INTRODUCTION:

The WHO constitution explicitly declares that every individual has the inherent right to experience "the highest attainable standard of health"¹ Now this standard of health should be also maintained in the healthcare center as nosocomial infection, as opposed to being present at the time of admission, is acquired within the healthcare setting. The term "nosocomial" originates from the Greek word 'nosokomeion,' where 'Nosos' signifies disease, and 'Komeo' means to take care of. Nosocomial infections denote those acquired during medical treatment within a hospital or healthcare service unit. “At any time over 1.4 million people worldwide suffer from infectious complications acquired in hospital.”² Nosocomial infectionsare linked to considerable morbidity and heightened mortality rates^3.

Now that we understand the place of infection, it is also essential to understand the origin of the entry of the pathogens as microorganisms utilize the human body for sustenance, reproduction, and colonization. These infectious microscopic entities, referred to as pathogens, can multiply rapidly⁴. Nosocomial infections usually originate externally, with potential sources encompassing various elements within the hospital ecosystem such as individuals, objects, food, water, and air. Nosocomial infections present a significant challenge in numerous healthcare facilities, impacting approximately 40% of patients during their hospital stay ⁵.

Das in 2014 contends that without quality care, all factors equally contribute to a 12% incidence of hospital-acquired infections in ICU patients⁶ Implementing evidence-based quality control measures is vital for effective infection control. Nosocomial infections persist as a concern in healthcare facilities globally. Given the prevailing misunderstandings and the imperative to reassess infection control, it is crucial to consistently educate and enlighten nurses on the rationale behind implementing infection control measures. This not only ensures the safety of patients but also safeguards the well-being of healthcare personnel^7.

The place and entry of pathogens are understood and now the process of transmission into hosts must be halted by the professionals dealing with these patients. Nurses in hospitals are crucial for preventing infections by maintaining a healthy environment and adhering to standard precautions^5,11. The nursing profession, being both an art and a science, involves caring interactions with clients. Nurses bear the duty to strictly follow hospitals' preventive measures against nosocomial infections and other diseases^5,12.

So, the focus on “how” to reduce nosocomial infection is to be highlighted by educating the Nurses on preventing and eliminating the infection. Astudythat assessed staff nurses' nosocomial infection knowledge and practices to create an informative bookletshowed the presence of only 3% adequate knowledge, 40% moderate, and 57% inadequate while in practices: none good, 20% fair, and 80% poor. In conclusion, a Positive correlation was found and emphasizes ongoing education for health awareness, essential for reducing infection spread. The study confirms the effectiveness of a structured teaching program in enhancing prevention knowledge¹.

Similarlyin a study, nurses' knowledge and practices for infection control were assessed. The findings revealed that 92% had unit policies, and 47% received infection control education in the past year, with notable room for improvement⁸. Along the same lines, another study found that among first-year B.Sc. nursing students in selected Kerala colleges, 18% had poor knowledge, 64% had average knowledge, and 18% had good knowledge of infection control. No significant associations were noted with age, gender, education, residence, or socioeconomic status at the 0.05 level of significance. The investigators highlighted crucial implications for nursing practice, administration, and education⁹. Supporting the Idea of developing a step for continuous training a study by Sharma in 2018 revealed that a structured teaching program and checklist significantly improved staff nurses' knowledge and practice regarding nosocomial infection¹⁰. Before the intervention, 67.50% had inadequate knowledge, 28.80% had moderate knowledge, and 3.80% demonstrated adequate practice levels.

Therefore, based on this literature, in the pilot study, a sample size of 10 was considered who were required to answer all 36 questions in the prepared questionnaire. After the pre test the participants were administered the educational module by the scholar and reassessed on the same questionnaire to ensure fairness. The standards and tools of comparison are outlined in the same section as the title. The main aim of this study is to understand if there is a statistically significant difference between the pre-test score and post-test score, if yes then the study is relevant else the study is not statistically relevant.

Demographic variables were also undertaken in the case and poses the sub-question which will be assessed in the main research study, i.e., Does the demographic variables of the participants play a significant role in the pre-test score (knowledge score before the educational module)? A descriptive study about the demographic variables of the sample participants is given which may not be useful for analysis here but is useful in the main study where it answers the question by the second hypothesis being tested. Please note, here Pre-test refers to the test taken before receiving the educational module and the post-test refers to the test taken after receiving the educational module prepared by the scholar educating Nurses about techniques like bundle care.

Bundle care for nosocomial infections is a comprehensive strategy that combines evidence-based practices to prevent and control healthcare-associated infections. It includes key components like hand hygiene, device care, environmental hygiene, patient education, and more. The goal is to reduce infection rates, enhance patient safety, and improve overall healthcare outcomes.

Figure1: Pre-test knowledge score of participants

PRE-TEST SCORE:

Out of 36 marks, the mean score of the participants was 8.5 with a standard deviation of 3.06 marks on either side of the means. This score adds up to roughly 25% of total marks, hence the need for further research and implementation of educational module is highly desired.

Sample Characteristics:

Gender:

In the pilot study, 8 participants were female and 2 were male.

Figure 2: Sample distribution by gender

Age:

The sample has been divided into 4 categories of age with the help of a boxplot.

Fig 3: Sample distribution by Age

Educational Qualification:

Fig 4: Sample distribution by Educational Qualification

We can see from our pie chart that 70% of the participants had highest certification of GNM, 20% of participants had completed Post Basic B.Sc. Nursing or B.Sc. Nursing and 10% of participants had completed Post graduate studies in Nursing or related fields.

Profession:

Fig 5: Sample distribution by Profession

From the chart we can observe that 90% of the participants had Nursing as their profession and 10% of the participants were Doctors.

Prior knowledge

Fig 6: Sample distribution by Prior knowledge

From our dataset we can observe that 20% of the participants had some prior knowledge about preventing Nosocomial infection, Ventilator Associated Pneumonia, Catheter associated Urinary Tract Infection and Central Line Associated Bloodstream Infection and Surgical Site Infections Whereas the 80% of sample did not have prior knowledge about the above outline care-bundles and hence again reinstating the need for the research.

Hypothesis Testing:

For the pilot study the following hypothesis is taken into account.

H: Statistical difference in mean pre-test score and mean post-test score implying the effect of the educational module on the knowledge of participants

H₀: There is no significant difference in knowledge of the participants before and after the educational module implying no use of this research study.

H_a: There is a significant and positive difference between the knowledge of participants before and after the educational module implying the usefulness of the research study.

For the pilot study only, this hypothesis is being tested, and further on accepting the usefulness of this study another hypothesis that will be assessed is the effect of demographic factors on the knowledge score.

Post Study Test:

The same participants were re-assessed on the initial questionnaire to affirm fairness to the study. The analysis is carried out and observed if there is a significant difference between the pre-study and post-study knowledge scores of the participants.

Pilot Study Sample:

Post Test Score:

Fig 7: Post-test knowledge score of participants

The heavy tail on the left has been shifted towards the right implying more participants achieving high marks. The educational module has positively impacted the participant’s knowledge.

Fig 8: Statistical result for comparing the knowledge scores.

Further, a paired t-test is carried out to see the significant difference between pre-test knowledge score and post-test knowledge score of pilot study participants. The paired t-test validates our intuition, with more than 99% confidence we can reject the Null Hypothesis and accept the alternate hypothesis that the Educational Module is effective and highly recommended for healthcare workers. The p-value is less than 0.01(alpha/level of significance = 0.01), the Confidence intervals do not contain 0 and are very far from it also the mean difference in the knowledge score is 20.8 which is almost 60% increase in the knowledge score of the participants.

RESULT AND DISCUSSION:

Ten participants from the population were taken to conduct a pilot study. A low score of knowledge in the pilot study participants was observed. The result of the study accepted a significant and positive difference between the knowledge of participants before and after the educational module implying the usefulness of the research study. Due to the educational module by the scholar, the knowledge score has drastically increased in the post-module test. From the pilot study, it is highly evident and supportive that the research on a larger population will be meaningful and should be conducted further.

The implications of this study extend to nursing practice, education, administration, and research within the field of nursing: In nursing practice, implementing continuing education programs is crucial to enhance staff nurses' health awareness and early prevention skills, thereby reducing the risk of nosocomial infection spread through bundle care. In nursing education, nursing schools and colleges should prioritize enhancing students' knowledge of nosocomial infection spread, its impact on patients and healthcare personnel, and measures to mitigate infection rates through bundle care. In nursing administration, it's essential for administrators to ensure health personnel have adequate support, including high-quality and resourceful protective equipment. Strict policies should also be established for the proper disposal or disinfection of protective equipment as needed. In nursing research, emphasis should be directed toward investigating the spread and effects of nosocomial infection, understanding transmission mechanisms, and assessing the viability of organisms. This research focus aims to reduce morbidity and mortality rates associated with nosocomial infections through structured teaching tools and techniques like bundle care.

The outcomes derived from the pilot study provide robust evidence and compelling support for the significance of conducting a more extensive research study involving a larger population. The findings strongly advocate for the pursuit of further investigation to gain a more comprehensive and nuanced understanding of the subject under consideration.

REFERENCES:

1. Pascal, A., Mathew, A. M., Philip, B. A., Sebastian, E., Sibi, S. M., and P.V, J. A study to assess the effectiveness of structured teaching programme on knowledge regarding prevention of urinary tract infection among adolescent girls in selected schools at Kollam District. Asian Journal of Nursing Education and Research. 2019; 9(3): 391. https://doi.org/10.5958/2349-2996.2019.00084.3

2. Sharma, A. K. A pre-experimental study to assess the effectiveness of structured teaching programme on knowledge and practice regarding nosocomial infection among the staff nurses in selected hospitals at Jaipur, Rajasthan. Asian Journal of Nursing Education and Research. 2018; 8(1): 25. https://doi.org/10.5958/2349-2996.2018.00007.1

3. D’Souza, L. S. M., M, M., and John, J. Prevention of Nosocomial Infection in NICU, Asian Journal of Nursing Education and Research. 2014; 4. https://doi.org/10.52711/2349-2996

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9. Ancy A Chitra B, Jancy Saji, Sibi Achankumju, Silpa Biju, Ann Benzily. A Descriptive Study to Assess the Knowledge regarding Infection control among First year B.Sc. Nursing Students at selected Nursing Colleges with a view to develop an Instructional Package on Infection control. Asian Journal of Nursing Education and Research. 2023; 13(1):36-8.

10. Ashok Kumar Sharma. A Pre-Experimental Study to assess the Effectiveness of Structured Teaching Programme on Knowledge and Practice Regarding Nosocomial Infection among the Staff Nurses in Selected Hospitals at Jaipur, Rajasthan. Asian J. Nursing Education and Research. 2018; 8(1): 25-32.

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Received on 22.12.2023 Modified on 07.03.2024

Int. J. of Advances in Nur. Management. 2024; 12(2):69-73.

DOI: 10.52711/2454-2652.2024.00015