Knowledge and Prevention of Nosocomial Infection among ward nurses at Federal Medical Centre, Umuahia

This research work was carried out to estimate the knowledge and prevention of nosocomial infection among ward nurses at Federal Medical Centre, Umuahia Abia state. Four objectives were set and four questions formulated. A descriptive survey research method was used for the study. A sample size of one hundred and fifty (150) nurses was drawn from eight wards, (Medical and Surgical), at Federal Medical Centre Umuahia. A self-developed questionnaire with seventeen (17) structured questions was the instrument of data collection. Data were collected, analyzed and presented in tables, pie chart, bar chart, histogram, and percentages. The results revealed that nurses were well knowledgeable about nosocomial infection, though little deficiencies exist in the area of infection control practice and compliance, such as hand washing frequency. This study therefore recommends continuing education/seminar/ workshop for all health care givers, to sensitize them with the knowledge and practice of nosocomial infection. Volume 2 | Issue 4 | 1 of 6


Introduction
Infection in the hospital is as old as disease itself. Often times, patients present with disease other than their primary complaints, if that happens during hospitalization, it is termed Nosocomial/ Hospital acquired or health care associated infection [1]. According to Rick, nosocomial is an infection manifested by patients 72 hours after the patient's visit/admission to the hospital for hospital care [2]. The infection must have neither been there nor incubating prior to the patient's visit/admission to the hospital. Ducel and Benson, extended it to 14 days after discharge [3]. Nosocomial infection is defined in various ways by authors but all have common elements. Common sites of the infection are urinary, respiratory and gastro intestinal tract; others are surgical wound, blood and skin [4].
Common pathogens are bacteria, fungi, viruses, some of which are highly pathogenic/virulent, others not (normal flora) expect when out of their normal habitats in the body. Transmission to susceptible hosts is by direct or indirect contact [5].
Predisposing factors are broken skin and mucus membranes (wound), immune suppression, extremes of age, many sick patients in one room, breach of infection control practice and procedures, abuse of antibiotics and invasive procedures [6].
Patients with Nosocomial infection are liable to prolong hospitalization, increased cost and inconveniences. Nosocomial infection is a global problem and among the leading causes of death in developed and developing countries [7].
Ward Nurses therefore should practice measures to prevent infection spread, hence this research work on the knowledge and prevention of Nosocomial infection among ward nurses at Federal Medical Centre.

Study Design
The descriptive survey method was used according to Ige, is the finding out of or researching into something through question and observation in various ways so as to get a solution to the problem under study [8]. The method was chosen for its allowance for orderly collection, easy analysis, interpretation and report of patient's acts to the subject under study. This design, the descriptive survey involves observing and describing the subject's behavior without influencing it.

Study Population
This consists of nurses in medical and surgical wards of Federal Medical Centre, Umuahia.

Sample/Sampling Technique
The technique used for the study was stratified random sampling. The wards to be studied were selected by simple random sampling. Pieces of paper written "Yes" or "No" with the ward, were used to pick the wards to be used i.e. the "Yes". This was done to give all the population under study equal chance. Eight (8) wards with yes were chosen for the study.  Table 2: A total of 150 nurses were selected from the eight randomly selected surgical and medical wards.

Instrument for Data Collection Procedure
Questionnaire was the instrument used for data collection. A list of structured questionnaire in relation to the reviewed literature and stated objectives were used to obtain data from the subjects. The questionnaires were structured and unstructured.

Validity/Reliability of the Instrument
The questionnaire was constructed and assessed for content and face validity, then approved by Michael Okpara University of Agriculture Ethical and Research Committee. Eight copies were given out for pilot study and was later compared and found to be consistent and the instrument deemed reliable.

Procedure for Data Collection
The research team visited Federal Medical Centre, Umuahia wards and distributed the questionnaire in person. A total of one hundred and fifty (150) copies of questionnaire were distributed to trained staff nurses in the wards. The filled questionnaires were collected by hand few hours later and on the following day, the return was 100%.

Method of Data Analysis
The questionnaire were sorted and edited for completeness. The responses were summed up in tables and charts.

Ethical Considerations
Permission was taken from the nursing services department and wards. Explanatory note was attached to each questionnaire for respondents. All data gathered were used for academic purpose only and the respondent's privacy and anonymity maintained.

Results
A total of one hundred and fifty (150) questionnaires were distributed each containing seventeen (17) questions. This represents a hundred percent of the sample population. The data were analyzed and the results presented in tables, pies, bar charts, histogram and percentage.     The bar chart above shows that majority of the respondents got their information about nosocomial infection from lecturers and seminars-89 (53.33%); followed by reading books-35 (23.33%); through hospital workers 20 (13.33%) and through radio and television-15 (10%).      In the above table, the respondents with application of a, b, and c above have 120 (80%), use of sterile materials-20 (13.33%); use of gloves and mask (3.33%), use of clean materials-Nil. Table VII above shows urinary tract as the highest respondent-34 (23.33%), followed by surgical wound and respiratory tract-30 (20%) each; gastro-intestinal tract and blood-20 (13.33%) and skin-15 (10%).   Sterilization of re-usable equipment 10 6.67%z

SECTION A: DEMOGRAPHIC
All of the above 120 80%

Total 150 100%
Table VIII: Shows that respondents to all the above option are 120 (80%); sterilization of re-usable equipment, adequate ventilation and use of screen-10 (6.67%).   Table X shows nurses who wash their hands on arrival at work (3.33%), In-between patient procedure 50 (33.3%), after glove removal 15 (10%) and (53.33%) wash their hands after a, b, and c.    Table XII shows 120 (80%) of respondents agreeing to all health workers practically standard precaution while 10 (6.67%) responded to nurses only, doctors only, nurse and doctors only, each.

Discussion
On the knowledge of nosocomial infection, figure 2 shows that all nurses at F.M.C wards have heard of nosocomial infection and in table 3, 100% reported that the infection is developed during admission in the health care facilities. In figure 3, varied indications shows that 80 (53.33%) got the information through lectures and seminars, 35 (23.33%) through hospital workers and 15 (10%) via radio and television. This agreed with Bello et al, a research study on the knowledge and information source among clinical health care students in Ghana, and came to the conclusion that students simply demonstrated moderate knowledge of formal classroom training [9]. It also agreed with Oni et al. who reported that decrease in surgical wound site nosocomial infection in surgical wards of UCH Ibadan between 1995 and 2004 was traced back to the knowledge gained in the yearly refresher course in surveillance and control of hospital infection, organized by the infection control unit of the department of medical microbiology of the university [10].  [12].
On the findings on table VIII, 80% supported all methods of barrier nursing, which agreed with Paoulette, an article in French that the uses of disposal equipment and adequate safety measures have decreased infection of the respiratory virus, tuberculosis and incision site resulting from multi-resistance bacteria due to poor hospital sanitation [13]. La Poutreau, revealed that nurses have many tools available to create a safe environment that is free of infection [7]. Their full use of barrier principle is of great efficacy in the war against nosocomial infection.
Hand washing as a standard precaution is the most effective control measure against transmission agents. Table IX shows timing of hand washing of FMC ward nurses. Exactly 53.33% respondents washed their hands not less than 15 -30 seconds, which is in agreement with Blacks, who reported that at least 15 seconds hand scrub helps prevent and control infectious agents [6]. Also, table viii, which shows frequency of hand washing as, 3.33% on arrival to work, 33.33% in between patient's procedure, 10% after glove removal and 53.33% for the application of all of the above. This agreed with La Poutreau, who reported that hand washing is an important component of infection control and isolation precaution which should be routinely practiced by all ward nurses [7].
Nursing, with the primary responsibility of giving the best and quality care to the sick and well through evidence-based practice acquired through skill and knowledge, has a vital role to play in the prevention and spread of infection to patients during hospital admission.
Patients should be seen as people with little or no knowledge of nosocomial infection, and the course of their admission, as predisposing factors.
Every nurse on duty should utilize all the acquired skills and knowledge expected of her/him as a professional, towards managing patients and their environment in order to attain maximum reduction of nosocomial infection and its consequences.
The researcher would wish to suggest that further studies be carried out on this topic to identify contributions of others in the health care field toward prevention of nosocomial infection.
Nursing services department should keep proper monitoring of the statistics of patients diagnosis on admission, on discharge and duration in the hospital, as a guide to check nosocomial infection.
Since nosocomial infection is acquired through invasive procedures, wound dressing, contagious/infectious diseases, blood and other body fluid contacts, the standard of aseptic technique should not be compromised; barrier nursing/isolation and standard precaution should not be neglected in the care of our hospitalized patients.
From the findings of this study, the researcher recommends a sensitization seminar and health education on the consequences of nosocomial infection, for staff and for the community as a whole.
Nurses should also include nosocomial infection issues in their ward report discussion. Nurses should update their knowledge for efficiency in their performance, through the use of research work, internet and nursing journals.

Conclusion
Nosocomial infection outcome ranges from prolonged hospital stay, increased cost, discomfort/inconveniences to mortality, if not well managed. It has no limit and can get across to all in contact with hospital environment. This study was carried out to determine the knowledge and prevention of nosocomial infection among ward nurses at Federal Medical Centre (FMC), Umuahia. It was found that the nurses have a wealth of knowledge of nosocomial infection but still needed individualized task to the practice as in how and when to practice. Deficiencies were found in the areas of hand washing, mask application, equipment handling and health education of our patients.