Download RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1
NAME
OF
THE
CANDIDATE
AND MISS.AMRUTHAVAHINI AMBADIPUDI,
ADDRESS
1ST YEAR M. Sc NURSING,
( IN BLOCK LETTERS)
S.D.M INSTITUTE OF NURSING SCIENCES,
SATTUR,
DHARWAD -580009.
2
NAME OF THE INSTITUTION
S.D.M INSTITUTE OF NURSING SCIENCES,
MANJUSHREE NAGAR, SATTUR,
DHARWAD -580009.
3
COURSE OF STUDY AND SUBJECT
1ST YEAR M.Sc. NURSING,
MEDICAL SURGICAL NURSING
SPECIALITY.
4
5
DATE OF ADMISSION TO THE COURSE
09.07.2011
TITLE OF TOPIC:
“A STUDY TO ASSESS THE KNOWLEDGE AND COMPLIANCE OF STAFF
NURSES REGARDING SELECTED ASPECTS OF UNIVERSAL PRECAUTIONS.”
6
BRIEF RESUME OF THE INTENDED WORK
Introduction
Infection control is the discipline concerned with preventing the spread of infections
within the health-care setting. It is an essential part of the infrastructure of health care.
Infection control addresses factors related to the spread of infections within the health-care
setting whether patient-to-patient, from patients to staff and from staff to patients, or
among-staff, including prevention via hand hygiene, usage of personal protective
equipments (PPE), disinfecting and handling of contaminated articles. It is on this basis that
the common title being adopted within health care is "Infection Prevention & Control."1
Universal precautions were originally devised by the United States for disease control
and prevention. Universal precautions apply to blood, body fluids, secretions, excretion,
non intact skin and mucous membrane. Standard precautions have played an important role
in minimizing the risk of exposure to blood borne pathogens in health care settings.2 In spite
of strict international standard guidelines and adequate training of the nursing professionals
during the curriculum, studies have proved that the standard universal precautions are not
followed in most of health care delivery system in the developing countries.
One of the central safety issues involving risk is compliance with the mandatory
precautions and regulations designed to prevent hospital acquired infections. Universal
Precautions have been widely promoted in high-income countries to protect health care
workers (HCWs) from consequent risk of infection with blood borne pathogens. In lowincome countries, the situation is very different Universal precautions are often practiced
partially, if at all, thereby exposing the Health Care Workers to unnecessary risk of
infection.3 According to WHO among the 35 million health workers worldwide, about 3
million experience percutaneous exposures to blood borne pathogens each year; two million
of those to HBV, 0.9 million to HCV and 170 000 to HIV. These injuries may result in 15
000 HCV, 70 000 HBV and1000 HIV infections. More than 90% of these infections occur
in developing countries4. Compliance with standard precautions has been shown to reduce
the risk of exposure to blood and body fluids. It’s been observed that better knowledge of
universal precautions among HCWs was one of the correlates of good compliance. 5
6.1 Need for the study
Regulated health professionals must be aware that appropriate infection control is
an integral part of practice. It plays a critical role in the health and safety of everyone
involved, including health care providers, clients and their families.6 Universal precautions
is evidence-based and outlines practice expectations for all nurses in all roles and practice
settings. Ensuring the use of safe, effective and ethical infection prevention and control
measures is an important component of nursing care. The nurse is trained to be
knowledgeable about the latest research and practices in preventing, detecting, and treating
infections. All standards provide a guide to the knowledge, skills, judgment and attitudes
that are necessary to practice the profession safely. They describe what each nurse is
accountable and responsible for in practice.2
Through hospital acquired infections, twice as many nurses have acquired HIV
infection when compared to physicians. One reason that may account for the increased
vulnerability of nurses is the greater amount of time nurses spend in direct patient contact 7.
Many studies have highlighted that staff compliance to Universal precautions is generally
scarce, and practice interventions to improve compliance are generally inadequate in their
effect. Strategies to protect health workers include implementation of Universal
Precautions, immunization against hepatitis B, provision of personal protection and the
management of exposures. Elimination of unnecessary sharps and proper disposal of
contaminated waste also minimizes the potential for exposure. Successful implementation
of these strategies is of paramount importance in preventing infections.4
Hand hygiene, has been recognized for more than 150 years as the single most
effective and cost-effective means of preventing hospital acquired infection, as well as an
effective means of preventing illness in the community. Despite this, many studies have
documented that compliance with hand hygiene recommendations in healthcare settings is
consistently less than 50%. Intensive education programs have been associated with modest
improvements in hand hygiene and dramatic reductions in rates of hospital-acquired
infections.8
Since the mid -1980s the use of gloves as an element of personal protective equipment
has become an every-day part of clinical practice for healthcare workers9. A study
conducted in (2001) provided evidence that vancomycin resistant enterococcus remained on
the hands of healthcare workers after the removal of gloves. Therefore, the use of gloves as
a method of barrier protection reduces the risk of contamination but does not eliminate it
and hands are not necessarily clean because gloves have been worn hence proper hand
washing is mandatory after removal of gloves.10
National and international guidelines recommend that protective clothing should be
worn by all healthcare workers when in close contact with the patient, materials or
equipment may lead to contamination of uniforms or other clothing with microorganisms,
or when there is a risk of contamination with blood, body fluids, secretions, or excretions
(with the exception of perspiration).11 A quasi-experimental study conducted in (2002)
investigated that use of gowns and gloves minimized the transmission of VRE. 12
A study demonstrated a lack of knowledge about guidance on using particulate
respirator masks among staff caring for patients with SARS and suggested that focused
training on the use of personal protective equipment and the transmission risk of SARS is
required.
13
Further a systematic review indicated that different protective eyewear offered
some protection against physical splashing of infected substances into the eyes but that
compliance was poor.9
Needle stick and other percutaneous injuries are among the most common and
avoidable occupational hazards in the hospital.14 A review of needle stick injuries in
Scotland suggested that 56% of injuries would ‘probably’ or ‘definitely’ have been
prevented if a safety device had been used.15
Statistics from India, evidences available from other countries and investigators
personal experiences’ provide an insight into the health risks associated with non
compliance of universal precautions. Hence it is felt that it would be appropriate to
undertake a study on knowledge and compliance of universal precautions among the staff
nurses’. Further it would highlight the existing problems with regards to infection control
and would help the decision makers in the institution to evaluate and revise certain
strategies and protocols of infection control and protect the clients’ health, as well as the
health care providers’. To forgo the fact the investigator acknowledges that no such study
has been conducted on knowledge and compliance of universal precautions among the staff
nurses’, in the selected hospital, Dharwad.
6.2 Review of literature
SECTION A - Knowledge on Universal Precautions.
SECTION B - Compliance regarding universal precautions.
SECTION A – Review of literature related to knowledge on Universal precautions.
A study was conducted to assess the awareness and knowledge of standard
precautions among nurses in a university teaching hospital in Ajman, UAE. All nurses
working in the hospital were given a structured, self-administered, anonymous
questionnaire: 101 nurses participated (range of experience from < 1 to 22 years). Overall
97.0% of respondents were familiar with the concept of standard precautions. Of these
61.2% believed that the blood and body fluids of all patients are potentially infectious
irrespective of their diagnostic status, while 27.6% thought only diagnosed patients and
11.2% only suspected cases are potentially infectious. Less than half agreed that standard
precautions aimed to protect both health care workers as well as patients (45.9%). The study
highlights a need to implement a programme to improve knowledge on standard
precautions.16
A cross-sectional survey was conducted to investigate the nurses’ knowledge and
compliance with Universal Precautions (UP) in an acute hospital at Hong Kong. A total of
450 nurses were randomly selected from a population of acute care nurses and 306 were
successfully recruited in the study. The study revealed that the nurses’ knowledge of UP
was inadequate. In addition, UP was not only insufficiently and inappropriately applied, but
also selectively practiced. Nearly all respondents knew that used needles should be disposed
of in a sharps’ box after injections. The nurses had difficulty in distinguishing between deep
body fluids and other general body secretions that are not considered infectious in UP. A
high compliance was reported regarding hand-washing, disposal of needles and glove
usage. However, the use of other protective wear such as masks and goggles was
uncommon. The results also showed no significant relationships between the nurses’
knowledge and compliance with UP. 17
SECTION B – Review of literature related to compliance regarding universal
precautions.
A cross sectional survey was conducted on compliance of universal precautions in
North India , the results were as follows, knowledge and understanding of Universal
precautions were partial, and Universal Precautions compliance was suboptimal, eg. only
32% wore eye protection when indicated, and 40% recapped needles at least sometimes.
After controlling for confounding, compliance with Universal Precautions was associated
with being in the job for a longer period, knowledge of blood borne pathogen transmission,
perceiving fewer barriers to safe practice and a strong commitment to workplace safety
climate. The study concluded that interventions to improve UPs' compliance among HCWs
in tertiary HCFs in India are urgently needed. A multifaceted approach promoting positive
perception of UPs compliance should include appropriate training. 3
A study was conducted to assess the Cypriot nurses' compliance with the main
aspects of Standard Precautions at the Republic of Cyprus. Self-completed questionnaires
that examined the frequency of the implementation of Standard Precautions were
distributed to a convenience sample of 668 nurses. The response rate was 89.37%.The
results showed inadequate compliance with Standard Precautions. Full compliance with all
the main aspects of Standard Precautions was reported by only 9.1% of the participants.
Male nurses and those who had not been exposed previously to pathogens reported better
compliance, in comparison to female nurses and those who had been exposed previously.
Nurses who had participated previously in an educational program about Standard
Precautions reported a higher frequency of implementing them than those who had not
participated. The nurses' age and frequency of the implementation of Standard Precautions
were found to be significantly and positively correlated. The results can be used to enhance
nurses' safety by focusing on areas of non-compliance.18
An observational study was conducted an on Health Care Workers (HCWs) to assess
the compliance with hand washing in Bangalore. Doctors, nurses and ward aides working in
different wards of the hospital were the participants. The results were in 270 observed
opportunities for hand washing, average compliance was 63.3%. Noncompliance was
highest among doctors followed by nurses. Ward aides were most compliant. The study
concluded that compliance with hand washing was moderate. Variation across the hospital
ward and type of HCW suggests that targeted educational programs may be useful.19
A study was conducted to evaluate self-reported compliance with personal protective
equipment (PPE) use among surgical nurses and factors associated with both compliance
and non-compliance, in the Pomeranian region of Poland. They were surveyed using a
confidential questionnaire. The survey indicated that compliance with PPE varied
considerably. Compliance was high for glove use (83%), but much lower for protective
eyewear (9%). Only 5% of respondents routinely used gloves, masks, protective eyewear
and gowns when in contact with potentially infective material. Adherence to PPE use was
highest in the municipal hospitals and in the operating rooms. Significantly higher
compliance was found among nurses with previous training in infection control or
experience of caring for an HIV patient. The most commonly stated reasons for noncompliance were non-availability of PPE (37%), the conviction that the source patient was
not infected (33%) and staff concern that following locally recommended practices actually
interfered with providing good patient care (32%). They recommend wider implementation,
evaluation and improvement of training in infection control, preferably combined with
practical experience with HIV patients and easier access and improved comfort of PPE.20
A study was conducted to assess knowledge, attitude, and practices of biomedical
waste management among health care personnel among hospitals of Allahabad city. The
participant medical personnel included were doctors (75), nurses (60), laboratory
technicians (78), and sanitary staff (70). Results were Doctors, nurses, and laboratory
technicians have better knowledge than sanitary staff regarding biomedical waste
management. Knowledge regarding the colour coding and waste segregation at source was
found to be better among nurses and laboratory staff as compared to doctors. Regarding
practices related to biomedical waste management, sanitary staff was ignorant on all the
counts. However, injury reporting was low across all the groups of health professionals
Hence concludes that lack of proper and complete knowledge about biomedical waste
management impacts practices of appropriate waste disposal.21
6.3 Statement of the problem
“A STUDY TO ASSESS THE KNOWLEDGE AND COMPLIANCE OF STAFF NURSES’
REGARDING SELECTED ASPECTS OF PRECAUTIONS IN A SELECTED HOSPITAL,
DHARWAD.”
6.4 Objectives of the study
1. To assess the level of knowledge of staff nurses regarding selected aspects of universal
precautions.
2. To determine the compliance of staff nurses’ towards selected aspects of universal
precautions.
3. To correlate the knowledge with compliance of staff nurses regarding selected aspects of
universal precautions.
4. To find the association between the knowledge and compliance with selected sociodemographic variables regarding selected aspects of universal precautions.
6.5 Operational definitions
1. Knowledge – In this study, knowledge refers to correct responses by the staff nurses to the
items listed in the structured knowledge questionnaire regarding selected aspects of
universal precautions such as Hand washing, personal protective equipments(PPE) and
disposal of contaminated waste practiced by staff nurses.
2. Compliance - The extent to which the staff nurses adhere to the standards of universal
precautions. It will be influenced by factors such as self- efficacy, knowledge of selected
aspects of universal precautions, place of work, years of professional experience and
resources available in the health care environment.
3. Universal precautions: In this study, Universal precautions refers to selected aspects of
infection control practices such as
hand washing, personal protective environment
equipments, disposal of contaminated waste practiced by staff nurses.
4. Staff Nurse – In this study, Staff Nurses’ are referred to those who have completed the
prescribed number of years of course that is 4 years degree or 3 ½ year diploma in General
Nursing & Midwifery with State Registration.
6.6 Hypotheses
H0: There will be no significant correlation between the knowledge and compliance of staff
nurses on universal precautions at 0.05 level of significance.
6.7 Assumptions
1. It is assumed that staff nurses will have some knowledge regarding selected aspects of universal
precautions.
2. Universal precautions are practiced by staff nurses in the health care delivery system as a part of
Infection control standard operating procedure.
3. Adequate knowledge and compliance may help the staff nurses to prevent hospital acquired
infections.
6.8 Delimitations
The study is limited to staff nurses in a selected hospital in Dharwad.
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MATERIALS AND METHODS
7.1
Source of data
The data will be collected from the staff nurses working in a selected Hospital, Dharwad.
7.2 METHODS OF DATA COLLECTION
7.2.1 Type of study approach
: Descriptive study
7.2.2 Research design
: Non experimental research design.
7.2.3 Variables under study
Study variable
: Knowledge and Compliance of staff nurses’
regarding selected aspects of universal Precautions.
Attribute Variables
: Personal characteristics which include age,
qualification, professional work experience, place of
work site.
7.2.4 Setting
: A Selected Hospital in Dharwad District.
7.2.5 Population
: The population consists of staff nurses working in a
selected hospital, Dharwad.
7.2.6
Sampling technique
: Non probability convenient sampling technique.
7.2.7 Sample size
: Sample size consists of 150 nurses working in a
selected hospital, Dharwad.
7.2.8 Duration of study
: 1 Month (data collection).
7.2.9 Inclusion criteria for sampling
1 Staff Nurses who are working in the selected hospital Dharwad.
2. Staff Nurses who will give consent to participate in the study.
3. Staff Nurses who has working experience of 6 months and more.
7.2.10 Exclusion criteria for sampling
1. Staff nurses who are above the level of ward supervisors.
2. Staff nurses who are on leave or absent from duty at the time of data collection.
3. Staff nurses who are not giving consent for the study.
7.2.11 Instruments intended to be used

SECTION A: Socio demographic profile consisting of items related to qualification,
professional experience and place of work site.

SECTION B: A structured knowledge questionnaire will be used to assess knowledge of
staff nurses regarding selected aspects of Universal precautions.

SECTION C: Observation checklist will be developed to determine compliance of nurses
regarding selected aspects of universal precautions.
7.2.10 7.2.12 Data collection method
To conduct the research study the investigator will obtain permission
from the concerned authority of the hospital. The investigator will obtain informed
consent from the subjects. In order to derive data from the subjects the investigator will
administer the structured knowledge questionnaire to collect data from the subjects.
Observation checklist will be developed to determine compliance of nurses regarding selected
aspects of universal precautions.
7.2.13 Data analysis plan
Descriptive statistics

Mean, median and standard deviation will be used to assess level of knowledge and
compliance of staff nurses.

Frequencies and percentages will be used for analysing the selected
socio- demographic data by using Tables, diagrams.
Inferential statistics

Karl Pearson’s correlation coefficient to find out relationship between the
knowledge and compliance.

Chi-square test will be used to determine the association between level of
knowledge, compliance and selected socio demographic variables.
7.3
Does the study require any investigations or interventions to be conducted on
patients, humans or other animals? If so please describe briefly.
Yes, the knowledge and compliance of staff nurses regarding selected aspects of universal
precautions will be assessed by using structured knowledge questionnaire and observation
checklist.
7.4
Has ethical clearance been obtained?
Yes, Ethical clearance has been obtained from Institutions’ ethical committee.
8
LIST OF REFERENCES
1. Infection control. available at http://en.wikipedia.org/wiki/Infection_control.
2. Kosier, Erb et al, Fundamentals of Nursing Process Concepts Process & Practice. 5 th Edition,
California: Addison –Wesley 2007;681-683,702.
3. Kermode M et al. Compliance with Universal/Standard Precautions amongst healthcare workers
in rural north India. American Journal of Infection Control. 2005; 33(1):27-33.
4. World Health Organization. Secretariat of the Safe Injection Global Network, Department of
Essential
Health
Technologies,
Health
Organization
2003.Available
at
http://www.who.int/injection_safety/toolbox/docs/AM_HCW_Safety.pdf.
5. Gershon RR et al. Compliance with universal precautions among health care workers at three
regional hospitals. Am J Infection control .1995; 23(4):225-36.
6. Practice Standard: Infection Prevention and Control (1995), College of Nurses of Ontario.
Available at http://bloomberg.nursing.utoronto.ca.
7. Gerberding JL. Needle stick prevention: New paradigms for research. Infection Control and
Hospital Epidemiology. 2004; 13(5): 257-258.
8. Dr.McGeer A. Implementing Effective Hand Hygiene Programs in Healthcare. Department of
Infection
Control
and
Microbiology.
Mount
Sinai
Hospitals.
Available
at
http://microbiology.mtsinai.on.ca.
9. Pratt RJ et al. The epic Project: Developing National Evidence-based Guidelines for Preventing
Healthcare associated Infections. Phase 1: Guidelines for Preventing Hospital-acquired
Infections. Journal of Hospital Infection. 2001;47(Supplement):S1-S82.
10. Tenorio AR et al. Effectiveness of gloves in the prevention of hand carriage of vancomycinresistant enterococcus species by health care workers after patient care. Clinical Infectious
Disease. 2001; 32: 826-829.
11. Garner JS. Hospital Infection Control Practices Advisory Committee. Guideline for isolation
precautions in hospitals. Infection Control and Hospital Epidemiology; 17: 1, 53-80,
and American Journal of Infection Control. 1996; 1 (24): 24-52.
12. Puzniak LA et al. To gown or not to gown: The effect on acquisition of vancomycin-resistant
enterococci. Clinical Infectious Diseases. 2002 ; 35:18-25.
13. Chia SE et al. Appropriate use of personal protective equipment among healthcare workers in
public sector hospitals and primary healthcare polyclinics during the SARS outbreak in
Singapore. Occupational Environmental Medicine. 2004; 62: 473-477.
14. Expert Advisory Group on AIDS and the Advisory Group on Hepatitis. Guidance for clinical
health care workers: Protection against infection with blood-borne viruses, 1998.London:
Department of Health.
15. Cullen BL et al. Potential for reported needle stick injury prevention among healthcare workers
through safety devices usage and improvement of guideline adherence: expert panel
assessment. Journal of Hospital Infection. 2006; 63: 445-451.
16. .Sreedharan J et al. Knowledge about standard precautions among university hospital nurses in
the United Arab Emirates. Eastern Mediterranean Health Journal. 2011;17(4): 331-334.
17. Chan R et al. Nurses’ knowledge of and compliance with universal precautions in an acute care
hospital, International Journal of Nursing Studies. 2006; 39(2):157-163.
18. Efstathiou G. Papastavrou E, et al. Compliance of Cypriot nurses with Standard Precautions to
avoid exposure to pathogens. Nursing & Health Sciences. 2011;13: 53-59.
19. Suchitra JB et al. Hand washing Compliance – Is It A Reality? Online J Health Allied Scs.
2006;4:2.
20. Ganczak M et al. Surgical nurses and compliance with personal protective equipment. Journal
of Hospital Infection. 2009;66(4)346-3
21. Mathur V et al. Knowledge, attitude, and practices about biomedical waste management among
healthcare personnel: A cross-sectional study.Indian J Community Med 36:143-5.
9
SIGNATURE OF THE CANDIDATE
10
REMARKS OF THE GUIDE
The study is of current interest and
feasible to conduct.
11
11.1 NAME AND DESIGNATION OF Mrs. HELENA. R. JOSEPH, M.Sc(N),
GUIDE ( IN BLOCK LETTERS)
ASSOCIATE PROFESSOR,
DEPT
OF MEDICAL SURGICAL
NURSING
SDM
INSTITUTE
OF
NURSING
SCIENCES,
SATTUR, DHARWAD.
11.2 SIGNATURE
11.3 CO-GUIDE (IF ANY)
________
11.4 SIGNATURE
------------
11.5 HEAD OF THE DEPARTMENT
PROF.GANGABAI .B.KULKARNI
SDM
INSTITUTE
OF
NURSING
SCIENCES,
SATTUR, DHARWAD
11.4 SIGNATURE
12
12.1 REMARKS OF CHAIRMAN This study is genuine and relevant to
AND PRINCIPAL
the present scenario to assess the
knowledge and compliance of staff
nurses regarding the selected aspects of
universal precautions and it is relevant
and appropriate.
12.2 SIGNATURE