An infection is considered as nosocomial, if it manifests 48 hours or more after hospital admittance or within 30 yearss of discharge following inmate attention. Ten to thirty per centum of the patients admitted to infirmaries in India get nosocomial infections as against merely 5 % in developed universe. ( 2 ) Nosocomial infections are transmitted from one patient to another through the wellness attention workers ( HCWs ) who do non pattern control measures such as manus lavation, usage of baseball mitts etc. ” . In 1847Ignaz Semmelwies, a Magyar doctor proposed the importance of Hand Washing for first clip. ( 3 ) Hand hygiene which is a modifiable hazard factor, has been recognized as the most effectual step to forestall the spread of infections. But HCWs frequently forget to rinse their custodies before interacting with the patients. Such contaminated custodies play of import function in conveying infections, and therefore protracting the infirmary stay, bacterial opposition, high costs for patients and decease.
HCWs are at an increased hazard of needle stick hurts ( NSI ) due to the environment in which they work. Hence, they are at hazard of geting blood borne pathogens such as HIV, hepatitis B and C, and other diseases. NSI cause about 1.3 million early deceases, a loss of 26 million old ages of life, and an annual outgo of around US $ 535 million. ( 4 )
As the conformity of wellness workers from the available beginnings was hapless and pantie in India, it was decided to take up this survey to find the cognition and perceptual experience of HCWs towards manus hygiene and the happening of NSI, the factors responsible for it and the fortunes under which they occur.
MATERIALS AND METHODS
A cross sectional survey was carried out in physicians and nurses working in Basaveshwara Medical college Hospital and Research Centre towards the cognition and attitudes of manus rinsing pattern from October 2012 to December 2012.
After obtaining clearance from the institutional ethical commission, permission was obtained from the concerned governments to set about the survey. A sum of 275 employees gave verbal consent out of which 55 were Doctors, 143 were nurses and 77 were housemans.
A pre designed and pretested questionnaire was administered to find the cognition and perceptual experience of manus hygiene and incidence of NSI. The questionnaire was divided into three classs. First class consisted of socio-demographic and occupational inside informations. Second about cognition, perceptual experience and the hinderance factors associated with manus hygiene. Third class consisted of the inside informations pertained to incidence of hurt due to needle stick, crisp objects and the factors associated with them. A sum of 25 inquiries were imposed to measure the cognition. Correct reply was awarded 1 grade and incorrect nothing, maximal being 25 and minimal 0. The points were divided into 5 equal classs. Very hapless cognition was given to those who scored & lt ; 5, 6 – 10 hapless, 11 – 15 adequate, 16 – 20 good and & gt ; 21 really good. For perceptual experience of manus hygiene and effectivity of some steps to better manus hygiene in the establishment, the topics were asked to rate on a graduated table of 1 to 5. Last portion of the questionnaire consisted information sing needle stick hurts, crisp objects and the factors associated with it. The information therefore obtained was compiled and analyzed
.
Tables
Table 1. Baseline features of the survey group
Particulars
Doctors
n ( % )
Nurses
n ( % )
Number
55 ( 20 % )
143 ( 52 % )
Age in old ages ( Mean + SD )
41.94 +12.7
26.72 +3.7
Sexual activity
Male
42 ( 77 % )
52 ( 37 % )
Female
13 ( 23 % )
91 ( 63 % )
Old ages of experience ( Mean + SD )
11.9 + 10.25
3.8 + 1.82
Discipline
Non Surgical
25 ( 46 % )
98 ( 68 % )
Surgical
30 ( 54 % )
45 ( 32 % )
Table 1 shows the baseline features in the survey group. physicians constituted 20 % , nurses 52 % , and interns 28 % of the sample. Average age of the Doctors was 41.94 +12.7 year with average experience of 11.9 + 10.25yrs. Average age of the nurses was 26.72 +3.7 year with average experience of 3.8 + 1.82 year. Mean age of the housemans was 23.32 +1 year. Seventy seven per centum of the physicians were males, 58 % of housemans were males where as 63 % of the nurses were females.
Table 2: Cognition of Hand Hygiene and continuance of Hand hang-up in HCWs.
Profession
Knowledge of manus hygiene
Duration of Hand hang-up
Adequate Ns ( % )
Good N ( % )
Very Good N ( % )
3 Sec n ( % )
10 Sec n ( % )
20 Sec n ( % )
60 Sec n ( % )
Doctors
4 ( 7 )
32 ( 35 )
19 ( 58 )
0 ( 0 )
3 ( 5 )
12 ( 22 )
40 ( 73 )
Nurses
27 ( 19 )
109 ( 76 )
7 ( 5 )
4 ( 3 )
24 ( 17 )
35 ( 24 )
80 ( 56 )
Interns
11 ( 14 )
54 ( 70 )
12 ( 16 )
0 ( 0 )
12 ( 15 )
18 ( 24 )
47 ( 61 )
Table 2 shows the degree of cognition of manus hygiene of assorted HCWs. None of them have hapless cognition. Fifty eight per centum of the physicians had really good cognition whereas 76 % of nurses and 70 % of housemans had good cognition
Table 3: Percept of HCWs on how of import is Hand Hygiene
How effectual is Hand Hygiene
Not
effectual N ( % )
Barely
effectual N ( % )
Do n’t cognize n ( % )
Effective
n ( % )
Very effectual N ( % )
To Self
0 ( 0 )
6 ( 2 )
8 ( 3 )
68 ( 25 )
193 ( 70 )
To Hospital Administration
3 ( 1 )
3 ( 1 )
11 ( 4 )
41 ( 15 )
217 ( 79 )
To Other Hospital Staff
3 ( 1 )
3 ( 1 )
6 ( 2 )
62 ( 23 )
201 ( 73 )
To patient
0 ( 0 )
8 ( 3 )
8 ( 3 )
42 ( 15 )
217 ( 79 )
Table 3 shows the participants reacting to a 5 point Likert graduated table on perceptual experience of the importance of Hand hygiene. Most of them believed manus hygiene to be either ‘effective ‘ or ‘very effectual ‘ to them, and besides felt it held similar importance for hospital disposal, other staff and to patients. Two per centum of them felt that manus hygiene is non at all of import to the infirmary disposal and other hospital staff.
Table 4: How effectual would the following be to better manus hygiene in your establishment?
How of import is manus
Hygiene
Not
Effective N ( % )
Barely
Effective N ( % )
Do n’t cognize n ( % )
Effective N ( % )
Very effectual N ( % )
Acceptable soap merchandise available
14 ( 5 )
11 ( 4 )
19 ( 7 )
52 ( 19 )
179 ( 65 )
Hand rubs easy available
3 ( 1 )
7 ( 3 )
6 ( 2 )
88 ( 32 )
171 ( 62 )
Hand hygiene postings displayed
13 ( 5 )
47 ( 17 )
11 ( 4 )
77 ( 28 )
127 ( 46 )
Regular manus hygiene instruction
11 ( 4 )
11 ( 4 )
11 ( 4 )
91 ( 33 )
151 ( 55 )
Table 4 shows the effectivity of peculiar actions in bettering manus hygiene in the establishment. All the four activities presented in the study were perceived either ‘effective ‘ or ‘very effectual ‘ . Hand hang-ups made easy available was the most effectual factor whereas exposing manus hygiene postings was least effectual among the four activities.
Table 5: Trial of significance ( X2 ) for assorted variables
X2
‘P ‘ value
Significance
Experience of physicians and nurses and cognition of manus hygiene
14.33
& lt ; 0.001
Highly important
Discipline and cognition of manus hygiene
8.4
& lt ; 0.02
Highly important
Received formal instruction on manus hygiene and cognition about manus hygiene
1.33
& gt ; 0.1
Not important
Profession and incidence of NSI
25.59
& lt ; 0.001
Highly important
Knowledge of recapping and incidence
of NSI
2.18
& lt ; 0.05
Not important
Incidence of hurt with sharps and profession
11.15
& lt ; 0.01
Highly important
Profession and continuance of manus hang-up
27.10
& lt ; 0.001
Highly important
Incidence of hurt with crisp objects and profession
1.21
& gt ; 0.05
Not important
Consequences:
A sum of 275 topics were enrolled in the survey. Fifty eight per centum of the physicians had a really good cognition of Hand Hygiene and 35 % and 7 % of them had good and equal cognition severally. While 76 % of nurses had good sum of cognition, 19 % had adequate and merely 5 % had really good cognition of manus hygiene. Seventy per centum of the housemans had good cognition and 14 % and 16 % of housemans had equal and really good cognition severally.
Chi square trial was applied between any formal instruction or preparation received on manus hygiene and cognition on manus hygiene. However the trial showed no statistically important difference at 5 % degree.
Average old ages of experience of physicians was found to be 11.9 + 10.25 year and nurses 3.8 + 1.82 year. Chi square trial was applied to the experience of the HCWs and cognition on manus hygiene. The trial showed statistically important difference at 5 % degree.
The whole of the nursing staff and the physicians were divided into two classs. One class consisted of physicians related to surgical field such as General surgery, ENT, Orthopedics etc and the nurses working under them. The other class consisted of them who were non related to surgical procedure straight such as those working in Dept of General Medicine, Dept of Pediatrics, Dept of Radiology etc and the nursing staff working under them. Casualty was included in surgical class. Chi square trial was applied to the above two classs and there was a statistically important difference at 5 % degree between the class ( surgical and non-surgical ) and cognition of manus hygiene.
Participants were asked how effectual manus hygiene is. The responses were plotted on a 5 point Likert graduated table runing from non effectual to really effectual. Ninety five per centum of the respondents answered that manus hygiene is either effectual or really effectual to them. When asked about the effectivity of manus hygiene towards hospital disposal and to other hospital staff, about 95 % answered that it is either effectual or really effectual. Whereas 1 % answered that it is non effectual to either hospital disposal or other hospital staff. Percept of manus hygiene towards patients was found to be either effectual or really effectual in 94 % of the respondents.
A set of inquiries in the questionnaire was related to the perceptual experience of how effectual a undermentioned alteration can be made to better manus hygiene in the establishment. The responses were plotted on a 5 point Likert graduated table runing from non effectual to really effectual. When asked about the acceptable soap merchandise made easy available, 84 % of them answered that it would be effectual and 7 % of them were non certain. Effectiveness of manus hygiene would increase if manus hang-ups are made easy available. Displaying of manus hygiene postings would non be that effectual as 32 % of them answered that it could be non effectual. Regular instruction on manus hygiene would be really effectual in bettering the manus hygiene in the establishment as 94 % of them responded as effectual.
The respondents were asked the factors responsible for hapless attachment with manus hygiene. The most common ground was due to the deficiency of soap, towel or sinks followed by annoyance and waterlessness of the tegument and deficient clip. The uncommon grounds were incredulity, dissension with the recommendations etc.
The incidence of needle stick hurts was found to be 50 % in nurses, 31 % in physicians and 25 % in housemans. Chi square trial was applied between the profession of HCWs and incidence of NSI. The trial showed statistically important difference at 5 % degree.
Thirty four per centum of the respondents said that recapping should be done instantly after giving injection. Out of which 14 % were nurses, 12 % were housemans and 7 % physicians. Fifty per centum of the nurses had NSI in last 2 old ages with average continuance of 1.2 months back. The most common cause was during recapping. Incidence of NSI in physicians and housemans was found to be 31 % and 25 % severally, the most common cause once more being recapping. Chi square trial was applied to the cognition of recapping and incidence of NSI. The trial showed no statistically important difference at 5 % degree.
Incidence of hurt with sharps was found to be 11 % . The highest incidence was observed among physicians which was 63 % followed by the nursing staff 21 % and interns 16 % . Chi square trial was applied to the incidence of hurts with the sharps and the profession of the HCWs. The trial showed no statistically important difference at 5 % degree.
Discussion
This cross sectional survey was taken up in a third attention learning infirmary in order to happen out the degree of cognition and perceptual experience of the wellness workers towards manus hygiene. Hand hygiene being simple and effectual manner to forestall the transmittal of infections has been emerged as an of import facet in quality betterment plan.
The cognition tonss ranged from equal to really good in physicians, nurses and housemans in this survey. In a survey conducted in Pakistan by Anwar et Al ( 5 ) found that 17 % of the doctors were cognizant of WHO recommendations of manus hygiene. They had besides found that the manus hygiene was non practiced due to miss of sinks, soap, H2O and disposable towel. Similar findings were found in our survey besides. The sensed barriers in our survey were divided into three classs which were – deficiency of resources, attitude, and behaviour of HCWs. Lack of resources ( 37 % ) was the chief ground for hapless attachment which included factors such as sinks non available, deficiency of soap, towel etc. This was followed by attitude ( 35 % ) which included factors such as incredulity, dissension with recommendations, deficient clip etc. The last ground being related to behaviour of HCWS ( 28 % ) which included factors such as forgetfulness, no function theoretical account etc. Another survey conducted by Zimakoff et Al ( 6 ) has shown the same factors as barriers for manus lavation.
Our survey concluded that the old ages of experience in the infirmary significantly correlates with the degree cognition. A survey conducted by JB Suchitra and N Lakshmi Devi. ( 7 ) concluded that old ages of experience significantly co related to increased cognition which is similar to our survey.
In an intercession survey in Nigeria examined the impact of systematized instruction ‘s impact on their cognition, attitudes and conformity with cosmopolitan safeguards. The research revealed that a figure of positive alterations occurred over the period of the survey with regard to knowledge about cosmopolitan safeguards. The decision emphasizes that it is really of import for instruction about cosmopolitan safeguard to be incorporated within current undergraduate and in-service preparation programmes for nurses. ( 8 ) Our survey tried to happen out the association between any formal instruction received and cognition of manus hygiene as conducted by JB Suchitra and N Lakshmi Devi. ( 7 ) In contrast to their findings which showed betterment in the degree of cognition of manus hygiene, our consequences showed no statistically important association. The ground may be the continuance of clip that had elapsed after having the instruction. Peoples tend to bury things as the clip base on ballss and peculiarly those which they do non pattern.
Optimum continuance for executing manus hang-up is 1 min ( 9 ) and the cognition about it was significantly lower in nurses. Chi square trial was applied to the cognition of optimum continuance of manus hang-up and the profession of the HCWs. The trial showed statistically important difference at 5 % degree.
Our survey suggests that the participants are cognizant of importance of manus hygiene, which are similar to the findings of Jumaa ( 10 ) and Yuan et Al. ( 11 ) The factors identified by the participants for bettering manus hygiene patterns in their establishment are manus hang-ups made easy available and regular manus hygiene instruction.
The prevalence rate of NSI in last two old ages was 38.9 % which was similar to the survey conducted by Bayapa Reddy N et Al ( 12 ) and Haile D and Berhane Y in Northwest Ethiopia ( 13 ) . Sing the happening of NSI it was found that most figure of hurts i.e. , 83 % occurred due to injection acerate leaf and merely 17 % while suturing. A survey conducted by Moges T and Takele T ( 14 ) in Awassa metropolis southern Ethiopia found that 54.4 % of NSI was due to injection needle and 16.7 % while suturing which is similar to our survey.
In a survey conducted by Khurram S et Al ( 15 ) in Rawalpindi, Pakistan showed that 43.3 % of NSI occurred in surgical section followed by 23 % in non surgical sections, whereas 52 % of the NSI occurred in surgical section and 48 % in non surgical sections. Chi square trial was applied to the cognition of optimum continuance of manus hang-up and the profession of the HCWs. The trial showed statistically important difference at 5 % degree.
Most of the NSI occur during recapping of the acerate leaf ( 53.33 % ) which is similar to the survey conducted by Nsubuga FM, Jaakkola MS in Mulago, Uganda ( 16 ) and by Iram Manzoor et Al ( 17 ) Hence Chi square trial was applied to cognize the association between cognition of recapping of needle and needle stick hurts. The trial showed no statistically important difference at 5 % degree. The ground may be that the cause of NSI may be multifactorial. Though recapping plays a major function other factors such as taking injection from others while giving injection contribute. These consequences are in contrast to a survey carried out by Zafar A et Al ( 18 ) at Aga Khan infirmary, Pakistan which reported that more than half of the hurts ( 52.8 % ) occurred while pulling the blood samples.
Decision
Hand hygiene is simple and play a critical function in forestalling the infirmary acquired infections. The cognition and perceptual experience towards manus hygiene among wellness workers is of extreme of import in accomplishing the quality patient attention. The cognition should be converted as pattern to accomplish the end. A periodic and on-going reorienting instruction plan sing Universal Precautions which includes manus hygiene, handling of the sharps and other protective steps is indispensable for forestalling the infirmary acquired infections. Role of wise mans plays a function particularly in the nursing staff and housemans. However this research is non without restrictions. Since it was transverse sectional survey of measuring the cognition no reorienting instruction has been imparted on the wellness workers. However such surveies help the infirmary directions to cut down the load of Hospital Acquired Infections.