CHAPTER
ONE
INTRODUCTION
1.1
Background to the Study
Nosocomial infections, also known as Hospital Acquired Infections
(HAIs), are infections acquired during a hospital stay for conditions unrelated
to the infection itself. These infections can manifest within 48 hours of
admission or even after discharge (Hildron et al., 2022). They are commonly
caused by pathogens such as bacteria (Lepelletier et al., 2020), viruses
(De-Oliveira et al., 2020), and fungi found in the hospital environment,
including air, surfaces, and equipment. These pathogens are typically not
present in the patient before admission and are often transmitted through
direct contact during invasive procedures (Anderson et al., 2021). Some
pathogens exhibit high resistance to antimicrobial agents, leading to the use
of more expensive and potent treatments (Mulvey & Simor, 2022).
The
prevalence of nosocomial infections is a significant concern globally,
affecting patients across all age groups, including neonates (Aly et al.,
2019), immunocompromised adults, and the elderly (Lepelletier et al., 2020).
The most common types of nosocomial infections are those related to the urinary
tract, surgical wounds, respiratory tract, and bloodstream (Lo, 2020).
Globally, these infections impact approximately 1.4 million people at any given
time (WHO, 2022).
Nosocomial
infections in developing countries poses unique challenges. Despite efforts by
international and intergovernmental organizations, issues such as inadequate
infrastructure, leadership deficits, and healthcare worker behavior remain
significant obstacles. Effective infection control in these settings cannot be
resolved merely by promoting hand hygiene or providing supplies without proper
training (WHO, 2021).
In
developed countries, the burden of HAIs is considerable, affecting 5% to 15% of
hospitalized patients in general wards and up to 50% in intensive care units
(ICUs) (WHO, 2021). In contrast, the magnitude of HAIs in developing countries
is often underestimated or unknown due to complex diagnostic processes and
limited surveillance capabilities (Allegranzi & Pittet, 2020). Surveillance
systems in developed countries, such as the National Healthcare Safety Network
in the U.S. and the German hospital infection surveillance system, provide valuable
data, but such systems are often lacking in developing regions due to economic
and systemic challenges (WHO, 2021). Prevalence of hospital-wide HAIs varies
significantly across countries. For instance, Algeria, Burkina Faso, Senegal,
and Tanzania report prevalence rates ranging from 2.5% to 14.8% (Vincent et
al., 2020; DiA et al., 2019; Atif et al., 2019). In surgical wards, cumulative
incidence rates range from 5.7% to 45.8% in Ethiopia (Messele et al., 2020) and
Nigeria (Kesah et al., 2020), with the latter study indicating an incidence
density of 26.8 infections per 1000 patient-days in pediatric surgical patients
(Kesah et al., 2020). An infection control program in a Nigerian teaching
hospital reduced the HAI rate from 5.8% in 2013 to 2.8% in 2022 (Abubakar,
2019).
In
Nigeria, nosocomial infection rates have been reported as 2.7% in Ife, 3.8% in
Lagos, and 4.2% in Ilorin (Odimayo et al., 2019). Infections can be endogenous,
originating from the patient's normal flora, or exogenous, resulting from exposure
to hospital environments, personnel, or medical devices (Medubi et al., 2020).
Infection rates vary by body site, hospital type, and infection control
practices. Surgical site infections (SSIs) are prevalent in general surgery,
while urinary tract and bloodstream infections are common in medical services
and nurseries (Taiwo et al., 2021). For instance, urinary tract infections,
predominantly caused by indwelling catheters, account for 34% of nosocomial
infections (Tolu, 2021). Surgical wound infections, which represent 17% of
HAIs, are influenced by factors such as age, obesity, and surgical site
contamination (Odimayo et al., 2019). Lower respiratory infections, including
pneumonia, constitute 13% of nosocomial infections and are particularly severe,
with a case fatality rate of 30% (Taiwo et al., 2021).
Urinary tract infections (UTI) represent the most
common (34%) type of nosocomial infections. Indwelling catheters cause the
majority while others are caused by genito urinary procedures (Tolu, 2017).
Surgical wound infections
represent 17% nosocomial infection
and are the
second most common hospital
acquired infections. The
classification of wound infections is based on the degree of bacterial
contamination, including clean, clean contaminated and contaminated. Co-morbid
and contamination of the surgical site contribute to the infection rate. The
risk factors for surgical wound infections include age, obesity, concurrent
infection and prolonged hospitalizations. The origin of the bacterial agent is
dependent on direct inoculation from a host’s flora, cross-contamination, the
surgeon’s hands, air-borne contamination and devices such as drains and
catheters (Odimayo et al., 2018). Lower respiratory infection (LRI) or
pneumonia represents 13 % of nosocomial infections (Taiwo et al., 2019). This is the most dangerous of all nosocomial
infections with acase fatality rate of 30%.
It manifests in the intensive care unit or post-surgical recovery room. Endotracheal intubation and tracheostomy dry
the lower respiratory tract mucous and provide entry for microbes.
This study therefore aims at investigating the measures
utilized for the prevention of nosocomial infection in labour ward, Niger Delta
University Teaching Hospital, Bayelsa State..
1.2 Statement of Problems
Nosocomial infections have been recognized as a
problem affecting the
quality of health care and a principal
source of adverse healthcare outcomes.
Within the realm
of patient safety, these infections have serious impact such as
increased hospital stay days, increased
costs of healthcare, economic hardship
to patients and their families and even deaths, are among the many negative
outcomes (Anderson et al., 2019).
Nosocomial infections in labor wards are a significant
concern for healthcare facilities, including Niger Delta University Teaching
Hospital (NDUTH), Okolobiri, Bayelsa State. These infections pose a severe risk
to patient safety and health outcomes, leading to extended hospital stays,
increased healthcare costs, economic strain on patients and their families,
and, in some cases, mortality. Despite the implementation of various preventive
measures, the persistent occurrence of nosocomial infections indicates
potential gaps in current practices or challenges in adherence. Understanding
and addressing these gaps are crucial for enhancing infection control and
ensuring better healthcare quality in the labor ward at NDUTH Okolobiri.
Furthermore, it was noted by the researcher that healthcare workers were
not observing strict Aseptic measures. It is with the above information that the researcher tends to carried out this
study to investigate nursing measures utilized for the prevention of nosocomial
infection the Labour ward, Niger Delta University Teaching Hospital, Bayelsa
State..
1.3
Objectives of Study
Objectives
of the study are to
1.
Assess current level of knowledge of
nurses regarding infection control measures.
2. Identify
the nursing measures utilized for the prevention of nosocomial infection in the
Labour ward of Niger Delta
University,(NDUTH), Bayelsa
3.
Investigate current level of practices
of nurses regarding infection control
1.4 Research Questions
1.
What is the current level of knowledge
of nurses regarding infection control measures?
2. What
nursing measures are utilized for the prevention of nosocomial infections in
the Labour ward of Niger Delta
University,(NDUTH),Bayelsa
3.
What is the current level of practices
of nurses regarding infection control measures?
The findings of this study will be of great
importance to several groups. Health workers will find the study a valuable
tool for counseling patients dealing with nosocomial infections, as it provides
insights into effective preventive measures and their implications. Nurses and
midwives will benefit from the study as it will help them decide on the most
appropriate infection prevention strategies for individuals at specific times.
Additionally, it will offer them a deeper understanding of nosocomial infections,
enhancing their ability to provide comprehensive health education on treatment
and prevention. For researchers, the study will serve as a useful resource for
those interested in conducting related research in the future, contributing
valuable information to the field of infection control.
1.6
Scope of Study
The study is focused on investigating the nursing
measures utilized for the prevention of nosocomial infection in NDUTH,
Okolobiri. It will also look at the level of knowledge of nosocomial infections
among nurses in NDUTH Okolobiri
1.7 Operational Definition of Terms
The key terms in this research were defined as
follows:
Infections: This is referred to the
process of infecting or the state of being infected bacteria or fungi that
generates to a disease while being admitted in the hospital.
Measures Utilize: refer to the
specific actions or methods employed to gather data or information in a
particular context or for a specific purpose.
Nosocomial infections:
also referred to as healthcare-associated infections (HAI), are infection(s)
acquired during the process of receiving health care that was not present
during the time of admission.
Nurse: A nurse is a
healthcare professional who is trained and licensed to provide medical care and
support to individuals, families, and communities across various healthcare
settings.
Nursing Intervention: involves
specifying the actions or strategies undertaken by a nurse to achieve specific
healthcare goals or outcomes for a patient or group of patients.
Prevention: involves clarifying
the specific actions, strategies, or measures implemented to reduce the
occurrence or severity of a particular health issue or problem.
CHAPTER
TWO
LITERATURE
REVIEW
Introduction
This chapter is concern with the review of
literature on the topic under consideration. It is carried out under the
following headings: Conceptual review, theoretical review, empirical review and
Summary of literature review.
2.1 Conceptual Review
Etiology of
Nosocomial Infections
Numerous epidemiological studies have documented
that nosocomial infections are commonly caused by pathogens such as bacteria,
fungi, parasites and viruses transmitted from one patient to another through
indirect or direct contact (Edwards et al., 2019). The most common
pathogens are the bacteria. In 1938, it
was established that bacteria recovered from the human body could be divided
into two categories: the resident flora
(microbiota), or transient flora. The resident microbiota, also commonly
referred to as normal flora consists of bacteria mostly found in the
superficial cells of the skin and has protective functions. However, these bacteria may cause infections in
non-intact skin. The most dominant
species of resident microbiota is Staphylococcus epidermis. Transient
rnicrobiota colonizes the superficial layers of the skin
and is more amenable to removal by routine hand
hygiene and such bacteria
are often acquired by healthcare
workers during direct contact
with patients, or contaminated
environmental surfaces, within the patient's surroundings (Hayden et al.,
2022). The transmission of transient bacteria depends on the number of
microorganisms on the surface, toxins produced during colonization, skin
moisture, and the transmission of pathogens by healthcare workers (Abbo et
al., 2019). The most common types of transient bacteria implicated
innosocomial infections are the Staphylococcus aureus, Escherichia coli,
{3eta-hemolytic Streptococci, Serratia mercescens, Klebsiellapneumonia,
Pseudomonas aeruginosa, Enterobacter species and Clostridium difficile. The affected body systems depend on the
virulence ofthe pathogens and the body system affected. Some of the bacteria become highly resistant
to multiple classes of antimicrobial agents including antibiotics such as
Methicillin and Vancomycin (Hayden et al., 2022). The resistance of
bacteria to antimicrobial agents requires prescription of more potent and
expensive classes of antibiotics and they contribute to extended hospital stay
days, and ultimate increased cost of healthcare (Scott , 2019).
The causative agents of nosocomial infections are
commonly present in hospitals and other healthcare facilities and may be
transmitted from one source to susceptible hosts by more than one route. For
example, some of the pathogens are transmitted by "direct contact between
the healthcare workers and patients or by "indirect contact with
environmental surfaces and inanimate objects, or by air. The most common method
of transmission of nosocomial infections from an infected patient to a
susceptible patient, often via the contaminated hands of healthcare workers, is
“direct contact" (De Oliveira et al., 2019).
2.1.1 Causes
And Transmission of Nosocomial Infections
Nosocomial infections are commonly transmitted when
health care providers become complacent and do not practice correct hygiene
regularly. Also, increased use of outpatient treatments in recent decades means
that a greater percentage of people who are hospitalized today are likely to be
seriously ill with more weakened immune systems than in the past. Moreover,
some medical procedures bypass the body’s natural protective barriers. Since
medical staff move from patient to patient, the staff themselves serve as means
for spreading the pathogens i.e. acting as vectors (Pollack, 2019).
The drug-resistant Gram-negative bacteria, for most
part, threaten only hospitalized patients whose immune systems are weak. They can
survive for a long time on surfaces in the hospital and enter the body through
wounds, catheters and ventilators (Pollack, 2020). According to Jain, Persaud
& Perl (2019) and Pollack (2019), nosocomial infections can be transmitted
as follows;
Direct Contact Transmission: This involves a direct
body surface-to-body surface contact and physical transfer of microorganisms
between a susceptible host and infected or colonized person, such as when a
person turns a patient, gives a patient a bath, or performs other patient-care
activities that require direct personal contact. Direct-contact transmission
can also between two patients, with one serving as the source of the infectious
microorganisms and the other as a susceptible host.
Indirect Contact Transmission: This involves contact
of a susceptible host with a contaminated intermediate object, usually
inanimate, such as contaminated instruments, needles or dressings or
contaminated gloves that are not changed between patients.
Droplet Transmission: Transmission occurs when
droplets containing microbes from the infected person are propelled a short
distance through the air and deposited on the hot’s body; droplets are
generated from the source person mainly by coughing, sneezing and talking and
during the performance of certain procedures such as bronchoscopy.
Airborne Transmission: Dissemination can be either
airborne droplet nuclei (small-particle residue, 5µm or smaller in size of
evaporated droplets containing microorganisms that remain suspended in the air
for long period of time) or dust particles containing the infectious agent.
Microorganisms carried in this manner can be dispersed widely by air currents
and may become inhaled by a susceptible host within the same room or over a
longer distance from the source patient, depending on environmental factors;
therefore, special air-handling and ventilation are required to prevent
airborne transmission. Microorganism transmitted by this mode are Legionella,
Mycobacterim tuberculosis and the rubeola and varicella viruses.
Common Vehicle Transmission: This applies to
microorganisms transmitted to the host by contaminated items such as, food,
water, medications, devices and equipment.
Vector-borne Transmission: This occurs when vectors
such as mosquitoes, flies, rats and other vermin transmission microorganisms.
2.1.2 Standard
Measures for Nosocomial Infection Treatment
The application of standard measures during patient
care is determined by the nature of the health care worker-patient interaction
and the extent of anticipated blood, body fluid, or pathogen exposure. For some
interactions, e.g. performing venipuncture, only gloves may be needed, but for
others, e.g. intubations, us e of gloves, gown, and face shield or mask and
goggles is necessary. Standard measures are also intended to protect the
patient by ensuring that healthcare personnel do not transmit infectious agents
to patients through their hands or equipment during patient care (Siegel et
al., 2017).
Identification of patients infected with blood-borne
pathogens cannot be reliably made through medical history and physical
examination, and it is not feasible or cost-effective to test all patients for
all pathogens prior to giving care. Standard measures are therefore recommended
for use on all patients regardless of diagnosis and treatment setting. Decision
regarding the level of measures to use will depend on the nature of the
procedure and not on the actual or assumed serological status of the patient.
It is not safe to take precautions only with people from so-called “high-risk
groups” because many people belonging to such groups may not necessarily be
infected while many infected people may not even be from the high-risk groups
(The Health Infection Control Practices Advisory Committee, 2017).
2.1.3 Components
of the Standard Measures for Nosocomial Infection Treatment
The infection control problems that emerge during
outbreak investigations often indicate the need for new recommendations or
reinforcement of existing infection control recommendations to protect
patients. Because such recommendations are considered a standard of care and
may not be included in other guidelines, they are usually added to the standard
precautions. Three such areas of practice that have been added are respiratory
hygiene/cough etiquette, safe injection practices and use of masks for the
insertion of catheters or injection of material into spinal or epidural spaces
via lumbar puncture (Siegel & Lakshmi, 2017).
The transmission of SARS-CoV in emergency
departments by patients and their family members during the widespread of SARS
outbreaks in 2003 highlighted the need for vigilance and prompt implementation
of infection control measures at the first point of encounter within a
healthcare setting (e.g. reception and triage areas in emergency departments,
outpatient clinics, and physician offices). The strategy proposed has been
termed respiratory hygiene/cough etiquette and it is intended to be
incorporated into infection control practices as a new component of standard
precautions. The strategy is targeted at patients and accompanying family
members and friends with undiagnosed transmissible respiratory infections, and
applies to any person with signs of illness including cough, congestion,
rhinorrhea, or increased production of respiratory secretions when entering a
healthcare facility. The elements of respiratory hygiene/cough etiquette
include:
l Education
of healthcare facility staff, patients and visitors.
l Posted
signs in language(s) appropriate to the population served, with instructions to
patients and accompanying family members or friends.
l Source
control measures (e.g. covering the mouth/nose with a tissue when coughing and
prompt disposal of used tissues, using surgical masks on the coughing person
when tolerated and appropriate).
l Hand
hygiene after contact with respiratory secretions.
Spatial separation, ideally more than three feet, of
persons with respiratory infections in common waiting areas when possible.
Covering sneezes and coughs and placing masks on coughing patients are proven means of source containment that
prevent infected persons from dispersing
respiratory secretions into the
air (Siegel & Lakshmi, 2017).
Masking may be difficult in some settings, e.g. pediatrics, in which case emphasis by
necessity may be on cough etiquette. Physical proximity of less than 3feet has
been associated with an increased risk for transmission of infections via the
droplet route, e.g. Neisseria meningitidis and group A Streptococcus, and
therefore supports the practice of distancing infected persons from others who
are not infected. The measures stated above should be effective in decreasing
the risk of transmission of pathogens contained in large respiratory droplets,
e.g. influenza virus, adenovirus, Bordetella pertussis and Mycoplasma
pneumoniae. Healthcare personnel were advised to observe droplet precautions,
i.e. wear a mask, and hand hygiene when examining and caring for patients with
signs and symptoms of a respiratory infection. Healthcare personnel who have a
respiratory infection are advised to avoid direct contact with patients,
especially with high-risk patients. If this is not possible, then a mask should
be worn while providing patient care (Centre for Disease Control, CDC, 2017).
2..1.4 Measures for Nosocomial Infections Prevention
Health care workers should assume that every person
is potentially infected or colonized with an organism that could be transmitted
in the healthcare setting and, therefore, should apply the following infection
control practices while delivering health care (CDC, 2017).
2.1.5 Hand
Hygiene
This has been cited frequently as the most important
practice in reducing the transmission of nosocomial infection in health care
settings and it is an essential element of the standard precautions. Hand hygiene
includes hand washing with both plain or antiseptic-containing soap and water
and the use of alcohol based products (gels, foams or rinses), which do not
require the use of water (Siegel & Lakshmi, 2017). According to Siegel
& Lakshmi (2017), hand hygiene involves; Avoiding unnecessary touching of
surfaces that are close to the patient to prevent contamination of clean hands
by environmental surf aces and transmission of pathogens from contaminated
hands to surfaces. Hand washing with either a non- antimicrobial soap and water
or an antimicrobial soap and water when hands are visibly dirty, contaminated
with proteinaceous material, or visibly soiled with blood or body fluids.
Hand hygiene should be performed before having
direct contact with patients; after having contact with blood, body fluids,
excretions, mucous membranes, non-intact skin, or wound dressings; after
contact with a patient's intact skin, e.g., when taking pulse or blood pressure or lifting a patient; if
hands will be moving from a contaminated-body
site to a clean-body site during patient
care; after contact with inanimate objects (including medical equipment) in the
immediate vicinity of the patient; and after removing gloves (WHO, 2018). Hand
washing with non-antimicrobial soap and water or with antimicrobial soap and
water is recommended if contact with spores, e.g. Clostridium difficile or Bacillus anthracis,
is likely to have occurred. The physical action of washing and rinsing hands
under such circumstances is recommended because alcohols, chlorhexidine,
iodophors, and other antiseptic agents have poor activity against s pores.
Artificial finger nails or extenders should not be worn if duties include
direct contact with patients at high risk for infection and associated adverse outcomes,
e. g. those in intensive care units (ICUs) or operating rooms (Siegel et
al., 2017).
2.1.6 Personal Protective Equipment (PPE)
Personal Protective Equipment refers to a variety of
barriers used alone or in combination to protect mucous membrane airways, skin
and clothing from contact with infectious agents. The selection of PPE depends
on the nature of patient interaction and/or the likely mode(s) of transmission
(Siegel & Lakshmi, 2017). The following PPE are the WHO recommended
standard precautions for the prevention of nosocomial infections; PPE should be
worn when the nature of the anticipated patient interaction indicates that
contact with blood or body fluids may occur. Prevent contamination of clothing
and ski n during the process of removing PPE.
PPE should be removed and discarded before leaving the patient's room or
cubicle.
2.1.7 Gloves
Under standard precautions for the prevention of
nosocomial infections, gloves should be worn when it can be reasonably
anticipated that contact with blood or other potentially infectious materials,
mucous membranes, non-intact skin, or potentially contaminated intact skin,
e.g. of a patient incontinent of stool or urine, could occur. Gloves with fit
and durability appropriate to the task should be used. Disposable medical
examination gloves should be worn for providing direct patient care such as
wound dressing, phlebotomy, setting intravenous infusion, etc. For cleaning the
environment or medical equipment, disposable medical examination gloves or
re-usable utility gloves should be worn. Gloves should be removed after contact
with a patient and/or the surrounding environment (including medical equipment)
using proper techniques to prevent hand contamination. The same pair of gloves
should not be worn for the care of more than one patient and gloves should not
be re-used, because this practice has been associated with the transmission of
pathogens. Gloves should be changed during patient care if the hands will move
from a contaminated body site, e.g. perineal area, to a clean body site, e.g.
face (Campbell, 2020).
2.1.8 Gowns
Gowns should be appropriate for protecting the skin
and preventing soiling or contamination
of clothing during procedures and patient care
when contact with blood, body fluids, secretions, or excretions is
anticipated. A gown should be worn for direct patient contact if the patient
has uncontained secretions or excretions and it should be removed and hand
hygiene performed before leaving the patient’s environment. Gowns should not be
re-used even for repeated contacts with the same patient. Routine donning of
gowns upon entrance into a high-risk unit, e.g. intensive care unit, is not
indicated (Siegel & Lakshmi, 2017).
2.1.9 Mouth,
Nose, and Eye Protection
According to WHO (2014), PPE should be used to
protect the mucous membranes of the eyes, nose and mouth during procedures and
patient care activities that are likely to generate splashes or sprays of
blood, body fluids, secretions and excretions. Select masks, goggles, face
shields, and combinations of each according to the need anticipated by the task
to be performed. A face shield that fully covers the front and sides of the
face or a mask and goggles (in addition to gloves and gown) should be worn
during aerosol-generating procedures, e.g. bronchoscopy, suctioning of the
respiratory tract (if not using in -line suction catheters), and endotracheal
intubation in patients who are not suspected of being infected with an agent
for which respiratory protection is otherwise recommended, e.g. M.
tuberculosis, SARS or hemorrhagic fever viruses.
2.1.10 Respiratory
Hygiene/Cough Etiquette
Healthcare personnel should be educated on the
importance of source control measures in containing respiratory secretions to
prevent droplet and fomite transmission of respiratory pathogens, especially
during seasonal outbreaks of viral respiratory tract infections in communities,
e.g. influenza, adenovirus, parainfluenza virus (Kampf & Loffler, 2020).
WHO (2014) therefore recommended that the following measures should be
implemented to contain respiratory secretions in patients and accompanying
individuals who have signs and symptoms
of a respiratory infection, beginning at the point of initial encounter
in a healthcare setting, e.g. triage,
reception, and waiting areas in emergency departments, outpatient clinics, and
physician offices;
Post signs at entrances and in strategic places,
e.g. elevators and cafeterias, within ambulatory and in-patient settings with
instructions to patients and other persons with symptoms of a respiratory
infection to cover their mouth/nose when coughing or sneezing, use and dispose
of tissues, and perform hand hygiene
after hands have been in contact with respiratory secretions. Provide tissues
and no-touch receptacles, e.g. foot pedal operated lid or open and
plastic-lined waste basket, for disposal of tissues. Provide resources and
instructions for performing hand hygiene in or near waiting areas in ambulatory
and in-patient settings; provide conveniently located dispensers of
alcohol-based hand rubs and, where sinks are available, supplies for hand
washing. During periods of increased prevalence of respiratory infections in
the community, e.g. as indicated by increased school absenteeism, increased
number of patients seeking care for a respiratory infection, offer masks to
coughing patients and other symptomatic persons, e.g. persons who accompany ill
patients, upon entry into the facility or medical office and encourage them to
maintain special separation, ideally a distance of at least 3 feet from others
in common waiting areas. Some facilities may find it logistically easier to
institute this recommendation year round as a standard of practice.
2.1.11 Patient
Placement
The potential for transmitting infectious agent s should
be included in patient placement decisions. Patients who pose a risk for
transmission to others, e.g. uncontained secretions, excretions or wound
drainage and infants with suspected viral respiratory or gastrointestinal
infections, should be placed in a single-patient room when available. WHO (2020)
recommended that patient placement should be based on the following principles;
l Route(s)
of transmission of the known or suspected infectious agent.
l Risk
factors for transmission in the infected patient.
l Risk
factors for adverse outcomes resulting from a hospital acquired infection (HAI)
in other patients in the area or room being considered for patient placement.
l Availability
of single-patient rooms.
l Patient
options for room sharing, e.g., cohort patients with the same infection.
2.1.12 Patient Care Equipment and Instruments/Devices
Policies and procedures should be established for
containing, transporting, and handling patient care equipment and
instruments/devices that may be contaminated with blood or body fluids. Organic
materials should be removed from critical and semi-critical instruments/devices
using recommended cleaning agent s before high-level disinfection and
sterilization to enable effective disinfection and sterilization processes
(WHO, 2020). PPE should be used according to the level of anticipated
contamination when handling patient care equipment and instruments/devices that
are visibly soiled or may have been in contact with blood or body fluids
(Siegel & Lakshmi, 2017).
2.1.13 Care of the Environment
According to WHO (2013), policies and procedures
should be established for routine and targeted cleaning of environmental
surfaces as indicated by the level of patient contact and degree of soiling.
Surfaces that are likely to be contaminated with pathogens should be cleaned and disinfected more
frequently, including those surfaces that are close to the patient (e.g. bed
rails, over bed tables) and frequently touched in the patient care environment (e.g. door
knobs, surfaces in and surrounding toilets in patient rooms), compared to other
surfaces (e.g. horizontal surfaces in
waiting rooms).
WHO (2013) went further to recommend that in
facilities that provide health care to pediatric patients or have waiting areas with child play toys, e.g. obstetrics/gynecology
offices and clinics, policies and procedures should be established for cleaning
and disinfecting toys at regular
intervals. Use the following principles in developing such policy and
procedures;
l Select
play toys that can be easily cleaned and disinfected.
l Do
not permit use of stuffed furry toys if they will be shared.
l Clean
and disinfect large stationary toys (e.g. climbing equipment) at least once a
week and whenever visibly soiled.
l If
toys are likely to be mouthed, rinse with water after disinfection or wash in a
dishwasher.
l When
a toy requires cleaning and disinfection, do so immediately or store in a
designated labeled container separate from toys that are clean and ready for
use.
Multi-use electronic equipment should be included in
policies and procedures for preventing contamination and for cleaning and disinfection, especially those
items that are used by patients, those used during delivery of patient care,
and mobile devices that are moved in and out of patient rooms frequently
(Akyol, 2017).
2.1.14 Textiles and Laundry
Siegel & Lakshmi (2017), documented in their
research that in health centres used textiles and fabrics should be handled
with minimum agitation to avoid contamination of air, surfaces and persons. If
laundry chutes are used, ensure that they are properly designed, maintained,
and used in a manner to minimize dispersion of aerosols from contaminated
laundry.
2.1.15 Safe Injection Practices
According to WHO (2013), the following
recommendations apply to the use of needles, cannulas that replace needles,
and, where applicable, intravenous delivery systems.
l Use
aseptic technique to avoid contamination of sterile injection equipment.
l Do
not administer medications from a syringe to multiple patients, even if the
needle or cannula on the syringe is changed. Needles, cannulas, and syringes
are sterile, single-use items; they should neither be re-used for another
patient nor allowed to contact a medication or solution that might be used for
another patient.
l Fluid
infusion and administration sets, i.e. intravenous bags, tubing and connectors,
should be used for one patient only and disposed appropriately after use.
Consider a syringe or needle/cannula contaminated once it has been used to
enter or connect to a patient’s intravenous infusion bag or administration set.
l Use
single-dose vials for parenteral medications whenever possible.
l Do
not administer medications from single-dose vials or ampoules to multiple
patients and do not combine leftover contents for later use.
l If
you must use multi-dose vials, both the needle or cannula and syringe used to
access the multi-dose vial must be sterile.
l Do
not keep multi-dose vials in the immediate patient treatment area; store in
accordance with the manufacturer's recommendations and discard if sterility is
compromised or questionable.
l Do
not use bags or bottles of intravenous solution as a common source of supply
for multiple patients.
2.1.16 Infection
Control Practices for Special Lumbar Puncture Procedures
Health workers are instructed to always wear a
surgical mask when placing a catheter or injecting material into the spinal
canal or subdural space, i.e. during myelograms, lumbar puncture and spinal or
epidural anesthesia (Siegel, 2017).
Nurses Knowledge of Nosocomial Infections
Knowledge refers to a recall of information and it
is a pre-requisite to appropriate behavioral change. It is the most important
tool for effecting behaviour change (Gbefwi 2022). The linkage between
knowledge and behaviour has been stated in the cognitive behaviour theory,
which states that behaviour is mediated through cognition and that knowledge is
necessary but not sufficient to produce behaviour change (Federal Ministry of
Health, FMOH, 2017).
According to Saka & Adebara (2019) who carried
out a study on prevention of nosocomial infections in the new born: the
practice of private health facilities in rural communities of Nigeria, poor
knowledge on infection prevention was observed, disinfectants such as 0.5%
chlorine solution was most commonly used in private hospitals even though the
practice of aseptic hand washing was good. Sherwood et al., (2018) who
suggested that a solid background knowledge of epidemiology and micro-organisms
would empower nurses with sufficient confidence to question practices and depend
on their own ability to make informed decisions. Gorbach et al., (2018)
stated that nurses need training about nosocomial infections, general and
specific hazards of the work site and processes, safety rules, procedures
related to the particular work assignment, and prevention and control
strategies including work practice behaviors. Most clinical nurses should be
given recognition for awareness of infection control problems specific to their
work place.
Nursing
Measures Utilized for the Prevention of Nosocomial Infections
A study conducted among health care workers in rural
north India, showed low compliance with eye protective wears. A high proportion
of health care workers were not complying with needle recapping precautions.
The study also showed that compliance with standard precautions was associated
with being on the job for a longer period, knowledge of blood-borne pathogen
transmission and strong commitment to workplace safety. The study suggested
that interventions to improve compliance to standard precautions among health
care workers in rural north India should address knowledge and understanding as
well as safety measures by the employee’s organizations (Kermode et al., 2019). A related study conducted among health
care workers in public and private health care facilities in Abeokuta
metropolis in Nigeria showed that about one-third of all respondents always
recapped used needles. Use of re-capped needles was highest among doctors but
less among trained nurses. Less than two-thirds (63%) of the respondents always
used personal protective equipment, but more than half (56.5%) had never worn
goggles during deliveries and surgeries. Almost all (94.5%) of the health care workers observed hand washing after
handling patients (Sadoh et al., 2022).
Odusanya (2022) conducted a study on awareness and
compliance with universal precautions amongst health workers at an emergency
medical service in Lagos, Nigeria, and found that the group of health workers
had good knowledge about exposure risks at work but did not translate their
knowledge into safe work practices. Only 42% of the respondents complied with
the universal precautions.
Ogunsola & Adesiji, (2008) reported that most
wards in Nigerian hospitals lack adequate facilities for effective hand hygiene
and use the bucket and bowl method as an alternative to running water. Likewise
Devnani et al (2019) reported that insufficient or inconveniently positioned
sinks, inadequate access to soap and water, unavailability of hand paper towels
or electrical dryers are obstacles which hinder appropriate hand hygiene
practice.
Nurses’ hands come into close contact with patients
and are frequently contaminated during routine patient care: e.g. auscultation
and palpation or while touching contaminated surfaces, devices or materials
such as changing of dressing (Kampf & Loffler, 2020). Nazarko (2009),
discovered that nurses often fail to practice hand hygiene because they are
busy and they feel hand hygiene takes up precious time. In addition, nurses
often perceive that gloves can be used as an alternative to hand hygiene. They
usually tend to remove the gloves without washing their hands or use the same
gloves to deliver intended care to multiple patients. Even when they remove
their gloves, only 20% of nurses actually clean their hands while study claim
that nurses avoid hand hygiene because they are frightened that skin problems
such as dermatitis could develop, especially with alcohol hand-rubs (Nazarko,
2013). According to Saka & Adebara (2019) who carried out a study on
prevention of nosocomial infections in the new born: the practice of private
health facilities in rural communities of Nigeria, more than half (58.8%) of
the hospitals assessed had stocks of 0.5% of chlorine solution, and 11.8% of
the facilities had available instructions for mixing of solution. Majority
(94%) of the hospitals did not label the chemical solution. Only 29.4% of the
hospital health care providers wore protective rubber gloves. Also, 17.5% kept
the instrument in chlorine solution for at least 10 minutes immediately after
its use. Knowledge of correct mixture of chlorine solution was poor. Aseptic
practice using soap was very common (70.6%). The knowledge of hand washing by
staff between clients was 64.7%. Barrier to infection prevention practices with
the use of linen was 58.8% as shown in table 3, while 52.9% of the hospitals
changed linen between patients. Half of the hospital wiped couches with
chlorine solution at least once daily.
Rabussay and Korniewicz (2022) pointed out that by
giving conscious thought to standardized gloving practices, infection control
can be improved, thereby enhancing the safety of workers and patients.
Courtenay (2018) discovered that, application of the principles of infection
control is a vital part of effective day to day nursing practice. An important
consideration for nurses is practices that can affect health and illness. The
infection control practices of nurses and other health care professionals are
therefore of paramount importance. The rapidly changing in infection control
systems requires nurses to possess increasing knowledge, clinical competency,
greater independence, and autonomy in clinical judgment.
Lymers et al., (2017) who showed that needle
stick injuries were the most frequently reported incident. Nurses were themost
exposed group, which has also been shown in other studies. The high rate of
needle stick injuries among assistant nurses can be explained by their frequent
contact with patient blood, because upon delegation from the nurse, they also
administer injections, perform venipuncture.
The most accidents occurred in the wards.
MaryRocha et al., (2020), conducted a study
to evaluate the practice of hand washing, and discovered that there exist the
use of gloves and the handling and disposal of needle sticks and other sharp
objects among nurses.
2.2 Theoretical Review
The
theoretical framework used for this study is Green Precede Model.
Green
Precede-Proceed Model
Green, Levine &Deeds (1980) describe health
education as any combination of learning experience designed to encourage
people to adapt their behaviour so that they practice healthy habits. They have designed an “educational diagnosis”
model called “PRECEDE”, which is an acronym for “Predisposing, Reinforcing and
Enabling Causes In Educational Diagnosis and Evaluation. They further designed
an “ecological diagnosis” model called “PROCEED” which is an acronym for
“Policy, Regulatory, and Organizational Constructs in Educational and
Environmental Development.”
Two
basic proposition underscore the outcome oriented Precede-Proceed Model:
·
Health and health behaviours are caused
by multiple factors.
·
Health education designed to influence
behaviour must be multidimensional.
Seven
Phases of Precede-Proceed Model
Phase 1: Consideration of
quality of life what are the major social problems of concern?
Phase 2: Identify specific
health problems contributing to social problems identified in in phase I.
Phase 3: Identify the specific
health-related behaviours that seem liked to the selected health problems.
Phase 4: Sort and categorize
predisposing factors (attitude, beliefs, values, perceptions), enabling factors
(barrier such as limited facilities), inadequate personnel or community
resource lack of income or insurance or restrictive laws and reinforcing
factors that the feedback of the learner receives from others which may
encourage or discourage behavioural change.
Phase 5: Decide which factors
make up the three classes on which the intervention will focus.
Phase 6: Develop and implement
the programme.
Phase 7: Evaluate the
programme.
Flow Chart Of The Green Precede-Proceed Model
Figure
2.1. The Precede–Proceed Model for Health Programme Planning and Evaluation.
From Green and Kreuter (2005). Adapted and used with permission from Green and
Kreuter (Green, 2015)
2.5.2 Application of Green Precede-Proceed Model to
the Study
In the application of the model, the researcher
considers the quality of nursing measures for the prevention of nosocomial
infections such as what are the major social problems of concern.
Identification of the specific health problems contributing to social problem
identified. Identification of the specific health-related behaviours that seem
linked to the selected health problems are also made. The sorting and
categorization of factors that the practice of nursing measures into
predisposing factors (attitude, beliefs, values, perceptions), enabling factors
(barriers such as limited facilities), inadequate personnel or community
resources, lack of income or insurance or restrictive laws and reinforcing
factors that feedback of the learner receives from which may encourage or
discourage behavioural change was made by the researcher. Decision on which
factors make up the three classes on which the intervention will focus,
development and implementation of nursing measures for nosocomial infections
prevention. Continuous evaluation of the programme is vital thus, the relevance
of the practice of nursing measures for nosocomial infections prevention is
emphasized in this study.
2.3 Empirical Review
.According to Saka & Adebara (2019) who carried
out a study on prevention of nosocomial infections in the new born: the
practice of private health facilities in rural communities of Nigeria, poor
knowledge on infection prevention was observed, disinfectants such as 0.5%
chlorine solution was most commonly used in private hospitals even though the
practice of aseptic hand washing was good. Sherwood et al., (2018) who
suggested that a solid background knowledge of epidemiology and micro-organisms
would empower nurses with sufficient confidence to question practices and
depend on their own ability to make informed decisions. Gorbach et al.,
(2018) stated that nurses need training about nosocomial infections, general
and specific hazards of the work site and processes, safety rules, procedures
related to the particular work assignment, and prevention and control
strategies including work practice behaviors. Most clinical nurses should be
given recognition for awareness of infection control problems specific to their
work place.
Ogunsola & Adesiji, (2008) reported that most
wards in Nigerian hospitals lack adequate facilities for effective hand hygiene
and use the bucket and bowl method as an alternative to running water. Likewise
Devnani et al (2021) reported that
insufficient or inconveniently positioned sinks, inadequate access to soap and
water, unavailability of hand paper towels or electrical dryers are obstacles
which hinder appropriate hand hygiene practice.
Nurses’ hands come into close contact with patients
and are frequently contaminated during routine patient care: e.g. auscultation
and palpation or while touching contaminated surfaces, devices or materials
such as changing of dressing (Kampf & Loffler, 2020). Nazarko
(2009),discovered that nurses often fail to practice hand hygiene because they
are busy and they feel hand hygiene takes up precious time. In addition, nurses
often perceive that gloves can be used as an alternative to hand hygiene. They
usually tend to remove the gloves without washing their hands or use the same
gloves to deliver intended care to multiple patients. Even when they remove
their gloves, only 20% of nurses actually clean their hands while study claim
that nurses avoid hand hygiene because they are frightened that skin problems
such as dermatitis could develop, especially with alcohol hand-rubs (Nazarko,
2023). According to Saka & Adebara (2019) who carried out a study on
prevention of nosocomial infections in the new born: the practice of private
health facilities in rural communities of Nigeria, more than half (58.8%) of
the hospitals assessed had stocks of 0.5% of chlorine solution, and 11.8% of
the facilities had available instructions for mixing of solution. Majority
(94%) of the hospitals did not label the chemical solution. Only 29.4% of the
hospital health care providers wore protective rubber gloves. Also, 17.5% kept
the instrument in chlorine solution for at least 10 minutes immediately after
its use. Knowledge of correct mixture of chlorine solution was poor. Aseptic
practice using soap was very common (70.6%). The knowledge of hand washing by
staff between clients was 64.7%. Barrier to infection prevention practices with
the use of linen was 58.8% as shown in table 3, while 52.9% of the hospitals
changed linen between patients. Half of the hospital wiped couches with
chlorine solution at least once daily.
Rabussay
and Korniewicz (2022) highlighted the importance of standardized gloving
practices in enhancing infection control within healthcare settings. Their
study demonstrated that paying conscious attention to the consistent and
correct use of gloves can significantly improve safety for both healthcare
workers and patients. By standardizing gloving practices, the likelihood of
cross-contamination and the spread of infections can be effectively reduced,
creating a safer clinical environment.
In a
related investigation, Courtenay (2018) explored the critical role of applying
infection control principles in daily nursing practice. The research revealed
that these principles are fundamental to effective nursing care and essential
for preventing infections. Courtenay emphasized that nurses must be aware of how
their practices can influence health and illness, making infection control
practices a crucial aspect of their work. The study also addressed the
necessity for nurses to adapt to rapidly changing infection control systems. It
highlighted that to effectively manage these changes, nurses need to
continuously expand their knowledge, enhance their clinical skills, and
exercise greater independence and autonomy in their clinical decision-making.
This ongoing development is vital for maintaining high standards of infection
control and ensuring a safe healthcare environment.
Lymers et
al. (2017) conducted a comprehensive study on needle stick injuries among
healthcare workers in hospital settings. The research focused on various
categories of healthcare staff, with a particular emphasis on nurses and
assistant nurses, who are most at risk due to their frequent interaction with
needles and patient blood. The study's population included a broad range of
healthcare workers across different hospital wards, although the exact sample
size was not specified. The participants were instructed to meticulously report
every needle stick injury they encountered. This involved documenting the
circumstances of each injury, including the type of needle used, the context of
the incident, and the immediate actions taken following the injury. The
findings from the study were revealing. Needle stick injuries emerged as the
most commonly reported type of incident among the healthcare workers surveyed.
Among these workers, nurses, especially assistant nurses, were identified as
the most vulnerable group. This increased risk is largely due to their frequent
tasks involving needles, such as administering injections and performing
venipuncture.
The study
also found that the majority of these injuries occurred in hospital wards. This
suggests that wards, being the primary locations for numerous medical
procedures, are critical areas where safety measures need to be reinforced. The
high rate of injuries among assistant nurses can be attributed to their
substantial exposure to patient blood and the tasks they perform under the
delegation of registered nurses. Overall, the study highlights a significant
occupational hazard within healthcare settings and underscores the necessity
for enhanced safety protocols, better training, and improved protective
equipment to mitigate the risk of needle stick injuries, particularly in
high-risk areas like hospital wards.
MaryRocha
et al., (2020), conducted a study to evaluate the practice of hand
washing, and discovered that there exist the use of gloves and the handling and
disposal of needle sticks and other sharp objects among nurses. This study aimed to evaluate
the effectiveness of a nurse-led educational program in improving cervical
cancer awareness among undergraduate students at Cross Rivers State University
in Cross Rivers State, Nigeria. To achieve this, a descriptive survey design
was employed, which provided a detailed assessment of the students' knowledge
before and after the educational intervention. The research targeted
undergraduate students from various faculties at Cross Rivers State University.
A sample of 250 students was selected using Taro Yamane’s Sampling formula to
ensure the sample was representative of the student population and statistically
reliable. Participants were chosen through simple random sampling, which
ensured that each student had an equal chance of being included, thereby
reducing potential biases. Data were collected using a structured questionnaire
designed to gauge students' knowledge about cervical cancer. The questionnaire
was divided into sections covering demographic information and specific
questions about cervical cancer prevention, symptoms, and treatment. The
validity of the instrument was confirmed through expert review, and its
reliability was tested using the test-retest method, resulting in a reliability
coefficient of 0.82. The data collection process was carried out by trained
research assistants over a period of four weeks. Participants completed the
questionnaire both before and after the educational intervention to assess
changes in their knowledge levels. The analysis of the data revealed a
significant improvement in cervical cancer awareness among the students
following the intervention. The results indicated that the educational program
effectively increased participants' understanding of cervical cancer
prevention, symptoms, and treatment. Based on these findings, it is recommended
that similar nurse-led educational programs be implemented across other
faculties and universities to enhance health awareness and support early cancer
detection. Ethical standards were strictly adhered to throughout the study,
with informed consent obtained from all participants and their confidentiality
maintained. In conclusion, the study demonstrated that nurse-led educational
interventions are highly effective in boosting cervical cancer awareness among
university students. This underscores the importance of integrating such
programs into the health education curricula at universities.
2.4 Summary of Literature Review
Attempts has been made to review various literatures
on measures utilized for the prevention of nosocomial infection
in the elderly patient on admission. This was done under the following sub-headings: Conceptual review, theoretical
review, empirical review and Summary of literature review. The review reveals
that nosocomial infections are commonly caused by bacteria, fungi, parasites,
and viruses transmitted through direct or indirect contact in healthcare
settings. Bacteria, especially Staphylococcus species, are the most common
pathogens. Transmission routes include direct contact, indirect contact via
contaminated objects, droplet transmission, airborne transmission, common
vehicle transmission, and vector-borne transmission. Preventive measures
include hand hygiene, personal protective equipment (PPE), patient placement
strategies, proper handling of patient care equipment, environmental cleaning,
safe injection practices, and infection control during special procedures like
lumbar punctures. These measures are essential for reducing the spread of
infections and ensuring patient safety.The theoretical framework used in the
study is the Green Precede-Proceed Model, which involves seven phases focusing
on identifying health problems, health-related behaviors, and factors
influencing behavior change. Regarding empirical findings, studies have
highlighted issues such as low compliance with infection control measures,
inadequate hand hygiene practices among healthcare workers, varying levels of
use of personal protective equipment, concerns about needlestick injuries, and
challenges in the handling and disposal of sharps.
CHAPTER
THREE
RESEARCH
METHODOLOGY
This
chapter presents all methodologies employed by the researcher during the course
of the study. Discussed in this chapter were research design, area of study,
population of study, sample size and sampling procedure, instrument for data
collection, validity and reliability of research instrument, procedure for data
collection, ethical considerations and method of data analysis.
3.1
Research design
This
study will adopt a descriptive
cross-sectional study design to assess the knowledge and use of personal
protective equipment among health workers of Niger Delta University Teaching
Hospital Okolobiri, Bayelsa State. This design was adopted because descriptive
research is used to describe characteristics of a population or phenomenon
being studied. It is cross-sectional so as to allow the researcher analyze data
from a population, or a representative subset, at a specific point in time that
is, cross-sectional data.
3.2 Research Setting
The
study will be carried out in Niger Delta University Teaching Hospital (NDUTH)
Okolobiri. The Hospital was established in 1982 as a cottage hospital, it had
served various times as general hospital in 1996 at the creation of Bayelsa
State. It became a Teaching Hospital in October 2007 as part of upgrading. The
hospital is located in Okolobiri town between Ogboloma and Obunagha
communities. NDUTH is made up of 20 blocks which are representations of the
twelve units/departments including nurses, doctors, pharmacists, medical
laboratory scientist, paramedical workers and other non-medical workers. It
is one of the biggest teaching hospital in the south-south regions of Nigeria
with about 200-bed spaces. The staff strength is about 500, and the study
population constitutes 30% of the staff strength. The departments and units
studied were those ones that handle biohazards, namely; intensive care unit,
theater, wards, laboratories, casualty, outpatient departments, and blood bank.
It consist of nine(9) wards. It is
accessible by road either through Igbogene or Nigeria liquefied Natural Gas
(NLNG) Obunagha road. The NDUTH Okolobiri is been chosen by the researcher as
the area of study due to the fact that it is a major tertiary hospital and is
visited by most people within and outside the state for their health care.
3.3
Target population
The
target population will comprise of all Health Workers in Labour Ward, at the
Niger Delta University Teaching Hospital. The Healthcare Workers studied will
be Medical Doctors, Nurses, laboratory scientists, and hospital
attendants/orderlies. These groups of HCWs are known to come in contact with
hospital hazards. Hospital records show that the number of workers in this
category is 88 (Labour Ward NDUTH Okolobiri, 2024)
3.4 Sampling size
A
sample size of 72 will be arrived at,
using Tara Yamene formula.
This will
be obtained as follows:
Taro
Yamane’s formula
n =
N
Where n=sample size
N=population size
E=error of sampling (0.05)
n =
88
n =
88
n =
88
n =
88
n =
72
Therefore,
sample size for each category of health workers are as follows:
|
Category
of health workers |
Population |
Sample
size |
|
Medical
doctors |
2 X 72/88 |
2 |
|
Nurses |
66 X 72/88 |
54 |
|
Laboratory
scientists |
12 X 72/88 |
9 |
|
Hospital
attendants |
8 X 72/88 |
7 |
|
Total |
88 |
72 |
3.5 Sampling Technique
The
sampling technique that will be used for this study will be a simple random
sampling technique. This will be accomplished by employing a basic balloting
method, where pieces of paper will be randomly distributed, and participants
will be instructed to choose one. Participants who select a paper marked
"yes" will be included in the study, whereas those who choose a paper
marked "no" will not be part of the study.
3.6 Instruments for data collection
4.
The instrument for data collection will
be a self-structured questionnaire. The questionnaire was based on the
literature, experience of the researcher and objectives set for the study. The
questionnaire was divided into a biographical section (A) referring to gender,
age, categories of staff, qualifications, experience, and the type of ward,
hospital and duration of working in the particular ward; Section (B) access
current level of knowledge of nurses regarding infection control measures.
Section (C) identify the nursing measures utilized for the prevention of
nosocomial infection in the Labour ward of
Niger Delta University,(NDUTH),Bayelsa Sometimes, Rarely and Never
Respectively; while Section (D) investigate current level of practices of nurses
regarding infection control
3.7
Validity of the instrument
Validity
which include face and content validity will be ensured through consultation
with my supervisor and other experts in Faculty of Nursing Sciences, Niger
Delta University for correctness and appropriateness in-tandem with the
objectives of the study.
3.8
Reliability of instrument
To
ascertain the reliability of the instrument, test-retest method will be
employed by the researcher. The instrument will be administered to 20 Health
Care Workers in the Amassoma General
Hospital, Bayelsa State and it will be repeated after two
weeks and subjected to Pearson’s moment correlation coefficient to ascertain
the level of reliability of the instrument and expected to arrive at a
coefficient of 0.75 to ascertain the reliability of the instrument.
3.9
Method of data collection
On receipt of approval from the hospital ethical
committee, a descriptive survey questionnaire will be distributed to all
consenting participants. A consent form and a cover letter will be attached to
each questionnaire. Participants who gave their consents to participate in the
study received elaborated explanation on the purpose of the study and the type
of questions and how to answer. Filling of the questionnaire took about 40
minutes to 1hour. Questionnaires will be retrieved immediately. This process will
last for 2 days.
3.10
Method of data analysis
Data
collected will be analysed using frequency distribution tables and simple percentage
using the formula below:
Total
respondents 1
3.11
Ethical consideration
A letter of introduction will be
collected from the Dean, Faculty of Nursing Sciences, Niger Delta University and will be submitted
to the research and ethical committee, Niger delta university Teaching
Hospital. Information session will be
held at each ward under study where the participants will be invited to take
part. A participation information leaflets will be attached to each
questionnaire. Contact details of the researcher were made available to
participate in the event of any of queries. Individual information written
consent will be obtained from all the participants, who assured of their right
to confidentiality, anonymity and privacy will be strictly voluntary and
participants will be informed that they are free to decline, participate or withdraw
without fear that they would be affected adversely. Collected data will be in a
confidential and protective manner, with access only to the researcher and
statistician.
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