KNOWLEDGE, ATTITUDE AND PRACTICE OF STANDARD PRECAUTIONS AMONG HEALTH CARE WORKERS
Health care workers (HCWs) are at a high risk of needle stick injuries and blood borne pathogens, such as HIV, and Hepatitis B and C viruses, as they perform their clinical activities in the hospital3. Standard precautions are a set of guidelines that aim to protect HCWs from infections from blood, body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes while providing care to patients.54 Compliance with universal precautions has been shown to reduce the risk of exposure to blood and body fluids.64
Aims and objectives
This study was aimed at assessing the level of knowledge, attitude and practice of standard precautions among HCWs in Central Hospital, Warri, Delta State, Nigeria.
The study was carried out between June and December, 2011 at Central Hospital, Warri, Delta State, Nigeria. The respondents were doctors, trained nurses, laboratory scientists, laboratory technicians, health assistants and waste handlers. They were selected through a stratified sampling technique. The instrument was an interviewer administered 98-item semi-structured questionnaire that assessed the knowledge, attitude and practice of standard precautions.
A total of 200 respondents were studied. The age of the respondents (in years) ranged from 22 – 60, with a mean age of 38.3 + 9.1. The modal age was 30. There were more females 144 (72.0%) than males 56 (28.0%). The respondents with tertiary level 160 (80.0%)
of education were more represented. Some 124 (62.0%) of all respondents had good knowledge of standard precautions, 140 (70.0%) had good attitude of standard precautions, and 138 (69.0%) had good practice of standard precautions. The higher the educational level, the higher the level of knowledge, attitude and practice of standard precautions. Some 87 (43.5%) reported always recapping needles after use, 52 (26.0%) always detach needles from syringes, 74 (37.0%) had needle stick injuries in the last one year. Compliance with non-recapping of needles by the HCWs was however good 113 (56.5%). A high percentage usually washed their hands after handling patients. A large proportion of respondents (80.0%) were not immunized, only (40.0%) had hepatitis B virus vaccine.
The level of knowledge attitude and practice of standard precautions was influenced by certain variables such as age, sex, occupation, level of education. In this study, there is need to increase awareness and further improve on compliance with standard precautions in this present day scourge of HIV pandemic .It is recommended that staffs should be trained regularly on standard precautions, hepatitis B virus immunization should be made compulsory, though free, needle recapping should be prohibited, unsafe and unwarranted use of injections should be minimized and a PEP protocol should be in place with a well-known designated PEP focal person.
Standard precautions, knowledge, attitude, practice, blood-borne infection, needle stick injury, health care workers, compliance.
TABLE OF CONTENTS
Title page – – – i
Declaration – – – ii
Certification – – – iii
Dedication – – – iv
Acknowledgement – – – v
Abstract – – – vi
Key words – – – vii
Table of contents – – – viii
List of tables – – – ix
List of figures – – – xi
Definition of terms – – – xii
CHAPTER ONE: Introduction – – 1
CHAPTER TWO: Literature review – – 14
CHAPTER THREE: Methodology – – 43
CHAPTER FOUR: Results – – 55
CHAPTER FIVE: Discussion – – 88
CHAPTER SIX: Conclusion and recommendations – 97
References – – – 101
Appendix: (Questionnaire, letter from ethical committee and score-
schedules for Knowledge, Attitude and Practice of Standard Precautions) – – – 111
LIST OF TABLES
Table 4.1: Socio-demographic characteristics of respondents showing age group, sex, marital status, religion.
Table 4.2: Socio-demographic characteristics of respondents showing ethnicity, educational level, occupation, years of service.
Table 4.3: Occupation of respondents by sex distribution.
Table 4.4: Source of information on standard precaution.
Table 4.5: Diseases transmitted by needle stick injury.
Table 4.6: Facilities methods of disease prevention.
Table 4.7: Attitude towards standard precaution.
Table 4.8: Attitude following needle stick injuries.
Table 4.9: Willingness to perform the procedures on HIV positive patients.
Table. 4.10: Ways to protect self if managing HIV positive patients.
Table 4.11: Frequency of needle stick injuries in the last one year.
Tale 4.12: Practice following spill of blood and body fluids.
Table 4.13: Injection safety practices.
Table 4.14: Methods of needle disposal.
Table 4.15: Methods of handling used reusable instruments.
Table 4.16: Duration of been immunized with HBV immunization.
Table 4.17: Scores for knowledge, attitude and practice towards standard precautions.
Table 4.18: Knowledge of standard precautions and socio-demographic variables of respondents.
Table 4.19: Attitude towards standard precautions and socio-demographic variables of respondents.
Table 4.20: Practice of standard precautions and socio-demographic variables of respondents.
Table 4.21: Knowledge, attitude and practice of standard precautions and ever had needle stick injury.
Table 4.22: Ever had needle stick injuries and recapping of needles after use.
Table 4.23: Ever had needle stick injuries and detaching of needles after use.
LIST OF FIGURES
Figure 4.1: Respondents who have heard of standard precautions.
Figure 4.2: Knowledge of HIV immune status of respondents.
Figure 4.3: Prevalence of needle stick injuries.
Figure 4.4 Respondents immunized against HBV infection.
DEFINITION OF TERMS
Attitude: Way of feeling, thinking or behaviour. In this study, the same definition/assumption applies.
Blood-borne infections : Occupation Safety and Health Administration (OSHA) defines blood-borne infections as infections from pathogenic micro-organisms that are present in human blood and can cause diseases in humans. These pathogens include, but not limited to HBV, and HIV. In this study, the same definition applies.
Compliance: Practice of obeying rules or request made by people in authority. In this study, it is the extent, to which the HCWs obey or implement the definitions and recommendations of standard precaution laid down by the Centres for Disease Control (CDC).
Knowledge: The Oxford Advanced Learner’s Dictionary (2001:658) defines knowledge as the information, understanding and skills that one gains through education or experience. It also defines knowledge as the state of knowing about a particular fact or situation. In this study, knowledge refers to the awareness of basic principles of standard precautions.
Practice: Is the usual or expected way of doing something in a particular organization or situation. In this study, practice refers to the extent that the HCWs implement or comply with recommended strategies of standard precautions.
Safety (sharps) container or box: A puncture/liquid proof container designed to hold used sharps safety during collection, disposal and destruction.
Sharps injury: An injury, which occurs when a sharp object penetrates the skin or mucous membranes.
Standard precautions: Care taken in advance to avoid a risk. In this study, it is an approach to infection control to treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other blood borne pathogens, by use of barrier equipment like hand gloves, face masks, gowns, boots.