ABSTRACT
This study was carried out to examine the factors that are affecting the compliance of nurses to standard precaution in Olabisi Onabanjo Teaching Hospital, Sagamu, Ogun State. The specific objectives the study was to; Assess the level of knowledge and understanding among nurses about standard precaution practices; Determine the level of compliance of nurses to standard precaution; Investigate the factors affecting the practices of standard precaution among nurses; and Examine the type of precaution that nurses practices.
A total of 154 questionnaire were administered to nurses at all levels in Olabisi Onabanjo Teaching Hospital, out of which 120 were retrieved for the study which was analysed using statistical package for social science (SPSS).
It was observed from the study that a good number of the nurses knowledge about standard precautions. Also, a higher percentage of them comply with standard precaution on a daily basis as it relates to their work.
In addition, discomfort with PPE shortage of time; staff and supplies; and the absence of staff safety policies and management were the most common factors observed to influence compliance with standard precautions.
The study recommended that; Health care workers should improve and update their knowledge of standard precaution in nursing; The nurses and medical unit should at all times comply with standard precaution in the nursing profession and Adequate equipment and enabling environments should be provided in all of our healthcare facilities so as to improve on the standard precaution practices among medical practitioners.
CHAPTER ONE
INTRODUCTION
1.1 Background of study
Healthcare workers (HCWs) are at direct risk of exposure to blood and other body fluids and aerosols during the course of their job. Consequently, they are at risk of infection of blood borne viruses including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Occupational exposure to blood can result from percutaneous (needle stick or other sharps injury) and muco-cutaneous injury (splash of blood or other body fluids into the eyes, nose, or mouth), or blood contact with non-intact skin. Needle stick injury (NSI) is the most common form of occupational exposure to blood which results in transmission of blood borne infection (Baker, 2013). WHO (2008) reports that the global prevalence of hospital acquired infections among the healthcare workers rise by 12% annually and continue to press on a huge burden in public health arena. Despite this worrying trend, relevant literature reports that, compliance with Standard Precautions is low among healthcare workers, leading to high rates of exposure to microorganisms among health care workers via several modes (needle sticks, hand contamination with blood, exposure to air-transmitted microorganisms).
Nurses are at risk of acquiring and transmitting hospital acquired infections in the course of delivering the nursing care. Thousands of nurses are being exposed to blood, body fluids that contain blood products, used needles, scalpels and other sharps objects in hospital wards (obstetrics, general, emergency), clinics and theatres. In health care services, nurses are particularly at risk of being exposed to blood and sharp devices because they perform more bedside nursing care and procedures than any other health care worker (Dummy, 2010). Measures to prevent the transmission of these infectious microorganisms are therefore a significant component of nursing care. This prevention is achieved through the practice of infection prevention, including the implementation of infection prevention standard precautions (Amadu &Saka, (2012).
Preventing and controlling infection in health care facilities involves two levels of approach, standard precautions and additional (transmission-based) precautions. Standard precautions are taken to reduce the risk of transmitting blood-borne microorganisms and other pathogens from both recognized and unrecognized sources. These precautions are used as a minimum, in the care of all patients in health care facilities and settings, regardless of their diagnoses or presumed infection status. SPs guide health care workers (HCWs) to practice regular hand hygiene , use personal protective equipment (PPE) like gloves, masks, eye protection, face shield and gowns when contact with mucus membranes , blood and body fluids of patients is anticipated, correct disposal of sharps and other clinical waste.
Major reported factors that affect compliance with standard precautions include but not limited to lack of understanding and knowledge among healthcare workers on SPs (Fayaz et al, 2014; Sreedharan et al, 2011), shortage of time to implement the precautions (work overload),because there are limited staffs, limited resources, uncomfortable equipment, skin irritation, forgetfulness, distance from the necessary facilities, and insufficient support from management in creating a facilitating work environment (Efstathiou et al, 2011). Moreover, certain socio-demographic variables such as age, sex, job category, marital status, working site in the hospital and work experience were found to be associated with compliance with standard precautions (Felix, et al, 2013). In view of this, the study will be looking at the compliance level and factors affecting Nurses and Midwives compliance to Standard Precaution in a government owned hospital in Ogun State (Olabisi Onabanjo Teaching Hospital).
1.2 Statement of Problem
Occupational exposure to blood or other body fluids in healthcare facilities constitutes a significant risk of transmission of HIV and other blood borne pathogens to healthcare workers (nurses). HIV/AIDs in particular is a major threat in the workplace (ILO, 2011). The prevalence of Hospital Acquired Infections (HAIs) has increased globally especially among the health-workers (Nurses and mid wives) and so, emphasis on strict implementation and compliance with standard precautions among health care workers is emphasized. Compliance with standard precautions among healthcare professionals was reported to be inadequate with regard to eye protection, avoidance of needle recapping, glove use when required, washing hands before and after patient contact, use of facemasks, and avoidance of a used needle that is disassembled from a syringe and in implementation of precautions for all patients (Jawad et al, 2013; McGaw et al, 2012 and Alice et al, 2013).
Although standard precautions have been practiced for a long time, full compliance has been difficult to achieve due to certain factors. Though, a number of studies on health care workers’ (nurses and midwives) knowledge and compliance to standard precautions and factor affecting compliance with standard precaution have been done in Nigeria (Okeke, 2009; Adeniran, Wilson & Ayebo, 2006), yet there is need to conduct more research on the subject matter. It is against this background that this study examined the level of factors affecting with compliance with standard precaution among nurses working in Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State.
· Lack of understanding and knowledge among health care workers.
· Shortage of time to implement the precautions (work overload)
· Limited resources
· Lack of proper training
· Distance from the necessary facilities
· Insufficient support from management in treating a facilitating work environment.
1.3 Objectives of the Study
The aim of the study is to investigate the factors that are affecting the compliance of nurses to standard precaution. The specific objectives are to be achieved through the following objectives:
Ø assess the level of knowledge and understanding among nurses about standard precaution practices.
Ø Determine the level of compliance of nurses to standard precaution
Ø Investigate the factors affecting the practices of standard precaution among nurses
Ø Examine the type of precaution that nurses practices.
1.4 RESEARCH QUESTION
1. What are factors that influence the practice of standard precautions among nurses and midwives?
2. What are the level of compliance with standard precaution specifically hand hygiene and use of PPE among the nurses ?
3. What type of standard precautions do the nurses and midwives practice?
1.5 Research Hypothesis
H01: There is no significant relationship between knowledge of nurses about standard precaution and their compliance with standard precautions.
H02: There is no significant relationship between nurses’ years of experience and compliance to standard precaution.
1.6 Scope of the Study
This study will focus only on factors influencing compliance with standards precaution with respect to nurses. Geographically, it only covered Olabisi Onabanjo University Teaching hospital which is notably significant.The study will only looked at occupational hazards nurses encounter when performing their duties, the level of nurses knowledge regarding standard precaution and their level of compliance with standard precaution how limited resources and other factors affect compliance with standard precaution among health workers.
1.7 Significance of the Study
The findings from this study will reveal the level of compliance of nurses to standard precaution practice that influence compliance with standard precautions among nurses. The study may also enlighten the health care workers on the importance of strict adherence and compliance with infection prevention standards as this will not only ensure their safety but also promote their productivity and service delivery. To the academia, this study may help the academicians to formulate theories which will help in the describing and understanding of factors affecting compliance with infection prevention standards among the health workers. It may also equip them with the knowledge and information on the various ways in which these factors can be addressed.
1.8` Operational definitions of terms
1. Factors: This refers to the circumstances, facts or influence that contribute to a result. Factors that are focused on this study includes: knowledge among health care workers, proper training, limited resources. The factors includes, lack of understanding and knowledge among health care workers, shortage of time to implement the precautions, limited resources, insufficient support from management.
2. Compliance: this refers to the action or fact of complying with a wish or command such as specification, policy, standard or law.
3. Standard Precaution: these ae set of infection practices used to prevent transmission of diseases that can be acquired by contact with blood, bodyfluids, non_intact skin and mucous membrane.
4. Nurses: these are people trained to care for the sick or infirm especially in the hospital. They are teachers, advocate, care givers, innovators.