Knowledge, attitude and practice universal basic precautions by medical personnel in a teaching hospital

Adherence to Infection Prevention Practice Standard Protocol and Associated Factors Among Healthcare Workers

Introduction

Healthcare-associated infection affects more than 100 million patients annually. Healthcare workers' poor adherence to standard infection prevention and control procedures can result in many negative consequences, ranging from disability to death.

Methods

A facility-based, cross-sectional study was conducted in June 2021 among 379 healthcare workers selected using a stratified random sampling technique. All types of healthcare providers except pharmacy professionals were included in the study. Standardization and validation of the study tool were performed ahead of data collection. Multivariable regression was used to assess the variables associated with adherence.

Results

The study found that 60.2% of healthcare workers (95% CI, 55.1-65.2) had good adherence to infection prevention practices, and 68.7% and good knowledge of infection prevention practices. Training on infection prevention methods (adjusted odds ratio [AOR] = 1.68; 95% CI, 1.04-2.72), availability of water supply at hand washing station (AOR = 2.90; 95% CI, 1.62-5.31), and attitude toward infection prevention (AOR = 2.64; 95% CI, 1.65-4.24) were identified as predictors of adherence to infection prevention and control procedures.

Conclusion

More than half of the participants had good adherence to infection prevention guideline practices. In-service infection prevention training, a consistent water supply at the hand washing station, and a positive attitude of participants were associated with good adherence to infection prevention practices.

Occupational health hazards among healthcare providers and ancillary staff in Ghana: a scoping review

OBJECTIVE

The strict implementation of occupational health and safety policy curbs exposure to occupational hazards. However, empirical evidence is lacking in the Ghanaian context. This review primarily aimed to explore exposure to occupational hazards among healthcare providers and ancillary staff in Ghana.

DESIGN

A scoping review was conducted based on Arksey and O'Malley's methodological framework and Levac et al's methodological enhancement.

DATA SOURCES

Searches were conducted of the PubMed, MEDLINE, CINAHL, Embase, PsycINFO and Scopus databases, as well as Google Scholar and websites of tertiary institutions in Ghana, for publications from 1 January 2010 to 30 November 2021.

ELIGIBILITY CRITERIA

Quantitative studies that were published in the English language and focused on occupational exposure to biological and/or non-biological hazards among healthcare professionals in Ghana were included.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted the data based on the type of occupational exposure and descriptive characteristics of the studies. The data are presented in tables and graphs. A narrative summary of review findings was prepared based on the review research questions.

RESULTS

Our systematic search strategy retrieved 507 publications; however, only 43 met the inclusion criteria. A little over one-quarter were unpublished theses/dissertations. The included studies were related to biological, psychosocial, ergonomic and other non-biological hazards. 55.8% of the studies were related to exposure to biological hazards and related preventive measures. In general, health workers were reported to use and comply with control and preventive measures; however, knowledge of control and preventive measures was suboptimal.

CONCLUSION

Work is needed to address the issue of occupational health hazard exposure in Ghana's health system. More research is needed to understand the extent of these exposures and their effects on the health system.

An Assessment of the Knowledge, Attitude, and Practice Toward Standard Precautions Among Health Workers From a Hospital in Northern Cyprus

BACKGROUND

The objective was to assess the knowledge level, attitude, and practice of health care workers towards standard precautions, and to identify the related factors. Furthermore, it was attempted to identify the proportion of having the experience of needle stick injuries (NSIs) and associated factors among participants.

METHODS

A cross-sectional study was conducted in a teaching hospital among 233 health workers using a self-administrated questionnaire. The questionnaire included eight knowledge items, seven practice items, and five attitude items. Based on the mean score of each category, responses were grouped into "satisfactory" and "unsatisfactory". Univariate, bivariate, and multivariable logistic regression analyses were done.

RESULTS

The mean age of the participants 32.95 (SD ± 9.70) and 62.2% of them were women. 57.5% of the staff had a satisfactory level of correct knowledge (>5 correct answers), 37.3% had a satisfactory positive attitude (>3 correct answers), and 30.9% had a satisfactory practice (>3 correct answers) towards standard precautions. The occupation was one of the predictors as doctors were less likely to have satisfactory knowledge and practice compared to nurses (OR = 0.269, 95% CI: 0.10-0.70 and OR = 0.248, 95% CI: 0.08-0.77, respectively). Out of 174 participants, 31.6% of them reported experiencing NSIs and support staff were 71% less likely to experience NSIs compared to nurses & paramedics.

CONCLUSION

The findings revealed a substandard adherence of standard precautions among participants, which highlighted the necessity of the provision of a periodic, tailored training program based on the occupation and risk exposure.

Assessment of Knowledge and Practices of Standard Precaution against Blood Borne Pathogens among Doctors and Nurses at Adult Emergency Room in Addis Ababa, Ethiopia

Background

Standard precautions are infection control techniques against pathogenic microorganisms that are present in human blood and can cause disease in humans.

Objective

This study aims to assess knowledge and practice of standard precautions against blood borne pathogens among doctors and nurses in adult emergency room, Addis Ababa, Ethiopia.

Methods

Institutional based cross sectional study was conducted from February to March 2018. A total of 128 study participants selected from four public hospitals were enrolled in this study. Data were collected using standardized pretested questionnaire and thencoded, entered, checked for completeness, and analyzed using SPSS version-23 statisticalsoftware. Chi-square test was used to measure the association between variables. P values <0.05 were taken as statistically significant.

Result

The mean knowledge score of standard precaution measures was 10.3 out of 14 knowledge items. Out of 32 doctors, 93.8% (n=30) have good knowledge and out of 91 nurses, 86.8% (n=79) have good knowledge. The mean practice level of the study subjects was 8.5 out of 12 practice items. Majority (73.6%) of nurses have good practice level than doctors (21.8%). Knowledge level was significantly associated with the presence of infection control officer, infection control guideline, and washing hands before touching patients. Profession, training, and the presence of infection control guideline in emergency room were significantly associated with practice level of respondents (P<0.05).

Conclusion

Both nurses and doctors have good knowledge of standard precaution measures. However, nurses have better practice level than doctors. Orientation during employment and continuous training programs should be provided for the newly employed health workers. In addition sustainable supply systems should be available in each hospital management.

Knowledge of standard precautions and barriers to compliance among healthcare workers in the Lower Manya Krobo District, Ghana

Background

Implementing standard precautions (SP) has been a major challenge for health care workers (HCWs) especially those in developing countries thereby compromising their safety and increasing their exposure to blood-related pathogens. Compliance with safety precautions and occupational accidents among health workers are often unreported. The literature on knowledge and compliance to SP in Ghana is scanty. We report findings of a study that examined knowledge of SP, compliance and barriers to compliance with SP among HCWs in two health facilities in Ghana.

Methods

This is a facility-based cross-sectional study involving 100 HCWs from two health facilities in the Lower Manya Krobo District of the Eastern region. Statistical analysis summarised data on socio-demographic characteristics of respondents, knowledge of SP and compliance and barriers to SP in frequencies and percentages.

Results

Most respondents had been working as health staff for 0–5 years (65.0%). Generally, knowledge of the basic concepts of SP was low; only 37.0% of HCWs knew that SP includes hand washing before and after any direct contact with the patient, 39.0% knew about cough etiquettes and 40.0% knew about aseptic techniques which involve infection prevention strategies to minimise the risks of infection. Fifty percent of respondents always protect themselves against BBFs of patients. About a quarter of the respondents do not recap needles after use and 28.0% of respondents sometimes promptly wipe all blood spills. HCWs were of the opinion that wearing PPEs—such as gloves, aprons, gowns and goggles—might cause patients to panic sometimes (63.0%) and complying with SP sometimes interferes with the ability to provide care (38.0%). Sometimes, because of the demands of patient care, HCWs do not have enough time to comply with the rigours of SP (44.0%) and sometimes PPEs are not available.

Conclusion

Education programmes on the benefits of SP should be organised frequently. The OHS national policy together with the application of the IPC training manual in all health care facilities must be enforced. Communities of practice should be established and sanctions and rewards should be introduced to limit negative behavior and reinforce positive attitudes as regards SP.

Infection control and practice of standard precautions among healthcare workers in northern Nigeria

Background:

Healthcare-associated infections (HAIs) have been reported to be a serious problem in the healthcare services as they are common causes of illness and mortality among hospitalized patients including healthcare workers (HCWs). Compliance with these standard precautions has been shown to reduce the risk of exposure to blood and body fluids.

Aims:

This study therefore assesses the level of knowledge and compliance with standard precautions by the various cadre of HCWs and the factors influencing compliance in hospital environment in Nasarawa State, Northern Nigeria.

Settings and Design:

Nasarawa State has a current human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) prevalence rate of 10.0%, which was higher than most states in Nigeria with a high level of illiteracy and ignorance. Majority of the people reside in the rural areas while a few are found in the towns, informal settlements with no direct access to healthcare facilities are common.

Materials and Methods:

This study is an analytical, cross-sectional study. Proportional sampling technique was used to obtain a representative sample and a structured self-administered questionnaire was used to collect relevant information from the healthcare providers working in Nasarawa State from January to February 2009.

Statistical analysis used:

To describe patient characteristics, we calculated proportions and medians. For categorical variables, we compared proportions using chi-square tests. A logistic regression model was produced with infection control as outcome variable to identify associated factors.

Results:

A total of 421 HCWs were interviewed, Majority (77.9%) correctly describe universal precaution and infection control with 19.2, 19.2, and 28.0%, respectively unable to recognize vaccination, postexposure prophylaxis, and surveillance for emerging diseases as standard precaution for infection control. About 70.1% usually wear gloves before handling patients or patients’ care products, 12.6% reported wash their hand before wearing the gloves, 10.7% washed hands after removal of gloves, and 72.4% changed gloves after each patient. Only 3.3% had a sharp disposal system in their various workplaces. Majority (98.6%) of the respondents reported that the major reason for noncompliance to universal precautions is the nonavailability of the equipments. There was a statistically significant difference in the practice of standard precaution among those that were exposed to blood products and body fluid compared to those that had not been exposed in the last 6 months (χ² = 3.96, P = 0.03), public healthcare providers when compared to private health workers (χ² = 22.32, P = 0.001), among those working in secondary and tertiary facilities compared to primary healthcare centers (χ² = 14.64, P = 0.001) and urban areas when compared to rural areas (χ² = 4.06, P = 0.02). The only predictor of practice of standard precaution was exposure to blood and body fluid in the last 6 months odds ratio (OR) = 4.56 (confidence interval (CI) = 1.00-21.28).

Conclusions:

This study implies that inadequate workers’ knowledge and environment related problems, including the lack of protective materials and other equipments and utilities required to ensure safety of HCWs is a crucial issue that need urgent attention. Institution of a surveillance system for hospital acquired infection to improve consistent use of standard precautions among health workers is recommended in Nigeria and other low income countries in Africa.

Compliance to occupational safety measures among the paramedical workers in a tertiary hospital in Karnataka, South India

BACKGROUND

The guidelines for minimizing occupational health risk from exposure to highly infectious diseases is already established but little information exists on the compliance of these measures among paramedical workers in India.

OBJECTIVE

To study the awareness of occupational safety measures such as universal precautions, biomedical waste handling, disposal and its compliance in their daily practice.

METHODS

A hospital-based cross-sectional study was undertaken in a tertiary private hospital in Karnataka, Bangalore, India. Data was collected using a pretested and predesigned proforma from 120 respondents: 85 nurses and 35 laboratory technicians.

RESULTS

27 (32%) nurses and 20 (57%) laboratory technicians could relate universal precautions to infection prevention. Only 6 (7%) nurses and 2 (6%) technicians had knowledge about proper hospital waste segregation. 45 (52.9%) nurses and 15 (42.8%) technicians had knowledge about post-exposure prophylaxis. 3 (4%) nurses and 9 (26%) technicians were formally trained in following universal precautions. Adequate hand washing was practiced among 17 (20%) nurses and none of the technicians. Faulty practice such as recapping of needle was prevalent among 57 (67%) nurses and 29 (83%) technicians. 32 (38%) nurses and 10 (29%) technicians received hepatitis B vaccine.

CONCLUSION

As knowledge and practice regarding different aspects of universal precautions was not satisfactory, training was warranted urgently in the study population. Also, suggestions were made to develop and implement institutional policies on the universal precautions and ensuring supply of personal protection equipment.

Improving universal precautions and client teaching for rural health workers: a peer-group intervention

Health workers can contribute to HIV prevention by minimizing HIV transmission in health facilities and increasing client teaching. We offered a peer-group intervention for Malawian rural health workers to build their universal precautions and teaching skills. A quasi-experimental design using independent sample surveys and observations compared health workers in an intervention and delayed intervention control district at baseline and at 15 and 30 months post-intervention. Controlling for demographic factors, the intervention district had more reported HIV teaching at 15 and 30 months and also had higher universal precautions knowledge and fewer needle stick injuries at 30 months. Observations at 15 and 30 months post-intervention showed higher levels of teaching in the intervention district. Observed glove wearing and hand washing were also higher at 30 months. This intervention should be made available for health workers in Malawi and provides a potential model for other high-HIV prevalence countries.

Health beliefs of midwives about HIV/AIDS protection and the barriers to reducing risk of infection

Purpose

Using a health belief model (HBM), this study aims to assess the knowledge, attitudes and practices of Iranian midwives in relation to HIV/AIDS protection behavior and to determine the needs of interventional programs for promotion of the behavior among midwives of maternity care units.

Design/methodology/approach

This was a cross‐sectional study in five selected hospitals in Isfahan. All 58 midwifery personnel of maternity wards of these hospitals participated in the study. Tools for data collection were a checklist to assess midwives' practice and a questionnaire to assess knowledge, attitude, and the HBM of midwives about HIV/AIDS‐protection methods.

Findings

A total of 58 midwifery personnel with average working experience of 10.92±7.98 years were assessed in the study and with a high knowledge, positive attitude and moderate practice about HIV/AIDS protection methods. The midwives perceived two main barriers, which impacted on their self‐efficacy and their protection behavior. These barriers were the emergency conditions of the work and the low availability of protective equipment.

Originality/value

HIV/AIDS protection behavior and HBM of midwives can be promoted by overcoming management barriers such as inadequate midwifery personnel in emergency conditions and insufficient protective equipment. The behavior also needs to be promoted by educational interventions which focus on improving midwives' perceived risk of HIV/AIDS infection.

Peer group intervention reduces personal HIV risk for Malawian health workers

PURPOSE

To test a peer group intervention to address personal HIV prevention needs of rural health workers in Malawi.

DESIGN

Using a quasi-experimental design, we compared district health workers in two districts of Malawi that were randomly assigned to either the intervention or delayed control condition. We used independent sample surveys at baseline, 15 months, and 30 months postintervention. Intervention district workers received a peer group intervention after the baseline; control district workers received the delayed intervention after final data collection.

METHODS

The 10-session intervention for primary prevention of HIV infection was based on the primary healthcare model, behavioral change theory, and contextual tailoring based on formative evaluation. Differences in HIV-related knowledge, attitudes, self-efficacy, and behaviors were analyzed using t tests and multiple regression controlling for baseline differences.

FINDINGS

Health workers in the intervention district had higher general HIV knowledge, more positive attitudes about condoms, higher self-efficacy for safer sex, and more involvement in community HIV prevention at both the 15-month and 30-month postintervention survey. At 30 months, intervention district workers also reported less stigmatizing attitudes toward persons living with AIDS, more HIV tests, and lower risky sexual behaviors.

CONCLUSION

The intervention should be sustained in current sites and scaled up for health workers throughout Malawi as part of a multisectoral response to HIV prevention.

CLINICAL RELEVANCE

Incorporating a peer group intervention focused on personal as well as work-related HIV prevention can reduce health workers' risky behaviors in their personal lives, potentially reducing morbidity and mortality and enhancing workforce retention. Reducing stigmatizing attitudes may also improve the quality of health services.

Experiences of stigma in healthcare settings among adults living with HIV in the Islamic Republic of Iran

Background

People living with HIV (PLHIV) sometimes experience discrimination. There is little understanding of the causes, forms and consequences of this stigma in Islamic countries. This qualitative study explored perceptions and experiences of PLHIV regarding both the quality of healthcare and the attitudes and behaviours of their healthcare providers in the Islamic Republic of Iran.

Methods

In-depth, semi-structured interviews were held with a purposively selected group of 69 PLHIV recruited from two HIV care clinics in Tehran. Data were analyzed using the content analysis approach.

Results and discussion

Nearly all participants reported experiencing stigma and discrimination by their healthcare providers in a variety of contexts. Participants perceived that their healthcare providers' fear of being infected with HIV, coupled with religious and negative value-based assumptions about PLHIV, led to high levels of stigma. Participants mentioned at least four major forms of stigma: (1) refusal of care; (2) sub-optimal care; (3) excessive precautions and physical distancing; and (4) humiliation and blaming. The participants' healthcare-seeking behavioural reactions to perceived stigma and discrimination included avoiding or delaying seeking care, not disclosing HIV status when seeking healthcare, and using spiritual healing. In addition, emotional responses to perceived acts of stigma included feeling undeserving of care, diminished motivation to stay healthy, feeling angry and vengeful, and experiencing emotional stress.

Conclusions

While previous studies demonstrate that most Iranian healthcare providers report fairly positive attitudes towards PLHIV, our participants' experiences tell a different story. Therefore, it is imperative to engage both healthcare providers and PLHIV in designing interventions targeting stigma in healthcare settings. Additionally, specialized training programmes in universal precautions for health providers will lead to stigma reduction. National policies to strengthen medical training and to provide funding for stigma-reduction programming are strongly recommended. Investigating Islamic literature and instruction, as well as requesting official public statements from religious leaders regarding stigma and discrimination in healthcare settings, should be used in educational intervention programmes targeting healthcare providers. Finally, further studies are needed to investigate the role of the physician and religion in the local context.

Impact of a peer-group intervention on occupation-related behaviors for urban hospital workers in Malawi

Using a pre- and posttest design with no control group, the authors evaluated the impact of a peer-group intervention on work related knowledge and behavior for health workers at an urban hospital in Malawi. The authors surveyed unmatched random samples of health workers, observed workers on the job, and interviewed clients about hospital services at baseline and at 6 months after the intervention. Universal precautions knowledge, reported hand washing, and reported client teaching were significantly higher at the final evaluation. The outcome differences remained robust in multivariate analyses with controls for demographic factors of age, gender, education, food security, and job category. Observations reported consistently greater use of universal precautions, more respectful interactions, and more client teaching at final evaluation. Patient surveys reported more discussion with health workers about HIV at the final evaluation. Peer-group interventions can prepare health workers in Malawi for HIV prevention and offer a potential model for other African countries.

Professional risk, knowledge, attitudes and practice of health care personnel in Serbia with regard to HIV and AIDS

The aim of our investigation was to assess HIV/AIDS-related professional risk, knowledge, attitude and practice of health care workers in Nis. A cross-sectional study of health personnel from Primary Health Centre, Clinical Medical Centre and Dental Clinic in Nis was performed. The data were collected by an anonymous questionnaire. Mantel-Haenszel X2 testing and multiple logistic regression analysis were applied. Results show that 89% of health personnel perceived high professional risk of acquiring HIV infection. The risk perception of acquiring HIV infections was higher among those who were frequently exposed to patients' blood and other body fluids (OR = 10.1 95% CI = 3.1-32.5), and those who had treated HIV-positive patients (OR = 3.0 95% CI = 1.0-8.8). The majority of respondents had insufficient knowledge about the modes of HIV transmission. Nearly two thirds of health personnel agreed that every hospitalized patient should be tested for HIV, and more than four fifths of them agreed that their personal protection was more important than the confidentiality of patient's HIV/AIDS status. Twenty nine percent of health personnel use adequate protection during their daily work with patients. These findings indicated a need for urgent educational and training initiatives of HIV and AIDS for all categories of health care workers.