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Rajiv Gandhi University of Health Science, Karnataka,
Bangalore
PROFORMA SYNOPSIS FOR REGISTRATION FOR
DISSERTATION
MRS. DHANYA.P.NAIR.
1. NAME OF THE CANDIDATE
AND ADDRESS
D/O MR. K.R.PURUSHOTHAMAN NAIR
KALAPPURACKAL HOUSE
UZHAVOOR EAST POST
KOTTAYAM DISTRICT
KERALA-686634
M.S RAMAIAH INSTITUTE OF
2. NAME OF THE INISTITUTION
NURSING EDUCATION AND
RESEARCH
M.S.R.I.T.POST
BANGALORE-560054
M.Sc NURSING (1ST YEAR)
3. COURSE OF STUDY AND
SUBJECT
MEDICAL SURGICAL NURSING
DISSERTATION PROTOCOL
31-5-2007
4. DATE OF ADMISSION TO
COURSE
5.
TITLE OF THE TOPIC:
EFFECTIVENESS OF STRUCTURED TEACHING MODULE FOR
NURSES ON KNOWLEDGE REGARDING PREVENTION AND
MANAGEMENT OF MRSA (METHYLINE RESISTANT
STAPHYLOCOCCUS AUREUS) INFECTIONS.
1
6. BRIEF RESUME OF INTENDED WORK
INTRODUCTION:
"Every human being is the author of his own health”
…. Buddha
As long as one is healthy, he or she is safe. Health deteriorates due
to various reasons, and sometimes it requires hospitalization. Hospitalization disrupts
normal routine functioning of client and his family. Hospital is a place, which
harbours germs, or organisms, which leads to infections among the clients health care
providers.1
Staphylococcus aureus is one of the most versatile nosocomial
pathogens. The wide spread use of penicillin in the early 1950’s saw the spread of
penicillin resistant in Staphylococcus aureus hospitals, after which time methicillin
and its derivatives become the drug of choice for the treatment of infections 2. Even
before methicillin was widely used Jevons identified strain of Staphylococcus aureus
with natural resistance to this antibiotic in 1961.Thereafter, methicillin resistant
S.aureus emerged as a major pathogen world wide2.
Several survey has confirmed that the incidence of MRSA
( Methyline Resistant Staphylococcus Aureus) varies form region; during last 20
years, the proportion of isolates resistant to methicillin less than 1%in Scandinavia
and more than 30% in India, France ,Italy and Spain. In the 1990s, a type of the few
antibiotics began to showing up in the wider community.
Today, that form of
Staphylococcus known as CA-MRSA (Community Acquired Methyline Resistant
Staphylococcus Aureus) is responsible for many serious skin and soft tissue Infections
and for serious form of pneumonia. MRSA (Methyline Resistant Staphylococcus
Aureus) infection can be fatal. Media as “super bug” because of its multiple drug
resistance.3 has referred it
2
In recent years, MRSA (Methyline Resistant Staphylococcus
Aureus) has become a particularly significant problem in Indian hospitals. In one
study conducted in tertiary care hospital in India, Methyline Resistant Staphylococcus
Aureus) MRSA (carriage rate ranged between 28.4%in out patients to 35 % in inpatients. MRSA is often seen in units such as trauma, burns, surgical, pulmonary and
intensive care. These units are fertile environment for MRSA because of open
wounds, frequent dressing changes requiring handling by multiple health care
workers, use of intra luminal devices, and inherent immuno-compromised state of
patients.3
Staphylococcus bacteria are commonly found in the skin or in
the nose of about one third of population. Staphylococcus bacteria are generally
harmless unless they enter the body through a cut or other open wound. Healthy
people can be carriers and they pass germ to others. But in older adults and people
who are ill or have weakened immune systems it causes serious illness called
Methicillin-resistent Staphylococcus Aureus. MRSA’s resistance to commonly used
antibiotics has developed over time as a result of the widespread use of antibiotics,
individuals who do not complete the prescribed course of medications, improper
prescribing of antibiotics, and the sharing of medications. For many years, prescribing
antibiotics was the standard of practice whether it was appropriate or not. Over time,
the “bugs” have adapted to the drugs in their efforts to survive, and drugs that were
once effective can no longer kill the organisms.4
The first documented MRSA outbreak in the United States
occurred at a Boston hospital in 1968 but the disease was confined to hospitals and
nursing homes for many years. Over the last decade it has started to emerge
drastically in critical care units, operation theatres, etc. In 1990s, a type of MRSA
began showing up in the wider community. Today, that form of staphylococcus
known as CA-MRSA (Community Acquired Methiline Resistant Staphylococcus
Aureus) is rapidly evolving bacteria and resistant to most of the antibiotics.5
A CDC (Centre for disease control) reports published in
October 2007 issue of the Journal of American Medical association suggested that
3
MRSA infections are more prevalent than previously thought. A strategy for National
Health Service trusts (NHS) recommends options for specific patient groups and is
drawn from approaches found to be practical and effective across various NHS
clinical settings. There is good evidence and /or strong consensus that screening
should be applied to almost all patients including pre-operative patients, emergency,
orthopaedic, trauma, critically ill patients, and patients on dialysis.6
Other patients include, all patients previously known to be
MRSA positive, all elective surgical patients, oncology/chemotherapy patients,
patient admitted from high-risk settings etc. Practising strict aseptic techniques,
including hand washing, use of personal protective equipments and isolating the
patients who are found to be MRSA positive helps to reduce the infection level at
hospitals.6
6.1 NEED FOR THE STUDY
Hospitalisation can be an experience for the patients as
being comforted and “cared for.” However it can be also an experience for anxiety
and depression. There may be pain, disability and uncertainty for the patients; along
with added up infection from the hospitals.
MRSA is usually introduced into an institution by a
colonised or infected patient or health care worker. It is well known that colonisation
with MRSA precedes infection. Several modes of transmission exist, including
transient colonisation of hospital staff and contact with heavily contaminated fomites
and environmental surface of the infected patients. Factors contributing to the
transmission and perpetuation of this organism include prolonged hospital stay and
use of several broad-spectrum antibiotics. Carriage of the pathogen by healthcare
workers who can transmit the pathogen to the patients with whom they have contact
also directly contributes to the continuance of the problem.4
4
As above-mentioned, the main mode of transmission
includes hands of healthcare workers, environment, and air (less frequent). Major risk
factors include, surgical and traumatic wounds, superficial skin lesions such as
pressure sores ulcers and dermatitis, colonisation of nose or skin with MRSA,
presence of invasive devices, prolonged hospital stay, extreme age, excessive use of
antibiotics, patients at high units, immune response/immunosuppressive therapy,
overcrowding and staff shortage, inadequate facilities for hand washing, frequent
transfer of patients and staff between units and hospitals.4
The National Nosocomial Infections Surveillance
(NNIS) System of the Centre for Disease Control and Prevention (CDC) performed a
survey from October 1986 to April 1998. They ranked hospital wards according to
their association with central-line bloodstream infections. The highest rates of
infection occurred in the burn ICU, the neonatal ICU, and the pediatric ICU.
Nosocomial infections are estimated to more than double the mortality and morbidity
risks of any admitted patient and probably result in as many as 70,000 deaths per year
in the United States. This is the equivalent of 350,000 years of life lost in the United
States. 7
The National Statistics department said that there is a
sudden rise in the death rates due the people suffering from MRSA, the so-called
hospital super bug. According to the latest figures MRSA is now six times more likely
to be a factor in the deaths of people in National Health Service (NHS) hospitals. A
total of 1,168 people had MRSA recorded on their death certificate as a principal
cause of death or a contributory factor in 2004, a rise of 213 from 2003. Fears of
lethal hospital infections such as MRSA are driving a record 50,000 patient a year
abroad for treatment. Despite billions being poured into the Health Service, patients
are now spending £163 million a year on medical services overseas. India, Hungary
and Turkey are among the most popular destinations for medical tourists. So the
health tourism also one factor, which invites infection, forms other countries to India.6
Incidence of MRSA infections is increasing due to
unsanitary conditions in hospitals and over crowding. According to a survey
5
conducted by Indian Medical Association, it shown that the incidence of MRSA in
1990s, as 0.5% is now has been increased to 3-4 % in tertiary hospitals. A study
conducted in Hinduja Hospital about programme of MRSA surveillance in India, 739
culture swabs were taken from patients form different cities, 235 (32%) were found to
be multiply resistant with the individual figures for resistance being (47%) Bangalore,
42.5 %( Delhi) and in 27 % (Bombay). MRSA is emerging to be a significant
problem pathogen in the surgical setting with vancomycin probably the only reliable
choice for these infections.10
A study was conducted in August1997, St Johns Medical
college hospital, Bangalore in the burns unit, to determine the prevalence of MRSA in
colonisation in health workers. 34 health care workers screened for the same using
swab from hairline, nostril, axilla, and hands. 17 out of 34 screened were MRSA
positive; 16 people tested positive for the methicillin- sensitive strain of, 7 of
Staphylococcus Aureus them were also MRSA-positive at different site. In total, over
two third of all healthcare workers were colonised by Staphylococcus Aureus.3
Treatment of MRSA is mainly by the drugs such as Mupirocin,
Vancomycin, Teicoplanin etc, in which mupirocin is not even started available in
India and the cost of vancomycin and teicoplanin is not affordable for poor people to
have a complete course of particular medication. It is always “prevention is better
that cure”. So it’s a high time for nurses to have knowledge about basic preventive
measures of MRSA infection and its management.
Also, student researcher’s own experiences from working with
the isolation wards in an oncology unit, motivated need of giving awareness to the
nurses regarding the knowledge of prevention and management of MRSA infections.
6.2 REVIEW OF LITERATURE
Review of literature is the key step in research process. Literature
review of present study has been collected and presented under following headings,
6
6.2.1
General information about MRSA infections.
6.2.2
Incidence associated with MRSA infections
6.2.3
Role of health care professional in prevention and management of MRSA
infections.
6.2.4
Effectiveness
of
teaching
programme/awareness
of
prevention
and
management of MRSA infections for nurses.
Literature related to;
6.2.1 General information about MRSA
Staphylococcus aureus is a gram positive organism, usually
found as normal flora of skin and mucous membrane of human. Pathogenic ones can
cause severe infections. Staphylococcus bacteria are generally harmless unless they
enter the body through a cut or other open wounds. It has been shown that because of
gene mutation and long-term antibiotic use, some of the strains are become resistant
to the penicillin’s and it is called MRSA (Methicillin resistant staphylococcus aureus).
Experts so far uncovered 17 strains of MRSA, with differing degrees of immunity to
the effects of various antibiotics. Two particular strains, clones 15 and 16, are thought
to be more transmissible than the others, and accounts for 96%of MRSA bloodstream
infections in UK.4
The main mode of transmission includes hands of healthcare
workers, environment, and air (less frequent). Major risk factors include, surgical and
traumatic wounds, superficial skin lesions such as pressure sores ulcers and
dermatitis, colonisation of nose or skin with MRSA, presence of invasive devices,
prolonged hospital stay, extreme age, excessive use of antibiotics, patients at high
units, immune response/immunosuppressive therapy, overcrowding and staff
shortage, inadequate facilities for hand washing, frequent transfer of patients and staff
between units and hospitals.6
In 1990s, a type of MRSA began showing up in the wider
community. Today, that form of staphylococcus known as CA-MRSA (Community
Acquired Methyline Resistant Staphylococcus Aureus) is rapidly evolving bacteria
7
and resistant of most of the antibiotics. The risk factors of CA-MRSA is young age
especially children, participating in contact sports, sharing towels and athletic
equipments, having a weakened immune system, living in crowded unsanitary
conditions, recent hospitalisation and antibiotic use and association with healthcare
workers etc.6
MRSA infections can cause a broad range of symptoms
depending on the part of the body is infected. These may include surgical wounds,
burns, catheter sites, eye, skin, and blood. Infection often results in redness, swelling
and tenderness at the site of infection. Generally symptoms starts as small red bumps
that resemble pimples, boils or painful abscess that require surgical drain. Healthy
individuals act as the carries of infections.6
Sample for screening is collected from anterior nares
(nose).This is the most common carriage site for MRSA. Other sites include swabs
from axilla, perineum and any skin lesions, if present. Three testing methods are in
use in laboratories in UK: direct culture on an MRSA-selective agar, broth enrichment
with sub culture, and PCR rapid test. In India broth enrichment with sub culture is
widely used.6
Treatment
is given with antibiotics such as mupirocin,
vancomycin, teicoplanin, and other drugs are used as per sensitivity to the particular
organism and per clinicians order. Chlorhexidine bath is also used for external
decolonization. Three consecutive negative screening is done weekly, are required to
declare MRSA negative.6
6.2.2 Incidence associated with MRSA
The first epidemics caused by MRSA occurred in eastern
Australia in the late 1970s and this, or a closely related organism, first became a
clinical problem in England in 1980-1981, in the northeast Thames region. A survey
conducted over a six-month period by the Staphylococcus Reference Laboratory
revealed that by 1987-1988 this strain (Methyline Resistant Staphylococcus Aureus 1) was affecting 50 different hospitals. Eleven other epidemic strains were also
8
identified during the survey, each affecting up to eight hospitals. In one year a single
strain of MRSA, prevalent in south-east England, produced 40 infections, including
bacteraemia, pneumonia, surgical wounds, and skin and urinary tract infections, and
three attributable deaths in one acute hospital.6
The National Statistics department said that there is a sudden
rise in the death rates due the people suffering from MRSA, the so-called hospital
super bug. According to the latest figures MRSA is now six times more likely to be a
factor in the deaths of people in National Health Service (NHS) hospitals. A total of
1,168 people had MRSA recorded on their death certificate as a principal cause of
death or a contributory factor in 2004, a rise of 213 from 2003.6
A study conducted in department of Microbiology and
Immunology, Choithram Hospital & Research Centre, Indore. MRSA prevalence
increased from 12% in 1992 to 80.83% in 1999. Indian literature shows that MRSA
incidence was as low as 6.9% in 1988 and reached to 24% and 32.6% in Vellore and
Lucknow in 1994 and was of the same order in Mumbai, Delhi and Bangalore in 1996
and in Rohtak and Mangalore in 1999. However, in some of the centres it was as high
as 87%.9
Sir Dorabji Tata Centre for Research in Tropical
Diseases, Society for Innovation and Development, Indian Institute of Science
Campus, Malleswaram, Bangalore, conducted a study on genotyping of methicillinresistant Staphylococcus aureus strains from two hospitals in Bangalore, South India.
Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen
in India, and up to 70% methicillin resistance has been reported from hospitals in
various parts of India.11
6.2.3 Knowledge of nurses regarding prevention and management of
MRSA
A Study conducted by B.S.Coopler and B.S.Gibbler on
Isolation measures in hospital management of MRSA shows that intensive control
measures including patient isolation is effective in controlling MRSA. No well
designed studies exist to that allows the role of isolation measures alone to be
9
assessed. None the less, there is evidence that concerted efforts that include isolation
can reduce MRSA even in endemic settings. Current isolation measures
recommended in national guidelines should continue to be applied until further
research establishes otherwise.
A study conducted in Ninewells Hospital and Medical School,
Dundee, UK, on infection control and management of MRSA: assessing the
knowledge of staff in an acute hospital setting .The aim of this study was to assess the
knowledge and perceived practice of staff regarding MRSA and its management in an
acute hospital setting. A further aim was to determine what staff felt was needed in
terms of information or education on the risks, management and treatment of MRSA.
A questionnaire survey was carried out through group administration during a study
day and by face-to-face interviews. Subjects included in the questionnaire were
regarding infection and colonization, treatment, and the availability of local support
and advice. There were 174 responses, divided equally between doctors and nurses.
Knowledge on many aspects of MRSA and its management was deficient, although
the majority of participants who felt that they required additional information about
MRSA acknowledged this.8
A study conducted in USA, at Society for health care
Epidemiology of America (SHEA) on preventing nosocomial transmission of multi
drug-resistant strains of Staphylococcus aureus. In spite of infection control practices
followed in the hospital they noted that there is a steady rise of MRSA infections, a
task force was appointed draft the evidence based guidelines in preventing
nosocomial transmission of pathogens. This study has recommended contact
precautions for patients colonized or infected with this type of pathogens. They
recommend many facilities should require this as a policy.12
6.2.4. Effect of teaching programme/awareness of MRSA infections for nurses.
A study conducted on Contact precautions for
Clostridium dificile and Methicillin-Resistant Staphylococcus aureus (MRSA) in
School of Nursing and Midwifery, University of Southampton , and implications
emerging from a single case study designed to explore a group of nurses' and
10
healthcare assistants' infection control practice, and to introduce interventions aimed
at implementing best practice. The study was undertaken on one hospital ward and the
sample comprised all permanently employed nurses and healthcare assistants (n=18).
Guidelines on Contract Precautions were developed and informed by an expert panel
of infection control nurses (n=100) from across the UK. Analyses of the data from all
three phases of the study revealed that participants experienced great difficulty
comprehending infection control recommendations and varied in the extent to which
they adopted them. Their capacity to understand and implement these
recommendations was hampered, not only by a lack of knowledge, but also by
irrational beliefs, inaccurate perceptions of risk, both in relation to themselves and
patients, and a lack of ability or willingness to exercise clinical judgment, particularly
in relation to glove use. It has shown that a structured protocol on contact precautions
was effective in implementing isolation precautions. These findings highlight the need
for further study in the drive to improve this crucial aspect of health care services.14
A study was conducted on Impact of education on knowledge,
attitudes and practices among various categories of health care workers on
nosocomial infections, Department of Microbiology, Mysore University, Karnataka.
A total of 150 subjects were included. A scoring system was devised to grade the
Knowledge, Attitude and Practice Score. (KAP score). They were further subjected to
a series of similar questionnaires at intervals of 6, 12 and 24 months after an
education module. Subjects in each category of staff (n=10) were observed for
compliance to hand washing practices in the ward in the post-education period. Total
compliance was 63.3% and ward aides were most compliant 76.7% Education has a
positive impact on retention of knowledge, attitudes and practices in all the categories
of staff. There is a need to develop a system of continuous education for all the
categories of staff. In order to reduce the incidence of nosocomial infections,
compliance with interventions are mandatory.15
11
6.3 STATEMENT OF PROBLEM
A Study to Assess the Effectiveness of Structured Teaching Module for Nurses on
Knowledge Regarding Prevention and Management of MRSA (Methyline Resistant
Staphylococcus Aureus) Infections at Selected Hospitals of Bangalore.
6.4 THE OBJECTIVES OF THE STUDY
1. To assess the knowledge of nurses regarding prevention and management of
MRSA infections.
2. To determine the effectiveness of structured teaching module among nurses
regarding MRSA infections.
3. To find the association between post test knowledge scores and their selected
socio demographic variables.
6.5 RESEARCH HYPOTHESES
H1: There is significant difference between pre-test and post-test level of
knowledge of nurses.
H2: There is significant association between knowledge and sociodemographic variables.
6.6 OPERATIONAL DEFINITION:
1. Effectiveness
:
Refers to gain in knowledge by nurses regarding
MRSA infections as determined
by significant difference in pre-test and posttest knowledge as measured by a questionnaire.
2. Structured teaching
module
:
It refers to systematically organised teaching
strategy for a duration of one hour on prevention
12
and management of MRSA infections.
3. Knowledge
:
Ability to give correct response to questions
asked by investigator measured by structured
knowledge questionnaire
4. MRSA prevention
:
and management
It refers to measures to be taken to avoid the
occurrence infections in the hospitals and
management modalities by nurses by
various methods.
5. Nurses
:
Registered nurses working in different units of
Hospitals for the study
7. MATERIALS AND METHODS
7.1 Sources of data:
Registered Nurses working in different units in selected hospitals for study.
7.2 METHODS OF DATA COLLECTION
7.2.1 Type of study approach
:
Evaluative study
7.2.2 Research design
:
One group pre-test post-test preexperimental design
7.2.3 Variables under study
:
Independent variable :Dependent variable :Attribute variables :-
structured teaching module
Knowledge of Nurses
Age, socio economic status, gender,
professional qualification, experience,
previous exposure, experience,
religion ,habitat.
13
7.2.4 Sampling technique
:
Non probability convenient sampling
technique
7.2.5 Sample size
:
50 nurses.
7.2.6 Follow up
:
A post test knowledge assessment will be done
after administering teaching module after 10
days and subsequent follow up is not done.
7.2.7 Comparison parameters :
Comparison between pre-test and post- test
knowledge scores.
7.2.8 Duration of the study
:
One month.
7.2.9 INCLUSION CRITERIA

Registered nurses who are working in different units in selected
hospitals of Bangalore

Nurses who are qualified with diploma/or degree certificate.

Nurses who are available during the period of data collection.
EXCLUSION CRITERIA

Nurses who are not willing to participate in the study

Nurses who have already undergone training programme on
management of MRSA Infections.
7.2.10 INSTRUMENTS USED
1. Section A
:
Socio-demographic variables consisting
of age, gender, professional
qualification, socioeconomic status,
religion, previous exposure, habitat etc.
2. Section B
:
Structured knowledge questionnaire
regarding various aspects of prevention
and management of MRSA infections.
14
7.2.11 Data collection procedure
After obtaining permission from the concerned authority, the
investigator will take written consent from the participants and explain the purpose of
the study and questionnaire will be administered followed by administration of a
teaching module and a post-test will be conducted after one week, subjected for data
analysis.
7.2.12
Statistical methods used:
The data obtained will be analysed in terms of objectives of the study
using descriptive and inferential statistics. The plan of data analysis is follows:
Descriptive statistics
- Frequency and percentages will be used to analyse the socio-demographic
data, and knowledge scores.
-
Mean, mean statistics, median and standard deviation of pre test and post test
knowledge scores, will be used to assess the knowledge.
Inferential statistics:
-
Paired’ test to assess the effectiveness of structured teaching module on
knowledge regarding prevention and management of MRSA infections.
-
“Chi-square” to determine the association between post test knowledge and
selected socio-demographic variables.
15
7.3 Does the study require any investigation or intervention on patients
or other humans/ animals. If so please describe briefly?
Yes, structured teaching module regarding prevention and management of
MRSA infections will be provided and knowledge will be assessed.
7.4 Has ethical clearance been obtained?
Ethical clearance will be obtained from concerned authority and the ethical
committee. Written consent will be obtained from the subjects.
Confidentiality and anonymity of the subject will be maintained.
16
8. LISTS OF REFERENCES
1. Spink VW, Ferris V. Quantitative action of penicillin inhibitor from penicillinresistant strain of Staphylococcus. Science 1945; 102: 102-221.
2. Jevons MP. Celbenin-resistant staphylococci. BMJ 1961; 1: 124-25.
3. Krishnan Unny Prabha, Aravind Preetha. Screening of burns unit staff of a tertiary
care Hospital for MRSA colonization.Indian J Crit Med 2000; 10: 16-41
4. Vaghela G, L Shah,.M patel,S Mulla. Study of antibiotic sensitivity pattern of
Methicillin- resistant Staphylococcus aureus. Indian J Crit Care Med 2007; 11: 99-10.
5. Barrold SS. Emeregnce of mrsa infections. 1998 jan-mar (cited 1999dec
10):1(2);available in www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html.
6. Griffith A. NHS Scottish Health Technology Assessment Report.2006 (cited in
2006jJune) available in www.dh.gov.uk.reduorgmrsa
7. B S Cooper, S P Stone, C C Kibbler. Isolation measures in the hospital
management of methicillin resistant Staphylococcus aureus (MRSA). BMJ 2004 Sep
4; 329(7465): 533
8 P.M. Easton, A. Sarma, F.L.R. Williams. Infection control and management of
MRSA: assessing the knowledge of staff in an acute hospital setting.
Journal Hosp Infect 2007;66(1): 29-33
9 Verma S, Joshi S, Chitnis V, Hemwani N. Growing problem of methicillin resistant
staphylococci--Indian scenario. Indian J Med 1996;42(1):1-3
10 Metha A,Rodrigues C,Kumar R, et al .A pilot programme of MRSA surveillance
in India. Journal of PG Med 1996; 42:1-3
17
11 Gayathri Arakere, Savitha Nadig, Swedberg. Genotyping of Methicillin-Resistant in
Staphylococcus aureus Strains from two Hospitals Bangalore.Journal of clinical
microbial 2005;43: 3198–202
12 SHEA guigeline for preventing nosocomial transmission of multidrug- resistant
strains of Staphyloccus aureus ,Infect Control Hosp Epidemiol 2003; 24(5):362-386
13 Srinivasan S, Sheela D, S, Mathew. Risk factors and associated problems in the
management of infections with methicillin resistant Staphylococcus aureus. Indian J
Med Microbiol 2006; 24:182-5
14. Jacqui Prieto. Contact precautions for Clostridium difcile and Methicillin-resistant
Staphylococcus aureus (MRSA), Assessing the impact of a supportive intervention to
improve practice. Journal of Research in Nursing 2005; 10(5):511-26
15. Suchitra JB, Lakshmi Devi N. Impact of education on knowledge, attitudes and
practices among various categories of health care workers on nosocomial infections.
Indian J Med Microbiol 2007; 25:181-7
18
9.
Signature of the Candidate
10.
Remarks of the Guide
The study highlights the major
responsibilities of nurses during blood
transfusion. Very few studies are found
in this area. Hence it is feasible study to
conduct.
11.
Name and Designation of:
(in Block Letters)
Mrs. Prof. PRATIBHA SWAMY
PROFESSOR AND HOD
MEDICAL – SURGICAL NURSING
11.1
GUIDE
11.2
SIGNATURE
11.3
CO-GUIDE – (If any)
11.4
SIGNATURE
11.5
Head of the Department.
11.6
Signature.
12.1
Remarks of the Chairman and
Principal.
NIL
The synopsis of this study broadened the
current nursing practice and it is feasible
and relevant.
Signature.
12.2
19