22 Original article

Impact of an infection-control program on nurses’ knowledge and attitude in pediatric intensive care units at Cairo University hospitals Yasmine S. Galala, John R. Labibb and Walaa A. Abouelhamdb Departments of aPublic Health and Community Medicine and bPediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt Correspondence to Yasmine S. Galal, MSc, MD, Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt Tel: + 20 122 446 0236; fax: + 23644383; e-mail: [email protected]

Received 8 May 2013 Accepted 31 July 2013 Journal of the Egyptian Public Health Association 2014, 89:22–28

Background Healthcare-associated infection is a prominent problem among patients in pediatric intensive care units (PICU) as it could result in significant morbidity, prolonged hospitalization, and increase in medical care costs. The role of nurses is extremely important in preventing hazards and sequela of healthcare-associated infections. Objective The aim of this study was to assess the effect of a health education program regarding infection-control measures on nurses’ knowledge and attitude in PICUs at Cairo University hospitals. Participants and methods This was a pre–post test interventional study in which a convenient sample of 125 nurses was taken from the nursing staff in different PICUs at Cairo University hospitals. The study took place in three phases. In the first phase, the nursing staff’s knowledge, attitude and practice concerning infection-control measures were tested using a selfadministered pretested questionnaire and an observation checklist. The second phase included health education sessions in the form of powerpoint and video presentations; and in the third phase the nurses’ knowledge and attitude on infection-control measures were reassessed. Results A significantly higher level of knowledge was revealed in the postintervention phase as compared with the preintervention phase with regards to the types of nosocomial infections (94.4 vs. 76.8%, Po0.001), the at-risk groups for acquiring infection (95.2 vs. 86.4%, P = 0.035) and the measures applied to control nosocomial infections (89.6 vs. 68%, Po0.001). Nurses in the postintervention phase had significantly more knowledge about the types of hand washing (99.2 vs. 91.2%, P = 0.006). A significantly higher percent of nurses in the postintervention phase knew the importance of avoiding recapping syringes (72.8 vs. 34.4%, Po0.001) and believed that infection-control measures could protect them completely from acquiring infection (79.2 vs. 65.6%, P = 0.033). Statistically significant higher total knowledge and attitude scores were revealed in the postintervention phase as compared with the preintervention one (Po0.001). The percentage practice score of observed units was the highest among nurses in the neonatal intensive care unit at the Japanese Hospital (88%), whereas it was the lowest in the emergency pediatric unit (65%). Conclusion and recommendations There is scope for improvement in knowledge and attitude after educational program was offered to the nursing staff. Educational training programs should be multidisciplinary interventions in the era of quality control to help healthcare workers realize the importance of basic infection-control measures in reducing pediatric morbidity and mortality and improving the quality of care. Keywords: healthcare-associated infection, healthcare workers, infection-control measures, pediatric intensive care unit J Egypt Public Health Assoc 89:22–28 & 2014 Egyptian Public Health Association 0013-2446

Introduction The specialty in pediatric critical care medicine was developed as an offshoot of neonatology, pediatric general and cardiac surgery, and pediatric anesthesiology. Although the first pediatric intensive care unit (PICU) 0013-2446 & 2014 Egyptian Public Health Association

emerged in the late 1950s and early 1960s, pediatric critical care medicine was not formally recognized as a specialty until 1987, when the American Board of Pediatrics first offered a certifying examination, paving the way for hospital credentialing of pediatric intensives [1]. DOI: 10.1097/01.EPX.0000444562.71691.06

Copyright © Journal of the Egyptian Public Health Association. Unauthorized reproduction of this article is prohibited.

Impact of infection-control program Galal et al.

The PICU is a section of hospital that provides sick children with the highest level of medical care. The PICU provides intensive nursing care by monitoring parameters such as heart rate, breathing, and blood pressure. It also allows the medical staff to provide therapies that might not be available in other parts of the hospital such as ventilators and certain medications that can be given only under close medical supervision [2]. A nosocomial infection, also called healthcare-associated infection (HCAI), is a prominent problem among most patients in the PICU due to the nature of infants and children as well as the nature of the modern critical care environment. Young patients are in disadvantage because of their immature immune system, lack of exposure to antigens, and their relatively porous physical barriers to microbial invaders [3]. The majority of HCAIs become evident 48 hours or more after admission; however, HCAIs may not become clinically evident until after discharge [4]. HCAIs result in significant morbidity, prolonged hospitalization, increase in healthcare costs, and contribute to patient deaths [5]. Efforts to reduce the rate of HCAIs in children are often hampered by the lack of pediatric-specific research, lack of national pediatric-specific quality measures to guide prevention of HCAIs, and the implementation of infection-prevention practices validated only in adult populations [6]. HCAIs are generally related to multiple factors such as the knowledge and attitude of healthcare personnel regarding infection control [7], environmental factors such as those related to cleanliness of instruments, floors, and walls [8], and antimicrobial resistance [9]. Prevention of these infections depends on daily implementation and monitoring of infection-prevention and control practices, which should aim at breaking the chain of infection at all possible sites [10]. Infection control has a particular important role in PICUs which must take into account the specificity of needs and environment of pediatric patients. The role of nurses is extremely important in preventing the hazards and sequela of HCAIs and protecting patients, themselves, and other healthcare personnel from acquiring infection [11]. Many studies have reinforced the fact that compliance of nurses to infection-control guidelines could be improved by educational interventions that address their knowledge, attitude, and practice (KAP) [12]. The role of nurses in infection control has been addressed in many studies [13,14]; however, to the researchers’ best knowledge, no data have been reported regarding nurses’ KAP of infection control in PICUs at Cairo University hospitals. By assessing the nursing staff ’s KAP, we have baseline data to start with for monitoring and consequently improving their KAP regarding infection control.

Aim of the work This study was conducted to assess the effect of a health education program regarding infection-control measures

23

on nursing staff ’s KAP in PICUs at Cairo University hospitals. This would be accomplished by: (1) assessing nursing staff ’s KAP regarding infectioncontrol measures in PICUs, (2) providing health education sessions addressing proper infection-control measures, and (3) reassessing the nursing staff ’s knowledge and attitudes after providing the educational program.

Participants and methods Study design

A pre–post interventional study to test the effect of health education regarding infection-control measures on nurses’ knowledge and attitudes in PICUs at Cairo University hospitals. Study site and study period

The current study was conducted in PICUs at Cairo University Hospital. The included units were (a) the neonatal intensive care units at Monira, Japanese, and Kasr El-Ainy hospitals and (b) PICUs at Monira and Japanese hospitals including cardiothoracic and emergency departments. The study took place over 3 months duration from 15 September 2012 to 15 December 2012 and included three phases. The first phase tested the nursing staff ’s KAP regarding infection-control measures. The second phase included health education sessions to all nurses who participated in the first phase. The third phase reassessed the nurses’ knowledge and attitudes regarding infection-control policies (each phase took nearly 1 month’s duration). Practice was not assessed in the postintervention phase because it is usually standardized and also due to work overload in PICUs. Study sample

A convenient sample of 125 nurses was selected from the nursing staff working in different PICUs at Cairo University hospital who accepted to participate. Study tools and data collection technique

(1) A self-administered pretested questionnaire was designed to collect and record data. It included three sections. The first section included demographic data and job characteristics such as nurses’ age, qualification and years of experience, pre-employment examination, and previous infection-control courses. The second section included data to assess the nurses’ knowledge regarding infection-control measures and precautions. The third section assessed the nurses’ attitudes regarding infection-control policies and precautions [12,14]. (2) An observation checklist was used for the assessment of nurses’ practices regarding infection-control procedures including environmental control (13 items), hand hygiene (13 items), personal protective equipment (PPE) (14 items), injection safety (8 items), handling and disposal of sharps (5 items), waste

Copyright © Journal of the Egyptian Public Health Association. Unauthorized reproduction of this article is prohibited.

24 Journal of the Egyptian Public Health Association

management (6 items), decontamination of patient care equipment (13 items), specimen handling (3 items), and personal hygiene (2 items). The total practice score (out of 77 items) was computed for different units in which correct answers scored 1 and incorrect or not done scored 0 [5,15]. (3) Health education materials included powerpoint presentations regarding infection-control principles and guidelines and video showing proper hand hygiene.

Data processing and analysis

Data were entered and analyzed using the statistical package for social sciences (SPSS, version 16; SPSS Inc., Chicago, Illinois, USA). Descriptive statistics such as frequency, percentage, arithmetic mean, and SD were used. Comparison between preassessment and postassessment data was performed using the McNemar test for qualitative data variables and paired t-test for quantitative variables. Ethical and administrative issues

Verbal consents were obtained from all participants in the study according to Helsinki decelerations of biomedical ethics [16]. Also, all required permissions were obtained from the Chairman of the Pediatric Hospital and from the Chair of the infection-control units.

Results The study group comprised 125 nurses working in different PICUs at Cairo University hospitals. Table 1 shows that nearly half (48.8%) of the study sample was less than 30 years old, with a mean age of 30.76 ± 7.58 years. Most of the study participants (98%) were female. Nearly 61% of the nurses were married. About 59% of the nurses had a diploma in nursing and the mean years of experience was 11.25 ± 7.35 years. More than 50% of the nurses have attended infection-control courses. Nearly threefourth of the study group has received pre-employment examination (clinical and laboratory examination). The respondents were asked a few questions to assess their knowledge regarding nosocomial infections, components of an infectious cycle, and hand washing (Table 2). In the postintervention phase, nurses had significantly more knowledge as compared with the preintervention phase regarding the types of nosocomial infections (94.4 vs. 76.8%, Po0.001), the at-risk groups for acquiring nosocomial infections (95.2 vs. 86.4%, P = 0.035), and the measures applied to control nosocomial infections (89.6 vs. 68%, Po0.001). Moreover, nurses in the postintervention phase had significantly more knowledge compared with that in the preintervention phase regarding all items related to infectious cycle. The respondents were asked to identify some precautions to prevent acquiring nosocomial infections. Regarding the required vaccinations for nursing staff, nurses in the postintervention phase had significantly more knowledge

Table 1. Demographics, qualification, and training of nurses in pediatric intensive care units, Cairo University hospitals Nurses’ characteristics Age (years) o30 Z30 Marital status Not married Married Qualification Bachelor nursing Institute of technical nursing Diploma in nursing Infection-control courses Yes No Pre-employment examination Yes No

n = 125 [N (%)] 61 (48.8) 64 (51.2) 49 (39.2) 76 (60.8) 32 (25.6) 19 (15.2) 74 (59.2) 65 (52) 60 (48) 101 (80.8) 24 (19.2)

compared with that in the preintervention phase (92 vs. 16%, Po0.001). Similarly, the nurses’ knowledge about the precautions applied when dealing with hepatitis A patients was significantly higher in the postintervention phase when compared with the preintervention phase (92 vs. 56%, Po0.001). Nearly 97% of the nurses in the postintervention phase identified correctly that they have to wash their eyes and mouth with running water if they were exposed to accidental splashes of blood or body fluids, compared with 89.6% of those in the preintervention phase (P = 0.035). As for hand washing, nearly all (99.2%) nurses in the postintervention phase knew that the types of hand washing include plain, antiseptic, and surgical, compared with 91.2% of those in the preintervention phase. This difference was statistically significant at a P-value of 0.006. Moreover, the nurses’ knowledge in the postintervention phase was significantly higher when compared with the preintervention phase concerning the conditions in which plain hand washing is not enough (87.2 vs. 51.2%, Po0.001) and when to use disinfectants (84.8 vs. 42.4%, Po0.001). Regarding the spectrum of activity of alcohol, 68 and 98.4% of nurses in the preintervention and postintervention phases, respectively, knew that alcohol was effective against bacteria, viruses, and fungi but not against spores (Po0.001) (Table 2). The nurses’ knowledge in the postintervention phase was significantly higher as compared with that in the preintervention phase regarding all items related to PPE except their importance. A significantly higher percent of nurses in the postintervention phase knew the importance of avoiding recapping syringes as a universal precaution in reducing the risk of transmission of blood-borne pathogens (72.8 vs. 34.4%, Po0.001) and correctly identified that the sharp box should be emptied when half-full only to minimize the risk of infection (85.6 vs. 43.2%, Po0.001). Similarly, in the postintervention phase, nurses had significantly more knowledge regarding the precautions to be taken when they were exposed to accidental needle-stick injury (NSI); they knew that they have to wash the injured site with water and soap and take the postexposure prophylaxis (66.4 vs. 32.8%, Po0.001). The knowledge regarding the modes of

Copyright © Journal of the Egyptian Public Health Association. Unauthorized reproduction of this article is prohibited.

Impact of infection-control program Galal et al.

25

Table 2. Knowledge of the study group regarding nosocomial infections, the infectious cycle, and hand washing (pre-intervention and post-intervention) Variables Nosocomial infection Definition Etiologic agents Types At-risk groups Sources Policies to control Infectious cycle Components Breakage Portals of entry Precautions against acquiring nosocomial infection Infected cases Infected wound Contaminated mucous membranes (eye and mouth) Dealing with hepatitis A patients Vaccinations for nursing staff Hand washing Types Plain washing is not enough Effect of alcohol Conditions for using disinfectants

Pretest [n (%)] 115 111 96 108 124 85

(92) (88.8) (76.8) (86.4) (99.2) (68)

46 (36.8) 84 (67.2) 64 (51.2)

Post-test [n (%)] 119 115 118 119 124 112

P-value

(95.2) (92) (94.4) (95.2) (99.2) (89.6)

0.424 0.503 o0.001* 0.035* 1.000 o0.001*

89 (71.2) 117 (93.6) 114 (91.2)

o0.001* o0.001* o0.001*

106 117 112 70 20

(84.8) (93.6) (89.6) (56) (16)

114 122 121 115 115

(91.2) (97.6) (96.8) (92) (92)

0.115 0.180 0.035* o0.001* o0.001*

114 64 85 53

(91.2) (51.2) (68) (42.4)

124 109 123 106

(99.2) (87.2) (98.4) (84.8)

0.006* o0.001* o0.001* o0.001*

*Significant at 95% confidence level.

transmission of hepatitis B and C virus was significantly higher among nurses in the postintervention phase when compared with that in the preintervention phase (96.8 vs. 64%, Po0.001). Only 34 (27.2%) nurses in the preintervention phase correctly knew the definition of decontamination, compared with 85 (68%) nurses in the postintervention phase (Po0.001). At the postintervention phase, nurses had significantly more knowledge compared with that in the preintervention phase regarding the correct definition of sterilization (71.2 vs. 54.4%, P = 0.009). Thirty-six percent of nurses in the preintervention phase knew the proper way for disposal of infected items compared with 86.4% of those in the postintervention phase (Po0.001) (Table 3). In the present study, no statistically significant differences were observed between the preintervention and postintervention phases regarding their attitudes towards hand washing, whether before or after using gloves and towards frequent hand washing. A significantly higher percent of nurses in the postintervention phase compared with those in the preintervention phase believed that infection-control measures could protect them completely from acquiring infection (79.2 vs. 65.6%, P = 0.033). There was also a statistically significant difference (P = 0.002) between nurses’ attitudes in both phases regarding antibiotic abuse: 65.6% of nurses in the postintervention phase believed that they should not use antibiotics when suspecting any infection compared with 44% in the preintervention phase. The respondents were also asked to state their attitude towards the importance of certain aspects of standard precautions. The nurses’ attitude regarding the importance of avoiding recapping was uniformly poor in the preintervention phase, being only 40.8%, whereas it was 91.2% among nurses in the postintervention phase. This difference was highly significant at P-value less than 0.001. A significantly higher percent of nurses in the postintervention phase compared with those in the preintervention phase

thought that they should not avoid infectious patients as long as they follow the required precautions (92 vs. 75.2%, Po0.001) and also believed that they should not avoid using disinfectants as long as they are used properly (96.8 vs. 87.2%, P = 0.008) (Table 4). Table 5 shows statistically significant higher knowledge and attitude scores in the postintervention phase with a mean of 37.176 ± 3.494 and 13.264 ± 1.666, respectively, compared with 28.672 ± 4.499 and 12.248 ± 1.615 in the preintervention phase. Figure 1 shows the evaluation of nursing practices regarding infection-control measures in different PICUs using an observational checklist that included the following items: environmental control, hand hygiene, PPE, injection safety, handling and disposal of sharps, waste management, decontamination of patient care equipment, specimen handling, and personal hygiene. Analysis of results revealed that the percentage practice score of the observed units was the highest in the neonatal intensive care unit at the Japanese hospital (88%), whereas the lowest score was observed in the emergency pediatric unit (65%).

Discussion HCAIs continue to be one of the most important public health problems in many countries throughout the world as they represent one of the most common complications affecting hospitalized patients. These infections result in morbidity, mortality, increased length of hospital stay, and consequently additional medical costs [17]. Infection control through appropriate standardized prevention procedures is thus a key component of practice for all healthcare professionals, not only for their health but also to reduce nosocomial infections and thus improve patient safety [18]. However, it has been documented that the level of compliance with the use of infection-control

Copyright © Journal of the Egyptian Public Health Association. Unauthorized reproduction of this article is prohibited.

26 Journal of the Egyptian Public Health Association

Table 3. Knowledge of the study group regarding universal precautions and blood-borne pathogens (pre-intervention and post-intervention) Variables

Pretest [n (%)]

PPE Importance Sequence of taking off How to handle infected gloves Changing the gown When to wear the mask and eye goggles Blood-borne pathogens and how to reduce their risk Avoid recapping syringes Sharp box Precautions in case of accidental NSI Mode of transmission of hepatitis B and C Proper disposal of syringes Protocol of environmental cleaning Decontamination Sterilization Cleaning instruments Management of blood spillage Disposal of infected items Disposal of infected sheets

Post-test [n (%)]

P-value

123 71 81 22 75

(98.4) (56.8) (64.8) (17.6) (60)

124 118 119 102 108

(99.2) (94.4) (95.2) (81.6) (86.4)

1.000 o0.001* o0.001* o0.001* o0.001*

43 54 41 80 106

(34.4) (43.2) (32.8) (64) (84.8)

91 107 83 121 118

(72.8) (85.6) (66.4) (96.8) (94.4)

o0.001* o0.001* o0.001* o0.001* 0.029*

34 68 106 104 45 110

(27.2) (54.4) (84.8) (83.2) (36) (88)

85 89 114 115 108 116

(68) (71.2) (91.2) (92) (86.4) (92.8)

o0.001* 0.009* 0.134 0.061 o0.001* 0.307

NSI, needle-stick injury; PPE, personal protective equipment. *Significant at 95% confidence level.

Table 4. Attitude of the study group regarding hand hygiene and other infection control protocols (pre-intervention and post-intervention) Variables I think I have to wash my hands Before using gloves After using gloves Frequently I believe infection control policies Completely protect nurses Do not hinder work Applied for both infectious and noninfectious cases I think I should not use antibiotics when suspecting any infection Precautions to minimize the risk of infection I believe I should take the required vaccinations I should avoid recapping syringes I care about periodic check-up I believe I should not avoid infectious patients as long as I am following the precautions I think nurses should not avoid using disinfectants as long as they are used properly

Pretest [n (%)]

Post-test [n (%)]

P-value

119 (95.2) 118 (94.4) 111 (88.8)

124 (99.2) 115 (92) 109 (87.2)

0.125 0.607 0.851

82 119 121 55

(65.6) (95.2) (96.8) (44)

99 118 121 82

(79.2) (94.4) (96.8) (65.6)

0.033* 1.000 1.000 0.002*

120 51 113 94 109

(96) (40.8) (90.4) (75.2) (87.2)

116 114 107 115 121

(92.8) (91.2) (85.6) (92) (96.8)

0.424 o0.001* 0.307 o0.001* 0.008*

*Significant at 95% confidence level.

Table 5. Total knowledge and attitude scores of the study group (preintervention and postintervention)

Knowledge score Attitude score

Pretest (mean ± SD)

Post-test (mean ± SD)

100

P-value

90 80

28.672 ± 4.499

37.176 ± 3.494

o0.001*

12.248 ± 1.615

13.264 ± 1.666

o0.001*

88

87

84

82 65

70

*Significant at 95% confidence level.

Percentage

Variables

Figure 1.

60 50 40 30

guidelines by healthcare workers (HCWs) has been low [19], despite the fact that evidence-based procedures enhancing appropriate practices in healthcare facilities have been published [20]. In the current study, the nurses’ knowledge in the postintervention phase was significantly higher as compared with that in the preintervention phase regarding the types of nosocomial infections, the at-risk groups for acquiring nosocomial infections, and the measures applied to control nosocomial infections. Regarding the vaccinations required for the nursing staff, nurses in the postintervention phase

20 10 0

NICU japanese

NICU Monira

NICU Kasr El-Ainy

Cardiothoracic

Emergency

Distribution of the total practice score regarding infection-control measures in pediatric intensive care units. NICU, neonatal intensive care unit.

had significantly more knowledge compared with those in the preintervention phase (Po0.001). Similarly, in a study conducted by Yamini et al. [21] on the perception and

Copyright © Journal of the Egyptian Public Health Association. Unauthorized reproduction of this article is prohibited.

Impact of infection-control program Galal et al. 27

practice regarding infection-control measures among nurses, most of the respondents (88.3%) were of the opinion that HCWs should be immunized against hepatitis B (P = 0.024). Hand hygiene is the first initial step towards successful infection control in any healthcare facility [22] because HCWs’ hands are the main source of HCAI transmission [21]. In the current study, it was found that a significantly higher percent of nurses in the postintervention phase as compared with those in the preintervention phase knew the types of hand washing (P = 0.006) and the conditions for using disinfectants (Po0.001). In another study conducted by Jain et al. [14] to assess infection-control practices among doctors and nurses in a tertiary care hospital, it was found that knowledge regarding hand hygiene was 86.8%. Moreover, a positive attitude towards hand washing was observed in the current study in both the preintervention and postintervention phases, whether before using gloves (95.2 and 99.2%, respectively, P = 0.125) or after using gloves (94.4 and 92%, P = 0.607) and towards frequent hand washing (88.8 and 87.2%, P = 0.851). The positive attitude towards hand washing was also associated with a high compliance score (range 70–100%) among the study participants (untabulated data). However, it has been stated in a study conducted by Whitby et al. [23] that although standard precautions and guidelines for hand washing have been established to decrease the transmission of HCAIs, adherence to such policies was uncommon. Whereas exposure to biologic agents and subsequent infection is not the only occupational hazard faced by HCWs, infections present the greatest risk, especially those caused by blood-borne organisms [24]. Although there is a growing awareness of the seriousness of HIV and hepatitis B and C and how these viruses are transmitted, many HCWs do not perceive themselves to be at risk [25]. Universal precautions are good hygiene habits that reduce acquiring HCAIs due to exposure to blood and body fluids; they include barrier precautions (BPs) (e.g. gloves, mask, gown, goggles, etc.), hand washing, correct handling and disposal of sharps, and aseptic techniques [26]. In the present study, significant differences were observed between the pretest and posttest phases regarding most of the items related to universal precautions. In accordance with the previous finding, a study conducted by Mohamed and Wafa [27] found statistically significant differences between knowledge about universal precautions related to blood and body fluids in the pre-education and posteducation phases. BPs reduce the risk of infection among HCWs as they decrease the direct contact of body fluids and pathogens and thus reduce the chance of infectivity [24]. In the current study, almost all the nurses knew the importance of BPs, whereas the nurses’ knowledge in the postintervention phase was significantly higher regarding all the other items of BPs. Moreover, it was found that nurses adhered to the use of BPs in the present study with a score ranging from 71.5 to 100%. However, in a study conducted in Pakistan to determine the

practice of BPs among HCWs, it was observed that HCWs did not consistently use BPs. Wearing gloves (69%) was the most common means of BPs in that study, followed by goggles (27%), gown (21%), and mask (13%) [24]. Moreover, suboptimal compliance with BPs was reported by other studies [14]. As NSIs are a major source of hospital-acquired infections to HCWs, proper handling and disposal of needles is mandatory so that this preventable source of infection is no more a cause of nosocomial infections [28]. In the current study, nurses in the postintervention phase had significantly more knowledge when compared with those in the preintervention phase regarding the importance of avoiding recapping syringes as a universal precaution to reduce the risk of transmission of blood-borne pathogens (72.8 vs. 34.4%, Po0.001). In accordance with the present study, a considerable percent (76%) of HCWs at Kasturba Medical College in India knew that used needles and syringes are not to be recapped after use [21]. Similarly, in a study conducted in Turkey, it was found that 73% of HCWs did not recap the needles after use [29]. In the current study, a significantly higher percent of nurses in the postintervention group knew the precautions that should be taken when exposed to accidental NSI (66.4 vs. 32.8%, Po0.001) and the proper method of disposal of syringes (94.4 vs. 84.8%, P = 0.029). However, in a study conducted by Yamini et al. [21], 88.3% of HCWs were aware of the appropriate sequence of events to be followed if they were exposed to accidental NSI and also of the importance of its notification to the appropriate authority. In that study also, the majority of HCWs (86%) were aware of the fact that used syringes and needles are to be disposed in puncture-resistant containers. Hepatitis C virus infection is an emerging health problem worldwide; awareness about the disease is necessary for its prevention and control particularly among nursing staff [30]. In the current study, the nurses’ knowledge in the postintervention phase regarding the mode of transmission of hepatitis B and C virus had significantly improved after the educational intervention (P = 0.029). Similar results were concluded from a study conducted by Mohamed and Wafa [27], who observed that the knowledge of nurses about hepatitis C virus infection and the use of preventive measures had been inadequate before an educational program was provided to them and improved after their participation in the program. These results were also consistent with the findings of a study conducted in Egypt, where there was an increase in staff’s knowledge about viral hepatitis and their compliance with preventive precautions from pretest to post-test [31]. It has been found in a study conducted by Suchitra and Devi [32] that a yearly education program on nosocomial infections and their prevention helps in the retention of KAP among HCWs and also in better adherence to BPs. In the current study, it was found that nearly half (48%) the study group has not undergone any training program for infection control. It was also observed that the percentage practice score related to infection-control measures in different PICUs was the lowest among nurses in the

Copyright © Journal of the Egyptian Public Health Association. Unauthorized reproduction of this article is prohibited.

28 Journal of the Egyptian Public Health Association

emergency pediatric department (65%), which could be attributed to work overload and time factor.

Conclusion

of the requirements of the award of Doctor of Philosophy]. De Montfort University; 2011. 9 Falcone M, Venditti M, Corrao S, Serra P. Role of multi-resistant pathogens in health-care-associated pneumonia. Lancet Infect Dis 2011; 11:11–12. 10 Allegranzi B, Borg M, Brenner P, Bruce M, Callery S, Damani V, et al. Epidemiology of health care-associated infections. In: Friedman C, Newsom W, editors. IFIC basic concepts of infection control. 2nd ed., revised Ireland, UK: International Federation of Infection Control; 2011. 11 Rosenthal VD, Maki DG, Jamulitrat S, Medeiros EA, Todi SK, Gomez DY, et al. International nosocomial infection control consortium (INICC) report, data summary for 2003–2008, issued June 2009. Am J Infect Control 2010; 38:95–106.

The current study found that health education was successful in improving the knowledge and attitudes of nurses regarding infection-control measures in different PICUs at Cairo University hospitals. Thus, application of health education and training programs is mandatory for nurses to continuously upgrade their KAP and subsequently minimize nosocomial infections and reduce the duration and the cost of stay of pediatric patients.

13 Ellis S. Role of emergency nurses in controlling infection. Emerg Nurse 2012; 20:16–21.

Recommendations

14 Jain M, Dogra V, Mishra B, Thakur A, Loomba P. Infection control practices among doctors and nurses in a tertiary care hospital. Ann Trop Med Public Health 2012; 5:29–33.

(1) Educational training programs should be multidisciplinary in the era of quality control to help HCWs realize the importance of basic infection-control policies in reducing morbidity and mortality and improving the quality of care. (2) Encouraging the adherence to recommended universal precautions and safety practices should be an integral part of providing high-quality care. (3) Providing sufficient resources to conduct training programs that are both educational and motivational.

12 Saleh DA, Elghorory LM, Shafik MR, Elsherbini EE. Improvement of knowledge, attitudes and practices of health care workers towards the transmission of blood-borne pathogens: an intervention study. J Egypt Public Health Assoc 2009; 84 (5&6): 423–441.

15 Zafar A, Aslam N, Nasir N, Meraj R, Mehraj V. Knowledge, attitudes and practices of health care workers regarding needle stick injuries at a tertiary care hospital in Pakistan. J Pak Med Assoc 2008; 88:57–59. 16 Thompson A, Temple N. Ethics, medical research, and medicine: commercialism versus environmentalism and social justice. Am J Bioeth 2003; 3:69–70. 17 Mauldin PD, Salgado CD, Hansen IS, Durup DT, Bosso JA. Attributable hospital cost and length of stay associated with health care-associated infections caused by antibiotic-resistant Gram-negative bacteria. Antimicrob Agents Chemother 2010; 54:109–115. 18 Christenson M, Hitt JA, Abbott G, Septimus EJ, Iversen N. Improving patient safety: resource availability and application for reducing the incidence of healthcare-associated infection. Infect Control Hosp Epidemiol 2006; 27:245–251. 19 Gammon J, Morgan-Samuel H, Gould D. A review of the evidence for suboptimal compliance of healthcare practitioners to standard/universal infection control precautions. J Clin Nurs 2008; 17:157–167. 20 Rutala WA, Weber DJ. the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for disinfection and sterilization in healthcare facilities. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/ Disinfection Nov 2008.pdf. [Accessed 20 October 2012].

Acknowledgements The authors are thankful to the Chairman of the Pediatric Department at Cairo University Hospital for his kind permission to conduct this study. The authors also thank all the nursing staff in different pediatric intensive care units at Cairo University Hospital for their participation in the study. The research team thanks Dr Shaymaa Baher, Assistant Professor of Public Health, Faculty of Medicine, Cairo University, for her guidance and valuable assistance in managing and analyzing data.

Conflicts of interest There are no conflicts of interest.

References 1 Fuhrman B, Zimmerman J. Pediatric critical care. 4th ed. Philadelphia: Elsevier; 2011. 2 Trevor D, Niranjan K, Edwin V. Pediatric intensive care: a global perspective. In: Nichols DG, editor. Roger’s textbook of pediatric intensive care. 4th ed. PA: Lippincott Williams and Wilkins; 2008. pp. 18–23. 3 Zingg W, Harbarth S. Infectious diseases in the pediatric intensive care unit. Crit Care 2008; 12:306. 4 WHO. World Health Organization prevention of hospital-acquired infections. 2nd ed. Geneva: WHO 2002. Available at: http://www.who.int/csr/ resources/publications/whocdscsreph200212.pdf. [Accessed 7 November 2012]. 5 Sessa A, Giuseppe GD, Albano L, Angelillo IF. the Collaborative Working Group. An investigation of nurses’ knowledge, attitudes, and practices regarding disinfection procedures in Italy. BMC Infect Dis 2011; 11:148. 6 Foster CB, Sabella C. Health care-associated infections in children. J Am Med Assoc 2011; 305:1480–1481. 7 Ward DJ. The role of education in the prevention and control of infection: a review of the literature. Nurse Educ Today 2011; 31:9–17. 8 Wichaikull S. A comparison of the factors which influence infection control in pediatric wards in England and Thailand [submitted for partial fulfillment

21 Yamini Jain A, Mandelia C, Jayaram S. Perception and practice regarding infection control measures amongst healthcare workers in district government hospitals of Mangalore, India. Int J Health Allied Sci 2012; 1:68–73. 22 World Health Organization. WHO guidelines on hand hygiene in health care: first global safety challenge: clean care is safe care. Geneva: WHO 2009. Available at: http://www.ncbi.nlm.nih.gov/books/NBK144013. [Accessed 10 September 2012]. 23 Whitby M, McLaws ML, Ross MW. Why healthcare workers don’t wash their hands: a behavioral explanation. Infect Control Hosp Epidemiol 2006; 27:484–492. 24 Javed M, Saleem S, Mazhar S, Nasrullah M, Younas M, Javed A, et al. Practice of barrier precautions in a government sector teaching hospital. J Rawalpindi Med Coll 2012; 16:188–190. 25 Saleem T, Khalid U, Ishaque S, Zafar A. Knowledge, attitudes and practices of medical students regarding needle stick injuries. J Pak Med Assoc 2010; 60:151–156. 26 Kaur R, Kaur B, Walia I. Knowledge, attitude and practice regarding universal precautions among nursing students. Nurs Midwifery Res J 2008; 4: 115–127. 27 Mohamed S, Wafa A. The effects of an educational program on nurses’ knowledge and practice related to hepatitis C virus: a pretest and posttest quasi-experimental design. Aust J Basic Appl Sci 2011; 5:564–570. 28 Payghan BS, Kadam SS, Kumar P, Sridevi BK. Knowledge and perception of health care workers towards clean care practices in a tertiary care hospital. J Evol Med Dent Sci 2013; 2:1459–1465. 29 Talas MS. Occupational exposure to blood and body fluids among Turkish nursing students during clinical practice training: frequency of needle-stick/ sharp injuries and hepatitis B immunization. J Clin Nurs 2008; 18: 1394–1403. 30 Ghahramani F, Mohammadbergi A, Salehi N. Survey of the students’ knowledge about hepatitis in Shiraz University of Medical Sciences. Hepat Month 2006; 6:59–62. 31 Abou Shady M, Ibrahim Y, Salem Y. Implementation and evaluation of educational program for nurses regarding nosocomial infection control at Mansoura University Hospital. New Egypt J Med 2001; 24:226–233. 32 Suchitra JB, Devi NL. Impact of education on knowledge, attitudes and practices among various categories of health care workers on nosocomial infections. Indian J Med Microbiol 2007; 25:181–187.

Copyright © Journal of the Egyptian Public Health Association. Unauthorized reproduction of this article is prohibited.

Impact of an infection-control program on nurses' knowledge and attitude in pediatric intensive care units at Cairo University hospitals.

Healthcare-associated infection is a prominent problem among patients in pediatric intensive care units (PICU) as it could result in significant morbi...
381KB Sizes 0 Downloads 3 Views