1

CHAPTER ONE

1.1 Background of the Study

Health care workers are at risk of exposure to not only HIV infection but also other

infections. Transmission of these infections in health care settings can occur from patient

to health care workers, between patients or from health care worker to patients. The risk

to staff arises from; sharps and hollow needles, splashing of conjunctivae and mucous

membranes with contaminated blood and body fluids, Heavy contamination of broken

skin e.g. cuts and Handling of large quantities of blood and body fluids without

protective clothing. The risk to patients arises from, use of recycled hollow needles and

syringes; contaminated blood transfusion; poor ward facilities and cleaning. Realizing

these risks, infection control measures should be taken to protect patients and health care

workers against all sort of infections, which are spread by ramous routes of transmission.

The universal precautions or standard precautions were developed to protect essentially

health care workers against blood-borne infections through needle-sticks and mucous

membrane exposure to contaminated blood and body fluids. These precautionary

measures are applied 2, all patients regardless of their presumed infection status and to:

blood, semen and vaginal sections, all dead body fluids.

Standard precautionary measures are considered the most important strategy for

successful infection control in the health care setting. They involve work practices which

avoid direct contact with blood and all body fluids and guard against needle stick injuries
 2

and exposures to mucous membranes. The infection control practices include

Handwashing, Appropriate use of personal protective equipment including gloves, mask,

eye goggles, face shield and gown. Use of disposables and proper cleaning, disinfection

and sterilization of patient-care equipment. Proper housekeeping and management of

spillage and Disposal of sharps and infectious wastes.

Hand washing is a process of rumoring to transient, potentially pathogenic micro-

organisms from the hands and it is a critical factor in management of all patients. Since

the hands serves as the easiest means of infection transmission, it should be washed

boutinely before and often coming into contact with patient, when they are contaminated

with blood and body fluids. After removing gloves and before and after each patient care

produce. This practice renders the hands free from infections.

Appropriate use of personal protective equipment like gloves, masks, eye goggles or face

shields, plastic aprons, rubber boots, serves as a shield against splashes of blood, body

fluids, secretions or excretions thus curbing cross infection.

Disinfection and sterilization of patient care equipment is applied when reusable items

are used, they must be thoroughly cleared, disinfected and sterilized after each use Most

microorganisms are readily destroyed by heat at about 70-80 oC. 4 autoclaves are not

available, reusable items maybe disinfected by boiling for 10-30 minutes.

Proper disposal of sharps and infections waste is another relevant remedy 2 prevent cross

infection.
 3

Additional precautions are used for patients known or suspected to be infected by

pathogens that are spread by airborne, droplet, contact or by combined route of

transmission. Additional precautions are used when standard precautions alone are not

adequate to interrupt transmission, Additional precautions include Airborne precautions,

Droplet precautions and contact precautions. This measures are adopted with the care of

an HIV/AIDs patient or another with an opportunistic infections. Additional isolation

precaution should be used when standard precautions alone are inadequate to stop

transmission.

In the airborne precautions, patients who are known or suspected to have illness such as

measles, disseminated varicella, zoster, active pulmonary tuberculosis which are

transmitted by airborne. Contact precautions should be used for patients known or

suspected to have serious illness, due to pathogen easily transmitted by direct patient

contact or by indirect contact with items in the patients environment. Such illness include

the following enteric infections, viral conjunctivitis and skin or wound infections with

multi drug resistant bacteria such as methicillin resistant staphylococcus aureus and

herpes zoster disease.

The significance of infection control in health care setting cannot be overemphasized as

both the patient’s and health care workers are capable of spreading microorganism if

adequate infection control measures are not strictly adhered to. This study therefore,

assess the practice of standard precautions for the prevention of cross infection by nurses

and other health care workers.

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1.2 Statement of the Problem

Although the provision of protective equipments, gadgets, or barriers such as gloves,

gowns and apron has not been made sufficient by the ministry of health to the health

facilities. The researcher discovered that the little which has been made available is not

being utilized by nurses to control the existence of cross infection in St. Luke’s Hospital

Anua. Also, some nurses are faced with safe handling of contaminated material and

equipments e.g. re-capping of needle and proper waste disposal which often results in the

transmission of infectious agent either to themselves or to other patients.

During the researcher’s clinical experience in St. Luke’s Hospital, Anua. It was observed

that most nurse do not adhere to standard precautionary measures. Instance abound where

a nurse was met talking, even without a face mask at a wound dressing procedure, and

being a training hospital, student nurses on their clinical experience suffer the same fate.

This implies negatively on the student during their routine nursing procedure.

1.3 Purpose/Aim of the Study

The purpose of the study is to investigate the use of standard precautionary measures in

the prevention of cross infection among nurses in St. Luke’s Hospital Anua, Akwa Ibom

State.
 5

1.4 Specific Objectives

- To assess the influence of environmental control in the prevention of cross

infection among nurses in St. Luke’s Hospital Anua.

- To examine the use of personal protective equipment in the prevention of cross

infection among nurses in St. Luke’s Hospital, Anua.

- To investigate proper disposal of biohazards among nurses.

1.5 Research Questions

- How can environmental control prevent cross infection among nurses.

- How can control of personal protective equipment prevent cross infection among

nurses.

- In what ways can proper disposal of waste prevent cross infection among nurses.

1.6 Hypothesis

(a) There is no statistical significant difference between the influence of

environmental control and prevention of cross infection among nurses in St.

Luke’s Hospital Anua.

(b) There is no significant between the use of personal protective equipment and the

prevention of cross infection.

(c) There is no significant between proper disposal of biohazard waste and infection

prevention among nurses.

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1.7 Scope of the Study

The scope of this study covers Recast

- Assess how environmental control can prevent the spread of infection among

nurses in St. Luke’s Hospital, Anua.

- Determine the proper use of personal protective equipment in infection

prevention.

- Ascertain how proper disposal of biohazard waste influences prevention of

infection.

1.8 Significance of the Study

The significance of this study will be of benefit to the following people;

Nurses

- Promote the health and welfare of nurses working in the setting.

- Promote the nurses from exposure to blood borne infections.

Client/Patient

- Promote the health of client/patient.

- Prevents the spread of infection from patient to patient

- Reduce the risk of nosocomial infection.

Hospital

- Improves the quality assurance level.

- Boost employees satisfaction.

 7

Government

- The study will help government and health policy makers in making proper plans

for the distribution of standard precautional resources e.g. gloves and mask to

hospitals.

Future Researchers

- This study will serve as a reference material for further research to scholars on

similar topic.

1.9 Operational Definition of Terms

- Standard Precautionary Measures: Those things implemented to protect

the health worker from contacting infection.

- Practice: The expected procedure or way of doing something.

- Prevention: The act of avoiding or hindering something from taking place.

- Cross Infection: Transmission of infections agents between patients and health

workers in a clinical environment.

- Nurses: A group of people who are trained to give care to people who are sick or

injured.

- Hospital: Institution providing treatment and nursing care for the sick or injured

people.
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CHAPTER TWO

LITERATURE REVIEW

Standard Precautionary measures are guidelines or strategies on prevention of cross

infection among nurses who are exposed to cases susceptible to infection, patient and

other health care workers. These guidelines include the practice of hand hygiene,

cough/respiration etiquette, use of personal protective equipment (face mask, gloves,

theatre gowns, boots and aprons), proper handling of health care equipment including

environmental sanitation and control.

This chapter is concerned with reviews of related literature on standard precautionary

measures and prevention of cross infection among nurses, it is outlined under the

following headings:

- Conceptual review

- Theoretical Framework

- Empirical Review

2.1 Conceptual Review

 9

According to REGONIEL, 2015, A conceptual framework represents the researchers

synthesis of literature on how to explain a phenomenon. It maps out the actions required

in the course of the study given, the previous knowledge of other research point of view

and the observations of the subject of research. He also went further to state that

conceptual framework is the researchers understanding of how the particular variables in

his study connect with each other.

Standard precautionary measures are set of measures formulated to parent transmission

of blood pathogens when providing health care services. It reduces the risk of exposure to

blood and body fluids (Gershon, 2013). These precautionary measures are evidenced

base clinical work practices published by the Centre of Disease Control (CDC) in 1996

and updated in 2007 that prevent transmission of infectious agent in health care settings.

These measures are sets of activities which must be used for all patients care within all

health care settings. They are designed to prevent the transmission of microorganism

between patients, even when the source of infection is not known. We do not always

known which patients have microorganisms that can cause infection.

The measure of standard precaution is regarded as a design to protect health care workers

from being exposed to potentially infected blood or body fluid through hand washing and

utilization of appropriate protective barriers such as gloves, mask, gown and eye wear by

applying the fundamental principle of infection prevention.

Standard precaution measures and prevention of cross infections are described as the

actions that should be carried out or taken in every health care situation to protect health
 10

workers and patients from infection regardless of what is known of the patient’s status

with respect to infection (Siegal, et al, 2007).

For a clearer understanding on standard precaution measures, here are the component of

standard precaution according to Wisconsin Department of Health, 2012.

- Hand Hygiene

Hand hygiene refers to both washing with plain or anti-bacterial soap and water and use

of alcohol get to decontaminate hands. When hands are not visibly soiled, alcohol gel is

the preferred method of hand hygiene when providing health care to clients.

Hand hygiene should be performed before and after contact with a client, immediately

after touching blood, body fluids, non-intact skin, mucous membranes, or contaminated

items (even when gloves are worn during contact), immediately after removing gloves,

when moving from contaminated body site to a clean body sites during client care, after

touching objects and medical equipment in the immediate client-care vicinity, before

eating, after using the restroom, and after coughing or sneezing into a tissue as part of

respiratory hygiene.

- Personal Protective Equipment (PPE)

PPE includes items such as gloves, gowns, masks, respirators, and eyewear used to create

barrier that protect skin, clothing, mucous membranes and the respiratory tract from

infectious agents.
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 Wear gloves when touching blood, body fluids, non-intact skin, mucous

membranes, and contaminated items. Gloves must always be worn during

activities involving vascular access such as performing phlebotomies.

 Wear a surgical mask and goggles or face shield if there is a reasonable chance

that a splash or spray of blood or body fluids may occur to the eyes, mouth or

nose.

- Needlestick and Sharp Injury Prevention

Safe handling of needles and other sharp devices are components of standard

precautions that are implemented to prevent health care worker exposure to blood

borne pathogens.

Rules

- Use needles should be discarded immediately after use and not recapped, bent,

cut, removed from the syringe or the tube holder, or otherwise manipulated.

- Any used needles, lancets, or other contaminated sharps should be placed in a bar

proof, puncture-resistant sharps container that is either red in colour or labeled

with a biohazard label.

- Do not overfill sharps containers. Discard after 2/3 full or when contents are at

the full line indicated on the container.

- Cleaning and Disinfection

Client care areas, common waiting areas, and other areas where clients may have

potentially contaminated surfaces or objects that are frequently touched by nurses,

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staff and should be cleaned routinely with EPA registered disinfectant. Surfaces;

instruments, items and surface e.g. trolley, mattress, floor, bed rails, cupboard etc

should be cleaned and disinfected.

- Respiratory Hygiene (Cough Etiquette)

Droplets respiratory secretions can spread infections to others in the same area.

Measures to avoid spread of respiratory secretions should be promoted to help

prevent respiratory disease transmission. Elements of respiratory hygiene and

cough etiquette include:

- Covering the nose/mouth with a tissue when coughing or sneezing or using the

crook of the elbow to contain respiratory droplets.

- Using tissues or handkerchief to contain respiratory secretions and discarding

(tissues) to the nearest waste receptacle after use.

- Performing hand hygiene (hand washing with non-antimicrobial soap and water,

alcohol-based hand rub, or antiseptic hand wash) immediately after contact with

respiratory secretions and contaminated objects.

- Asking clients with signs and symptoms of respiratory illness to wear a surgical

mask washing common areas. Provide tissues and non-touch receptacles for used

tissue disposal.

- Spacing sealing in out-patient department or waiting as at least here feet apart to

minimize close contact among persons in these areas.

 13

- Suppress such as tissue, waste baskets, alcohol get and surgical masks should be

provided in waiting rooms or areas.

- Waste Disposal

Sharp items should be disposed of in customers that are puncture resistant, leak-proof,

closable, and labeled with the BIOHAZARD SYMBOL or are red in colour. Sharps

container should be replaced when filled up to the indicated full line.

Non-sharp disposable items saturated with blood or body fluids (ie fluid can be poured or

squeezed from the item or fluid is flaking or dripping from the item) should be discarded

into biohazard bags.

Safe Injection Practices

Nurses and other health care personnel who give injections should strictly adhere to the

CDC recommendations –

Safe injection practices, which include:

- Use of a new needle and syringes every time a mediations vial or iv bag accessed.

- Use of a new needle and syringes with each injection of a client etc.

2.2 Empirical Review

This is based on the following objectives of the study:

- Environmental control in the prevention of cross infection.

- Personal Protective Equipment: In the precaution of cross infection.

- Biohazard waste disposal in infection prevention.

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2.2.1 Environmental Control in the Prevention of Cross Infection

A dirty clinical environment is one of the factors that may contribute towards infection

rates. Conversely, high standards of cleanliness will help to reduce the risk of cross-

infection. Good design in buildings, fixtures and fittings is also important to allow

efficient cleaning.

Health care facilities should be patient friendly and offer a safe environment for care.

Cleaning removes contaminants, including dust and soil, large numbers of micro-

organisms and the organs matter that may shield them, for example, faeces, blood and

other bodily fluids.

Health care settings are complex environments that contain a large diversity of microbial

flora, many of which may constitute a risk to the clients/patient, staff and visitors in the

environment. Transmission of microorganisms within a health care setting is intricate and

very different from transmission outside health care settings and the consequences of

transmission may be more severe. Transmission of infection involves:

- Presence of an infectious agent (e.g. bacterium, virus, fungus) on equipment,

objects and surfaces in the health care environment.

- A means for the infectious agent to transfer from patient-to-patient, patient-to-

staff, staff-to-patient or staff-to-staff.

- Presence of susceptible client/patient. Staff and visitors.

 15

In the health care setting, the role of environmental cleaning is important because

it reduces the number and amount of infectious agents that may be present and

may also eliminate route of transfer of microorganisms from one person or object

to another, thereby reducing the risk of infection.

Health care facilities may be categorized into two components for the purposes of

environmental cleaning.

- Hotel component is the area of the facility that is not involved in client/patient

care; this includes public areas such as lobbies and waiting rooms; offices,

corridors, elevators and stairwells; and service areas.

- Hospital component is the area of the facility that is involved in client/patient

care; this includes clients/patient units (including nursing stations); procedure

rooms; bathrooms; clinic rooms; and diagnostic and treatment areas.

Clients/patients shed microorganisms into the health care environment,

particularly if they are coughing, sneezing or having diarrhea. Bacteria and

viruses may survive for weeks or months on dry surfaces in the environment if

left uncleaned.

A regular cleaning regimen should be in place; any item this is visibly

contaminated with blood or body fluids must be immediately cleaned and

disinfected or removed from the setting on soft furniture must be cleanable with a

hospital-grade disinfectant, except those furnishing in long term care homes

where the furniture is supplied by the resident.

 16

In the health care setting, there are recommendations to promote group

environmental control.

- Health care settings should have policies that include the criteria to be used when

choosing finishes, furnishings and equipment to client/patient care areas.

- Infection prevention and control, environmental services and occupational Health

and safety should be involved in the selection of surfaces and finishes in

healthcare settings.

- In all health care settings: There must be a regular cleaning regimen in place.

- Worn, stained, cracked or torn furnishings must be replaced when identified.

- Clean plastic coverings with compatible agents on a regular basis and replace for

damaged.

- Equipment that cannot be adequately cleaned, disinfected or covered, including

electronic equipment, should not be used in the care environment.

2.2.2 Personal Preventive Equipment in the Prevention of Cross Infection

Personal preventive equipment use is part of standard precautionary for all health care

workers to prevent skin and mucous membrane exposure when in contact with blood and

body fluid of any patient.

This is used to protect both yourself and the patient from the risks of cross infection. It

may also be required for contact hazardous chemicals and some pharmaceuticals. PPS
 17

includes items like gloves. Aprons, masks, goggles or visors. In certain situations, such as

theatre, it may also include hats and footwear.

These equipment includes protective laboratory clothing, disposable gowns, disposable

gloves, eye protection, and face masks.

- Gloves: Gloves must be available in a range of sizes in areas. Wearing gloves

reduces contamination of hands and minimizes the risk that a health care worker

will become infected after contact with a patient’s blood or body substance. The

type of glove used will depend on the task involved:

- Non Sterile Gloves: Non sterile nitrite gloves are suitable for most situations

when contact with any blood or body substance, mucous membranes or non-intact

skin is anticipated.

- Sterile Gloves: Sterile gloves shall be worn for surgical procedures where asepsis

must be maintained.

- Masks: A mask shall be worn in any situation.

- When splash or splatter with blood or body substance to the mucous membranes

on the mouth and nose in anticipated.

- To protect staff from inhalation of infections aerosols or droplets, smoke or plume

of other airborne hazards.

- Eye/Face Protection: Eye/face protection shall be worn in any situation when

splash or spatter with blood or body substance to the mucous membrane of the

mouth, nose and or eyes is likely. Types of eye/face protection:

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- Chin length plastic face shield.

- Mask with visor attached.

- Safety glasses with side shields.

- Goggles

- Protective Clothing: Gown/aprons are to be worn to protect clothing and or skin

from becoming contaminated, soiled or wet from splashes or contact with blood

or body substances, or during cleaning or disinfections.

2.2.3 Biohazard waste disposal in infection prevention

Biohazard waste includes research related wastes that are contaminated with recombinant

or synthetic nucleic acids, agent infections to humans, animals or plants, or fluids that

may contain these contaminants. This waste needs to be collected, stored, treated and

disposal of using practices that minimize spill and exposure risk for lab personnel,

service workers and the general public. Biohazard boxes are used to dispose of medical

waste. There are corrugated disposable boxes with the large 8” Biohazard label on the

side to meet compliance. Once the box is full, the lid is closed, sealed and ready for

removal by an authorized sharps technician or another licensed biomedical waste

disposal company. Biohazard containers are used for the disposal of waste that may be

contaminated with pathogens that present a danger to people and the environment. A

biohazard container should be fully closable, should be free of leakages during handling,

storage or transport and be properly labeled with the appropriate colour-coded label. The
 19

type if container employed may vary according to the type of waste handled. For

example, needles, blades etc. Sharps should be disposal of in containers that cannot be

punctured by their contents, which contaminants wipes, gloves and disposable PPE may

be disposed of in closable bags.

Biohazardous waste containers must be rigid and leak-proof, with a tight-fitting lid, and

preferable a foot pedal to operate the lid. The containers may be any colour, but they

must be labeled with either the words “Biohazardous waste” or with a biohazard symbol

and the word “Biohazard”. Medical/biohazardous waste must be free from radioactive

and chemical contamination to be classified and disposal of as medical waste. There are

some procedure that must be followed when transporting waste from biohazardous waste

containers to medical waste pickup containers.

- Wear and use personal protective equipment appropriately when handling

biohazardous waste to prevent potential contact with and exposure to infections

material and also prevent the spread of infectious materials by (a) changing

gloves that have been used or may be contaminated (b) not touching doorknobs or

other clean surfaces with gloved hands (c) washing hands after removing gloves.

- Seal the biohazard bag closed and label with a lid.

- Close the container when it is 3/4ths full or when items do not freely fall into the

container, regardless of the fullness level.

2.3 Theoretical Framework

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The study is guided by Health Belief Model (HBM). The Health Belief Model is a

psychological model that attempts to explain and predict health behaviours. This is done

by focusing on the attitude and belief of individuals. The HBM was first delivered in the

1950’s by social psychologists, Hochbaurn, Rosenstock and Kegels who were working in

the US public health services. It was delivered as a result of failure to attending free

tuberculosis screening programmes. It is based on the understanding that a person will

take a health related action, like hand washing and use of gloves. It is based on the facts

that a negative health condition can be avoided and belief that he/she can be

recommended to take a health action. (Komolate, 2010).

Health belief model component consist of the following namely:

- Perceived susceptibility

- Perceived severity

- Perceived benefit

- Perceived barriers

- Cues to action

- Self-efficacy

The component related to this study are:

(1) Perceived Susceptibility: This is also called perceived vulnerability, refers to

one’s perception of the risk or the chance of contracting a health disease or

condition. These models predict that individuals who perceived that they are

susceptible to a particular health problem will engage in behaviours to reduce

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their risk of developing the health problem. Individuals with low perceived

susceptibility may deny that they are at risk for contracting a particular illness.

These individuals who believe they are at low risk of developing an illness are

more likely to engage in unhealthy or risky, behaviours and individuals who

perceive a high risk that they will be personally affected by a particular health

problem are more likely to engage in behaviours to decrease their risk of

developing the condition.

(2) Perceived Severity: This refers to the degree people deem a particular disease or

condition is serious, it includes how people perceive the consequences of a

serious health event or outcome, such as a diagnosis of cancer.

This model proposes that individuals who perceive a given health problem as

serious are more likely to engage in behaviours to prevent the health problem

from occurring (or reduce its severity).

APPLICATION TO THE STUDY

According to this theory, nursing leaders (nurses) will be motivated to adhere to standard

precautionary measures if they believe they were susceptible to infection. Education on

the attitude toward standard precautionary measures and prevention of cross infection

will help the nurse to develop a good attitude towards standard precautionary measures

so as to prevent cross infection among nurses and patients. Nurses may perceive severity

by understanding the serious consequences of infection caused by poor standard

 22

precautionary measures. Nurses may perceive benefit regarding the effective practice of

hand hygiene when it comes to decreasing cross infection.

CHAPTER THREE

3.0 Research Methodology

This chapter highlights the native of the study to includes research design, research

setting, target population, sampling size determination, sampling technique, instruments

for data collection, validity of instrument, reliability of instrument, method of data

collection, method of data analysis and ethical consideration.

3.1 Research Design

The research design used for this study is a descriptive design method.

3.2 Research Setting

The research was conducted in St. Luke’s Hospital Anua, Uyo, Akwa Ibom State. St.

Luke’s Hospital, Anua is located along Nwaniba Road with coordinates 5.0299 oN,

7.9578oE. It is bounded in the North by Ekpri Nsukara in the South by Mbak Village in

the East by Eniong Offot and in the West by Use Offot. The hospital is a Catholic

Missionary Hospital founded in 1937 and is headed by a Catholic Rev. Father. It has
 23

eight wards, six clinics, major and minor theatres, general outpatient department,

casualty, mortuary and electrical department. The hospital has a workforce made up of

twenty-five (25) doctors, one hundred and eighty (180) nurses, twenty (20) community

health extension workers, ten (10) pharmacists, fifty (50) administrative staff,

maintenance staff as well as cleaners.

3.3 Target Population

The target population used for this study was one hundred and eighty (180) nurses (male

and female) working in female medical ward, female surgical ward, male medical ward,

male surgical ward, pediatric ward, labour ward and postnatal ward in St. Luke’s

Hospital Anua, Uyo, Akwa Ibom State.

3.4 Sampling Size Determination

Using Taro Yamane formula for sample size determination, (1967)

Sample size (n) N

1 + N (e)2

Where N = Target Population = 180

e = Sampling error

= 180 180 180

= =
1 + 180 (0.1)2 181 (0.01), 181, = 99.447approximate to 100 respondents
 24

3.5 Sampling Technique

Stratified random sampling whereby the target population is being divided into strata e.g.

nurses in St. Luke’s Hospital is divided into female and male medical ward nurses,

female and male surgical ward nurses. A simple random sampling technique was used

where every member of the population is given equal opportunity of being selected for

the study.

3.6 Instrument for Data Collection

The instrument of data service for this study was close ended questionnaire based on the

objective.

3.7 Validity of Instrument

The instrument was presented to the supervisor who evaluated the clarity of items which

reflects the variables of the research study. She made necessary corrections to ascertain

the validity.

3.8 Reliability of Instrument

A test retest was carried out with 10 respondents outside the study area and was repeated

after 10-14 days. The respondents were consistent in their response proving the reliability

of the instrument.
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3.9 Method of Data Collection

The method of data collected for this study was face-to-face administration of structured

questionnaires to respondent. Explanation was given to respondent oh how to complete

the questionnaire. The completed questionnaires were collected and respondents were

thanked including the various ward/unit heads were also thanked for their cooperation

and the matron of St. Luke’s Hospital.

3.10 Method of Data Analysis

The data gotten from the respondents were analyzed accordingly, same transferred into a

spread sheet and summarized using descriptive statistics such as tables, frequency and

percentages.

3.11 Ethical Considerations

A letter of introductions was collected from the school authority which introduced the

researcher. The letter was given to the matron who is in charge of nurses working in St.

Luke’s Hospital Anua, Uyo, Akwa Ibom State. Permission to conduct the research was

given, the ward Heads and nurses were also informed through the matron.
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CHAPTER FOUR

4.1 Presentation of results using tables and charts

In this chapter, the data collected are arranged in tables and compound bar charts are

made. To answer research questions, 100 copies questionnaires which were filled by the

respondents were used for the analysis as follows:

Section A: Biographic Data of Respondents

Table 1: Bio Data of Respondents of St. Luke’s Hospital Anua, Akwa Ibom State 2017.
S/n Item No. of Respondents Percentage (%)
1. Age:
20-29 30 30
30-39 45 45
40-above 25 25
Total 100 100
2. Gender:
Female 85 85
Male 15 15
Total 100 100
3. Educational Qualification:
RN 58 58
RM 32 32
BNSC 10 10
Others - 1
Total 100 100
4. Marital Status:
Single 51 51
Married 28 28
Divorced 3 3
Widowed 18 18
 27

Total 100 100

5. Religion:
Christianity 100 100
Traditional - -
Islamic - -
Total 100 100
Result for Bio Data of Respondents

The findings from table 1 shows that 30% of the respondents were between the ages of

20-29, 45% were between the ages of 30-39, 25% were about the ages of 40 and above.

85% respondents were female and 15% were male. 58% were Registered nurses, 32%

were Registered midwives, 10% were BNSC qualified and nil % for others. 51% of

respondents were single, 28% were married, 3% were divorced, and 18% widowed.

100% of respondents were Christians, nil % were Islamic and traditional worshippers.

4.2 Answering of Research Questions

4.2.1 Research Question 1

The influence of environmental control in the prevention of cross infection among nurses

in St. Luke’s Hospital Anua, Uyo, Akwa Ibom State.

Table 2: Influence of Environmental Control

S/n Items Responses Frequency Percentage (%)

1. Are the beds adequately Yes 56 56%
spaced in the ward? No 44 44%
Total 100 100
2. Do you maintain a high Yes 32 32%
standard of cleanliness No 68 68%
in the ward Total 100 100
environment?
3. Is your ward Yes 74 74%
environment well No 26 26%
ventilated? Total 100 100
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4. Do you use equipment Yes 80 80%

that can be adequately No 20 20%
cleared? Total 100 100
5. Do you clean and Yes 50 50%
disinfect bad pans before No 50 50%
use? Total 100 100
90

80

70

60

50
Yes
40 No
30

20

10

0
Item I Item II Item III Item iv Item v

Figure 1: Bar-chart Showing Percentage of Respondents of Research Question 1.

As presented on the bar chart, it can be noticed that question 1, 56 (56%) said yes that

beds are adequately spaced in the ward, while 44 (44%) of respondent said No.

Question 2: 32 (32%) of respondent said yes that they maintain a high standard

cleanliness in the ward while 68 (68%) said No.

Question 3: 74 (74%) of respondents said yes that their ward environment is well

ventilated while 26 (26%) said No.

 29

Question 4: 80 (80%) of respondents said Yes that they use equipment that can be

adequately cleaned while 20 (20%) said No.

Question 5: 50 (50%) of respondent said Yes that they clean and disinfect bedpans before

use while 50 (50% said No.

4.1.2 Research Question II

The Use of Personal Protective Equipment for the Prevention of Cross Infection by

Nurses in St. Luke’s Hospital Anua, Uyo Akwa Ibom State 2017.

S/n Items Responses Frequency Percentage (%)

1. Do you wear gloves Yes 78 78%
when in contact with No 22 22%
non intact skin? Total 100 100
2. Do you wear mask when Yes 32 32%
carrying out a cough No 68 68%
inducing procedure? Total 100 100
3. Do you wear eye Yes 18 18%
goggles during No 82 82%
procedures where Total 100 100
splashing is possible?
4. Do you wear mask for Yes 60 60%
close patient care in an No 40 40%
infectious disease Total 100 100
outbreak?
5. Do you wear apron Yes 12 12%
when in direct contact No 88 88%
with an infectious Total 100 100
patient?
 30

100
90
80
70
60
50 Yes
No
40
30
20
10
0
Item I Item II Item III Item iv Item v

A Bar-chart Showing Percentage of Respondent for Question 2.

As presented on the bar chart, Question 1; 78 (78%) of respondent said Yes that they

wear gloves when in contact with non intact skin while 22 (22%) said No.

Question 2; 32 (32%) of respondent said Yes that they wear mask when carrying out a

cough inducing procedure while 68 (68%) said No.

Question 3: 18 (18%) of respondent said Yes that they wear eye goggle during

procedures where splashing is possible while 82 (82%) said No.

Question 4: 60 (60%) of respondent said Yes that they wear mask for close patient care in

an infectious disease outbreak while 40 (40%) said No.

Question 5; 12 (12%) of respondent said Yes that they wear apron when in direct contact

with an infectious patient while 88 (88%) said No.

 31

4.1.3 Research Question III

Proper Disposal of Biohazardous Waste in Infection Prevention Among Nurses in St.

Luke’s Hospital Anua, Uyo, Akwa Ibom State 2017.

S/n Items Responses Frequency Percentage (%)

1. Do you use biohazard Yes 20 20%
box to dispose of No 80 80%
medical waste? Total 100 100
2. Do you dispose of Yes 78 78%
disposals PPE in No 22 22%
closable bags? Total 100 100
3. Do you experience Yes 10 10%
bursting of biohazard No 90 90%
boxes under normal Total 100 100
condition of usage?
4. Do you fill the sharps Yes 50 50%
box to the brim before No 50 50%
removal? Total 100 100
5. Do you dispose of Yes 68 68%
sharps in containers that No 32 32%
cannot be punctured by Total 100 100
their contents?
 32

100
90
80
70
60
50 Yes
No
40
30
20
10
0
Item I Item II Item III Item iv Item v

A Bar-chart Showing Percentage of Respondent for Question 3.

As presented in the bar chart, Question 1, 20 (20%) of respondent said Yes that they use

biohazard box to dispose medical waste 80 (80%) said No.

Question 2; 78 (78%) of respondent said that they dispose, disposable PPE in closable

bags when 22 (22%) said No.

Question 3: 10 (10%) of respondent said that biohazard box burst at normal conditions of

usage while 90 (90%) said No.

Question 4: 50 (50%) of respondent said Yes that they fill the sharp boxes to the brim

before removal while 50 (50%) said No.

Question 5; 68 (68%) of respondent said Yes that they dispose sharps in containers that

cannot be punctured by their contents while 32 (32%) said No.

 33

CHAPTER FIVE

DISCUSSION OF FINDINGS

Research Question 1: What is the influence of environmental control in the prevention of

cross infection among nurses in St. Luke’s Hospital, Anua, Uyo?

From table 2, findings reveal that 78 (78%) of respondents accept that environmental

control influences prevention of cross infection through adequate bed spacing,

maintenance of high standard of cleanliness in the ward, proper ward ventilation and

disinfecting bed pans before use. These measures prevents cross infection among nurses.

Research Question 2: The use of personal preventive equipment for the prevention of

cross infection.

Table 3 revealed that 78% of the respondents properly use the personal protective

equipment in the prevention of cross infection and 18% of respondent wear eye goggle in

procedures where splashing is possible.

Research Question 3: Proper disposal of biohazardous waste in infection prevention.

From Table 3, findings reveal that 20% of respondent use, biohazard box to dispose

medical wasted and 50% of respondent fill the sharps box to the lorim before removal.

68% of respondent agreed to have disposed sharps in containers that cannot be punctured

by their content.

Previous studies show that biohazardous waste containers must be rigid and leak-proof,

with a tight fitting lid, and preferably a foot pedal to operate the lid.
 34

5.2 Implications to Nursing

Based on the results obtained from the study, the study is aimed at helping the nurses in

the following ways:

- To have an increased knowledge and practice of standard precautions to prevent

cross infection.

- It helps nurses to embrace the use of protective gadgets when in contact with,

blood, body fluids and secretions.

- To encourage the utilization of proper hand washing before and after patient care.

- Reduces the risk of cross infection among nurses.

- To enlighten on the importance of environmental control in infection prevention.

5.3 Limitation of the Study

Workload on the available nurses on duty, since nurses are busy with patient care,

procedure cannot be disrupted during the process of data collection from the respondents,

the researcher had to utilize the nurses from time to collect data.

5.4 Summary

The study was carried out on standard precaution measures in the prevention of cross

infections among nurses in St. Luke’s Hospital Anua, Uyo, Akwa Ibom State. The

researcher formulated three (3) specific objectives to be achieved.

 35

The study was chosen due to poor utilization of standard precautionary measures by

health care workers. Introduction was made and literature related to the study was

reviewed.

The framework used in the study was Health Belief Model (HBM). Questionnaire was

used for collection of data after being tested for validity and reliability. The study

revealed that most of the nurses practice standard precautionary measures as it is a means

of infection prevention.

It was discovered that some factors affect the practice of standard precautionary

measures, such factors like non availability of equipments, negative influence of personal

protective equipments, negative influence of personal protective equipment on nurses,

patient’s discomfort, lack of skills. Finally, most of the respondents considered that the

wearing secretions of the patients.

5.5 Conclusion

Based on the study, it was concluded that the nurses in St. Luke’s Hospital Anua, Uyo

practiced standard precautionary measures but lack of skills, non-availability of

equipments affects their proper practice of standard precautionary measures. Therefore,

provision of equipments will motivate them to use it and also regular seminar

presentations and educational training programmes for nurses will enhance its utilization.
 36

5.6 Recommendations

Based on findings of the study, the following recommendations were made:

- The Hospital Management should employ registered and well trained qualified

nurses.

- The hospital should make provision for necessary protective gadget like goggles,

gowns, etc which should be accessible to every nurse.

- Nurses should inculcate the habit of wearing goggles and gowns to protect

themselves when carrying out procedures that generate splashes like body fluids

and blood.

- Adequate provision of hand hygiene facilities and equipments in each ward

should be done for effective practice and strict adherence.

- The hospital should organize regular seminar presentations, educational training

programmes for nurses to improve their positive attitude towards standard

precautions and prevention of cross infection.

5.7 Suggestions for Further Studies

It is suggested that a similar study be carried out on:

- Effects of non-utilization of standard precautions in the hospital.

- The strategies for effective practice of standard precautions among nurses in

AKS.
 37

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 38

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 39

QUESTIONNAIRE

Instruction: Please tick (√) as appropriate

SECTION A

Demographic Data

1. Age: 20-29 30-39 40 and above

2. Gender: Male Female

3. Educational Qualification: RN RM BNSC Others

4. Marital Status: Single Married

5. Religion: Christianity Traditional Islamic

SECTION B

The influence of environmental control in the prevention of cross infection among nurses

in St. Luke’s Hospital Anua, Uyo, Akwa Ibom State.

6. Are the beds adequately spaced in your ward?

Yes No

7. Do you maintain a high standard of cleanliness in the ward environment?

Yes No

8. Is your environment well ventilated? Yes No

9. Do you use equipment that cannot be adequately cleaned?

10. Do you clean and disinfect bed pans before use? Yes No
 40

SECTION C

The use of personal protective equipment for the prevention of cross infection by nurses.

11. Do you wear gloves when in contact with non-intact skin? Yes No

12. Do you wear mask when carrying out a cough inducing procedure?

Yes No

13. Do you wear eye goggles during procedures where splashing is possible?

Yes No

14. Do you wear mask for close patient care in an infectious disease outbreak?

Yes No

15. Do you wear apron when in direct contact with an infectious patient?

Yes No

SECTION D

Proper disposal biohazardous waste in infection prevention.

16. Do you use biohazard box to dispose of medical wasted? Yes No

17. Do you dispose of disposable PPE in closable bags? Yes No

18. Do you experience bursting of biohazard boxes under normal condition of usage?

Yes No

19. Do you fill the ‘sharps’ boxes to the brim before removal? Yes No

20. Do you dispose of sharps in containers that cannot be punctured by their

contents?
 41

Yes No