staffs
include the basic elements such as hand
washing thoroughly with soap and water before caring out the procedure,
immediately. If gloves are torn and hand is contaminated with blood or other
body fluids soon after the procedure with gloves on again after removing the
gloves. Strict asepsis during the delivery or operative procedure are practices
“no touch technique” which is any instrument or part of instrument which is to
be inserted in the cervical canal much not touch any non-sterile object or surface
prior to insertion. Sterilization or high level disinfection of instrument with
meticulous attention should followed in the labour room .In case autoclaving is
not possible, the instrument must be fully immersed in water in a covered
container and boiled for atleast20 minutes4.
The concept of aseptic technique is not new to India Bhore committee
in 1946 high lighted about the septic and aseptic deliveries. It was
recommended that separate delivery rooms be required in all hospitals. Reasons
for this conference recommendation were not based on preventing the spread of
infection, but rather for technical efficiency, convenience, availability, ease of
staffing and maintaining harmonious staff relationship most conference agreed
that since sterile aseptic technique is observed in surgical procedure and in
deliveries, there is no series danger of spreading
infection to either the
maternity patient or surgical patient if the same room is used. It was felt that in
hospitals were space could always be available for deliveries, some flexibility
should be provided so that delivery room and operating room might be used for
whatever procedure was necessary5.
Every day 1500 women die from pregnancy or child birth-related
complication. In 2005 there was an estimated 5,36,000 maternal death
worldwide. Most of the death occurs in developing countries due to home
delivery and poor aseptic techniques. Data shows that less than two third (62%)
of women in developing countries receive assistance from a skilled health
worker when giving birth. This means that 45 million home deliveries each year
are not assisted by skilled health personal6.
Recent newspaper report, May 2005 claimed that although there is a
enough staff nurse in the labour room, she remains busy with her and may be
following strict aseptic technique but the sweepers and other support staff do
not followed the aseptic precaution which will transferred the infection to the
patient.
Every year about 5000 patient die unnecessary in India from
hospitals acquired infection(National audit office 2000).Many become infected
during simple procedure such as IV drugs, owing to poor hand washing and
aseptic technique in labour room7.
The health care professional in general and nurses in particular play
a vital role to ensure that the newborn has best possible beginning of life and the
nurse must be aware of the potential problems and alert to the infant’s changing
condition and to intervene appropriately when necessary. The nurse is the first
health care provider who has direct contact with the neonate during birth .Hence
nurses required the knowledge and skill to take care of the babies as well as in
aseptic technique to prevent infection to both mother and baby, so that many
complication can be prevented8 .
Hence keeping the above points in mind the researcher felt the need
to assess the knowledge of labour room staffs on the practices of aseptic
technique during labour.
6.2REVIEW OF LITERATURE
A literature review is an examination of the research that has been
conducted in a particular field of study. It is to find out the method of study, it
help us to determine what has been done in past and will give us pointers on
how to develop or make some progress on its status. It provides basis to locate
pertinent data and new ideas that need to be included in the present study9.
A survey was conducted to examine the aseptic precaution for insertion
of an Epidural catheter in the labour ward at New Zealand College of
anaesthetists. The study consist of 435 consultant anaesthetists and the sample
were selected by simple random method. Of the 435 consultant anaesthetists
survey, 367 responded (84%), revealing a wide variation in practices. It was not
thought to be essential practice to removed a watch before washing hand by 51
responded (14%),to wear a face mask by 105(29%) or to wear sterile gown by
45(12%).Three anaesthetists (1%) did not believed sterile gown were essential.
However all respondent indicated that an aseptic skin preparation was essential.
The result concluded that a minimal standard of essential precaution is needed
for insertion of an epidural catheter10.
A Prospective case controlled study was conducted to assess the
association between bacterial vaginosis and preterm labour and to compare it
with those who delivered at term in MeeadKadumHassan,Hefa-Al-shaheen&
jehanmajeed Almukh, Afghanistan. Data were collected and analyse on 179
women in spontaneous labour,72 with preterm labour and 107 at term this study
was confirmed that gononerella vaginosis was the commonest bacterial
pathogens isolated from women with preterm labour ,It was detected in 17 out
of 72 women with preterm labour (23.6%)in comparison to 2 of
107(1.9%)women who delivered at term (p< value0.001 ) follow by group
B.Streptococus in 4(5.5%),E-coli in 2(2.8%), proteusin 1(1.4),streptococcus
and Neisseria gonorrhoea in 1(1.4%),In addition to bacteria listed above,
Trichomonasvaginalis was detected in 4(5.5%) of women preterm labour. It was
found that 72.3% of women with preterm labour had preterm rupture of
membrane in comparison to 39.2%of control (p:<0.001).From this result it is
concluded strict precaution will reduce the bacterial infection11.
A cross sectional study was conducted to assess the quality of care
provided by nursing personal to new born in the labour room at Koirala Institute
of Health Science, Nepal. Care provided by nursing personal to 814 normal
newborn and sample were chosen by non-probability purposive sample
technique. Data was collected through observational method by trained nursing
personal, using 46 item pre-tested,validated and self-develop observational
check lists. Result concluded that care provided to newborn from birth to 2
hourand categorise as good and average due to strict aseptic technique practices
during labour .Over all quality of care was good in 42.3%,average in 57.64%
and non of them received poor care12.
A study was conducted to asses the professional attire at delivery part in
Chicago to document current practices a questionnaire was mailed to obstetric
nursing supervisor 30 metropolitan hospitals. Follow up letter and phone calls
resulted in a response rate of 100% .As the annual number of birth per hospital
increase ,the use of surgical attire (p=0.056)and surgical drapes (p=0.03)
decrease. No significant difference was found between physician and certified
nurse-midwife use of apparel (p>0.16) .However, less frequent use of the cap
and gown by the certified nurse midwife did approach statistically significance
(p=0.09).A significance difference (p<0.05) was found for the use of attire
between delivery room and birthing room settings;more surgical attire was
required for the more traditional delivery room births13.
A survey was conducted to assess the bacterial infection after intrapartum spinal anaesthesia in Kolkata. Study consists of 200 sample consultant
anaesthetist and samples were selected by lottery method. The intrathecal space
is entered during several diagnostic and therapeutic spinal procedures, including
lumbar puncture (50%), myelography (10%) and spinal anaesthesia (40%) and
can occur inadvertently during epidural anaesthesia. Cases of meningitis have
been reported after all of these procedures, although most published case has
involved spinal anaesthesia (89%). Post spinal procedure meningitis causes
serious infection; in one cases series, one third of cases resulted in death14.
6.3 STATEMENT OF THE PROBLEM.
“A study to assess the knowledge of staff nurses on the practice of aseptic
technique during labour in selected hospitals of Raichur, with a view to develop
self instructional module”.
6.4OBJECTIVES OF THE STUDY
1.
To assess the knowledge of staff nurses regarding the
practice of aseptic technique during labour.
2.
To analyse the relationship between knowledge of staff
nurses regarding the practice of aseptic technique with
demographic variables.
3.
To prepare a self-instructional module regarding the practice
of aseptic technique.
6.5. OPERATIONAL DEFINITION
 Knowledge:
Refers to the level of understanding of staff nurses
regarding the practice of aseptic technique as measured by their correct
responses to the correct item of questionnaire.
 Staff nurses: The title and position accorded to a registered
nurse who is permanent member of a Hospital.
 Labour: Labour is the process by which the foetus, placenta,
membrane and cord are expelled through the birth canal.
 Aseptic technique: A set of specific practices and procedure
performed under carefully controlled condition with the goal
of minimising contamination by pathogens.
 Self-instructional module: Systemic organization of
scientific information regarding the assessment on practice
of aseptic technique which serves as a hand guide for staff
nurses to practice the aseptic technique effectively.
6.6. HYPOTHESIS
H1-There will be significant relationship between knowledge of staff
nurses regarding the practice of aseptic technique and selected variables
(Age, Educational qualification, Experience and Previous orientation).
SELECTED VARIABLES
Variable is an attribute of a person or object that varies, which takes
on different values.
Two types of variables are identified in the study. They are:


Dependent Variable

Independent Variable
Dependent Variable: -The outcome of interest, the variable
that is hypothesized to depend on or caused by another variable i.e.
independent variable. In this study the knowledge of Staff Nurses on the
practice of aseptic technique is the dependent variable.
 Independent variable: -Independent variables are the stimulus or
activities that are manipulated or varied by the researcher to create an
effect on the dependent.
Selected variables:Age: Refers to the chronological age of the staff nurses. For the
present study it is categorized as
a. 20 – 25 years
b. 26 – 30 years
c. 36 years – above
Educational qualification: Refers to the professional education
of the staff nurses. For the present study it categories as:
a. G.N.M
b. BSc Nursing
Experience: It refers to years of working period .The following
ranges of experience are considered for the study.
a. <2years
b. 2-3years
c. > 3years
Previous orientation training: Refers to any training on the
practice of aseptic technique,previously expose or not.
a. Yes
b. No
7. MATERIALS AND METHODS
7.1 SOURCES OF DATA:
Design: The research design adopted for this study is descriptive
design.
Setting of the study: The present study was conducted in
selected hospitals of Raichur. Raichur district is one of the
backward districts; it has an area of 6,839 sq.mtand located in
the North region of Karnataka. Navodaya Medical College,
Hospital and Research Centre, Sanjeevani Maternity Hospital,
Nandini Hospital is selected for the study.
Population: - The population for present study are staff nurses.
Sample:-Consists of 100 staff nurses from the selected
Hospitals.
Sample Technique:-Purposive sampling technique will be used
to select the Hospital and Convenient sampling method to be
used to select the samples.
Inclusion criteria :The study includes the staff nurses who are –

in the age group of 20 years and above

working in selected Hospitals

available at the time of data collection

willing to participate in the study
Exclusion criteria
The study excludes the staff nurses who are not–

in the age group of 20 years

working in selected Hospitals

available at the time data collection

willing to participate in the study
7.2DATA COLLECTION INSTRUMENT
Structured self administered questionnaire will be used for data collection
and information will be gathered regarding knowledge of staff nurses on
practice of aseptic technique during labour.
7.3 DATA COLLECTION METHOD
After obtaining prior permission for data collection from the
selected Hospitals and concerns from the subjects, the investigator will assess
the knowledge of staff nurses regarding on the practice of aseptic technique, by
using structured self- administered questionnaire.
It consists of two parts:Part1- Deals with socio-demographic data.
Part2-Represent knowledge regarding on the practice of aseptic technique
among staff nurses during labour.
7.4 PLAN FOR DATA ANALYSIS:
The word analysis means categorizing and summarizing the data
statistically to obtained answers to research question. The following methods
were planned to analyze the data:

Frequency and percentage distribution would be used to
Summarizing the sample characteristics.

Mean and standard deviation were used to determine the
knowledge score.

Chi – square value will be computed to find the association
between knowledge with selected variables.
7.5 PROJECTED OUTCOME
The present study gives an insight regarding the knowledge level of staff
nurses regarding aseptic technique during labour by which the researcher can
implement educational programme to improve the awareness regarding
practices of aseptic technique during labour and also help the future researcher
to inculcate newer method of assessment and educational programmes.
7.6DOES
THE
STUDY
REQUIRE
ANY
INVESTIGATION
OF
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR HUMANS
OR ANIMALS? IF SO, DESCRIBE BRIEFLY?
Since it is a descriptive study, the study does not require any
investigation or intervention to be conducted.
7.7HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION?
 Permission will be obtained from the Institutional Ethical
Committee, Navodaya College of Nursing, Raichur.
 Permission will be obtained from Hospital authorities.
 Consent will be obtained from all the participants.
8. BIBLIOGRAPHY
1. Bjerke,Nancy,Hand Hygiene in Health care: Playing by the new rules,
Infection Control Today February 2003[cited February 2003].
2. Dix Kathy, Observing Standard Precaution in the OR, Infection Control
Today October 2002[cited February 2003]
3. Osman Cathy.Asepsis and Aseptic Practices in the Operating room.
Infection Control Today July 2000[cited February 2003].
4. Myles Textbook for Midwife 13 Edition. Churchill Livingstone
Publishes: 414-425.
5. Katherine Hauswirth APRN ,Gale Encyclopedia of Nursing and Allied
Health,2002 ,76(2):277-287.
6. WinnyHandwith,PregmaLaproscopes-Manufacture
of
high
Quality
Laproscopic instruments-www.pregnalaproscopic.com
7. http/www.who.int/makingpregnancy-safers/topics/maternalmortality/in/index.html
8. P.Padmanabam;ParvathySankaraRaman,Innovation and challenges in
Reducing
maternal
mortality,J
health
population
Nutr.2010
june;27(2):202-209.
9. PolitF.Denis and Bernadatta,Hungler B.P. Nursing Reserch Principles
methods London;JBLipincott company:1987
10. J.Morisslemons ,NewZealand
state journal of medicine infection.
November 2008:222-226.
11. Medical journal of Basrah University 2005 June.
12. Kathmandu University Medical journal (2009),vol 7.No 3, Issue 27,231237.
13. Journal of Nurse-Midwifery, volume 36, Issue 4 July,August 2005:240244.
14. Bacterial infection after intrapartum spinal Anesthesia,Kolkata 20082009,Weekly January 29,2010/59(03);65-69.
10. Remark of the Guide
:
11.Name and Designation of :
11.1 Guide
:
Mrs. Sreelekha.C
Associate Professor & HOD
Obstetrics& Gynaecological Nursing
Navodaya College of Nursing
Raichur.
11.2 Signature
:
11.3 Co-Guide
:
11.4 Signature
:
11.5 Head of the Department :
Mrs. Sreelekha.C
Associate Professor & HOD
Obstetrics& Gynaecological Nursing
Navodaya College of Nursing
Raichur.
11.6 Signature
:
12. Remarks of the
Chairman&Principal
12.1 Signature
:
: