ABSTRACT

Standard precautions are a set of guidelines that aim to protect health care workers from infections from blood, body fluids, secretions, excretions except sweat, non-intact skin, and mucous membranes while providing care to patients. However, compliance to the standard precautions is often low in low-income countries in spite of the greater risk of infection. This study examined the knowledge and practice of standard precautions among health care workers in public secondary health facilities in Abuja, the Federal Capital Territory of Nigeria. A quantitative descriptive survey was conducted with 83 doctors and 194 nurses using a structured questionnaire. Findings show suboptimal knowledge and practice of the standard precautions among the health care workers. Knowledge of post-exposure prophylaxis for HIV was low as well as hepatitis B immunization among the respondents. A lack or irregular supply of essential materials, such as personal protective equipment, was the main reason the respondents did not comply to the precautions. This report recommends the development and implementation of a comprehensive infection prevention and control program in health facilities in order to ensure compliance to the standard precautions by health care workers.  

CHAPTER 1

ORIENTATION TO THE STUDY

1.1      INTRODUCTION

Universal precautions are a set of guidelines that aim to protect health care workers (HCWs) from blood-borne infections (Bennett & Mansell 2004: 1017–9). In 1987, the Centers for Disease Control and Prevention (CDC) proposed the concept of “universal precautions” originally designed to protect health care workers from exposure to bloodborne pathogens. In 1996, CDC recommended that universal precautions be renamed standard precautions, which combine the major features of the universal precautions and body substance isolation (BSI). The precautions apply to all body fluids including blood, secretions, and excretions (except sweat) regardless of whether or not they contain visible blood, skin that is not intact, mucous membranes, any unfixed tissue or organ (other than intact skin) from human (living or dead), human immunodeficiency virus (HIV) or hepatitis B virus (HBV) containing culture medium or other solutions (Standard/Universal Precautions 2007).

Under the standard precautions, blood and body fluid of all patients are considered potentially infectious for HIV, HBV and other blood-borne pathogens. Standard precautions is regarded as an effective means of protecting HCWs, patients, and the public, thus reducing hospital acquired infections (Wang, Fennie, Burgess & Williams 2003:187–194). Standard precautions are designed to prevent health care workers from being exposed to potentially infected blood and body fluid by applying the fundamental principles of infection control, through hand washing, utilization of appropriate protective barriers such as gloves, mask, gown, and eye wear (Motamed, BabMahmoodi, Khaliilian, Peykanheirati & Nozari 2006:1205). In addition, the standard precautions stipulate that HCWs take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments or devices during procedures and disposal (CDC 1996).

1.2      BACKGROUND INFORMATION ABOUT THE RESEARCH PROBLEM

1.2.1 The source of the research problem

Standard precautions are practiced in high-income countries to protect HCWs from occupational exposure to blood and the consequent risk of infection with blood-borne pathogens. The situation is different in low-income countries, where standard precautions are partially practiced (Kermode, Jolley, Langkham, Thomas, Holmes & Gifford 2005: 27– 33). 

1.2.2 Background to the research problem

The practice of standard precautions is being widely promoted to protect HCWs from occupational exposure to body fluids and consequent risk of infection with blood-borne pathogens. HCWs are potentially exposed to blood-borne and other infections through contact with body fluids while performing their duties. HCWs frequently provide care to patients whose HBV, HIV and hepatitis C virus (HCV) status is unknown, and individuals may be asymptomatic for months to years while being infectious. The occupational health of the health care workforce of about 35 million people globally, representing about 12% of the working population, has been neglected (Wilburn & Eijkemans 2004: 451). About three million HCWs worldwide receive percutaneous exposure to blood-borne pathogens each year. These injuries may result in 15,000 HCV, 70,000 HBV and 500 HIV infections, and more than 90% of these infections occur in developing countries. Worldwide, about 40% of HBV and HCV infections and 2.5% of HIV infections in HCWs are attributable to occupational sharps exposures, which are mainly preventable (WHO 2002: 74).  The health consequences of these infections are enormous. For instance, about 60–85% of HCV infections result in chronic liver disease and a risk for liver cirrhosis and liver cancer (CDC 1998: 1–39).

The Occupational Safety and Health Administration (2002) estimates that 5.6 million HCWs worldwide, who handle sharp devices, are at risk of occupational exposure to blood-borne pathogens. Needle stick injuries were shown to be the commonest (75.6%) mechanism for occupational exposure in a Nigerian teaching hospital (Orji, Fasubaa & Onwudiegwu 2002:75–78). These injuries are usually under-reported for so many reasons, which include stigma that could be associated with an eventual infection with HIV in the affected HCW. There is no immunization for HIV and HCV, thus the most effective prevention is through regular practice of the standard precautions.

1.3       RESEARCH PROBLEM

Compliance to standard precautions is low in public secondary health facilities, especially in resource-limited settings, thus exposing HCWs to the risk of infection. Occupational safety of HCWs is often neglected in low-income countries in spite of the greater risk of infection due to higher disease prevalence, low level awareness of the risks associated with occupational exposure to blood, inadequate supply of personal protective equipment (PPE), and limited organizational support for safe practices (Sagoe-Moses, Pearson, Perry & Jagger 2001: 538–41). Blood and other body fluids from patients are becoming increasingly hazardous to those who provide care for them. There is therefore a need for adequate measures to ensure compliance to standard precautions and reduce the risk of infection among HCWs (Bamigboye & Adesanya 2006: 112–116).  

1.4       AIM OF THE STUDY

1.4.1 Research purpose

The purpose of this research is to determine the knowledge, practice and factors affecting the utilization of standard precautions among health care workers in public secondary health facilities in Abuja, Federal Capital Territory (FCT) of Nigeria.

1.4.2 Research objectives

The research objectives are to:

•        assess the  knowledge of standard precautions among health care workers in public secondary health facilities in Abuja;

•        determine the practice of standard precautions among health care workers in public secondary health facilities in Abuja;

•        identify factors affecting the practice of standard precautions among health care workers in public secondary health facilities in Abuja.

1.5         SIGNIFICANCE OF THE STUDY

This study examines the knowledge and practice of standard precautions among two categories of health care workers (doctors and nurses) in secondary health facilities in FCT. It also examines the factors promoting or inhibiting the practice. Findings from the study will be used by the Health and human Services Secretariat (HHSS) of the Federal Capital Territory Administration (FCTA), the hospital management, and other stakeholders in planning and targeting appropriate measures/interventions to improve compliance to standard precautions among health care workers. The health care workers will be the ultimate beneficiary of interventions that will be based on findings from the study. 

1.6         DEFINITION OF TERMS

•        Knowledge: The Oxford Advanced Learners Dictionary (2001: 658) defines knowledge as the information, understanding and skills that one gains through education or experience. It also defines knowledge as the state of knowing about a particular fact or situation. In this study, knowledge refers to the awareness of basic principles of standard precautions.

•        Practice: Practice is the usual or expected way of doing something in a particular organization or situation (Oxford 2001: 912). In this study, practice refers to the extent that health care workers implement recommended strategies of standard precautions.

•        Standard precautions: The Centers for Disease Control and Prevention defines standard precautions as a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed infection status, in any setting in which healthcare is delivered. It is based on the assumption that every person is infected or colonized with an organism that could be transmitted in the healthcare setting and thus health care workers need to apply infection control practices during the delivery of health care. The same definition/assumption applies in this study.

•        Nurses: Nurses are persons whose jobs are to take care of the sick or injured people, usually in a hospital (Oxford Learners Dictionary 2001:801). In this study, nurses refer

to registered nurses and nurse/midwives working in public secondary health facilities in FCT.

•        Doctors: A doctor is a person who has been trained in medical science and whose job is to treat ill or injured people (Oxford 2001: 343). In this study, doctors refer to graduates of medical schools working as medical practitioners in public secondary health facilities in FCT.

•        Occupational exposure: Occupational exposure is defined by the Occupational Safety and Health Administration (OSHA) of US Department of Labour as reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties. The same definition applies in this study.

•        Blood-borne infections: OSHA defines blood-borne infections as infections from pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, HBV and HIV. In this study, blood-borne infections are infections from pathogenic microorganisms that are present in human blood, are capable of causing disease in human, and are predominantly transmitted via blood and blood contact. 

1.7         RESEARCH DESIGN AND METHOD

This is a descriptive quantitative cross-sectional study that describes and examines factors associated with the practice of standard precautions. The study population consists of health care workers (doctors, nurses) in public secondary health facilities in FCT, who were sampled using the multistage stratified sampling technique. A structured, pre-coded questionnaire was used to collect data from the respondents.

1.8         LIMITATIONS OF THE STUDY

One limitation of this study was the self-report method of assessment of practice of standard precautions; the level of adherence to standard precautions may have been better assessed by observation, although observation will likely influence normal routines.

Also, some of the information requested in the data collecting tool may be under-reported due to recall bias, but to minimize this limitation, a short period of recall (three months) was requested in the questionnaire. 

1.9         STRUCTURE OF THE DISSERTATION

This research report is presented in five chapters: (1) Orientation to the Study, (2) Literature Review, (3) Research Design and Method, (4) Analysis, Presentation and Description of Research Findings, and (5) Conclusions and Recommendations.

Chapter 1:  Orientation to the study provides background information (which includes the risk of occupational exposure by HCWs) as well as the aim and significance of the study.

Chapter 2: Literature Review explores the literature, documents and other studies on knowledge and practice of standard precautions by HCWs.

Chapter 3: Research Design and Method explains the methods of data collection, sampling technique, study population, and ethical considerations.

Chapter 4: Analysis, Presentation and Description of Research Findings presents and analyzes the key findings from the study in relation to the background characteristics of the respondents.

Chapter 5: Conclusions and Recommendations summarizes the research findings and makes recommendations, based on the study findings.

1.10 CONCLUSION             

Observance of standard precautions is very important in reducing occupational exposure to infectious diseases and the spread of nosocomial infections among patients.  The need to improve the practi

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