CHAPTER ONE
INTRODUCTION
- BACKGROUND OF STUDY
Standard precautions are set of measures formulated to prevent transmission of blood borne pathogens when providing health care. Since identification of patients infected with these pathogens cannot be reliably made by medical history and physical examination, the Centers for Disease Control (CDC) has recommended that standard precautions are used on all patients, regardless of knowledge about their infection status. Health care workers (HCWs) are at risk of various occupational hazards in the hospital, including exposure to blood borne infections such as HIV and hepatitis B and C virus from sharps injuries and contact with body fluids.
Developing countries, which account for the highest prevalence of HIV-infected patients in the world, also record the highest rate of needle-stick injuries. The World Health Organization estimates that about 2.5% of HIV cases and 40% of HBV and HCV cases among HCWs worldwide are the result of these exposures. The risk of sero-conversion following a needle-stick injury from an HCV-antigen positive patient is estimated to range from 1.2% to 10%.
Compliance with standard precautions reduces the risk of exposure to blood and body fluids. Gershon et al. observed that better knowledge of universal precautions among HCWs was one of the correlates of good compliance. Michalsen et al. observed the same among physicians. Knowledge of standard precautions by HCWs may be influenced by their type of training. Jeong et al. in Korea observed that nurses who were working in the operating room need training to increase their compliance with standard precautions.
Compliance on the part of healthcare workers with standard precautions has been recognized as an efficient means to prevent and control health care-associated infections in patients and health workers. Standard precautions include hand washing; use of barriers (gloves, gown, cap and mask); care with devices, equipment and clothing used during care; environmental control (surface processing protocols and health service waste handling); adequate discarding of sharp instruments; and patient’s accommodation in accordance to requirement levels as an infection transmission source. Hand hygiene is most important among the standard precautions advocated. Adoption of safe practices for handling needle sticks and other sharp objects, in view of the possibility of outbreaks, especially of Hepatitis B and C is also a preventive measure worthy of mentioning.
Infections constitute a very common health problem worldwide, causing considerably high morbidity and mortality. Healthcare workers are more commonly exposed to blood and body fluids and are also susceptible to needle prick injuries and infections among healthcare workers are usually the result of these exposures. Initially, the Center for Disease Control and Prevention (CDC) recommended certain precautions for patients known or suspected to be infected. It was later revised that precautions must be consistently used regardless of infection status, and they were called ‘Universal Precautions’. CDC later included the universal precautions in a comprehensive new prevention concept termed the ‘Standard Precautions’(SPs) which included hand washing, use of protective barriers (gloves, gown, caps, masks), care of equipment and clothing used during procedures, environmental control (surface processing protocols, waste handling) and adequate discarding of sharp instrument.
Preventative healthcare and SPs are now considered pivotal components of good clinical practice. 6 In the developed world, great emphasis is laid in ensuring that (SPs) are adhered to by all medical professionals involved in dispensing healthcare to patients including doctors, nurses, paramedical staff and other healthcare related professionals. Healthcare workers should follow SPs because this helps in reducing the incidence of spread of infections.
Factors ranging from personal to organizational, which are responsible for non-adherence to the basic principles of SPs among healthcare providers. Although there is an increasing awareness locally about the need of instituting safe clinical practice, the extent to which this is practiced remains unknown. Medical doctors are seemingly more cautious about compliance with safety procedures due to their direct involvement with patients. The associated healthcare staff such as nurses and paramedical personnel is even more exposed to patients and their adherence to SPs is also vital.
However, there are other factors that are responsible for non-adherence to the basic principles of universal precautions among health care providers. From the available literature, the compliance with universal precautions among health workers in Agbor Delta State has not been determined.
- STATEMENT OF THE PROBLEM
There is no study or research that has been conducted specifically on the attitude of nurses towards implementation of universal precaution in central hospital. The deficient knowledge base among some of the health workers in general hospitals may be due to a lack of investment in staff training by the their employer or to limited understanding of health care workers’ safe behavior in the clinical setting or complacency. Therefore, due to insufficient information retention, knowledge and adherence to taught, practice may still be deficient in spite of training and education. Training and education have been found to be of paramount importance to developing awareness among health care workers, as well as improving adherence to good clinical practice
However, there is sometimes a high rate of non-compliance among health workers and this may be due to a lack of understanding among them on how to properly use protective barriers. This safety aspect of modern medical practice is important for the well-being of the people providing medical care as well as the patients who are being looked after by them. However, the loco-regional data on standard precautions (SPs) are extremely limited, and mainly related only to the complications arising from non-observance of standard precautions (SPs).
- AIMS AND OBJECTIVES
The main of the research is to determine the awareness and attitude of nurses towards implementation of universal precaution in central hospital. Other specific objectives include:
1. to determine the relationship between the attitude of nurses and implementation of universal precaution in central hospital.
2. to examine the attitude of nurses towards the implementation of universal precaution in central hospital Agbor Delta State.
3. to identify the causes of lack of implementation of universal precaution in central hospital Agbor Delta State.
4. the examine the importance of universal precautions in central hospital.
5. to determine the level of awareness of nurses towards the implementation of universal precaution in central hospital Agbor Delta State
6. to examine the challenges towards implementation of universal precaution in central hospital Agbor Delta State.
7. to proffer solutions to the challenges towards implementation of universal precaution in central hospital Agbor Delta State.
- RESEARCH QUESTION
1. what is the relationship between the attitude of nurses and implementation of universal precaution in central hospital?
2. what is the attitude of nurses towards the implementation of universal precaution in central hospital Agbor Delta State?
3. what are the causes of lack of implementation of universal precaution in central hospital Agbor Delta State?
4. what is the importance of universal precautions in central hospital?
5. what is the level of awareness of nurses towards the implementation of universal precaution in central hospital Agbor Delta State?
6. what are the challenges towards implementation of universal precaution in central hospital Agbor Delta State?
7. what are the solutions to the challenges towards implementation of universal precaution in central hospital Agbor Delta State?
- STATEMENT OF RESEARCH HYPOTHESIS
1. H0: there is no significant study to determine the awareness and attitude of nurses towards implementation of universal precaution in central hospital Agbor Delta State.
2. H1: there is a significant study to determine the awareness and attitude of nurses towards implementation of universal precaution in central hospital Agbor Delta State.
- SIGNIFICANCE OF STUDY
From the findings of this study there will be greater awareness of universal precautions among health care workers especially the nurses in central hospitals. This study will also expose ways in which awareness towards the implementation of universal precautions can be achieved such as participation in a greater number of seminars, conferences and training some of which may include universal precautions which not only encouraged safer work practices but also improved concordance with policy and procedures of the ministry of health.
The study will also be beneficial to the ministry of health on the need to create mass awareness and ensure positive attitude of nurses and general health care workers towards the implementation of universal precautions.
Furthermore, health practitioners will use the findings of this study to evaluate their level of compliance towards universal precautions and ways to stay safe as well as the importance of implementation.
The study will also be significant to health policy makers on formulating policies that will ensure the health and safety of health workers especially this in the central hospital.
Lastly, the study will serve as a research tool by other researchers for further study on the subject matter.
- SCOPE OF STUDY
The scope of this study will cover a study to determine the awareness and attitude of nurses towards implementation of universal precaution in central hospital Agbor Delta State.
- LIMITATION OF STUDY
- Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
2. Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.
- DEFINITION OF TERMS
Determine: cause (something) to occur in a particular way or to have a particular nature.
Awareness: knowledge or perception of a situation or fact.
Attitude: a settled way of thinking or feeling about something.
Nurses: a person trained to care for the sick or infirm, especially in a hospital.
Towards: expressing the relation between behaviour or an attitude and the person or thing at which it is directed or with which it is concerned.
Implementation: the process of putting a decision or plan into effect; execution
Universal precautions: Universal precautions refers to the practice, in medicine, of avoiding contact with patients' bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields.
Central hospital: A hospital is a health care institution providing patient treatment with specialized medical and nursing staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emergency department to treat urgent health problems ranging from fire and accident victims to a sudden illness.
