MEASURES
UTILIZED FOR PREVENTION OF NOSOCOMIAL
INFECTION IN THE LABOUR WARD OF UNIVERSITY OF CALABAR TEACHING HOSPITAL (UCTH),
CALABAR.
(Nursing
Science)
CHAPTER
ONE
INTRODUCTION
1.1
Background
to the Study
Nosocomial infection also known as
Hospital Acquired Infections (HAI) is a localized or systemic infection
acquired in a hospital or any other health care facility by a patient admitted
for a reason other than the pathology present during admission. It may also
include an infection acquired in a healthcare facility that may manifest 48 hours
after the patient’s admission into the health care facility or discharge (Hildron,
Edwards, Patel, Horan, Sievert, Pollock & Fridkin, 2008). Epidemiological studies
report that nosocomial infections are caused by pervasive pathogens such as
bacteria (Lepelletier, Perron, Bizouarn, Caillon, Drugeon, Michaud & Duveau,
2005), viruses (De-Oliveira, White, Leschinsky, Beecham, Vogt, Moolenaar, Perz &
Safranek, 2005) and fungi present in air, surfaces or equipment. The pathogens
are not present or incubating prior to the patient’s admission into healthcare
facility and are most likely transmitted by direct person-to-person contact during
invasive medical procedures (Anderson, Kaye, Chen, Schmader, Choi, Sloan &
Sexton, 2009). Some of the pathogens are highly resistant to antimicrobial
agents, andthis necessitates the prescription of more potent and costly antimicrobial
agents (Mulvey & Simor,2009).
Nosocomial infections are prevalent
nationally and internationally; and occur in patients of all age groups:
neonates (Aly, Herson, Duncan, Herr, Bender, Patel & EI-Mohandes, 2005),
immuno-compromised adults and the elderly (Lepelletier, Perron, Bizouarn,
Caillon, Drugeon, Michaud& Duveau, 2005).
The most frequent types
of nosocomial infections are
those associated with the
urinary tract, surgical wounds,
respiratory tract and blood
stream (Lo, 2008). It is a serious global public health issue, causing
the suffering of 1.4 million people across the world at any given time (WHO,
2007).
Nosocomial infection in developing
countries is difficult to address because it is such a complex problem with
diverse underlying causes. International non-governmental organizations (INGOs)
and inter-governmental organizations such as United Nations agencies add a
unique perspective to the push for infection control measures in hospitals in
the developing world. However, these
organizations have not been able to address all facets of the problem such as
infrastructure, leadership and individual health care worker behavior. Nosocomial infection control is not simply a
matter of encouraging hand hygiene in settings where clean water and soap may
not be consistently available. Nor is infection control a matter of providing
supplies to health care workers who are not trained to use them properly (WHO,
2010).
The burden of HAI is already
substantial in developed countries, where it affects from 5% to 15% of
hospitalized patients in regular wards and as many as 50% or more of patients
in intensive care units (ICUs) (WHO, 2009). In developing countries, the
magnitude of the problem remains underestimated or even unknown largely because
HAI diagnosis is complex and surveillance activities to guide interventions
require expertise and resources (Allegranzi & Pittet, 2008). Surveillance
systems exist in some developed countries and provide regular reports on
national trends of endemic HAI (Pittet, Allegranzi, Sax, Bertinato, Concia
& Cookson, 2005) such as the National Healthcare Safety Network of the
United States of America or the German hospital infection surveillance system.
This is not the case in most developing countries (WHO, 2010) because of social
and health-care system deficiencies that are aggravated by economic problems.
Additionally, overcrowding and understaffing in hospitals result in inadequate
infection control practices, and a lack of infection control policies,
guidelines and trained professionals also adds to the extent of the problem.
Hospital-wide HAI prevalence varied
between 2.5% and 14.8% in Algeria (Vincent, Rello, Marshall, Silva, Anzueto
& Martin, 2009), Burkina Faso (DiA, Ka, Dieng, Diagne, Dia & Fortes,
2008), Senegal and the United Republic of Tanzania (Atif, Bezzaoucha, Mesbah,
Djellato, Boubechou & Bellouni, 2006). Overall HAI cumulative incidence in
surgical wards ranged from 5.7% to 45.8% in studies conducted in Ethiopia (Messele,
Woldemedhin, Demissie, Mamo & Geyid, 2009) and Nigeria (Kesah, Egri-Okwaji,
Iroh & Odugbemi, 2009). The latter reported an incidence as high as 45.8%
and an incidence density equal to 26.8 infections per 1000 patient-days in
paediatric surgical patients (Kesah, Brewer, Yingrengreung & Fairchild, 2009).
In a study conducted in the surgical wards of two Ethiopian hospitals, the
overall cumulative incidence of patients affected by HAI was 6.2% and 5.7% (Messele,
Grottolo, Renzi, Paganelli, Sapelli, Zerbini & Nardi, 2009). In a study
from Nigeria, the implementation of an infection control programme in a
teaching hospital succeeded in reducing the rate of HAI from 5.8% in 2003 to
2.8% in 2006 (Abubakar, 2007).
In Nigeria, nosocomial infection
rate of 2.7 % was reported from Ife, while 3.8 % from Lagos and 4.2 % from
Ilorin (Odimayo, Nwabuisi & Adegboro, 2008). The cause of nosocomial infections might be
endogenous or exogenous. Endogenous infections are caused by organism present
as part of the normal flora of the
patient, while exogenous
infections are acquired through
exposure to the
hospital environment, hospital personnel
or medical devices (Medubi,
Akande & Osagbemi, 2006). Nosocomial
infection rates vary substantially by body site, by type of hospital and by the
infection control capabilities of the institution. The proportion of infections
at each site is also considerably different in each of the major hospital
services and by level of patient risk (Taiwo, Onile & Akanbi, 2005).This is
exemplified by surgical site infections (SSIs) which are most common in general
survey, whereas urinary tract infections and blood stream infections are most
frequent in medical services and nurseries.
Rates of nosocomial infection vary by surgical subspecialty, low in
ophthalmology and high in general surgery. The differences are largely due to
variations in exposure to high risk devices or procedures (Tolu, 2007).
Urinary tract infections (UTI)
represent the most common (34%) type of nosocomial infections. Indwelling
catheters cause the majority while others are caused by genito urinary
procedures (Tolu, 2007). Surgical
wound infections represent
17% nosocomial infection and
are the second
most common hospital acquired
infections. The classification of wound infections is based on the
degree of bacterial contamination, including clean, clean contaminated and
contaminated. Co-morbid and contamination of the surgical site contribute to
the infection rate. The risk factors for surgical wound infections include age,
obesity, concurrent infection and prolonged hospitalizations. The origin of the
bacterial agent is dependent on direct inoculation from a host’s flora, cross-contamination,
the surgeon’s hands, air-borne contamination and devices such as drains and
catheters (Odimayo, Nwabuisi& Adegboro, 2008). Lower respiratory infection
(LRI) or pneumonia represents 13 % of nosocomial infections (Taiwo, Onile &
Akanbi II, 2005). This is the most
dangerous of all nosocomial infections with acase fatality rate of 30%. It manifests in the intensive care unit or
post-surgical recovery room.
Endotracheal intubation and tracheostomy dry the lower respiratory tract
mucous and provide entry for microbes.
This study therefore aims at investigating
nursing measures utilized for the prevention of nosocomial infection in the
labour ward of University of Calabar Teaching Hospital (UCTH), Calabar, Cross
River State, Nigeria.
1.2
Statement
of Problems
Nosocomial
infections have been recognized as a
problem affecting the
quality of health care and a principal
source of adverse healthcare outcomes.
Within the realm
of patient safety, these infections have serious impact such as
increased hospital stay days, increased
costs of healthcare, economic hardship
to patients and their families and even deaths, are among the many negative
outcomes (Anderson, Kaye, Chen, Schmader, Choi, Sloan & Sexton, 2009).
Further more, it was
noted that Doctors and Midwives were not observing strict Aseptic measures. It
is with the above information the researcher carried out this study to
investigate nursing measures utilized for the prevention of nosocomial
infection in the labour ward of University of Calabar Teaching Hospital (UCTH),
Calabar.
1.3
Purpose
of Study
The
purpose of this study is to investigate nursing measures utilized for the
prevention of nosocomial infection in the labour ward of University of Calabar
Teaching Hospital (UCTH), Calabar.
1.4
Specific
Objectives
i.
To ascertain the level
of knowledge of nosocomial infection among nurses in UCTH, Calabar.
ii.
To identify the nursing
measures utilized for the prevention of nosocomial infection in the labour ward
of UCTH, Calabar.
1.5
Research
Questions
i.
How much do nurses in
University of Calabar Teaching Hospital (UCTH), Calabar know about nosocomial
infection?
ii.
What nursing measures
are utilized for the prevention of nosocomial infections in the labour ward of
UCTH, Calabar?
1.6
Hypothesis
There is no significant
relationship between thelevel of knowledge of nosocomial infection and nursing
measures utilized for the prevention of nosocomial infection in the labour ward
of UCTH, Calabar.
1.7
Scope
of Study
The
study is focused on investigating the nursing measures utilized for the
prevention of nosocomial infection in the labour ward of UCTH, Calabar. It will
also look at the level of knowledge of nosocomial infections among nurses in
UCTH, Calabar.
1.8
Significance
of the Study
The
findings of this study will be of significance to the following categories of
people;
Health Workers:
They will find this study to be an important tool for counselling patients
suffering from nosocomial infections.
Nurses And Midwives:
The findings in this study will aid nurses and midwives with deciding the most
suitable infection preventive measure for a particular individual at a
particular time. The findings in this study will also provide nurses and
midwives with more insight on nosocomial infections, which will help them give
comprehensive health talks on it treatment and prevention.
Researchers:
The findings in this study will also serve as a resource material to
researchers who wish to embark on related researches in the nearest future.
1.9
Limitation
of the Study
The limitation encountered by the
researcher was inability to distribute the questionnaire to all the nurses in
Calabar at the early stage of the research. This was due to the three
shift-duties of nurses (morning, evening and night) in all the various
hospitals in Calabar. However, the researcher overcame it by distributing questionnaire
during the morning and evening shift, face to face, whereby she collected
completed filled questionnaire at the spot.
1.10
Operational
Definition of Terms
The
key terms in this research were defined as follows:
·
Nosocomial:
This simply is a
disease originating in a hospital.
·
Infections:
This is referred to the
process of infecting or the state of being infected bacteria or fungi that
generates to a disease while being admitted in the hospital.
·
Nurse:
This simply means a person trained to care for people diagnosed of
nosocomial infection.
·
Prevention:
This is simply the act of stopping nosocomial infection from happening or occurring.
Measure: This refers to a
means of achieving a purpose of preventing the occurrence of nosocomial
infections in labour ward