|Year : 2020 | Volume
| Issue : 1 | Page : 42-46
Nursing students' knowledge and practice of infection control in burns and medical-surgical units at the University of Benin teaching hospital, Nigeria, 2019
, Oluwatosin Mary Oyewole2, Rachael Olufunmilayo Oduyemi3
1 Department of Medical-Surgical Nursing, School of Nursing, University of Benin Teaching Hospital Benin City, Nigeria
2 Department of Medical Surgical Nursing, School of Post Basic Nursing, Lagos University Teaching Hospital, Idi- Araba, Lagos State, Nigeria
3 Department of Nursing, School of Clinical Medicine, Oba Okunade Sijuade College of Health Sciences, Igbinedion University, Okada, Edo State, Nigeria
|Date of Submission||30-Jul-2019|
|Date of Acceptance||25-Aug-2019|
|Date of Web Publication||27-Dec-2019|
Mr. Olaolorunpo Olorunfemi
Department of Medical.Surgical Nursing, School of Nursing, University of Benin Teaching Hospital, Benin City, Edo State
Source of Support: None, Conflict of Interest: None
Context: Nursing students form a larger percentage among the health-care team. Therefore, for any infection control policies in the hospital to be effective; they must be put into consideration.
Aims: This study sought to find out the level of knowledge and practice of infection control (KPIC) among student nurses posted to Medical-Surgical and Burns Unit, and also determine if knowledge level will statistically predict the practice of infection control.
Settings and Design: This cross-sectional study was conducted on student nurses posted to Burns and Medical-Surgical Unit of University of Benin Teaching Hospital, Nigeria, 2019.
Materials and Methods: This study was conducted among 100 student nurses who were posted to Medical-Surgical and Burn Units through census method and KPIC questionnaires were administered.
Statistical Analysis Used: Data collected were analyzed using descriptive statistics and Spearman's correlation coefficient at 0.05 significant levels.
Results: The nursing students had low knowledge and do not practice infection prevention with mean score of 15.38 (3.32) and 14.17 (2.80), respectively. The result also revealed that there is a significant relationship between KPIC among nursing students using Spearman's correlation coefficient, which showed P < 0.001.
Conclusion: The level of KPIC measures was poor among nursing students, and those who are knowledgeable about infection control also have high compliance to infection control; we, therefore, recommend laborious training on infection control measures of nursing students prior to clinical posting.
Keywords: Burns, Infection control, Knowledge, Nursing students, Practice, Surgical procedure
|How to cite this article:|
Olorunfemi O, Oyewole OM, Oduyemi RO. Nursing students' knowledge and practice of infection control in burns and medical-surgical units at the University of Benin teaching hospital, Nigeria, 2019. J Nurs Midwifery Sci 2020;7:42-6
|How to cite this URL:|
Olorunfemi O, Oyewole OM, Oduyemi RO. Nursing students' knowledge and practice of infection control in burns and medical-surgical units at the University of Benin teaching hospital, Nigeria, 2019. J Nurs Midwifery Sci [serial online] 2020 [cited 2022 Oct 7];7:42-6. Available from: https://www.jnmsjournal.org/text.asp?2020/7/1/42/274179
| Introduction|| |
Infection control and prevention (ICP) was defined by the World Health Organization as a scientific approach and practical solution designed to prevent harm caused by infection to patient and health workers. ICP is essential in any well-functioning health system because it is a major tool used in preventing transmission of infection in health-care environment. This requires some basic knowledge in epidemiology of diseases; predisposing or risk factors that promote susceptibility to the infection. The Centers for Disease Control and Prevention postulated that 5% of all admitted patients, will contract hospital acquired infection and the spreading of these infections can be controlled through simple practices with little or no cost implication strategies, ranging from the basic tenet of handwashing technique, use of personal protective equipment, prevention of needlestick, sharp injuries, cough etiquette, cleaning, disinfection, and effective waste disposal.
In 2011, the Word Health Organization said that about 15% of all patients admitted into hospital developed hospital-acquired infection. In this modern day, it is totally unacceptable for an individual seeking medical help to be at risk of other infection. Infection controls in the hospital are, therefore a major challenge that must be considered. The incidence of hospital acquired infection is high in developing countries when compared to more industrialized countries. The practice of infection control in developing countries is low because of several influences such as knowledge deficient, government readiness, and absence of modern equipment necessary for infection control., In 2011, a study opined that prevalent of hospital acquired infection is high in Nigeria.
In 2014, a surveillance study was carried out about hospital-acquired infections and showed 4.9% prevalence rate of hospital-acquired infection and surgical site infection was found to be the second most prevalent of hospital-acquired infections in the hospital. A study showed an estimate total cost of $ 7,184,000 annually for hospital infection control and also identified developing countries such as Nigeria, with the greatest occurrence, in which the highest figures comes from Medical-Surgical Unit (68%) and Burn Units (35.5%). Other study shows that the health professionals (doctors, nurses, student nurses, and other health officers) are the major carrier of infection transmission in the hospital. Attention to universal precaution on infection prevention and practice is the way out but compliance by nursing students, nurses, doctors, and other members of health team is a major challenge. There are many research works on infection control among health workers, but students in the hospital are not considered because they considered not certified member of health team, but they have regular contact with patient, in fact, their population is more than certified health worker. Nursing students in particular are often exposed to various infections when posted to high-risk unit in the hospital to practice nursing. Therefore, for an effective control in the hospital, keen interest must be on these set of people in the hospital. Based on this identified high-risk areas and noticed gap in the literature reviewed, we aimed to determine Nursing Students' knowledge and practice of infection control in Burns and Medical-Surgical Units at the University of Benin Teaching Hospital, Nigeria, 2019.
| Materials and Methods|| |
A descriptive study conducted at University of Benin Teaching Hospital, Benin City, Nigeria, in 2019. Census method was used for sampling. The sample size is one hundred participants which comprises of all student nurses posted to Medical-Surgical and Burn Unit. The sample size was calculated using Taro Yamane formula, N = 133, error 5%, and 95% confidence interval, based on similar study. The students were recruited based on the inclusion and exclusion rules. The nursing students, currently undergoing training in school of nursing, University of Benin Teaching Hospital and Department of Nursing, University of Benin, were included in the study, while those students who were in their preclinical training and also fill out the questionnaire incompletely were excluded from the study. The ethical approval was obtained from the University of Benin Teaching Hospital Research and Ethical Committee, with approval reference Number: ADM/E22/A/VOL.V11/14568 on December 30, 2018, the hospital where the study was conducted. Principle of voluntary participation was applied, and proper explanation of the purpose of the research was ensured. Consent form was given to the participants to seek verbal and written consent before data collection. Students who declined inclusion were not penalized.
Data were collected through KPIC questionnaires to assess knowledge and practice of nursing students at various aspects of infection prevention and control. Content validity of KPIC questionnaire was assessed by some experts. Cronbach alpha statistics was used to determine the extent to which the instrument consistently measures what it is supposed to measure. This was carried out by administering the test to ten respondents and thereafter, the instrument was subjected to Cronbach's alpha test, to determine the reliability coefficient of the instrument.
The questionnaire consists of three sections: Section A – This contains four questions with options on demographic characteristics of the respondents; Section B – This contains eights questions with option on the knowledge of infection control that was analyzed using score rate answers (Yes or No). A score of 2 was given to right answer and 1 for wrong answer. A total score ranges from 0 to 11was rated as bad, scores below 12–15 as low knowledge while score 16 rated as borderline knowledge, scores from 17 to 19 was rated as good knowledge, and score 20–23 as excellent knowledge; Section C – This contains seven questions with options on practice of infection control through four-point Likert scale was used to grade the practice: “Not available/No, “Sometimes,” “most times” and “always.” A score of 4 was given for always 3 for most time, 2 for some time, and 1 for NO or NOT available,” this was rated as follows: A total score of 0–7 was rated very bad scores, 8–17 rated low practice, 18–22 scores rated good, and score of 23–28 were rated as excellence.
The researcher was assisted by three research assistants, who helped in the data collection and administration of the research instruments in the followings units: Burn ward, women and men medical and surgical wards of the University of Benin Teaching Hospital, Benin City. They also helped in supervision of the participants to avoid any interruption from the nonparticipating nursing students. The researcher and the assistants were present during the filling of the questionnaire for correction as well as to ensure high percentage of return of questionnaire. The data obtained were analyzed on computer through the use of Statistical Package for the Social Sciences (SPSS) version 21.00 statistical software (IBM Corp., released 2012, IBM SPSS Statistics for Windows, version 21.0 Armonk, NY, USA: IBM Corp.,). The statistical techniques used were: mean, standard deviation, frequency, and Spearman's correlation coefficient.
| Results|| |
Demographic characteristics of nursing students in total from the three wards were reported in [Table 1]. The sample was characterized by only few in middle-age adult. More than two-third of the student was female, and more than two-third of the student was Christian and about two-third were in year 3.
|Table 1: Demographic characteristics of student nurses posted to Burns and Medical-Surgical Units at the University of Benin Teaching Hospital, Nigeria, 2019|
Click here to view
Knowledge about infection prevention is reported in [Table 2]. It shows that the respondents had poor knowledge about the isolation precaution of pulmonary tuberculosis infection; Methicillin-resistant Staphylococcus aureus and meningococcal meningitis but have excellent knowledge about HIV's isolation precaution. It also shows that the respondents had excellent knowledge of infection control but was poor for use of immunoglobulin.
|Table 2: Knowledge of infection control among student nurses posted to Burns and Medical-Surgical Units at the University of Benin Teaching Hospital, Nigeria, 2019|
Click here to view
Practice of infection control among nursing student is reported in [Table 3]. It shows that the respondents had a low level of practice in the areas such as, wearing of eye shield when there is any risk of blood splash, wearing of glove for touching mucous membrane, and wearing of the glove when given an injection to the patient. The mean score for knowledge and practice of infection is reported in [Table 4]. It shows the mean score of practice of infection control falls within the stated scores for low practice of infection control. The table also shows that the mean score of knowledge of infection control is below the stated borderline scores of knowledge of infection control. Spearman's correlation statistics shows that there is significant relationship (r = −0.123, P < 0.001) between the KPIC.
|Table 3: Practice of infection control among student nurses posted to Burns and Medical.Surgical Units at the University of Benin Teaching Hospital, Nigeria, 2019|
Click here to view
|Table 4: Means of scores of knowledge and practice of infection control among student nurses posted to Burns and Medical-Surgical Units at the University of Benin Teaching Hospital, Nigeria, 2019|
Click here to view
| Discussion|| |
Knowledge has come to be recognized as a factor of production. Students' attitude or practices do change, but you can't make someone change. Instead, the person has to realize for themselves that the way they are acting is not effective and decide that they want to do something better; therefore, knowledge is pertinent in decision-making. The findings from this study show that nursing students have poor knowledge on infection prevention which agrees with a study, which stated that adherence to standard precautions is poor in public health facilities in resource-limited settings due to higher disease prevalence and limited organizational support. However, this disagree with a study which revealed that nurses have adequate knowledge of universal precautions and high compliance with the use of sterile gloves, handling and disposal of needles and other sharp objects was higher, especially among those with experience of 10 years and above. This disagreement between results may be due to difference in content of education or some differences between studies' population. Knowledge of universal precautions was highest among nurses compared to other health-care workers. The result may be due to the fact that the students are less experienced in health care management of patients.
The result of the analysis also shows that practice of infection control among the respondents is low. This agreed with the research carried out among 245 dental students and found out that the level of KPIC measures was poor among dental students. This further corroborates with a research regarding standard precautions among Iranian midwifery instructors, nursing instructors, auxiliary nursing instructors, and their students were found to be poor. Finally, the study also shows that the level of knowledge about infection control can be used to predict the practice of infection control. This means that, the knowledge level among student nurses will statistically predict the practice of infection prevention and control among them. This is in agreement with a study that identified theoretical-based predictors of condom use in a sample of 253 sexually active African-American college students and found that the knowledge of HIV is a predictor to the use of condom., This is also validated by study who found that there is a significant relationship between the extent to which the nurses' practice is evidence-based practice and nurses' knowledge of the practice.
Nevertheless, this study was faced with some limitation such as the research only covered one school of nursing, probably; there is a peculiarity in the school that affected the outcome of the study. Furthermore, not achieving the complete sample size due to the limitation of number of students is another major factor. The study will be better if extended to different school of nursing, from different state of the country.
| Conclusion|| |
The overall level of knowledge of ICP in this study indicates that majority of nursing students have poor knowledge on infection prevention and practice of infection control; we, therefore, recommend laborious training on infection control measures of nursing students prior to clinical posting. This will equip the student nurses with the knowledge and skills of infection prevention and control. Moreover, the hospital management is also expected to provide the necessary personal protective equipment, such as gowns, face masks, and gloves, for student nurses posted to various wards.
Conflicts of interest
There are no conflicts of interest.
All authors contributed to this research.
Financial support and sponsorship
The authors wish to sincerely thank all the nursing students who participated in the study and the staff nurses in Burn and Medical-Surgical Units of UBTH, Benin City.
| References|| |
Khan HA, Baig FK, Mehboob R. Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pac J Trop Biomed 2017;7:478-82.
Gerstman BB. Epidemiology Kept Simple: An Introduction to Traditional and Modern Epidemiology. Hoboken, NJ: John Wiley & Sons; 2013. p. 21-5.
Alice TE, Akhere AD, Ikponwonsa O, Grace E. Knowledge and practice of infection control among health workers in a tertiary hospital in Edo state, Nigeria. J Health Pharm 2013;1:20-7.
Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, McLaws ML, Moro ML, et al.
Global implementation of WHO's multimodal strategy for improvement of hand hygiene: A quasi-experimental study. Lancet Infect Dis 2013;13:843-51.
Baines R, Langelaan M, de Bruijne M, Spreeuwenberg P, Wagner C. How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over time. BMJ Qual Saf 2015;24:561-71.
Oli AN, Ekejindu CC, Ejiofor OS, Oli AH, Ezeobi I, Ibeh CC. The knowledge of and attitude to hospital-acquired infections among public and private healthcare workers in South-East, Nigeria. Br J Med Med Res 2016;11:1-10.
Akujobi CN, Ilo IA, Egwuatu CC, Ezeanya CC. Prevalence of Methicillin-Resistant Staphylococcus aureus
(MRSA) among healthcare workers in a tertiary institution in Nigeria. Orient J Med 2013;25:82-7.
Nakamura I, Fukushima S, Hayakawa T, Sekiya K, Matsumoto T. The additional costs of catheter-related bloodstream infections in intensive care units. Am J Infect Control 2015;43:1046-9.
Fan Y, Wei Z, Wang W, Tan L, Jiang H, Tian L, et al.
The incidence and distribution of surgical site infection in mainland China: A meta-analysis of 84 prospective observational studies. Sci Rep 2014;4:6783.
Raza MW, Kazi BM, Mustafa M, Gould FK. Developing countries have their own characteristic problems with infection control. J Hosp Infect 2004;57:294-9.
Zubair KO, Iregbu KC. Resistance pattern and detection of metallo-beta-lactamase genes in clinical isolates of Pseudomonas aeruginosa
in a central Nigeria tertiary hospital. Niger J Clin Pract 2018;21:176-82.
] [Full text]
Thapa S, Sapkota LB. Bacteriological assessment of stethoscopes used by healthcare workers in a tertiary care centre of Nepal. BMC Res Notes 2017;10:353.
Okpala PU, Uwak R, Nwaneri AC, Onyiapat JL, Emesowum A, Osuala EO, et al
. Nurses' knowledge and attitude to the care of HIV/AIDS patients in South East, Nigeria. Int J Community Med Public Health 2017;4:547-53.
Okechukwu EF, Motshedisi C. Knowledge and practice of standard precautions in public health facilities in Abuja, Nigeria. Int J Infect Control 2012;8:1-7.
Abdulraheem IS, Amodu MO, Saka MJ, Bolarinwa OA, Uthman MM. Knowledge, awareness and compliance with standard precautions among health workers in North Eastearn Nigeria. J Community Med Health Educ 2012;2:1-5.
Amoran O, Onwube O. Infection control and practice of standard precautions among healthcare workers in Northern Nigeria. J Glob Infect Dis 2013;5:156-63.
Halboub ES, Al-Maweri SA, Al-Jamaei AA, Tarakji B, Al-Soneidar WA. Knowledge, attitudes, and practice of infection control among dental students at Sana'a university, Yemen. J Int Oral Health 2015;7:15-9.
Murray A, Huang MJ, Hardnett F, Sutton MY. Strengthening HIV knowledge and awareness among undergraduate students at historically black colleges and universities. J Health Disparities Res Pract 2014;7:33-45.
Alnoumas SR, Enezi FA, Isaeed MM, Makboul G, El-Shazly MK. Knowledge, attitude and behavior of primary health care workers regarding health care-associated infections in Kuwait. Greener J Med Sci 2012;2:92-8.
Joy IE, Eghiaghe FA, Nwobu RA, Paul ON. Prevalence and multidrug antimicrobial susceptibility of bacteria isolates obtained from surgical site in Nigeria. Int J Curr Microbiol App Sci 2016;5:708-15.
[Table 1], [Table 2], [Table 3], [Table 4]