Reducing the Risk of Transmission of Nosocomial Infections

Reducing the Risk of Transmission of noocomial InfectionsCHAPTER 1 originThe timeworn precautions (SP), proposed by the united States Centers for Disease Control and Prevention (CDC) in 1996, ar escapelines for reducing the bump of contagious disease of nosocomial transmissions in infirmarys. It proposes that dead body fluid, longanimous blood, secretions, and excrement atomic number 18 infectious, hence preventive meatirees are necessity to protect some(prenominal) patients and health check personnel. These preventive measures include rid ofance of exact contact with patients and air-borne particles, and require hand washables and sterilization, the example of personal tutelar equipment (PPE), the safe disposal of acutely instruments and knock off management (Luo, He, Zhou Luo, 2010).1.1 earth of the StudyStandard precautions are specific whollyy designed to slew the pretend of getting occupational nosocomial transmissions from both known and unknown source s in the health caveat setting. Awareness and respectfulness with these recommendations is crucial for the prevention of occupational nosocomial infections in healthcare personnel and patients (Abdulraheem, Amodu, Saka, Bolarinwa Uthman, 2012).Standard precautions include hand process routine of personal protective equipment (gloves, gown, cap and mask) care with devices, equipment and clothing employ during care environmental entertain (surface processing protocols and health service waste handling) adequate discarding of sharp instruments and patients accommodation in conformance to requirement aims as an infection transmission source. Hand hygiene is close to beta measures among the example precautions advocated (Abdulraheem et al., 2012). Stringent observations of these measures protect the personnel against blood-borne viruses and to decrease transmission of cross infections among patients (Atif et al., 2013).Nurses are the group of health care brookrs with the mos t take contact with patients while providing care. in that respectfore, nurses adherence to infection prevention precautions would have a pro plant effect on reducing nosocomial infection rank (Al-Hussami Darawad, 2013). The causal agents that figure out infections are transmitted mainly by hands, after(prenominal) failure to comply with hygiene procedures. Hand washing is considered the most important measure in preventing infections. However, according to Jusot et al. (2004), in their study in the southeast cover of France, configuration of healthcare geters (HCWs) with SP was variable and often paltry. In terms of acquaintance, Chan et al. (2002) report that in Hong Kong, nurses companionship on SP was inadequate, in terms of applying precautions inappropriately and inadequately. In addition, Abdulraheem et al. (2012) in their study that conducted at North Eastern Nigeria also raise that only a very small proportion of HCWs had a healthy experience on SP.Different epidemiological characteristics of nosocomial infection in children results from the specificities of anatomy, physiology, medical conditions, therapeutic and surgical conditions and type of pathogens in pediatric populations. as well as that, the pediatric-hospitalized population is very heterogeneous, varying in age, diagnosis, and underlying illness, ranging from infants with congenital anomalies to adolescents with ninefold traumas. Consequently, even patients admitted to the same ward pose a different risk for hospital-acquired infections (Lopes et al., 2006). Pediatric disregardcer patients have an increased risk of potentially unsafe infectious complications ascribable to their underlying illnesses and intensive anti go offcer treatment (Simon et al., 2008). Thus, SP are very crucial in preventing these nosocomial infections.It is clear that SP reduces the extent to which HCWs open to the blood of differents, and, presumably, this in turn reduces their risk of occu pational infections with blood borne pathogens. Although it has been routinely practiced in high-income countries for a long time, it is hard to achieve full phase of the moon accord. Non obligingness has been associated with a range of factors, which include lack of knowledge, interference with spend a penny skills, risk perception, non wanting to offend patients, lack of equipment and time, uncomfortable PPE, inconvenience, work stress, and perceiving a weak organizational commitment to safety climate (Kermode et al., 2005).1.2 bother StatementThe reality of adopting SP within the hospital setting is far from what is recommended and had proven to be somewhat problematic (Gammon Gould, 2005). Efstathoiu, Papastavrou, Raftopoulos and Merkouris (2011) also reported that adherence with SP among nurses in Cyprus in influence to avoid exposure to microorganisms was low. More specifically, accord was found insufficient regarding hand hygiene guidelines, use of gloves when exposu re to body fluids was anticipated, philia protection, mouth and nose protection (mask use), wearing a gown when required, avoid recapping the needle after it was used for a patient, and provision of care considering all patients as potentially infectious. According to Gammon, Samuel and Gould (2008), in United Kingdom, staff meekness to SP was usually deficient, and practice interventions to improve adherence were generally limited in their effect.infirmary acquired infections (HAI) or nosocomial infections (NI), which pose a serious problem, imminent the health and safety of patients and medical personnel worldwide due to poor compliance towards SP. Nosocomial infections, defined as those occurring within 48 hours of hospital admission, trinity days of discharge or 30 days of an operation, usurp one in every ten patients admitted to hospital. These infections affect the feeling of medical care and increase medical care costs (Inweregbu, Dave Pittard, 2005). According to the cosmea Health Organization (WHO) (2009), hundreds of millions of patients develop HAI around the globe every course of instruction and as m some(prenominal) as 1.4 million cases occur in hospitals but each day.In pediatric setting, HCWs always assumed that children are low-risk patients. Although it was admit that the children peck also carry contagious diseases, but they often do non implement SP (Efstathoiu et al., 2011). Nosocomial infections are a crucial clinical complication in adult and children patients at the different hospital wards worldwide. Nosocomial infections bring considerable morbidity and mortality associated with prolonged hospital keep on and increased health care costs (Nagliate, Nogueira, Godoy Mendes, 2013). Kinnula et al. (2012) in their study at Finland and Switzerland found that 8.4% of children in a ward for pediatric infectious diseases acquired a viral HAI during their hospitalization, although only 13% of the HAIs manifested themselves during h ospitalization, the majority, 87%, occurring after discharge. So, from here can be proved that, SP are very important to be utilise in the clinical settings. Without these measures, NI will occur.For infirmary USM, pediatric oncology ward, 6 Utara (6U) showed the highest rate of NI if compared to others pediatric ward (Unit Kawalan Jangkitan Epidemiologi Hospital, 2013). This may be due to the low immune system of those children. Pediatric cancer patients are at an increased risk for specific HAI. These adverse events can result not only in operative morbidity and mortality, but also in an increased expenditure of limited financial and personnel resources (Simon et al., 2008). According to Unit Kawalan Jangkitan Epidemiologi Hospital (2013), the average NI occurred per month from noble 2012 to August 2013 was 3 cases, which contributed to 4.62% of total admission of the patient. This was quite a high number. Thus, interventions should be interpreted to investigate the complianc e take aim of the pediatric nurses towards SP and thus to reduce the infection rates.Table 1.2.1 Total nosocomial infection occurred per month at 6Ufrom August 2012 to August 2013 (Source Unit Kawalan Jangkitan Epidemiologi Hospital, 2013)DateTotal NITotal no. of admissionTotal % of admission in wardAugust 20124586.89September 20123476.38October 20122822.45November 20120500December 20121741.35January 20132653.0February 20135608.33March 20133624.84April 20132653.06May 20134715.6June 20133674.4July 20131761.31August 20134675.97AVERAGE3654.62Guidelines or policies that guide an individuals sort exist in a variety of settings (including health care settings), but people do not always comply with them. In order to explain and understand the factors that cultivate an individuals adherence with certain guidelines, which consequently may bring to the adoption of certain behavior, a number of conceptual models or theories had been authentic (Efstathiou et al., 2011).Conceptual framework that used in this study in explaining the knowledge and compliance towards SP among pediatric nurses at Hospital USM was adapted from the Theory of intend Behavior (TPB) by Ajzen (1991). The TPB leave alones a model that has potential benefits for predicting the intention to complete a behavior based on an individuals attitudinal, normative beliefs and perceived behavioral control. As for this study, the knowledge on SP, self-efficacy (attitude), awareness on the importance of banal operating procedures (SOPs), and some individual factors of nurses will entrance their practice towards SP in healthcare setting.1.3 look Objectives1.3.1General ObjectiveThe general aim of this study is to identify the knowledge and compliance towards measuring rod precautions among pediatric nurses at Hospital Universiti Sains Malaysia (Hospital USM).1.3.2Specific ObjectivesTo identify the take of knowledge regarding standard precautions among pediatric nurses at Hospital USM.To identify the t ake aim of compliance with standard precautions among pediatric nurses at Hospital USM.To get word the association mingled with selected socio-demographic in governing body (working ward, clinical working experience in geezerhood and highest nursing educational level) and level of compliance with standard precautions among pediatric nurses at Hospital USM.To determine the association amidst levels of knowledge regarding standard precautions and level of compliance among pediatric nurses at Hospital USM.To determine the association betwixt self-efficacy and level of compliance with standard precautions among pediatric nurses at Hospital USM.1.4Research QuestionsWhat is the level of knowledge regarding standard precautions among pediatric nurses at Hospital USM?What is the compliance level among pediatric nurses towards the application of standard precautions in the pediatric ward at Hospital USM?Is there whatever association between working ward and level of compliance with s tandard precautions among pediatric nurses at Hospital USM?Is there any association between clinical working experience in years and level of compliance with standard precautions among pediatric nurses at Hospital USM?Is there any association between highest nursing educational level and level of compliance towards standard precautions among pediatric nurses at Hospital USM?Is there any association between level of knowledge regarding standard precautions and level of compliance among pediatric nurses at Hospital USM?Is there any association between self-efficacy and level of compliance with standard precautions among pediatric nurses at Hospital USM? Research conjecture1.5.1 Hypothesis 1HO in that respect is no world-shaking association between working ward and level of compliance with standard precautions among pediatric nurses at Hospital USM.HA There is a of import association between working ward and level of compliance with standard precautions among pediatric nurses at H ospital USM.1.5.2 Hypothesis 2HO There is no significant association between clinical working experiences in years and level of compliance with standard precautions among pediatric nurses at Hospital USM.HA There is a significant association between clinical working experiences in years and level of compliance with standard precautions among pediatric nurses at Hospital USM.1.5.3 Hypothesis 3HO There is no significant association between highest nursing educational level and level of compliance with standard precautions among pediatric nurses at Hospital USM.HA There is a significant association between highest nursing educational level and level of compliance with standard precautions among pediatric nurses at Hospital USM.1.5.4 Hypothesis 4HO There is no significant association between level of knowledge and level of compliance with standard precautions among pediatric nurses at Hospital USM.HA There is a significant association between level of knowledge and level of compliance w ith standard precautions among pediatric nurses at Hospital USM.1.5.5 Hypothesis 5HO There is no significant association between self-efficacy and level of compliance with standard precautions among pediatric nurses at Hospital USM.HA There is a significant association between self-efficacy and level of compliance with standard precautions among pediatric nurses at Hospital USM.1.6 translation of Operational TermsKnowledgeKnowledge is defined as the level or degree of information acquired in a particular field. It is a basic requirement so that the positive changes in behavior can be developed. Knowledge can further bring into awareness and in turn leads to action. To develop nursing knowledge, it comes from both theoretical and practice perspectives. By gaining knowledge, it raises awareness of personal and professional accountability and the dilemmas of practice (Ndikom Onibokun, 2007). In this research, it was referred to the knowledge regarding SP and its application.Compliance Compliance is defined as the extent to which certain behavior (for example, following physicians orders or implementing healthier lifestyles) is in accordance with the physicians instructions or health care advice. It can be influenced or controlled by a variety of factors such as culture, economic and affectionate factors, self-efficacy, and lack of knowledge or means (Efstathiou et al., 2011). In this research, it was referred to compliance or adherence towards SP to prevent NI.Standard precautionsThe standard precautions are defined as guidelines to reduce the risk of transmission of blood-borne and other pathogens in hospitals. It proposes that body fluid, patient blood, secretions, and excrement are infectious. Hence these measures are incumbent to protect both patients and HCWs (Luo et al., 2010). Standard precautions include hand washing use of personal protective equipment (e.g., gloves, gown, cap, mask) care with devices, equipment and clothing used during care environmen tal control (e.g., surface processing protocols, health service waste handling) and adequate discarding of sharp instruments including needles (Vaz et al., 2010). In this research, SP referred to those policies that protect patient and HCWs such as hand washing, use of PPE, safe sharp disposal and waste management.Nosocomial InfectionsNosocomial infections are defined as infections that occur within 48 hours of hospital admission, three days of discharge or 30 days of an operation (Inweregbu, Dave Pittard, 2005). In my research, it was referred to the infections that acquired within the period of hospitalization.Self-efficacySelf-efficacy is defined as the bureau to control and guide ones own activities. General self-efficacy is a general confidence when the individual deals with changeable environments and faces new experiences (Luo et al., 2010). In this research, it was referred to the self confidence in implementing SP to prevent NI.1.7Significance of the StudyNosocomial infec tions control requires a junto of interventions, including knowledge about the use of SP, rational use of antimicrobials, hand washing and compliance with SP and manuals for prevention and controlling microorganisms. Health professionals low compliance with and difficulties to use SP had been demonstrated in some research though (Efstathiou et al., 2011 Luo et al., 2010). Hence, in reckon of application and even compliance failures that compromised patient and professional safety (Sax, Uckay, Richet, Allegranzi Pittet, 2007), it is necessary to pass judgment nurses knowledge and compliance about SP (Nagliate et al., 2013). By assessing the knowledge and compliance level toward SP among the nurses, interventions could be taken to improve the quality of health care services as well as provide a holistic nursing care to reduce the morbidity and mortality worldwide.In order to reduce HAI and protect the health of patients and HCWs, the relevant authorities and hospital infection co ntrol departments should pay more attention to nurse compliance towards SP, settle SP training, and provide sufficient practical PPE. Through learning, the attainment of knowledge and skills, and the formation of health beliefs and attitudes, health activity habits can be formed. Only when individuals are familiar with the content and meanings of the SP, with strengthening of the individuals health concepts, can individual practice change so as to improve compliance with SP. For nurses, the study on adherence towards SP and factors impacting compliancy should be strengthened in order to improve concepts of health and self-efficacy, to increase compliance with the SP and hence reduce the chances of NI (Luo et al., 2010).The reason that the researcher wished to conduct this research was because from the researchers observation during clinical posting, it was observed that, the nurses often neglected the importance of SP. For example, they did not apply the proper ways in implementing SP, some even did not adhere to it at all due to time saving and other reasons. On the other hand, the reason that this study been conducted at pediatric ward was because children is having low immunity if compared to adults, they are at high risk of acquiring NI, so the implementation of SP is very important to ensure a quality health care.In addition, no research on the knowledge and compliance towards SP had been done at Hospital USM before this. Thus, this study is crucial to assess the knowledge and compliance level towards SP among pediatric nurses at Hospital USM to provide a preliminary data that is crucial for the hospital. This study can provide a better insight into the magnitude of the problem of infection control in this hospital. By knowing all these, interventions can be taken if the knowledge and compliance level are disappointing to increase the knowledge and compliance towards SP among the pediatric nurses to reduce the morbidity and mortality rate.