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Knowledge And Perception Of Nosocomial Infection Among Health Workers And Resident
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1.2 Statement of the Problem
Healthcare workers (HCWs) are at menace
of occupational hazards as they carry out their clinical activities in
the hospital. Nosocomial infections have been acknowledged as a problem
disturbing the quality of health care and a principal source of adverse
healthcare outcomes. It has been recognized in the literature that
within the realm of patient safety, these infections have serious
impact. Increased hospital stay days, increased costs of healthcare,
economic destitution to patients and their families and even deaths, are
among the many negative outcomes (Emori et aI., 1991; Starfield et
aI.,2000; Angus et aI., 2001; Zhan &Miller, 2003; CDC, 2005;
Engemann et aI., 2005; Elward, et aL, 2005: Klevens et aL, 2007; Kaye et
aL, 2009; Edwards et aI., 2009; Scott II, 2009). $26 million (Anderson
et aI., 2009). These findings are indicative of the enormous economic
burden associated with nosocomial infections.
Epidemiological studies
report that nosocomial infections are caused by ubiquitous pathogens
transmitted, at least in part, by healthcare workers through direct and
indirect contact.
In 1938, Price established that microorganisms
recovered from human body could be divided into two categories: the
resident Hora (microbiota), or transient flora (Price, 1938). The
resident
microbiota, also commonly referred to as normal flora consists of bacteria mostly found in the
superficial
cells of the skin and mucous membranes; and in linings of the orifices
of digestive, respiratory and reproductive systems (Black, 2012). It has
been demonstrated in several immunological studies that resident
microbiota exhibits protective functions against invasion, or
outgrowth,
of pathogenic microorganisms and its depletion or aberration may lead
to opportunistic infections (Fujimura et aI., 2010). However, these
bacteria may cause infections in non-intact skin.
The most overriding species of resident microbiota is Staphylococcus epidermidis.
Transient microbiota are microorganisms present, under definite conditions, in any of the
locations
where resident microbiota are found. Some of these microorganisms take
possession of the superficial layers of the skin. They are more amenable
to removal by routine hand hygiene and such microorganisms are often
acquired by healthcare workers during direct contact with patients or
contaminated environmental surfaces, within the patient’s surroundings.
The most common types of transient bacteria are the Staphylococcus
aureus, Escherichia coli, {3eta-hemolyticStreptococci, Serratia
mercescens, Klebsiella pneumoniae, Pseudomonas aeruginosa,
Enterobacter species, Candida albicans and Clostridium difficile (Black, 2012). These are the
organisms frequently implicated in nosocomial infections (Monarca et aI., 2000; CDC 2002;
Lepelletier,
2005; Ribby et aI., 2005 &Hayden et al., 2006) and some of the
strains are resistant to antibiotics (Lodise et aI., 2002; Conly et aI.,
2004; Abba et al., 2005).
Epidemiological studies have demonstrated that transient bacteria are often acquired by
healthcare workers during direct contact with patients, or contaminated environmental surfaces,
within the patient’s surroundings (Monarca et aI., 2000; Lepelletier, 2005; Ribby et aI., 2005 &
Hayden
et aI., 2006). Epidemiological studies suggest that nosocomial
infections can be transmitted through direct person-to- person contact
between infected patient. healthcare workers, non-infected patients and
by indirect contact through equipment, supplies, medical procedures, or
air (CDC, 2000; WHO 2002). The affected body systems depend on the
virulence of the pathogens, accessibility of the pathogen to the patient
and susceptibility of the patient to the pathogen (CDC, 2000). The most
common types of nosocomial infections affect the urinary tract,
surgical wounds, respiratory system and blood stream (WHO, 2002).
Studies that have examined the impact of nosocomial infections caused by
antibioticresistant pathogens at a single center in Egor L.G.A and
some laboratories that served hospitals in Edo state, showed that
infections caused by antibiotic challenging pathogens were associated
with amplified mortality rates, increased lengths of hospital stay and
higher healthcare costs compared to the nosocomial infections caused by
pathogens susceptible to antibiotics.
These findings sustain the
notion that nosocomial infections present massive economic encumber to
the public and the healthcare system. In response to the realization of
the degree of the problem, various agencies including federal and state
governments, and professional societies – both nationally and
internationally, have devised measures aimed at reducing the incidence
of nosocomial infections. For example, Center for Infection Control and
Epidemiology developed guidelines for hand-hygiene in healthcare
settings and made recommendations for infection control practices which
were based upon the obtainable evidence surrounding the best practices
for patient care (Boyce at aI., 2002).
Furthermore, the Centers for Disease Control and Prevention (CDC), in cooperation with
government
and non-government organizations throughout the world, has synchronized
efforts and resources to help minimize the occurrence of nosocomial
infections; and recommend activities that increase quality of patient
care. In this regard, healthcare workers have been fostered to implement
strategies that would call attention to measures aimed at prevention of
the transmission of nosocomial infections. For that reason, healthcare
professionals have been encouraged to participate in in-service
continuing education on topics related to measures deemed necessary to
reduce the transmission of nosocomial infections.
The World Health
Organization (WHO), in conjunction with CDC, set prevention of
nosocomial infections as main concern by developing a practical guide
(manual) for the prevention of nosocomial infections globally (WHO,
2002). Some recommended strategies included in the manual were: the use
of hand decontamination, personal hygiene, exploitation of masks and
gloves; and proper methods of handling soiled clothing when healthcare
workers perform patient care activities. The manual also recommends
methods for preventing environmental transmission
including cleaning
the hospital environment, use of hot superheated water, disinfection of
patient equipment, sterilization, and prevention of transmission of
pathogens (for example, HIV, Hepatitis- B, Hepatitis-C viruses, and M.
tuberculosis) to staff. Above a/l, the manual recommends that hospitals
provide sufficient resources by training staff in infection control
programs such as appropriate patient isolation and sterilization
techniques and yearly work-plans and manuals for infection control
practices that are approved by infection control committees (WHO, 2002).
Such initiatives by the CDC suggest the importance with which
nosocomial infections should be addressed
(http://www.cdc.gov/ncidodlhip/prevention). Conversely, despite the
development of the above policies and recommendations, the incidence of
nosocomial infections and their collision on healthcare costs, morbidity
and mortality stay unabated (Anderson et aI., 2009 &Scott II,
2009) and healthcare workers are concerned in the transmission. The
centers for Medicare and Medicaid Services instituted a“payment reformâ€
program where the eventual reimbursement system will not cover costs
for preventable infections (nosocomial infections) acquired in the
course of treatment (Johnson, 2009). Moreover, the federal government
requires that healthcare institutions’ statistics on nosocomial
infections be made available to the public and hospitals with highest
rates of nosocomial infections will be penalized (DHHS, 2009).
Furthermore, the Healthcare Reform Law has instituted measures that
incentivize hospitals and other healthcare facilities to improve their
programs for reducing nosocomial infections. Findings from several
epidemiological studies divulge that healthcare workers such as
physicians, dentists and nurses are implicated in the transmission of
nosocomial infections.
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ABSRACT - [ Total Page(s): 1 ]Hospital acquired infections (HAIs) continue to be a threat to hospital admissions and workers thus contributing to mortalities and morbidities. Sophistication and type of services given by health facilities may determine health worker’s attitude towards combating these infections. The objective of this study is to compare knowledge, attitude and practice of HAIs among health workers at the three levels of health care in Nigeria, particularly the primary level that has to do with the resi ... Continue reading---
