Effectiveness of Structured Teaching Programme (STP) on selected Aspects of Hospital Acquired Infections (HAI’s)

Mr. Girish Degavi, Mr. Vasanth Damalli, Prabhu Jevoor

KLE University’s Institute of Nursing Sciences, Nehru Nagar, Belgaum, Karnataka.590010

*Corresponding Author Email: girishdegavi1984@gmail.com

ABSTRACT:

A study to evaluate the effectiveness of structured teaching programme (STP) on knowledge regarding selected aspects of hospital acquired infections (HAIs) among IVth year B.Sc nursing students studying in KLE University’s Institute of Nursing Sciences, Belgaum.

The objectives of the study were

1 To assess the existing knowledge of IV^th year B.Sc nursing students on selected aspects of hospital acquired infections.

2. To determine the effectiveness of structured teaching programme on HAIs among IV^th year B.Sc nursing students.

Methods

The conceptual framework of the present study is based on Ernestine Wiedenbach’s helping art of clinical nursing theory.

The study was conducted using one group pre test post test design.

The study was conducted using purposive sampling technique on a sample of 40 IV^th year B.Sc nursing students. Structured questionnaire were used to collect the data regarding HAIs among IV^th year B.Sc nursing students.

Finding of the study:

The Pre test and post test Frequency and percentage of knowledge scores of subjects regarding HAIs revealed pre test (60%) subjects had Inadequate knowledge (40%) had Moderate (00%) had Adequate knowledge where as in post test all the subjects (100%) had good knowledge scores.

Effectiveness of Structured teaching programme (STP) was assessed with paired ‘t’ test it was revealed that there was significant gain in knowledge at 0.05 level.

Interpretation and conclusion

The study findings were that Structured teaching programme (STP) is effective teaching strategy to improve the knowledge regarding hospital acquired infections among IVth year B.Sc nursing students.

KEY WORDS: Structured teaching programme –STP; hospital acquired infections –HAIs.

INTRODUCTION:

“Hospital should do the sick no harm”

(Florence Nightingale)

Hospital acquired infection (HAI’s), also called as nosocomial infection, is an infection that first appears between 48 hours and four days after a patient is admitted to a hospital or other health care facility. Hospital acquired infections are wide spread. And contribute to the increased morbidity and mortality in hospitals. With an increasing population, increased number of people with impaired immunity (age, illness, treatments), emergence of new organisms like HIV and increased bacterial drug resistance to antibiotics, this problem is going to increase. HAI’s and thereby increase the economic burden of the hospital by increasing the bed occupancy due to prolonged hospital stay.¹

The concept of Nosocomial Infections (NIs) suffered significant changes during the evolution of medical and nursing science. The term, firstly used to describe all possible damaging affects on the patient during his or her staying at the hospital.²

Hospital acquired infection is a serious health hazard in the world today. The persistent presence of nosocomial infections plagues the hospital administrator, health and providers and patients. No sooner is one set of organism identified and tackled a new and resistant one emerges. Nosocomial infections have a significant impact on the patient’s morbidity, mortality, and expenditure, hospital stay and on the financial concern of patients.³

The centers for Disease Control and Prevention (CDC) estimate that more than two million patients develop hospital acquired infections in the United States each year. About 90,000 of these patients die as a result of their infections. Hospital acquired infections usually are related to a procedure or treatment used to diagnose or treat the patient’s illness or injury. About 25% of these infections can be prevented by health care workers taking proper precautions when caring for patients.⁴

Hospital acquired infections can be caused by bacteria, viruses, fungi, or parasites. These microorganisms may already be present in the patients’ body or may come from the environment, contaminated hospital equipment, healthcare workers, or other patient. Depending on the causal agents involved, an infection may start in any part of the body. A localized infection is limited to a specific part of the body and has local symptoms. For example, if a surgical wound in the abdomen becomes infected, the area of the wound becomes red, hot and painful.⁴

NEED FOR THE STUDY:

Over 1.4 million people worldwide are suffering from HAIs. In the United States, it has been estimated that as many as one hospital patient in ten acquires a nosocomial infection, or 2 million patients a year. Estimates of the annual cost range from $4.5 billion to $11 billion. Nosocomial infections contributed to 88,000 deaths in the US in 1995. In France, prevalence was 6.87% in 2001 and 7.5% in 2006, some patients were infected twice. In Italy, in the year 2000, about 6.7% of hospitalized patients were infected, i.e, between 450,000 and 700,000 patients, which caused between 4,500 and 7,000 deaths. In Switzerland, extrapolations assume about 70,000 hospitalized patients are affected by nosocomial infections; between 2 and 14% of hospitalized patients.⁵

Nosocomial blood stream infections are a leading cause of death in the United States. If we assume a nosocomial infection rate of 5%, of which 10% are blood stream infections, and an attributable mortality rate of 15%, blood stream infections would represent the eighth leading cause of death in the United States.⁶

If 35 million patients are admitted each year to the approximately 7,000 acute care institutions in the United States, the number of nosocomial infections- assuming overall attack rates of 2.5%, 5%, or 10% - would be 875,000 , 1.75 million, or 3.5 million, respectively. If 10% of all hospital acquired infections involve the blood stream, 87,500, 1,75,000 or 3,50,000 patients acquire these life- threatening infections each year.⁶

In India, 30 to 35 percent of persons admitted to hospitals develop HAIs. Among hospital-acquired infections 30to40% are urinary tract infections, 15 to 20% surgical wound infections, 15 to 20% lower respiratory tract infections and 5 to 15% blood stream infections.3 The incidence of HAI in Karnataka has been recorded 6.5%.⁶

Intravenous or IV therapy is probably the most common acute care invasive procedure. Statistics are difficult to confirm, but at least 90 percent of all hospitalized patients are thought to require some type of IV therapy during their course of treatment. The risk of IV related infection, as in any invasive procedure, is a serious concern. In fact, current studies indicate that these central venous access devices (VADs) are often associated with significant hospital morbidity and mortality. The human and economic costs of catheter – related infections remain high. The additional cost burden of these nosocomial central VAD infections has been reported at $ 25,000 or more per episode.⁷

The high frequency of nosocomial infections places a substantial burden on individual patients and on the health care system. There is increased morbidity, including delayed wound healing, delayed rehabilitation, increased exposure to antimicrobial therapy and its potential adverse effects and prolonged hospitalization. The average prolongation of stay is 3.8 days for urinary infection, 7.4 days for surgical site infection, 5.9 days for pneumonia, and 7 to 24 days for primary blood stream infection.⁸

Hospital acquired infections (HAIs) significantly increase both the patient’s length of stay and the cost of disease. For this reason, HAIs are one of the most important problems that intensive study is devoted to many countries around the world. The purpose of this study was to investigate how HAIs prolong the length of stay and add unnecessary cost to the patient. The study compared two matched groups and suggested that a patient with a HAI spent an additional 23 days in the hospital compared with a patient not affected with a HAI. The results also showed that a patient with a HAI had to pay more in almost all cost categories compared with a non-infected patient. The additional cost for an infected patient was calculated as 2026.70 US dollars.⁸

Nurses regard isolation as central to controlling infection, but there is little evidence of its efficacy. Patients who are immuno compromised are likely to be exposed to infection during their hospital stay through contact with other patients, staff and invasive procedures.17 There is no evidence that protective isolation inside rooms reduces the risk of them developing a hospital acquired infection. It is essential for hospital staff to have adequate knowledge and they compliance with universal infection control procedures, while caring for all patients, regardless of their presumed infection status.⁹

STATEMENT OF PROBLEM:

A study to evaluate the effectiveness of structured teaching programme (STP) on knowledge regarding selected aspects of hospital acquired infections (HAIs) among IV^th year B.Sc nursing students studying in KLE University’s Institute of Nursing Sciences, Belgaum.

OBJECTIVES OF THE STUDY:

1 To assess the existing knowledge of IV^th year B.Sc nursing students on selected aspects of hospital acquired infections.

2. To determine the effectiveness of structured teaching programme on HAIs among IV^th year B.Sc nursing students.

OPERATIONAL DEFINITIONS:

1. Effectiveness: - Refers to significant difference in pre and post test knowledge scores on selected aspects of hospital acquired infections after administering structured teaching programme.

2. Hospital acquired infections: - Refers to the infection developing in patients after admission to the hospital, which was neither present nor in the incubation period at the time of hospitalization.

3. Selected aspects: - Refers here to urinary catheterization, intravenous therapy, wound dressing, intramuscular injection and blood collection procedure.

4. Structured teaching programme: - Refers to a teaching learning activity on which systematically organized information regarding selected aspects of hospital acquired infections.

Assumption

The study assumes that,

1. The Student nurses will have some knowledge on HAIs.

2. Structured teaching programme (STP) is one of the best teaching strategy in imparting knowledge regarding HAIs among student nurses.

Delimitation

This study is limited to the IV^th year B.Sc nursing students Studying in KLE University’s Institute of Nursing Sciences Belgaum.

REVIEW OF LITERATURE:

A study was conducted to assess the awareness of health care professionals about the preventive measures to be applied in the hospital to minimize the risk of HIV transmission in Pune hospitals. It was found that 85 percent nursing staff did not apply the Universal safety precautions and they have shown definite lacunae in knowledge regarding transmission of HIV and precautions to be taken while giving care to the HIV positive patients.¹⁰

A study was conducted to assess the knowledge, attitude ad practices among the different health care workers on nosocomial infections. A total of 150 health care workers i.e. 50 doctors, 50 nurses and 50 ward aids were included and interventions in the form of an education module designed to suit the need of each of these categories. The study showed an increase in the number of subjects in each category scoring good after the intervention; however this declined with the progress of the time. The study proved that there is a need to develop a system of continuous education for all categories of staff in order to reduce the incidence of hospital acquired infections.¹¹

A study was conducted to identify knowledge deficit concerning nosocomial pneumonia (NP) among critical care nurses in eastern Rajasthan states. The study revealed that, several important deficits in nosocomial pneumonia knowledge were identified indicating a need for critical care nurses to have greater exposure to nosocomial pneumonia prevention education, guidelines and research.¹²

A study was conducted to investigate nurses’ knowledge and clinical practice regarding care of patients with Indwelling Urinary Catheters (IUCs) in preventing nosocomial infections in four hospitals. It was found that, although the nurses’ knowledge in IUC care was relatively good, the nursing care for patients with IUC in the studied hospitals ought to be improved. This can be done by developing evidence based, culturally congruent guidelines for assurances of quality care.¹³

A cross sectional survey was conducted to investigate the nurses’ knowledge of and compliance with universal precautions in an acute hospital in Hong Kong. A total of 450 nurses were randomly selected from a population of acute care nurses and 306 were successfully recruited in the study. The study revealed that the nurse’s knowledge of Universal precautions was inadequate. In addition, universal precautions were not only insufficiently and inappropriately applied, but also selectively practiced. Nearly all respondents knew that used needles should be disposed of in a sharp’s box after injection. However, nurses had difficulty in distinguishing between deep body fluids and other general body secretions that are not considered infections in universal precautions. A high compliance was reported regarding hand washing, disposal of needles and gloves usage. However, the use of other protective wear such as masks and goggles were uncommon.¹⁴

A quasi experimental study was conducted to evaluate the effect of an educational training programme for 100 randomly selected hospital nurses on universal precautions in Changsha, China. Questionnaires were administered to the 100 nurses prior to and 4 months after the training. The result showed that educational training significantly improved Chinese nurses’ knowledge, practice and behaviour related to universal precautions. There remain room for improvement in glove use and needle stick injury reporting.¹⁵

A quantitative study conducted by Stule and Melby to investigate nurses’s belief, knowledge and perceptions of risk of contracting HIV while implementing their nursing care, in Northern Ireland. The questionnaire was responded by 42 qualified nurses. The findings indicated, negative and biased beliefs with inadequate knowledge and misguided perception regarding their risk of contracting HIV through the implementation of routine nursing care of the clients. Many of those nurses readily admitted their lack of knowledge.¹⁶

METHODOLOGY:

Research Design:

A One group pre-test post-test pre-experimental research design was adopted to carry out the present study.

Research Setting :

Based on the geographic proximity, feasibility to conduct the study and familiarity with the setting, the investigator selected IV^th Year B.Sc Nursing students of KLE University’s Institute of Nursing sciences, Belgaum.

Population:

The target population for the study consisted of IV^th Year B.Sc Nursing students of KLE University’s Institute of Nursing sciences, Belgaum.

Variable:

Independent variable: Structured teaching programme (STP) on HAIs.

Dependent variable: Knowledge score regarding HAIs.

Socio-demographic variable:

The socio-demographic variables considered for this study were gender.

Sample:

The sample size consists of 40 IV^th Year B.Sc Nursing students of KLE University’s Institute of Nursing sciences, Belgaum.

Sampling Technique

The investigator selected IV^th year B.Sc nursing students by using purposive sampling technique.

Description of the Tool

Part I: 1 items of demographic variables gender

Part II: A closed - ended questionnaire to assess the knowledge of the student nurses on selected aspects of HAIs. Part A has 10 items, regarding general information on selected aspects of hospital acquired infections. Part B had 7 items, regarding causes of selected aspects of hospitals acquired infections. Part C had 19 items regarding prevention of hospital acquired infections. Part D had 4 items regarding control of selected aspects of hospital acquired infections. For these 40 items total scoring was 40. Each question had 3 options, out of which one option was appropriate; each correct answer had one score and wrong answers had zero score.

Ethical clearance

Ethical clearance was obtained.

Reliability

The reliability of the tool is computed by using Spearman Brown’s prophecy formula, where ‘r’ value obtained was 0.788 which showed that the tool was reliable.

RESULT:

Pretest knowledge level on selected aspects of hospital acquired infections

Classification of respondents according to pre test knowledge scores on selected aspects of hospital acquired infections. The result indicated that 60% (24) of the respondents had inadequate knowledge, 40% (16) of respondents had moderate knowledge and none of the respondents possess adequate knowledge.

Aspect wise pre test mean knowledge scores of respondents on selected aspects of hospital acquired infections. The highest mean knowledge score 64.3% found in the aspect of knowledge on selected aspects of hospital acquired infections, followed by 39.6% found in the aspect of prevention of selected aspects of hospital acquired infections, 34.7% in the aspect of control of selected aspects of hospital acquired infections and lowest mean knowledge score 33.6% found in the aspect of causes of selected aspects of hospital acquired infections. However the overall mean knowledge score was 43.2 with SD as ±11.0.

Post test knowledge level on hospital acquired infection following selected procedures

Classification of respondents according to post test knowledge level on selected aspects of hospital acquired infections. The result indicated that 75 % (30) of the respondents had adequate knowledge and 25% (10) of the respondents had moderate knowledge on the post test. None of the respondents possessed inadequate knowledge in the post test.

Aspect wise post test mean knowledge scores of respondents on selected aspects of hospital acquired infection. The highest post test mean knowledge score 93.5% found in the aspect of selected aspects of hospital acquired infections, 92.1% in causes of selected aspects of hospital acquired infections, 88.6% in control of selected aspects of hospital acquired infections and the lowest post test mean knowledge score 84.2% found in the aspect of prevention of selected aspects of hospital acquired infections. However, overall post test mean knowledge score was 88.4% with SD as ±10.3.

Graph1: Classification of Respondent on pretest knowledge level on selected aspects of hospital acquired infections

TABLE -1 Aspect wise Pre test Mean Knowledge scores of Respondents on Hospital acquired infections. n =40

No.	Knowledge Aspects	Statements	Max. Score	Respondents Knowledge
No.	Knowledge Aspects	Statements	Max. Score	Mean	Mean(%)	SD(%)
I	selected aspects of hospital acquired infections	10	10	6.43	64.3	19.7
II	Causes of Selected aspects of hospital acquired infections	7	7	2.35	33.6	31.0
III	Prevention of HAIs following selected procedures.	19	19	7.53	39.6	12.1
IV	Control of HAIs following selected procedures.	9	9	3.13	34.7	26.9
	Combined	45	45	19.43	43.2	11.0

Graph 2: Classification of Respondent on post test knowledge level on hospital acquired infection following selected procedures

TABLE -2 Aspect wise Post test Mean Knowledge scores of Respondents on Selected aspects of hospital acquired infections n=40

No.	Knowledge Aspects	Statements	Max. Score	Respondents Knowledge
No.	Knowledge Aspects	Statements	Max. Score	Mean	Mean(%)	SD(%)
I	Hospital Acquired Infections (HAIs) following selected procedures.	10	10	9.35	93.5	8.9
II	Causes of Selected aspects of hospital acquired infections .	7	7	6.45	92.1	13.3
III	Prevention of HAIs following selected procedures.	19	19	16.00	84.2	12.3
IV	Control of HAIs following selected procedures	9	9	7.98	88.6	19.2
	Combined	45	45	39.78	88.4	10.3

Graph 3 : classification of respondents on knowledge level on hospital acquired infections fallowing selected procedures

Graph 4 : pre test and post test mean knowledge on hospital acquired infections fallowing selected procedures

TABLE – 3. Aspect wise Mean Pre test and Post test Knowledge scores of Respondents on Selected aspects of hospital acquired infections

n = 40

No.	Knowledge Aspects	Respondents Knowledge (%)						Paired ‘t’ Test
		Pre test		Post test		Enhancement
		Mean	SD	Mean	SD	Mean	SD
I	Hospital Acquired Infections (HAIs) s.	64.3	19.7	93.5	8.9	29.3	21.2	8.74*
II	Causes of Hospital Acquired Infections	33.6	31.0	92.1	13.3	58.6	34.2	10.84*
III	Prevention of HAIs	39.6	12.1	84.2	12.3	44.6	16.6	16.99*
IV	Control of HAIs	34.7	26.9	88.6	19.2	53.9	31.9	10.69*
	Total	43.2	11.0	88.4	10.3	45.2	14.0	20.42*

* Significant at 5% level, t (0.05,39 df)= 1.96

NURSING IMPLICATION:

Implications of the study are:

The findings of the study have implication for nursing practice, nursing education, nursing administration and nursing research.

Nursing practice:

The study showed inadequate knowledge of the nursing students on selected aspects of hospital acquired infections. Continuing education is an answer to the needs of the quality services as well as the development of student nurses.

To prevent complications and length of stay of patients in hospitals, student nurses should update the knowledge and practice regarding hospital acquired infections in particular prevention and control, in order to reduce the incidence of hospital acquired infections. Findings on student nurses knowledge help nursing personnel to plan continuing education or inservice education programme.

Nursing education:

Nursing curriculum should give more importance to infection control. This area should be taken seriously by nursing supervisors, nurse managers and nurse educators to update the knowledge of staff nurses and student nurses. There should be an ongoing education programme on infection control on regular basis by the staff and student nurses in hospital wards, so as to bring an awareness in the prevention and control of infection. More number of clinical teaching or incidental teaching by teachers will be beneficial for student nurses.

Nursing administration:

Nursing administrators may use the study findings to improve the quality of patient care. It highlights the need for nursing administrators to do performance appraisal, nursing audit, developing guidelines on infection control practices and updating nursing standard in infection control. Other cost effective programmes like in service education, planned teaching programmes, and learning materials can be provided to the student and staff nurses based on their learning needs.

Nursing research:

There is an extensive need to develop an infection control program. Research could be conducted to assesss the learning needs of staff and student nurses, so that meaningful need based information could be provided. Longitudinal experimental research and action research could be conducted on nurses knowledge and practice on hospital acquired infections.

RECOMMENDATIONS FOR FURTHER STUDY:

On the basis of the findings of the present study, the following recommendations have been made for further study:

· A similar study may be conducted by observation of practice related to hospital acquired infection control.

· Study could be replicated by using a larger sample.

· A comparative study may be conducted by testing different teaching strategies for other health care providers by using audiovisual aids and electronic aids.

Conclusion:

On the basis of the findings, the investigator concluded that the student nurses have inadequate knowledge regarding HAIs. The study strongly suggest that it is very important to enhance the knowledge of the student nurses to Prevent and control HAIs..

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Received on 09.10.2014 Modified on 27.10.2014

Int. J. Adv. Nur. Management 3(1):Jan. - Mar., 2015; Page 10-17

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