INTRODUCTION:

WHO reported that every minute a mother dies from complication in pregnancy and childbirth that means 1400 mothers die every day and more than half a million -mothers die every year.¹ About 830 women die from pregnancy or childbirth-related complications around the world every day. According to WHO estimates puerperal sepsis accounts for 15% of the 500000 maternal deaths annually.²

The aim of modern management of labor should be to ensure optimum condition for the mother and the fetus during and after delivery as well as emotional satisfaction of all involved. The place of delivery plays an important role in child survival and safe motherhood. The child born in unhygienic condition is more prone to get infected.³

Infection prevention and control is an integral component of nursing care delivery in any setting to reduce risks for morbidity and mortality in patients and care givers at all levels. Basic principles of infection prevention are simple and include personal hygiene and hand washing. Nurses share responsibility with other health care personnel for infection risk reduction in patients across entire continuum of care and play vital role in reducing risks for infection through a variety of direct care activities.⁴

Nurses are on the front line to answer questions from patients and families when the media report outbreaks of exotic infectious diseases and the development of new super Pathogens associated with health care.⁵

Staff education is an important component of the hospital infection control program. The efficiency of infection control measures is highly dependent on the compliance of the hospital staff. To secure their compliance, education is needed to inform the staff and to convince them that these measures are really worthwhile. Without an effective in-service education program, the work of infection control is rendered ineffective.

METHODOLOGY:

Design:

Research design selected for the study was descriptive correlational design

Sample and setting:

A study was conducted in labor room of Obstetric ward of SJMCH, Bangalore. A total of 42 parturient mothers and 62 health care professional were selected was purpusive sampling

Measurements:

It consisted of 2 sections. Section one provides Structured questionnaire to collect the baseline data which includes qualification, designation and years of experience. observational checklist to assess the compliance of infection control protocol. Section two includes Calibrated digital thermometer to check temperature for the assessment of puerperal infection and REEDA scale for assessment of episiotomy wound infection.⁶

Population:

Health care personnel conducting delivery and assisting in labor process and the event observed are the deliveries in which compliance to infection control protocols are followed.

Development of the instrument:

The tool was developed through an extensive review of literature on related studies, books, journal articles, internet search, opinion of the experts, discussion with guides and health care professionals.

Description of the tool:

Based on the objectives of the following instruments were developed to generate the data:

Section 1: Description of the professional variables

Section 2: Description of the compliance of infection control protocol

Section 3: Description of the incidence of maternal infection on postnatal mother

Section 4: Correlation between compliance to infection control protocol and maternal infection

Section 5: Association between protocol compliance and selected professional variables

METHOD:

A waiver of consent was taken from the HOD of OBG ward from St Johns Medical College Hospital. Data collection was carried out from 12-11-17 to 21-12-17. A subject was selected by purposive sampling technique based on inclusion and exclusion criteria. The baseline data was collected by questionnaire method. The compliance of infection control protocol (Hand Hygiene, Personal protective equipment, Biomedical waste management) was observed using checklist by the investigator.⁷A non-participatory observation was done. Duration taken for observation is 30-40 minutes (approx. Mothers were observed for puerperal infection on 1^st,2^nd and 3^rd day by using-

Calibrated digital thermometer for temperature

REEDA scale for Episiotomy wound (only on 3^rd day)

Follow up for Mothers by telephonic enquiry on 10^th day for the assessment of infection

Section I: Description of the professional variable

Table1a: Frequency, percentage of professional variables. n=62

Sn.

Variables

Designation

Staff nurse

Doctors

3.23%

96.77%

Professional Qualification

P.C. B. S c (N) students

MBBS student

PG students

Consultants

3.23%

8.06%

80.65%

8.06%

Year of experience

<1yr

1-5 yr.

6-10 yr.

>10 yr.

24.19%

66.13%

3.23%

6.45%

The data presented in table 1 depicts that 3.23% and 96.77% of the subjects were staff nurse and doctors, 3.23%, 8.06%, 80.65% and 8.06% were P.C B.Sc. students, MBBS students, PG students and consultants, 24.19%, 66.13%, 3.23% and 6.45% were <1 yrs,1-5 yr,6-10yr and >10 yrs. of experience

Section II: Description of the compliance of infection control protocol:

Objectives: To assess the compliance of health care professionals to the infection control protocols.

Table 2a: Compliance of health care professional to infection control protocol under category (hand hygiene, personal protective equipment and biomedical waste management) n =62

Infection control protocols	Maximum score	Range	IQR	Median score	Median %
Hand hygiene	12	0-12	5-12	5	41.67%
Personal protective equipment	31	16-31	26-29.7	28	90.32%
Biomedical waste management	7	6-7			96.8%

The above table shows that maximum score of Hand hygiene is 12, range (0-12), IQR (5-12), median score (5) and median percentage is 41.67%. Maximum score of Personal protective equipment is 31, range (16-31), IQR (26-27.9), median (28), median % is (90.32). Maximum score of biomedical waste management is 7, range is 6-7 and median percentage is 96.8.

Figure 1. Depicts that compliance to hand hygiene, steps of wearing PPE, mask, gown, gloves, steps of removing PPE is 44%, 80%, 100%, 83.3%, 100%, 75% and 96.8% respectively

Table 2b: Range, median, median % of total compliance to infection control protocol n=62

Maximum score	Range	IQR	Median	Median %
50	0-50	36 -47	40.5	81%

The above table shows that maximum score (50), range (0-50), interquartile range (36-47), median and median percentage for the compliance to infection control protocol is 40.5 and 81%.

Section III: Description of the incidence of puerperal infection on postnatal mother

OBJECTIVE: To assess the incidence of puerperal infection on postnatal mother n=42

Fig 2: line graph indicating incidence of temperature on 1^st, 2^nd and 3^rdday morning or evening

Figure 2 depicts that there is no evidence of temperature on 1^st, 2^nd and 3^rd day

Fig 3: Bar graph indicating incidence of episiotomy wound infection on 3^rd day or 10^th day

Figure 3 depicts that on 3^rd day 9.5% mothers had infection and 91% mothers had no infection and on follow up there is no evident of infection on 10^th Day

Fig 4: Bar graph indicating occurrence of redness, edema, ecchymosis, discharge and approximation

Figure 4 depicts that occurrence of redness, edema, ecchymosis, discharge and approximation is 4.5%, 4.5%, 0%, 0%, 0% among postnatal mothers.

Section IV: Correlation between compliance to infection control protocol and puerperal infection

OBJECTIVES: To correlate between compliance to infection control protocol and puerperal infection

Table 4a: Mean, SD, r value of compliance to infection control protocol and puerperal pyrexia (temperature

Variable

Mean

r value

p value

Infection control protocols

40.6

7.261

-0.126

0.425

Pyrexia (temperature)

36.7

0.24

The above table shows that the mean of the infection control protocol is 40.6±7.261 and for the pyrexia is 36.7±0.24. Correlation between these variables shows r value -0.126 with p value 0.425. There fore it shows that there is no correlation between infection control protocols and pyrexia

Table 4b: mean, SD, r value of compliance to infection control protocol and puerperal infection (episiotomy wound infection)

Variables	Median	r value	p value
Compliance to Infection control protocols	37.6	0.040	0.800
Episiotomy wound infection	0	0.040	0.800

The above table shows that the median of the infection control protocol is 37.6 and for the puerperal infection is 0. Correlation between these variables shows r value 0.040 with p value 0.800. There fore it shows that there is no correlation between infection control protocols and puerperal infection

Table 4c: Median and, r value of hand hygiene, PPE and BMW and puerperal infection (episiotomy wound infection)

Variables	Median	r value	P value
Hand hygiene
Hand hygiene	6.5	0.161	0.307
Episiotomy wound infection	0
Personal protective equipment
PPE	28	-0.171	0.276
Episiotomy wound infection	0
Biomedical waste management
BMW	7	0.072	0.648
Episiotomy wound infection	0

The above table shows that median for hand hygiene and puerperal infection is 6.5 and 0. Correlation between these variables shows R-value 0.161 with p value 0.307. Data shows that there is no correlation between hand hygiene and puerperal infection, median for PPE and puerperal infection is 28 and 0. Correlation between these variables shows r value is -0.171 with p value 0.276. Data shows that there is no correlation between PPE and puerperal infection), median for BMW and puerperal infection is 7 and 0. Correlation between these variables shows R-value 0.072 with p value 0.648. Data shows that there is no correlation between BMW and puerperal infection

Section V: Association of protocol compliance with selected baseline variables

Objectives: To determine the association between protocols compliance and selected baseline variables

Table 5: Shows that there is no association between protocol compliance and baseline variables like designation, professional qualification and years of experience at p>0.05 level of significance.

DISCUSSION:

The study sample in the present study consisted of 62 health care professionals of which 3.23% (2) and 96.77% (60) were staff nurse and doctors. In the present study 3.23% (2), 8.06% (5), 80.65% (50) and 8.06% (5) were P.C B.Sc. students, MBBS students, PG students and consultants and 24.19% (15), 66.13% (41), 3.23% (2) and 6.45% (4) were <1yrs. 1-5 yr,6-10yr and >10 yr. of experience.

The present study showed that median percentage for hand hygiene is (41.67%), personal protective equipment (90.32%) and biomedical waste management is 96.8%. median percentage for the compliance to infection control protocol is 40.5 and 81%.

The present study also showed that 1^st, 2^nd and 3^rd day morning and evening temperature is 36.8°C, 36.7°C, 36.7°C, 36.6°C, 36.8°C and 36.6°C respectively. On 3^rd day 9.5% mothers had infection and 91% mothers had no infection and on follow up there is no evidence of infection on 10^th Day assessed by REEDA scale and occurrence of redness and edema are 4.7%, 4.7%, there is no evidence of ecchymosis, discharge and approximation.

The present study showed that mean of the infection control protocol is 40.6±7.261 and for the pyrexia is 36.7±0.24. Correlation between these variables shows r value -0.126 with p value 0.425. There fore it shows that there is no correlation between infection control protocols and pyrexia. Correlation between infection control protocols and puerperal infection showed no correlation.

A present study shows that there was no association between protocol compliance and baseline variables like designation, professional qualification and years of experience at p>0.05 level of significance. A similar study conducted in Palestine revealed an association between age, education, work experience, and compliance with standard precautions but there is no significant association between training courses and compliance with standard precautions.²⁸

The similar study conducted in Tamilnadu showed that frequency and percentage distribution of pre -test level of practice on infection control in labour unit among Health care personnel is that 40(66.67%), 60(100%), 60(100%) had fair practice on clean birthing room environment, infection control practice during labour and birth and in safe waste management respectively, 60(100%) had excellent practice in storage of clean and sterile supplies. ⁸

RECOMMENDATIONS:

Similar study can be done on puerperal infection of women who are induced for labor.

Study can be done to assess the knowledge of HCP on infection control protocol

Similar studies can be done in the other ward like NICU to assess infection control protocols

CONFLICT OF INTEREST:

The author declares that they have no conflict of interest.

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Received on 20.07.2020 Modified on 11.09.2020

Int. J. of Advances in Nur. Management. 2021; 9(1):57-61.

DOI: 10.5958/2454-2652.2021.00016.0