Knowledge And Practice Of Infection Control Among Nurses:
[EMMANUEL GENERAL HOSIPITAL EKET AS CASE STUDY]

1.1 BACKGROUND

Infection-related diseases are still the main cause of death in Nigeria, according to the 2013 health profile acquired by the World Health Organisation (WHO, 2013) statistics. The burden of disease in Nigeria  includes HIV, TB, Malaria, other infectious diseases and respiratory infections. Expansion of the infection prevention and control movements occur due to the increase in infection occurrences in the country. This increase in infection-related disease’s impact the increase health financing in Nigeria with a government contribution to health care of 57.5% above the figures budgeted for (WHO, 2014).

Infectious patients are admitted into hospitals and therefore hospitals have become common settings for transmission of diseases. In hospitals, infected patients are a source of infection transmission to other patients, health care workers and visitors (Sydnor & Perl, 2011). Nosocomial infection, also known as hospital-acquired infections is one of the leading causes of death and has much economic cost due to increased hospitalization and prognosis (WHO, 2015). According to WHO (2010), Hospital acquired infection is defined as an infection occurring in a patient during the process of care within a health care facility which was not present or incubating at the time of admission. These infections are those occurring more than 48 to 72 hours after admission and within ten days after hospital discharge (Collins 2008:2). Due to the admission of patients with different organisms, the hospital environment has become saturated with highly virulent organisms, namely: Staphylococcus aureus, Streptococcus pyogenic, Escherichia coli, Pseudomonas aureginosa and Hepatitis viruses that survive in a hospital. These organisms cause diseases ranging from minor skin infections to life-threatening conditions such as sepsis (Sydnor, & Perl, 2011).

The Nigeria Ministry of Health has indicated that Ebola virus disease epidemic is a public health risk as  neighbouring country are suffering from the diseases and therefore preparedness in infection prevention and control measures should be strengthened. Efficient knowledge, good attitude and best practices by nurses in infection prevention and control may contribute to decreasing in infection rate in the hospital.

The Nigeria policy on health has stipulates that the health care institution should provide a safe environment for the patients in their care. Hospital nurses form the backbone of infection prevention and control, therefore possibly, will either contribute to infection transmission or prevent and control infection. According to Damani (2012), the environment in which a patient is nursed must be planned to reduce the risk of transmission of infection. Infection prevention and control measures aim to protect the vulnerable people from acquiring an infection while receiving health care (Damani, 2012). Lack of knowledge, bad attitudes and poor practices amongst nurses in the prevention and control of infections can lead to hospital-acquired infections.

In clinical practice, the researcher has observed cases where nurses handle contaminated linen with bare hands, put needles in the patient’s mattress after giving injections, do not clean the stethoscope between patients and do not wash hands regularly in the clinical environment. Poor infection prevention and control practices among nurses increase the rates of hospital-acquired infections.

Hand hygiene is the single most important intervention to prevent transmission of infection and should be a quality standard in all health institutions. An attitude of not washing hands among individuals involved in the provision of health care can increase the rate of hospital-acquired infections. In a study that was conducted in India, where Nair, Hanumantappa, Hinemath,Siraj and Raghunath (2013:3) assessed knowledge, attitude and practices of hand hygiene among medical and nursing students at a tertiary health care centre, the majority of students had poor knowledge with regard to hand hygiene.

Lack of knowledge among nurses can increase the rate of hospital-acquired infections. This is supported by a study that was conducted in Zimbabwe by Tirivanhu, Ancia and Petronella (2014:73) who determined the barriers of infection prevention and control practices among nurses at the Bindura provincial hospital. The study revealed that the majority of nurses’ lack knowledge on infection control principles as only n= 14 (28%) of n= 50 (100%) nurses had excellent knowledge on

infection control principles, n= 21 (42%) of n= 50 nurses did not utilize the infection control manuals. Infection control workshops were poorly organised as 68% of the nurses did not attend any workshop on infection prevention and control practices (Tirivanhu et al., 2014). Hayeh and Esena (2013:47) assessed the infection prevention and control (IPC) practices among health workers at Ridge Regional Hospital in Accra (Ghana). The study showed that knowledge in IPC practices among health care workers was moderate 51% (n= 204), as availability and access to material for IPC practices at the facility was 58% (n= 118) and overall compliance with IPC guidelines was 54% (n= 110).

The World Health Organisation (2016) has indicated that surgical site infections at this particular tertiary hospital in Nigeria are a research priority as there was an increase in wound infections of those people who had surgery at this hospital and this coincides with the researcher’s experiences and proposal. Therefore, this study determined the knowledge, attitude and practices of nurses in infection prevention and control within a tertiary hospital in Nigeria.

1.2 PROBLEM STATEMENT

A research problem is an area of concern in which there is a gap in the knowledge base needed for nursing practice (Burns & Grove 2011:146). The researcher has observed that nurses do not apply infection prevention and control measures in the hospital setting which is required to ensure patient safety. Lack of knowledge, attitude and practices in infection prevention and control contribute to high rates of hospital-acquired infections (Jain, Dogra, Mishra, Thaku and loomba, 2012 & Hayeh and Esena, 2013). Uncontrollable nosocomial infection contributes to prolonged stay, morbidity and mortality which put stress on health care economics of the country (Mishta, Banerjee & Gosain, 2014).

1.3 RESEARCH QUESTION

1.What is the level of knowledge, attitudes and practices of health care workers in infection prevention and control in Maiduguri ?

1.4 RESEARCH AIM

In order to address the research question, the aim of the study is to determine the knowledge, attitudes and practices of nurses regarding infection prevention and control in Maiduguri.

1.5 RESEARCH OBJECTIVES

Based on the aim, the following objectives have been set for the study to determine:

1.The knowledge of  midwifes  in infection prevention and control in Maiduguri.

2.The attitude of midwife  in infection prevention and control in Maiduguri.

3.The practices of midwife  in infection prevention and control in Maiduguri

4.To make recommendations to the risk programme and policies in Maiduguri

1.6 SIGNIFICANCE OF THE STUDY

This study on the knowledge and practice of infection control among midwives will be of immense benefit to the general public on the concept of infection and will also help the midwives to come to the understanding of the causes of infections during child birth and how to prevent and control it. This study will also assist hospitals to put in place prevention measures to curbing the rate of infection that occur during and after child birth. This study  will also add to existing literature in this study domain and will serve as a reference material to scholars, researchers and students who may want to carry out further research on this topic or related area in the future.

1.7 SCOPE OF THE STUDY

This study focuses on examining the knowledge of midwifes  in infection prevention and control in Emmanuel General Hosipital Eket. This study will also examine the attitude of midwife  in infection prevention and control as well as the practices of midwife  in infection prevention and control in Maiduguri. This study will further make recommendations to the risk programme and policies in Maiduguri. This study enroll nurses working at the federal government hospital, Maiduguri as the participants for this  study.

The major factors that posed a challenge to the researcher while carrying out this study were inadequate literature on this study domain, insufficient time and finance.

1.8 DEFINITION OF TERMS

KNOWLEDGE: Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts, skills, or objects. By most accounts, knowledge can be acquired in many different ways and from many sources, including but not limited to perception, reason, memory, testimony, scientific inquiry, education, and practice.

PRACTICE: Practice is the act of rehearsing a behaviour over and over, or engaging in an activity again and again, for the purpose of improving or mastering it, as in the phrase 'practice makes perfect'. It is important to note that practise is a verb and should not be confused with the noun practice.

INFECTION: The invasion and multiplication of microorganisms such as bacteria, viruses, and parasites that are not normally present within the body. An infection may cause no symptoms and be subclinical, or it may cause symptoms and be clinically apparent.

CONTROL:Control is a function of management which helps to check errors in order to take corrective actions, manage and prevent infection.

MIDWIVES: A midwife is a health professional who cares for mothers and newborns around childbirth, a specialization known as midwifery.