MEASURES UTILIZED FOR PREVENTION OF NOSOCOMIAL INFECTION IN THE LABOUR WARD OF UNIVERSITY OF CALABAR TEACHING HOSPITAL (UCTH), CALABAR
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1.1 Background of the study
Nosocomial infection also known as hospital-acquired infections is a localized or systemic infection acquired in a hospital or other health facility by a patient admitted for a reason other than the pathology present at admission. It may also include an infection acquired in a health facility that may manifest 48 hours after the patient’s admission to the health care facility or discharge (Hildron, Edwards, Patel, Horan, Sievert, Pollock and Fridkin, 2008). Epidemiological studies indicate that nosocomial infections are caused by invading pathogens such as bacteria (Lepelletier, Perron, Bizouarn, Caillon, Drugeon, Michaud and Duveau, 2005), viruses (De-Oliveira, Blanc, Leschinsky, Beecham, Vogt , Moolenaar, Perz & Safranek, 2005) and fungi in air, surfaces or equipment. Pathogens are not present or in incubation prior to patient admission to a health facility and are likely to be transmitted through direct person-to-person contact during invasive medical procedures (Anderson, Kaye, Chen, Schmader, Choi, Sloan and Sexton, 2009). Some pathogens are highly resistant to antimicrobial agents, which requires the prescription of more powerful and expensive antimicrobial agents (Mulvey and Simor, 2009).
Nosocomial infections are widespread nationally and internationally; and occur in patients of all age groups: newborns (Aly, Herson, Duncan, Herr, Bender, Patel and EI-Mohandes, 2005), immunocompromised adults and the elderly (Lepelletier, Perron, Bizouarn, Caillon, Drugeon, Michaud and Duveau). , 2005). The most common types of nosocomial infections are those associated with the urinary tract, surgical wounds, respiratory tract and bloodstream (Lo, 2008). It is a serious global public health problem that is causing the suffering of 1.4 million people around the world at some point (WHO, 2007).
Nosocomial infection in developing countries is difficult to treat because it is so complex a problem with various underlying causes. International non-governmental organizations (INGOs) and intergovernmental organizations such as UN agencies bring a unique perspective to the promotion of infection control measures in hospitals in the developing world. However, these organizations have not been able to address all facets of the problem such as infrastructure, leadership and the individual behavior of health workers. The control of nosocomial infections is not simply about encouraging hand hygiene in environments where clean water and soap are not always available. Infection control is also not about providing supplies to health workers who are not trained to use them properly (WHO, 2010).
The burden of nosocomial infections is already high in developed countries, where it affects between 5% and 15% of patients hospitalized in regular services and up to 50% or more of patients in intensive care units (WHO, 2009). . In developing countries, the magnitude of the problem remains underestimated or even unknown, largely because HAI diagnosis is complex and surveillance activities to guide interventions require expertise and resources (Allegranzi & Pittet, 2008). . Surveillance systems exist in some developed countries and provide regular reports on national trends in endemic nosocomial infections (Pittet, Allegranzi, Sax, Bertinato, Concia and Cookson, 2005) such as the US National Healthcare Safety Network or the US German hospital. Surveillance system. This is not the case in most developing countries (WHO, 2010) because of social and health system deficiencies aggravated by economic problems. In addition, overcrowding and lack of hospital staff lead to inadequate infection control practices, and the absence of infection control policies, guidelines and trained professionals also adds to the magnitude of the problem.
The prevalence of nosocomial infections at the hospital level ranged from 2.5% to 14.8% in Algeria (Vincent, Rello, Marshall, Silva, Anzueto and Martin, 2009), Burkina Faso (DiA, Ka, Dieng, Diagne, Dia and Fortes, 2008) and in Senegal. United Republic of Tanzania (Atif, Bezzaoucha, Mesbah, Djellato, Boubechou and Bellouni, 2006). The overall cumulative incidence of nosocomial infections in the surgical services ranged from 5.7% to 45.8% in the studies conducted in Ethiopia (Messele, Woldemedhin, Demissie, Mamo and Geyid, 2009) and in Nigeria (Kesah, Egri). -Okwaji, Iroh & Odugbemi, 2009). The latter reported an incidence of 45.8% and an incidence density of 26.8 infections per 1000 patient-days for pediatric surgery patients (Kesah, Brewer, Yingrengreung & Fairchild, 2009). In a study conducted in the surgical wards of two Ethiopian hospitals, the overall cumulative incidence of IAS patients was 6.2% and 5.7% (Messele, Grottolo, Renzi, Paganelli, Sapelli, Zerbini and Nardi, 2009). In a study conducted in Nigeria, the implementation of an infection control program in a university hospital reduced the rate of ADI from 5.8% in 2003 to 2.8% in 2006 (Abubakar, 2007). ).
In Nigeria, a nosocomial infection rate of 2.7% was reported in Ife, while 3.8% came from Lagos and 4.2% from Ilorin (Odimayo, Nwabuisi & Adegboro, 2008).
The cause of nosocomial infections could be endogenous or exogenous. Endogenous infections are assessed by an organism present in the flora, and exogenous infections are acquired through exposure to the hospital environment, hospital staff or medical devices (Medubi, Akande and Osagbemi, 2006). Nosocomial infection rates vary by site, body type, hospital type and infection control capabilities of the facility. The proportion of infections at each site is also different in each of the major hospital services and by level of risk for the patients (Taiwo, Onile and Akanbi, 2005). This is illustrated by surgical site infections (SSI), which are the most common in the general survey, while urinary tract infections and bloodstream infections are most common in medical services and nurseries. Rates of nosocomial infection vary by surgical subspecialty, low in ophthalmology, and high in general surgery. The differences are largely due to variations in exposure to high-risk devices or procedures (Tolu, 2007).
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, 2007). 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, Nwabuisi& Adegboro, 2008). Lower respiratory infection (LRI) or pneumonia represents 13 % of nosocomial infections (Taiwo, Onile & Akanbi II, 2005). 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 nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar, Cross River State, Nigeria.
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, Kaye, Chen, Schmader, Choi, Sloan & Sexton, 2009).
Further more, it was noted that Doctors and Midwives were not observing strict Aseptic measures. It is with the above information the researcher carried out this study to investigate nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar.
1.3 Purpose of Study
The purpose of this study is to investigate nursing measures utilized for the prevention of nosocomial infection in the labour ward of University of Calabar Teaching Hospital (UCTH), Calabar.
1.4 Specific Objectives
- To ascertain the level of knowledge of nosocomial infection among nurses in UCTH, Calabar.
- To identify the nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar.
1.5 Research Questions
- How much do nurses in University of Calabar Teaching Hospital (UCTH), Calabar know about nosocomial infection?
- What nursing measures are utilized for the prevention of nosocomial infections in the labour ward of UCTH, Calabar?
There is no significant relationship between thelevel of knowledge of nosocomial infection and nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar.
1.7 Scope of Study
The study is focused on investigating the nursing measures utilized for the prevention of nosocomial infection in the labour ward of UCTH, Calabar. It will also look at the level of knowledge of nosocomial infections among nurses in UCTH, Calabar.
1.8 Significance of the Study
The findings of this study will be of significance to the following categories of people;
Health Workers: They will find this study to be an important tool for counselling patients suffering from nosocomial infections.
Nurses And Midwives: The findings in this study will aid nurses and midwives with deciding the most suitable infection preventive measure for a particular individual at a particular time. The findings in this study will also provide nurses and midwives with more insight on nosocomial infections, which will help them give comprehensive health talks on it treatment and prevention.
Researchers: The findings in this study will also serve as a resource material to researchers who wish to embark on related researches in the nearest future.
1.9 Limitation of the Study
The limitation encountered by the researcher was inability to distribute the questionnaire to all the nurses in Calabar at the early stage of the research. This was due to the three shift-duties of nurses (morning, evening and night) in all the various hospitals in Calabar. However, the researcher overcame it by distributing questionnaire during the morning and evening shift, face to face, whereby she collected completed filled questionnaire at the spot.
1.10 Operational Definition of Terms
The key terms in this research were defined as follows:
- Nosocomial:This simply is a disease originating in a hospital.
- 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.
- Nurse: This simply means a person trained to care for people diagnosed of nosocomial infection.
- Prevention:This is simply the act of stopping nosocomial infection from happening or occurring.
Measure: This refers to a means of achieving a purpose of preventing the occurrence of nosocomial infections in labour ward