A Study to Assess the Knowledge, Attitude and Knowledge on practices regarding Infection control in Paediatric Intensive Care unit among 3^rd Year B. Sc. Nursing students, CON-SVIMS, Tirupati

 

Dr. A. Padmaja¹, A. Leelavathi², C. Rambabu², K. Sesha Kumar², R. Veena Bai², S. Swathi², P. Anil Kumar²

 

¹Professor cum Vice Principal, College of Nursing, SVIMS, Tirupati, Andhra Pradesh.

²2019 Batch Students, Dept. of Child Health Nursing, College of Nursing, SVIMS, Tirupati, Andhra Pradesh

 

ABSTRACT:

Introduction: If we talk about infection, it’s a separate branch (hospital infection control) which has a key role for the hospital in patient safety. Infection rates are highest in NICUs and paediatric intensive care units (PICUs), higher in paediatric hospitals than on paediatric wards in general hospitals, and lowest (usually less than 1%) in normal newborn nurseries. The nurse plays a critical role in preventing and controlling infectious disease. From day one nursing students learn about and are expected to participate in the infection prevention process. Aim: To assess the knowledge, attitude and knowledge on practices regarding infection control in paediatric intensive care unit among 3^rd year B.Sc Nursing students, CON- SVIMS, Tirupati. Method: Descriptive study with total of 50 3rd year B. Sc Nursing students was selected for the study through convenient sampling method. Tool used for the study was self structured multiple choice questionnaire, self-structured dichotomous check list was used to assess their knowledge levels, attitude and knowledge on practices to prevent infection in PICU. Conclusion: The present study concluded that 38% had adequate knowledge regarding infection control in PICU, majority 42% had moderately positive attitude towards infection prevention and 30% had adequate knowledge on practices to prevent infection in PICU. There is a need still, to improve the nursing students knowledge about the infection control includes standard precautions, infection control policy and practices through active teaching method and skill training clinical method.

 

 

 

INTRODUCTION:

A hospital is one of the most likely places for acquiring an infection because it harbours a high population of micro-organisms, some of which are resistant to certain antibiotics, which may lead to hospital acquired infections¹. If we talk about infection it’s a separate branch (hospital infection control) which has a key role for the hospital in patient safety.

 

Hospital Infection control is very essential for the safety and wellbeing of patients, hospital staffs and visitors of the hospital. It affects various Departments of the hospital and it also involves problems of quality risk management, clinical governance of health and safety. Hospital infection control program with stable structure should be present in all institutions that provide health care in order to create a managed environment.¹

 

Paediatric wards and hospitals are particularly suited to the transmission of infection. Infants and toddlers constitute a large proportion of the patients admitted. They frequently harbour infectious organisms and may shed pathogens, especially respiratory and gastrointestinal viruses, even if they are asymptomatic. Young children are also susceptible to many infections because they have not yet developed immunity.

 

Infection rates are highest in NICUs and paediatric intensive care units (PICUs), higher in paediatric hospitals than on paediatric wards in general hospitals, and lowest (usually less than 1%) in normal newborn nurseries. Children suffer significant morbidity and mortality from nosocomial infections. The consequences of these infections include prolongation of hospitalization, transfer to intensive care units, antibiotic therapy, placement or replacement of invasive devices and surgical procedures.²

 

Nosocomial infections are infections acquired in the hospital or other health care facilities that were not present or incubating at the time of the client’s admission. It is also referred to as hospital-acquired infections (HAIs). Most nosocomial infections are transmitted by health care personnel who fail to practice proper hand washing procedures or change gloves between client contacts. In an effort to raise awareness and provide guidance in combating HAIs in resource limited settings (RLS), the World Health Organization (WHO) launched the Global Patient Safety Challenge: Clean Care is Safer Care campaign.³

 

Infection prevention is a crucial component to provide quality care in any health care setting. Infections are leading cause of death and preventable illness. Many infection control measures such as appropriate hand hygiene and the correct application of basic precautions during invasive procedures are simple and low cost, but require staff accountability and behavioral changes, in addition to improving staff education, reporting and surveillance system. It has been estimated that the risk of healthcare associated infections is 2 to 20 times higher in developing countries compared to developed countries and 5% and 10% of patients admitted to hospital in developed countries acquire these infection⁴

 

Jitender Sodhi, Sidhartha Satpathy, et.al., (2016) conducted a prospective study to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. This study highlighted that the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggested the need to develop effective strategies for prevention of HAI to reduce costs of health care.⁵

 

The nurse plays a critical role in preventing and controlling infectious disease. From day one nursing students learn about and are expected to participate in the infection prevention process. An important component in preparing for clinical nursing practice is an understanding of the infection process and prevention techniques.⁶

 

Anita Bag (2018) conducted a study to assess knowledge Regarding Nosocomial Infections and its Prevention among B.Sc. Nursing Students in a selected Nursing College under West Bengal University of Health Sciences. The study showed that there is lack of knowledge regarding nosocomial infections among B.Sc. Nursing students⁷. Nurses constitute the largest percentage of the health care workers (HCW) and they are the ―nucleus of the health care system. Because they spend more time with patients than any other HCWs, their compliance with hand washing guidelines seems to be more vital in preventing the disease transmission among patients.⁸

 

Being nurse researchers with guidance from the expert teacher we were conducted this study to assess the knowledge, attitude and knowledge on practices of 3^rd year b.sc nursing students regarding infection control in paediatric intensive care unit, where they are posted during clinical area in paediatrics.

 

OBJECTIVES:

·      To assess knowledge, attitude and knowledge on practices regarding infection control in paediatric intensive care unit among 3^rd year B.Sc Nursing students

·      To find out the association between knowledge, attitude and knowledge on practices of nursing students with socio demographic variables.

 

MATERIAL AND METHODS:

A descriptive study was conducted in College of Nursing, SVIMS University, Tirupati, formal permission was obtained from The Principal, College of Nursing, SVIMS, Tirupati, prior to the actual data collection. A total of 50 3^rd year B.Sc Nursing students were selected for the study as participant through convenient sampling method. The tool contains 4 sections. Section-I was socio demographic variables (which includes Age in years, Gender, Religion, Marital status, Previous knowledge regarding infection control, Source of Information), Section – II, contains 10 self structured multiple choice questionnaire to assess the knowledge on prevention of infection in Paediatric Intensive Care Unit and Section-IV contains 15 self-structured dichotomous check list, to assess the knowledge on practices to prevent infection. In section II, IV each correct answer has a score of ‘1’ and for wrong answer a score of ‘zero’. Thus a maximum score of 10 were allotted to knowledge of nursing students on infection prevention and score of 15 were allotted to knowledge on practices of nursing students. The scores were interpreted in the following manner, score <50% was considered as inadequate knowledge, score of 51-75% considered as moderate knowledge, score of >75% was considered as adequate knowledge. In Section – III, a five point Likert Rating scale (5,4 ,3,2,1) tool was used, total items in this tool were 5 and the responses were categorized as strongly agree, agree, neutral, disagree and strongly disagree. Questions 1-5 have positive scoring. The total score was 25. The total score reflects the level of positive attitude towards infection prevention. The score was categorized as follows, Low positive attitude score of < 13, Moderately positive attitude score of 14-19, and Highly positive attitude score of >20.

 

Before collecting the data verbal and written informed consent was obtained after explaining the purpose and objectives of the study from the participants and assured for privacy and confidentiality of the information. The pilot study was conducted among 3 rd year B.Sc Nursing students of CON- SVIMS at Tirupati. The study was conducted with the sample size of 06. Reliability of the tool was assessed through split half method, r = 0.8. Content validity of the questionnaire was done by the experts from the Department of Paediatrics, Department of Child health nursing from different colleges. Necessary corrections were made for the final tool. Data collection was done over a period of 5 days with closed observation method during the data collection process.

 

Data obtained was coded in excel and entered in SPSS version 16 for analysis. Descriptive statistics such as frequency, percentage, mean and standard deviation were used for analyzing the demographic variables and nursing student’s knowledge, attitude and knowledge on practices regarding prevention of infection in paediatric intensive care units. Inferential statistics such as chi- square test were used to find out association between level of knowledge, attitude, and knowledge on practices with selected socio demographic variables.

RESULTS:

Table: 1: Distribution of nursing students according to frequency and percentage of demographic Variable.                                                   (N=50)

S. No.	Socio Demographic Variable	Frequency	Percentage %
1.	Age
	19 yrs	13	26.0
	20 yrs	30	60.0
	21 yrs	6	12.0
	22 yrs	1	2.0
2.	Gender
	Male	10	20.0
	Female	40	80.0
3.	Religion
	Hindu	34	68.0
	Muslim	8	16.0
	Christian	8	16.0
4.	Marital Status
	Married	2	4.0
	Unmarried	48	96.0
5.	Previous knowledge regarding Infection Control
	Yes	45	90.0
	No	5	10.0
6.	Source of information
	Classroom teaching	48	96.0
	Media	0	0
	Seniors	2	4.0
	Workshops / Conferences	0	0

 

The data presented in table-1 reveals that majority of nursing students 30(60%) belongs to age group of 20 years. Maximum nursing students 40(80%) were females, Majority of nursing students were belongs to Hindu religion 34(68%) and 48(96%) nursing students were unmarried, 45(90%) nursing students have previous knowledge regarding infection control and 48(96%) nursing students collecting the information from class room teaching.

 

Table- 2 shows that the present study found, 18(36%) had inadequate knowledge, 13(26%) had average knowledge and 19(38%) had adequate knowledge. Related to attitude of nursing students on infection prevention, majority 21(42%) had moderately positive attitude, 13(26%) had low positive attitude and 16(32%) were had high positive attitude. out of 50 nursing students 12(24%) had inadequate knowledge on practices, 23 (46%) had moderate knowledge on practices and 15 (30%) had adequate knowledge on practices.

 

 

Table-2: Categorization of knowledge, attitude and knowledge on practices score of nursing students.                                                   (N=50)

Categorization	Knowledge		Attitude		Knowledge on Practices
	Frequency	(Percentage)	Frequency	(Percentage)	Frequency	(Percentage)
Inadequate	18	36.0	13	26.0	12	24.0
Moderate	13	26.0	21	42.0	23	46.0
Adequate	19	38.0	16	32.0	15	30.0

 

Table-3: Association of Knowledge of nursing students with socio demographic variables                                                                          (N=50)

S. No.	Socio Demographic Variable	Inadequate	Moderate	Adequate	Chi square	‘p’ value	Sig
1.	Age
	19 yrs	0	3	10	15.077	0.020	**S
	20 yrs	14	9	7
	21 yrs	3	1	2
	22 yrs	1	0	0
2.	Gender
	Male	2	2	6	2.654	0.265	NS
	Female	16	11	13
3.	Religion
	Hindu	11	12	11	9.249	0.055	NS
	Muslim	2	0	6
	Christian	5	1	2
4.	Marital Status
	Married	0	2	0	5.929	0.052	NS
	Unmarried	18	11	19
5.	Previous knowledge regarding Infection Control
	Yes	17	12	16	1.180	0.554	NS
	No	1	1	3
6.	Source of information
	Classroom teaching	17	12	19	1.367	0.505	NS
	Media	0	0	0
	Seniors	1	1	0
	Workshops / Conferences	0	0	0

Note: * =Significant at P<0.05, ** =Significant at P<0.01,

NS=No significant, S= Significant

 

It was interpreted from table-3 that variable age has significant association with level of knowledge on infection control in PICU and other demographic variables were not had significant association. 

 

It was interpreted from table-4 that gender and religion has significant association with level of positive attitude on infection control in PICU and other demographic variables were not had significant association.

Table -4: Association of Attitude of nursing students with socio demographic variables                                                                               (N=50)

S. No.	Socio Demographic Variable	Low Positive	Moderately Positive	Highly Positive	Chi square	‘P’ value	Sig
1.	Age
	19 yrs	1	5	7	7.376	0.287	NS
	20 yrs	11	12	7
	21 yrs	1	3	2
	22 yrs	0	1	0
2.	Gender
	Male	1	1	8	13.278	0.001	** S
	Female	12	20	8
3.	Religion
	Hindu	9	18	7	14.545	0.006	** S
	Muslim	1	0	7
	Christian	3	3	2
4.	Marital Status
	Married	1	1	0	1.160	0.560	NS
	Unmarried	12	20	16
5.	Previous knowledge regarding Infection Control
	Yes	11	21	13	4.113	0.128	NS
	No	2	0	3
6.	Source of information
	Classroom teaching	12	20	16	1.160	0.560	NS
	Media	0	0	0
	Seniors	1	1	0
	Workshops / Conferences	0	0	0

Note: * =Significant at P<0.05, ** =Significant at P<0.01,

NS=No significant, S= Significant

 

 

 

Table-5: Association of Knowledge on Practices of nursing students with socio demographic variables                                                  (N=50)

S. No.	Socio Demographic Variable	Inadequate	Moderate	Adequate	Chi square	‘P’ value	Sig
1.	Age
	19 yrs	5	7	1	6.805	0.339	NS
	20 yrs	5	13	12
	21 yrs	2	2	2
	22 yrs	0	1	0
2.	Gender
	Male	6	3	1	9.112	0.011	*S
	Female	6	20	14
3.	Religion
	Hindu	5	16	13	14.819	0.005	**S
	Muslim	6	2	0
	Christian	1	5	2
4.	Marital Status
	Married	0	0	2	4.861	0.88	NS
	Unmarried	12	23	13
5.	Previous knowledge regarding Infection Control
	Yes	10	20	15	2.496	0.287	NS
	No	2	3	0
6.	Source of information
	Classroom teaching	12	22	14	0.785	0.675	NS
	Media	0	0	0
	Seniors	0	1	1
	Workshops / Conferences	0	0	0

Note: * =Significant at P<0.05, ** =Significant at P<0.01,

NS=No significant, S= Significant

 

It was interpreted from table-5 that gender and religion has significant association with level of knowledge on practices to prevent infection in PICU and other demographic variables were not had significant association.

 

DISCUSSION:

The present study found that 19(38%) had adequate knowledge, 13(26%) had average knowledge and 18(36%) had inadequate knowledge, Related to attitude of nursing students on infection prevention, majority 21(42%) had moderately positive attitude, 13(26%) had low positive attitude and 16(32%) were had high positive attitude. Out of 50 nursing students 12(24%) had inadequate knowledge on practices, 23 (46%) had moderate knowledge on practices and 15 (30%) had adequate knowledge on practices. This study finding was supported by the following studies Goma Niraula Shrestha, Bandana Thapa (2018)⁴ conducted a study to assess Knowledge and Practice on Infection Prevention among Nurses of Bir Hospital, Kathmandu, This study reveals that respondents had better knowledge than practice on infection prevention. Ishwari Sharma Paudel (2016)³ conducted a study to assess the Knowledge, Attitude and Practice of nursing students on Hospital Acquired Infections in Western region of Nepal. e, only 6% performed hand hygiene before patient contact. The nursing students had good knowledge regarding HAIs that was reflected in their attitude and practice on hand hygiene for the prevention of HAIs. Alpana Sagare, Sunita Tata, Simi Elsa Philip, Sangeeta Deodhar (2016)⁹, conducted a study to assess the Effectiveness of STP Regarding Protocol on Standard Precautions for the Prevention of Infection in Terms of Knowledge and Practice among Staff Nurses, Karad. This study shows that infection control knowledge among nurses is fairly good, but a wide range of improvements are needed. Hamed Sarani, Abbas Balouchi, et.al. (2016)¹⁰, conducted a study to assess the knowledge, attitude and practice of nurses about standard precautions for Hospital-Acquired Infection in Teaching Hospitals affiliated to Zabol University of Medical Sciences and the results indicate a low level of awareness among the personnel about hospital infection. Dr. Imad Fashafsheh, Mr. Ahmad Ayed, et.al. (2015)¹¹, conducted a study to assess the Knowledge and Practice of Nursing Staff towards Infection Control Measures in the Palestinian Hospitals. Based on findings the study concluded that inspite of having good practice level regarding infection control, nurses had fair knowledge level. Yakob E, Lamaro T and Henok A (2015)¹², conducted a study to assess knowledge, attitude and practice towards infection control measures among Mizan-Aman general hospital. Majority of health care workers’ knowledge, attitude and practice toward standard precaution were not sufficient, favourable and safe enough to the expected standard. Kanwalpreet Sodhi, Anupam Shrivastava, Muktanjali Arya, et.al. (2013)¹³ conducted a study to assess the knowledge of infection control practices among nursing professionals at our hospital. The infection control knowledge among the nurses was fairly good; how- ever, there is still a wide scope of improvement with regular educational programs and in-house training. Hany Girgis Eskander, Warda Youssef Mohammed Morsy, Hanaa Ali Ahmed Elfeky (2013)¹⁴, conducted a study to assess nurses' knowledge and evaluate their practice regarding infection control standard precautions. Based on findings of the study concluded that inspite of having satisfactory performance level regarding infection control standard precautions, critical care nurses had unsatisfactory knowledge level.

 

CONCLUSION:

The present study concluded that 38% had adequate knowledge regarding infection control in PICU, majority 42% had moderately positive attitude towards infection prevention and 30% had adequate knowledge on practices to prevent infection in PICU. There was significant association found in-between knowledge, attitude, and knowledge on practices with socio-demographic variables of nursing students. There is a need still, to improve their knowledge about the infection control through standard precautions and infection control practices by teaching method and skill training method to the students. The researchers provided information pamphlet on infection control in PICU to all the participants.

 

NURSING IMPLICATION:

The findings of this study have implications for nursing practice, nursing education, nursing administration and nursing research.

 

Nursing Practice:

The practices of infection control to be encouraged in all paediatric wards, especially ICUs like PICU, NICU and can be continued by all other settings where the source for infection is high.

 

Nursing Administration:

The findings of the study will help the infection control nurses for intervening and organizing more workshops, panel discussion, short-term skill training programme for nurses as being an administrator.

 

Nursing Research:

Research suggests that hand washing is the first key of infection prevention. Also nurse researchers can conduct more studies and evidence based practices for future purpose with help of advanced technology.

 

Nursing Education:

The nurse educators should play an active role in conducting in-service education programme, health educations and continuing education programmes to train nursing personnel of the institution regarding infection control.

 

REFERENCES:

1.     K. Vinodhini, A. Bhooma devi. Study on infection control practices among healthcare workers in a speciality hospital, Chennai. Pollution Research. 2016; 35 (3): 549-555. Available from: https://www.researchgate.net/publication/31580773.3

2.     Dorothy L Moore. Essentials of paediatric infection control. Paediatric Child Health. 2001; 6(8): 571–579.

3.     Ishwari Sharma Paudel, Vivek Ghosh, Purushottam Adhikari. Knowledge, Attitude and Practice of nursing students on Hospital Acquired Infections in Western region of Nepal. Journal of College of Medical Sciences-Nepal. 2016; 12(4): 169-73.

4.     Goma Niraula Shrestha, Bandana Thapa. Knowledge and Practice on Infection Prevention among Nurses of Bir Hospital, Kathmandu. Journal of Nepal Health Research Council. 2018; 16(40): 330-5^.

5.     Jitender Sodhi, Sidhartha Satpathy, et.al. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay and extra costs. Indian Journal of Medical Research. 2016; 143: 502-506.

6.     Jennifer Olin, Nursing Plays a Major Role in Infection Control. March 5th, 2012. Available from: https://www.rncentral.com/blog/2012/nursing-plays-a-major-role-in-infection-control/.

7.     Anita Bag. A Study to Assess Knowledge Regarding Nosocomial Infections and Its Prevention among B.Sc. Nursing Students in a Selected Nursing College Under West Bengal University of Health Sciences. International Journal of Scientific Research and Education.2018; 06 (05): 7938-7944.

8.     Namrata Dhanorkar, Shaila Mathew. Existing Knowledge and Selected Practices Regarding Infection Control Measures among NICU Nurses. International Journal of Science and Research. 2016; 5 (12): 767-774.

9.     Alpana Sagare, Sunita Tata, Simi Elsa Philip, Sangeeta Deodhar. A Study to Assess the Effectiveness of STP Regarding Protocol on Standard Precautions for the Prevention of Infection in Terms of Knowledge and Practice among Staff Nurses, Karad. International Journal of Science and Research. 2016; 7(6): 1143-1148.

10.   Dr. Imad Fashafsheh, Mr. Ahmad Ayed, Mrs. Faeda Eqtait, et.al. Knowledge and Practice of Nursing Staff towards Infection Control Measures in the Palestinian Hospitals. Journal of Education and Practice. 2015; 6(4): 79-90.     

11.   Hamed Sarani, Abbas Balouchi, Nosratollah Masinaeinezhad. et.al. Knowledge, Attitude and Practice of Nurses about Standard Precautions for Hospital-Acquired Infection in Teaching Hospitals Affiliated to Zabol University of Medical Sciences.2016; 8(3): 193-198.

12.   Yakob E, Lamaro T and Henok A. Knowledge, Attitude and Practice towards Infection Control Measures among Mizan-Aman General Hospital Workers, South West Ethiopia. Journal of Community Medicine and Health Education.2015; 5(5): 1-8.

13.   Kanwalpreet Sodhi , Anupam Shrivastava, Muktanjali Arya, et.al. Knowledge of infection control practices among intensive care nurses in a tertiary care hospitalJournal of Infection and Public Health. 2013; 6: 269-275.

14.   Hany Girgis Eskander, Warda Youssef Mohammed Morsy, Hanaa Ali Ahmed Elfeky. Intensive Care Nurses’ Knowledge and Practices regarding Infection Control Standard Precautions at a Selected Egyptian Cancer Hospital. Journal of Education and Practice. 2013; 4(19): 160-174

 

 

 

Received on 31.01.2020       Modified on 24.02.2020

Accepted on 19.03.2020    ©AandV Publications All right reserved