THE STUDY INTO THE KNOWLEDGE LEVEL AND CAUSES OF HOSPITAL
ACQUIRED INFECTIONS AMONG PATIENTS AT SUNTRESO
GOVERNMEN HOSPITAL
BY
WIREDU RICHARD
ADUTWUM RESEARCH INSTITUTE
SUNYANI- GHANA
JUNE, 2020
ABSTRACT
The main objectives of the study was to determine the level knowledge and causes of
hospital acquired infection. The study mirrors the study in the following specifics. This
study take into accounts all patient visiting Suntreso Government Hospital in Kumasi
Atonsu in the Kumasi Municipal Assembly (KMA). Informed consent was obtained
from all study participants and duly acknowledged by participants in agreement to the
study. The research comprises of five primary segments.
Purposive sampling
technique which is probability sampling methods was used. A total number of 100
Hospital Acquired Infection patients were picked as the sample size. The respondent
were made to answer questionnaires on the knowledge level and prevention of HAIs
and also in other to ascertain the cause of HAIs the respondents were interviewed.
Respondents demographic were sampled to aid the research bring clarity to the study.
Data were analysed with descriptive and inferential statistics using Statistical Package
for Social Sciences (SPSS), version 22. Descriptive data were presented in tables by
mean, standard deviation, and percentage where it was needed. In conclusion, majority
of HCWs have knowledge and understanding of HAIs' preventive methods However,
implementation of these knowledge through compliance of preventive methods must
be encourage among patients. Basing on the finding of this survey, the following
recommendations were made: Radio interviews should be done on HAIs so to increase
the knowledge level of the general public. Gloves Sterile gloves should be worn after
hand hygiene procedure while touching mucous membrane and non-intact skin and
performing sterile procedures (2A) e.g. arterial, central line and Foley catheter
insertion
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TABLE OF CONTENT
Contents
CHAPTER ONE ...................................................................................................... 1
INTRODUCTION ................................................................................................... 1
1.0 Background of the Study ..................................................................................... 1
1.1. Problem Statement.............................................................................................. 4
1.2 Research Objectives ............................................................................................ 5
1.3 Research Questions ............................................................................................. 5
1.4 Justification of the Study ..................................................................................... 5
1.5 Scope/Limitation to the Study ............................................................................. 6
1.6 Organisation to the Study .................................................................................... 6
CHAPTER TWO ..................................................................................................... 7
LITERATURE REVIEW ....................................................................................... 7
2.0 Introduction ......................................................................................................... 7
2.1 Concept of Hospital Acquired Infection.............................................................. 7
2.1.1 Symptoms of Nosocomial Infections ............................................................... 8
2.1.2 Causes Nosocomial Infections ......................................................................... 8
2.1.3 Prevention of Hospital Acquired Infections ..................................................... 9
2.1.4 Persons Mostly Affected By Nosocomial Pathogens ..................................... 12
2.1.5 The Emerging Trends of Nosocomial Infections ........................................... 13
2.2 Empirical Review .............................................................................................. 14
2.2.1 Studies on the Knowledge Level of Patient about Hospital Acquired Infection
................................................................................................................................. 14
2.2.2 Studies on the Causes of Hospital Acquired Infection ................................... 15
2.2.3 Studies on the Preventive Measures of Hospital Acquired Infections ........... 16
2.3 Summary of Literature Review ......................................................................... 17
CHAPTER THREE............................................................................................... 18
METHODOLOGY ................................................................................................ 18
3.0 Introduction ....................................................................................................... 18
3.1 Study Design ..................................................................................................... 18
3.2 The Population Size........................................................................................... 19
3.3 Sampling and Sampling Techniques ................................................................. 19
3.4 Research Collection ........................................................................................... 19
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3.5 Validity of the Research Instrument .................................................................. 20
3.6 Ethics Approval and Consent to Participate ...................................................... 20
3.7 Data Analysis..................................................................................................... 20
CHAPTER FOUR ................................................................................................. 22
DATA PRESENTATION, ANALYSIS AND DISCUSSION OF RESULTS .. 22
4.0 Introduction ....................................................................................................... 22
4.1 Demographic Information ................................................................................. 22
4.1.1 Age: ................................................................................................................ 22
4.1.2 Gender ............................................................................................................ 23
4.1.3 Education Level .............................................................................................. 24
4.2 Knowledge Level of Patient about Hospital Acquired Infection ...................... 24
4.3 Causes of Hospital Acquired Infection.............................................................. 26
4.4 Preventive Measures of Hospital Acquired Infections ...................................... 27
CHAPTER FIVE ................................................................................................... 31
SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATIONS
................................................................................................................................. 31
5.0 Introduction ....................................................................................................... 31
5.1 Summary of Findings ........................................................................................ 31
5.2 Conclusion ......................................................................................................... 33
5.3 Recommendation ............................................................................................... 35
REFERENCES ........................................................................................................ 36
APPENDIX .............................................................. Error! Bookmark not defined.
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LIST OF TABLE
Table 2.1 the common bacteria that are responsible for HAIs .................................. 9
Table 4.2 Knowledge Level of Patient about Hospital Acquired Infection ............ 25
Table 4.2 Cause of HAIs ......................................................................................... 27
Table 4.3. Differential nosocomial infection risk by patient and interventions ...... 28
Table 4.4 Aseptic measures appropriate for different levels of risk of infection .... 29
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LIST OF FIGURE
Figure 4.2: Gender of Respondents ......................................................................... 23
Figure 4.3: Education Level .................................................................................... 24
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CHAPTER ONE
INTRODUCTION
1.0 Background of the Study
Nosocomial infections also known as hospital acquired infections (HAIs) are
infections acquired in hospitals by patients who are admitted for a reason other than
that infection first appear 48 hours or more after hospital admission or within 30 day
after discharge. A prevalent survey in 2002 conducted under the auspices of the
World Health Organization [WHO] (2009) in 55 hospitals of 14 countries
representing 4 WHO regions (Europe, Eastern Mediterranean, South-East Asia and
Western Pacific) showed an average of 8.7% of hospital patients had HAIs. Hecker
et al (2003) defined Hospital Acquired Infections (HAIs) as those infections that were
not present at the time of patient’ hospitalization in a hospital or other medical
institutions and have been acquired after hospitalization.
Estimate of the annual cost of treatment for HAIs ranges from $4.5 billion to $11
billion and upwards contributed to 88 000 deaths in the U.S. in 1995 (Isbary, & Stolz,
2012). HAIs add to the imbalance between resource allocation for primary and
secondary healthcare by directing scarce funds to the management of potentially
preventable conditions. Razzak and Kellermann, (2002) indicated that this is
particularly important in developing countries where very little amount of resources
are available for use for an unbearable number of patients.
It is believed that one third of nosocomial infections are considered preventable and
that as many as 92% of deaths from hospital infections could be prevented. It is
extrapolated that the rate of incidence of HAIs in Ghana is approximately 152 000
out of 20.7 million people. Raka et al. (2003) published the first article in Kosovo in
1
the field of HAIs, which reported a mortality rate of 31% among new-borns, the
prevalence of hospital infections in UCCK was 17.4%.
In 2010, a data report for HAIs cases among 2.473 hospitals showed an increased
number of infections associated with the use of medical equipment, most of which
were displayed in surgical units (Badia et al., 2017). Also, other researchers reported
that patients who underwent surgical procedures had a greater chance of developing
HAIs, compared to other patients. Infection Control is the responsibility of the care
nurses and represents an integral element of patient safety programs.
An earlier study on HAIs at the Volta regional hospital in Ghana by Ocran and Tagoe,
(2014) isolated a total of 187 (85.8%) bacteria (made up of 55.5% non-pathogenic
and 30.3% pathogenic organisms from fomites in the Volta regional hospital, Volta
Region, Ghana). A recent investigation on the potential sources of transmission of
HAIs in the central regional hospital, cape coast, Ghana showed very high bacterial
isolates with a mean count of 1×10.
A nosocomial infection is contracted because of an infection or toxin that exists in a
certain location, such as a hospital. People now use nosocomial infections
interchangeably with the terms health-care associated infections (HAIs) and hospitalacquired infections. For a HAI, the infection must not be present before someone has
been under medical care.
One of the most common wards where HAIs occur is the intensive care unit (ICU),
where doctors treat serious diseases. About 1 in 10 of the people admitted to a
hospital will contract a HAI. They’re also associated with significant morbidity,
mortality, and hospital costs. As medical care becomes more complex and antibiotic
resistance increases, the cases of HAIs will grow. The good news is that HAIs can be
prevented in a lot of healthcare situations.
2
Bickley and Szilagyi, (2012) said many doctors can diagnose a HAI by sight and
symptoms alone. Inflammation and/or a rash at the site of infection can also be an
indication. Infections prior to your stay that become complicated don’t count as
HAIs. But you should still tell your doctor if any new symptoms appear during your
stay.
Infection may be acquired endogenously or from one's own body flora, and
exogenously or from patients, staff and the hospital environment. Contact, especially
with inadequately washed hands of the staff, plays an important role in hospital crossinfections. Hospital acquired infections are caused by various factors. Some of the
common ones include improper hygiene. Patients can get infections of diseases such
methicillin resistant staphylococcus aureus (MRSA), respiratory illnesses and
pneumonia from hospital staff and their visitors (Bereket, et al., 2012). Also Doctors
and nurses who do not practice basic hygienic measures such as washing hands
before attending to patients may spread MRSA among them. Other infections are due
to injections. There are cases where some hospital staffs do not give injections
properly. Infections like HIV and hepatitis B can be as a result of contaminated blood
due to sharing syringes and needles between patients when injecting medication into
their intravenous lines. Hospital acquired infections may also be as a result of torn or
improperly bandaged incisions during surgeries. These incisions get contaminated
with bacteria from the skin or the surrounding environment. Similarly, bacteria can
be introduced into the patient's body by contaminated surgical equipment. Also
breathing machines such as ventilators can spread infections like pneumonia among
patients using them. Staffs that do not use the proper infection control measures tend
to contaminate these machines with germs. There are also cases where people on
breathing machines are unable to cough and expel germs from their lungs.
3
Treatments for these infections depend on the infection type. Your doctor will likely
recommend antibiotics and bed rest. Also, they’ll remove any foreign devices such
as catheters as soon as medically appropriate. To encourage a natural healing process
and prevent dehydration, your doctor will encourage a healthy diet, fluid intake, and
rest.
HAIs are a significant cause of illness and death — and they can have devastating
emotional, financial, and medical consequences. Bennett and Brachman, (1998) at
any given time, about 1 in 25 inpatients have an infection related to hospital care.
These infections lead to the loss of tens of thousands of lives and cost the U.S. health
care system billions of dollars each year. Focused HAI prevention activities and
improved antibiotic use are synergistic. Addressing these challenges together can
amplify the impact of efforts to slow the development of antibiotic resistance.
Zhu et al. (2013) on all sampled surfaces, 46.1% pathogenic bacterial isolates showed
extensive resistant profile to commonly prescribed antibiotics. This suggests a high
potential of HAIs, thus assessing knowledge and attitude of workers and users of
these facilities on HAIs is needed.
The objectives of this current study were to assess the knowledge of patients on HAIs,
sources of knowledge of these infections, sources of these infections and their attitude
to prevent these infections. Those will help hospital authorities and information
services improve information dissemination as well as adopt more pragmatic
approach in helping reduce such infections.
1.1. Problem Statement
Patients are exposed to varieties of microorganisms during hospitalization. Hospital
acquired infections or diseases are on the rise. Patients present with one condition to
the hospital which is treated after their stay, but unfortunately go home with a
different condition.
4
Although infection is most prevalent in patients upon admission, health care workers
also act as potential vectors for pathogenic agents. Hospitals provide a favourable
transmission pathway for the spread of hospital acquired infections (nosocomial),
owing partly to poor infection control practices among health workers on one hand
and overcrowding of patients in most clinical settings on the other (McAlister et al.,
1999).
Due to the low knowledge level and occurrence of nosocomial infections recorded
above there is the need for research to be done about it to find the problem behind
causes and the knowledge level.
1.2 Research Objectives
The main objectives of the study is to determine the level knowledge and causes of
hospital acquired infection. The study mirrors the study in the following specifics
1. To assess the patients knowledge level on Hospital Acquired Infection
2. To identify the causes of Hospital Acquired Infection
3. To point out some of the preventive measures of Hospital Acquired Infections
1.3 Research Questions
1. What is the knowledge level of patient about hospital acquired infection?
2. What are the causes of hospital acquired infection?
3. What are the preventive measures of hospital acquired infections?
1.4 Justification of the Study
The purpose of the study will help educate the male patient on the knowledge level
on hospital acquired infections. The purpose of the study will help serve as baseline
data to measure the progress of the condition. The study seeks to help researchers to
understand and have more insight about the condition under study.
5
1.5 Scope/Limitation to the Study
This study will take into accounts all patient visiting Suntreso Government Hospital
in Kumasi – Atonsu in the Kumasi Municipal Assembly (KMA). Informed consent
will be obtained from all study participants and duly acknowledged by participants
in agreement to the study. Since each research has its constraints, the compilation of
information, data processing and evaluation will be a significant constraint. The
greatest limitation will be on the questionnaire, its interpretations to the illiterate,
since the researchers are student, we will combine both academic and the research,
and the time needed will be very limited. Another limitation is budgetary constraints,
since the researchers are student.
1.6 Organisation to the Study
The research comprises of five primary segments, Chapter 1 comprises the
background of the study, the declaration of problems, objectives and research issues,
the survey's meaning and scope/limitation, Chapter 2 Review the relevant topics and
literature in related to empirical review. Chapter 3 examines how the research will
be done by examining the methodology of studies. Chapter 4 examines the data's
assessment and discussion. Chapter 5 is the final section in which the results,
conclusions, suggestions and fields for further studies are summarised.
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CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
This section reviewed document relating to the topic the knowledge level and causes
of hospital acquired infection among patient at Suntreso Government Hospital.
Literature was organized based on the knowledge level and causes of hospital
acquired infection.
The literature review is done with the objectives of the research in mind. The primary
factors of the research are discussed in this section.
2.1 Concept of Hospital Acquired Infection
In the 1960s, growing concern over hospital acquired infection stimulated
considerable investment by US hospitals in the variety activities aimed at infection
surveillance and control to prevent these nosocomial infections. However there was
no comprehensive description of the type of programs in existence.in 1970s an
international conference on nosocomial was held at the center for disease control at
Atlanta. (Streiff, et al, 2016).
Although infection is most prevalent in patients upon admission, health care workers
also act as potential vectors for pathogenic agents. Hospitals provide a favourable
transmission pathway for the spread of nosocomial infections, owing partly to poor
infection control practices among health workers on one hand and overcrowding of
patients in most clinical settings on the other.
Yasir (2009) indicated that a nosocomial infection is contracted because of an
infection or toxin that exists in a certain location, such as a hospital. People now use
nosocomial infections interchangeably with the terms health-care associated
7
infections (HAIs) and hospital-acquired infections. For a HAI, the infection must not
be present before someone has been under medical care. One of the most common
wards where HAIs occur is the intensive care unit (ICU), where doctors treat serious
diseases. About 1 in 10 of the people admitted to a hospital will contract a HAI.
They’re also associated with significant morbidity, mortality, and hospital costs. As
medical care becomes more complex and antibiotic resistance increases, the cases of
HAIs will grow. The good news is that HAIs can be prevented in a lot of healthcare
situations. Read on to learn more about HAIs and what they may mean for you.
2.1.1 Symptoms of Nosocomial Infections
Gordts e al. (2010) for a HAI, the infection must occur:
1. Up to 48 hours after hospital admission
2. Up to 3 days after discharge
3. Up to 30 days after an operation
4. And in a healthcare facility when someone was admitted for reasons other
than the infection
Fitzpatrick (1988) indicated that Symptoms of HAIs will vary by type but the most
common types of HAIs are: urinary tract infections (UTIs), surgical site infections,
gastroenteritis meningitis and pneumonia. The symptoms for these infections may
include: discharge from a wound, fever, and cough, shortness of breathing, burning
with urination or difficulty urinating, headache, nausea, vomiting and diarrhoea.
People who develop new symptoms during their stay may also experience pain and
irritation at the infection site. Many will experience visible symptoms.
2.1.2 Causes Nosocomial Infections
Schmidt et al., (1994) Bacteria, fungus, and viruses can cause HAIs, Bacteria alone
cause about 90 percent of these cases. Many people have compromised immune
8
systems during their hospital stay, so they’re more likely to contract an infection.
Some of the common bacteria that are responsible for HAIs are shown in Table 2.1
Table 2.1 the common bacteria that are responsible for HAIs
Bacteria
Infection type
Staphylococcus aureus (S. aureus)
blood
Escherichia coli (E. coli)
UTI
Enterococci
blood, UTI, wound
Pseudomonas
aeruginosa (P. kidney, UTI, respiratory
aeruginosa)
Source: Schmidt et al. 1994
Of the HAIs, P. aeruginosa accounts for 11 percent and has a high mortality and
morbidity rate. Bacteria, fungi, and viruses spread mainly through person-to-person
contact. This includes unclean hands, and medical instruments such as catheters,
respiratory machines, and other hospital tools. HAI cases also increase when there’s
excessive and improper use of antibiotics. This can lead to bacteria that are resistant
to multiple antibiotics.
2.1.3 Prevention of Hospital Acquired Infections
Controlling nosocomial infection is to implement QA/QC measures to the health care
sectors, and evidence-based management can be a feasible approach. For those with
ventilator-associated or hospital-acquired pneumonia, controlling and monitoring
hospital indoor air quality needs to be on agenda in management. Whereas for
nosocomial rotavirus infection, a hand hygiene protocol has to be enforced.
Zimlichman et al., (2013) to reduce HAIs, the state of Maryland implemented the
Maryland Hospital-Acquired Conditions Program that provides financial rewards
and penalties for individual hospitals based on their ability to avoid HAIs. Despite
sanitation protocol, patients cannot be entirely isolated from infectious agents.
Furthermore, patients are often prescribed antibiotics and other antimicrobial drugs
9
to help treat illness; this may increase the selection pressure for the emergence of
resistant strains. Common ways of Preventing of Hospital Acquired Infections as
discussed by Kelly, and Monson, 2012 as follows:
Sterilization: Sterilization goes further than just sanitizing. It kills all
microorganisms on equipment and surfaces through exposure to chemicals, ionizing
radiation, dry heat, or steam under pressure (Block, 2001)
Isolation: Garner, J.S. and Hospital Infection Control Practices Advisory Committee
(1996) Isolation is the implementation of isolating precautions designed to prevent
transmission of microorganisms by common routes in hospitals. Because agent and
host factors are more difficult to control, interruption of transfer of microorganisms
is directed primarily at transmission for example isolation of infectious cases in
special hospitals and isolation of patient with infected wounds in special rooms also
isolation of joint transplantation patients on specific rooms.
Antimicrobial surfaces: Madkour et al., (2008) Micro-organisms are known to
survive on inanimate ‘touch’ surfaces for extended periods of time, this can be
especially troublesome in hospital environments where patients with
immunodeficiency are at enhanced risk for contracting nosocomial infections. A
number of compounds can decrease the risk of bacteria growing on surfaces
including: copper, silver, and germicides.
Surface sanitation: sanitizing surfaces is part of nosocomial infection in health care
environments. Modern sanitizing methods such as Non-flammable Alcohol Vapor in
Carbon Dioxide systems have been effective against gastroenteritis, MRSA, and
influenza agents.
10
Frank and Chmielewski (1997) Use of hydrogen peroxide vapour has been clinically
proven to reduce infection rates and risk of acquisition, hydrogen peroxide is
effective against endospore forming bacteria, such as Clostridium difficile, where
alcohol has been shown to be ineffective Ultraviolet cleaning devices may also be
used to disinfect the rooms of patients infected with Clostridium difficile or MRSA
after discharge
Hand washing: Trampuz, and Widmer (2004) Hand washing frequently is called the
single most important measure to reduce the risks of transmitting skin
microorganisms from one person to another or from one site to another on the same
patient. Washing hands as promptly and thoroughly as possible between patient
contacts and after contact with blood, body fluids, secretions, excretions, and
equipment or articles contaminated by them is an important component of infection
control and isolation precautions (Garner et al., 1983).
Aragon et al., (2005) improving patient hand washing has also been shown to reduce
the rate of nosocomial infection. Patients who are bed-bound often do not have as
much access to clean their hands at mealtimes or after touching surfaces or handling
waste such as tissues. By reinforcing the importance of hand washing and providing
sanitizing gel or wipes within reach of the bed, nurses were directly able to reduce
infection rates.
All visitors must follow the same procedures as hospital staff to adequately control
the spread of infections. Moreover, multidrug-resistant infections can leave the
hospital and become part of the community flora if steps are not taken to stop this
transmission. It is unclear whether or not nail polish or rings affected surgical wound
infection rates
11
Gloves: In addition to hand washing, gloves play an important role in reducing the
risks of transmission of microorganisms (Allegranzi and Pittet, 2009). Gloves are
worn for three important reasons in hospitals.
First, they are worn to provide a protective barrier for personnel, preventing large
scale contamination of the hands when touching blood, body fluids, secretions,
excretions, mucous membranes, and non-intact skin. In the United States, the
Occupational Safety and Health Administration has mandated wearing gloves to
reduce the risk of bloodborne pathogen infections (Twitchell and Wachs, 2003)
Secondly, gloves are worn to reduce the likelihood that microorganisms present on
the hands of personnel will be transmitted to patients during invasive or other patientcare procedures that involve touching a patient's mucous membranes and nonintact
skin.
Third, they are worn to reduce the likelihood that the hands of personnel
contaminated with micro-organisms from a patient or a fomite can transmit those
micro-organisms to another patient. In this situation, gloves must be changed
between patient contacts, and hands should be washed after gloves are removed.
Girou et al., (2004) argues that wearing gloves does not replace the need for hand
washing due to the possibility of contamination when gloves are replaced, or by
damage to the glove. Doctors wearing the same gloves for multiple patient operations
presents an infection control hazard.
2.1.4 Persons Mostly Affected By Nosocomial Pathogens
Nosocomial infections typically affect patients who are immune compromised
because of age, underlying diseases, medical or surgical treatments. Aging of our
population and increasingly aggressive medical and therapeutic interventions
12
including implanted foreign bodies and organ transplantations have created a cohort
of particularly vulnerable persons (Weinstein, 1991). As a result, the highest
infection rates are among intensive care unit (ICU) patients. Nosocomial infection
rates in adult and pediatric ICUs are approximately three times higher than elsewhere
in hospitals. The sites of infection and the pathogens involved are directly related to
treatment in ICUs. In these areas, patients with invasive vascular catheters and
monitoring devices have more bloodstream infections due to coagulase-negative
staphylococci. Studies have shown that cases of occult bacteremia in ICU patients
are probably due to vascular access-related infections (Weinstein and Fridkin, 2003).
2.1.5 The Emerging Trends of Nosocomial Infections
Three major factors are involved in nosocomial infections. The first is long-term
antimicrobial use in hospitals and other health care facilities. The increased concern
about gram-negative bacilli infections in the 1970s to 1980s led to increased use of
cephalosporin antibiotics. As gram-negative bacilli became resistant to earlier
generations of cephalosporin antibiotics, newer generations were developed (File,
1999). Widespread use of cephalosporin antibiotics is often cited as a cause of the
emergence
of
enterococci
as
nosocomial
pathogens.
Methicillin-resistant
Staphylococcus aureus (MRSA), perhaps also in response to extensive use of
cephalosporin antibiotics became a major nosocomial threat. Widespread empiric use
of Vancomycin in response to concerns about MRSA and for treatment of vascular
catheter associated infection by resistant coagulase-negative Staphylococci was the
major initial selective pressure for Vancomycin-resistant Enterococci. Use of
antimicrobial drugs in long-term care facilities such as ambulatory and extended care
settings and transfer of patients between these facilities and hospitals have created a
large reservoir of resistant strains in nursing homes (Taconneli et al., 2008).
13
Many hospital personnel also fail to follow basic infection control rules such as hand
washing between patient contacts. In intensive care units, asepsis is often overlooked in
the rush of crisis care (Weinstein, 1991). Lastly, the long-term use of vascular or other
device-related care in immunosuppressed patients has led to higher prevalence of
bloodstream infections and ventilator-associated pneumonia (Garland, and Uhing,
2009).
2.2 Empirical Review
It examines past empirical studies to answer a specific research question. Empirical
research is based on phenomena observed and measured and derives knowledge not
from theory or belief but from actual experience (Spilka, 2002). In this section, the
study examines the study done in the area of EBF in terms of the objective of the
study.
2.2.1 Studies on the Knowledge Level of Patient about Hospital Acquired
Infection
Madeo et al. (2008) did A pilot study to investigate patients reported knowledge,
awareness, and beliefs on health care–associated infection. The study used a
descriptive study of 110 patients was undertaken utilizing a developed questionnaire
to investigate patients' knowledge, perceptions, and beliefs around Hospital Acquired
Infection.
The results shows that respondents believed they were well aware of the risks of
Hospital Acquired Infection before hospital admission, but their knowledge on routes
of transmission and prevention of infection was poor. Twenty-eight percent of the
respondents were able to name Methicillin-resistant Staphylococcus aureus (MRSA)
as contributing to HAIs. Patients' main sources of information about infections were
newspapers and television.
14
Sarani et al. (2016) study was conducted to evaluate knowledge, attitude and practice
of nurses and patients against HAIs. Their study was conducted using a descriptive
cross-sectional on 170 nurses and patients working at teaching hospitals of Zabol,
Iran, under the supervision of Zabol University of Medical Sciences in 2014.
According to the results, most respondent do not have a good knowledge and practice
about infection control despite having an average efficacy. It is also necessary to
improve the knowledge of standard precautions, develop programs for HAI control,
and hold training courses based on successful educational models.
Gikas et al. (2002) the aim of their study was to organize a surveillance of HAI with
the participation of the greatest possible number of Greek hospitals, transferring the
experience from the local Cretan infection control network in an effort to create a
nationwide network. Special attention was paid to recruit all Greek university
hospitals in our attempt to expand the study base. The sudy found that the duration
of hospitalization, the number of operations, the total number of used devices and
invasive procedures were significantly correlated with HAI.
Patients have a high level of awareness of the risk of HCAI but have little knowledge
about how infections spread or about their prevention these studies found.
2.2.2 Studies on the Causes of Hospital Acquired Infection
Thompson et al. (1982) indicated that outbreaks of hospital-acquired infections are
caused by methicillin-resistant Staphylococcus aureus, this recognized with
increasing frequency in the United States. Two thirds of outbreaks have been
cantered in critical care units. Infected and colonized inpatients appear to be the
major institutional reservoir, and transient carriage on the hands of hospital personnel
appears to be the most important mechanism of serial patient-to-patient transmission.
15
In over 85% of hospitals into which they have been introduced, methicillin-resistant
strains of S. aureus have become established as endemic nosocomial pathogens.
Murni et al. (2015) in their study reducing hospital-acquired infections and
improving the rational use of antibiotics in a developing country which was aimed at
investigating the causes and reduction HAIs and antibiotic use. Their study found
multifaceted infection control interventions are effective in reducing HAI rates,
improving the rational use of antibiotics, increasing hand hygiene compliance, and
may reduce mortality in hospitalised children in developing countries.
Shurland et al. also in their study tried to identify factors cause Hospital Acquired
Infection. The objective of their study was to quantify the clinical impact of
methicillin-resistance in Staphylococcus aureus causing infection complicated by
bacteremia in adult patients, while controlling for the severity of patients' underlying
illnesses.
They found that 193 (44%) of the 438 patients had methicillin-resistant S. aureus
(MRSA) infection and 114 (26%) died of causes attributable to S. aureus infection
within 90 days after the infection was identified. Patients with MRSA infection had
a higher mortality risk, compared with patients with methicillin-susceptible S. aureus
(MSSA) infections (relative risk, 1.7 [95% confidence interval, 1.3-2.4]; P < .01),
except for patients with pneumonia (relative risk, 0.7 [95% confidence interval, 0.41.3]).
2.2.3 Studies on the Preventive Measures of Hospital Acquired Infections
According to Peleg and Hooper, (2010) Hospital-acquired infections are a major
challenge to patient safety. It is estimated that in 2002, a total of 1.7 million hospitalacquired infections occurred (4.5 per 100 admissions), and almost 99,000 deaths
16
resulted from or were associated with a hospital-acquired infection, making hospitalacquired infections the sixth leading cause of death in the United States; similar data
have been reported from Europe. The estimated costs to the U.S. health care budget
are $5 billion to $10 billion annually. Approximately one third or more of hospitalacquired infections are preventable.
In this discussion Sherwood et al. (1970) define briefly the scope of the problem,
explore some of the causes of the unacceptably high prevalence of hospital-acquired
infections, evaluate some of the current preventive measures, and speculate on
developments that may improve prevention and therapy. They did focused on
bacterial infections, although in certain classes of patients other organisms at times
may be etiologic.
2.3 Summary of Literature Review
The existing works have revealed a lot of information about HAI, IPC, factors
causing, Preventive Measures and knowledge on HAIs. It is established that hand
washing can minimize microorganisms acquired through contact with body fluid and
contaminated surfaces and so can other IPC standard precautions. Existing studies
have identified some factors that Causes of Hospital Acquired Infection.
17
CHAPTER THREE
METHODOLOGY
3.0 Introduction
Wiredu (2019) denoted that the word methodology is a system of specific guidelines
and processes for studies and for assessing information allegations. This chapter
converses the population and sample size, the research plan, instrumentation, data
collection technique and data analysis technique.
3.1 Study Design
The objective of this study is to determine the level knowledge and causes of hospital
acquired infection among patients. This included examining the knowledge level of
patients about hospital acquired infection, to identify the causes of hospital acquired
infection and also to point out some of the preventive measures of hospital acquired
infections.
Therefore, this research was organised in the context of a descriptive research
approach. Descriptive research is described as a technique of study that explains the
features of the researched population or event. Key informant interviews and focus
group discussions were utilised in this study. The qualitative descriptive design
describes people’s life experiences regarding a particular phenomenon (Polit & Beck,
2010). Qualitative descriptive design allowed the researchers to achieve the objective
of this study.
The study will be conducted at Suntreso Government Hospital, and is about 10
minutes’ drive from Kumasi Township. The hospital is found on Sunyani road and it
shares boundaries with Sofoline and Abrepo in the Kumasi Metropolitan Assembly
(KMA), Ashanti Region.
18
It renders services to the population in Kumasi, especially those residences at
Sofoline, Bantam, and Adum and also nearby towns.
3.2 The Population Size
Simons (2009) a research population is a survey of a group of people belonging to
the over-all population who share a common feature, such as age, sex or other
common feature, which is the primary focus of a scientific inquiry. People,
individuals, animals, objects can form the population of research.
Creswell & Zhang (2009) explicated that population type is in two forms, i.e.:
targeted and accessible populations. The population of this work will be drawn from
all patients at Suntreso Government Hospital.
3.3 Sampling and Sampling Techniques
A sample is a lesser set of a population that is used to draw inferences about the
greater set (Simons, 2009). Purposive sampling technique which is probability
sampling methods will be used. A total number of 100 Hospital Acquired Infection
patients will be pick as the sample size.
3.4 Research Collection
Research Instruments are measurement tools (for example, questionnaires, or scales)
designed to obtain data on a topic of interest from research subjects (Nicoll, and
Beyea, 1997). Research Instruments are measuring instruments for obtaining
information from research subjects on a topic of concern.
The primary source data were gathered for this study. The study was performed from
October 6, 2019, to January 18, 2019, on the sample size of 115 respondent. The
respondent were made to answer questionnaires on the knowledge level and
prevention of HAIs and also in other to ascertain the cause of HAIs the respondents
19
were interviewed. Respondents demographic were sampled to aid the research bring
clarity to the study.
3.5 Validity of the Research Instrument
Both the interview guide and the questionnaires were pretested on five patients, three
nurses, three and medical officers. The pre-test helped researchers to modify
questions for clarity. The pre-test also helped to ensure that the data collected
answered the research questions. The questionnaire was self-administered and
required about 15 minutes to be completed.
The research team had prolonged interactions with the participants to ensure an indepth understanding of emerging findings. Data transcriptions and coding were done
by the research team to ensure that the correct experiences and views of the
participants were reported. Discussion of themes by the research team was done to
ensure correct representations of participants. Study participants were consulted for
their comments on themes to make sure it represented their views.
3.6 Ethics Approval and Consent to Participate
The permission to conduct the research was undertaken by the competent authorities
and the ethics committee within the hospital. All participants had the opportunity to
accept or decline their participation in the study. Also they were provided that their
ethical rights would be respected, such as anonymously, confidentiality.
3.7 Data Analysis
Data were analysed with descriptive and inferential statistics using Statistical
Package for Social Sciences (SPSS), version 22. Descriptive data were presented in
tables by mean, standard deviation, and percentage where it was needed.
20
With the interviewed guide themes were developed through content analysis of data
collected Transcripts were read several times by the team to identify codes. The team
used similar code to create families and similar families grouped together as themes.
Themes were discussed by all researchers to make sure they reflected the
phenomenon that was captured during data collection. Some participants were also
consulted to make sure the themes developed represented their views.
21
CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND DISCUSSION OF RESULTS
4.0 Introduction
In this section, the finding and outcomes found from both the interview and
questionnaires are discussed. It reported the results of the investigation obtained from
the respondents in the South Suntreso Hospital in Kumasi. The detailed discussion
has been presented on the answers to each of the research question. The presentation
was organized under the main headings: demographic information and analysis of
the study's main data.
4.1 Demographic Information
In order to carry out the analysis of the information gathered in order to reply the
study questions, a quantitative review was carried out on the demographic
characteristics of the examines in order to assist in the analysis, since these
characteristics are considered to influence the results of the debate and the
importance of the generalisation of the study findings. Three demographical of the
respondent were inquired about i.e. age, gender and educational level.
4.1.1 Age:
The ages of the respondent were group into four, from age 21 to 30, 31 to 40, 41 to
50 and 51 to 60, they recorded 17, 40, 30 and 8 respectively. The implies majority of
the sampled respondents are between 31 to 40 years representing 42.11% followed
by those in the group 41 to 51 which had 31.58%. The results is presented in Figure
4.1.
22
21-30 years
31-40 years
41-50 years
51-60 years
30
8
Age
Series1
17
40
Figure 4.1: Age of Respondents
Source: Author’s fieldwork
4.1.2 Gender
Next to the age was gender, respondents were asked to indicate their sex and majority
were females representing 57 which is 60% of the respondents and males were 38
which is 40% of the respondents as presented in figure 4.2. Meaning most of the
people who are HAIs are females.
Female
Male
Gender
Series1
57
38
Figure 4.2: Gender of Respondents
Source: Author’s fieldwork
23
4.1.3 Education Level
The education level of the respondent were also asked, most of these patients had no
formal education which represents 32 (33.68%) it was followed by those with only
basic education which was also 26(27.37). the rest are those with high school
education and tertiary recorded 21 representing 22.11 and tertiary was 11 (16.84%).
Meaning majority of the respondent has no formal education.
No Education
Basic
High School
Tertiary
Educational Level
Series1
32
26
21
11
Figure 4.3: Education Level
Source: Author’s fieldwork
4.2 Knowledge Level of Patient about Hospital Acquired Infection
In other to test the knowledge level of patients about Hospital Acquired Infection six
questions were asked, firstly, respondents were asked whether they have heard of
HAIs 95 out of 115 representing 82.61% questioned “Yes” and 20 out of the 115
answered ‘No’ also representing 17.39%. Meaning majority of the patients have
heard of HAIs. Therefore the study was carried out on the 95 (82.61%) of the
respondents. The results is presented in table 4.1
Secondly, the 95 respondents were asked to define what HAIs is, among the
population 78 representing (82.11) answered correctly and 17 which is 17.89
24
answered wrongly. Per the result is presented in table 4.1 it is clear majority of the
respondent do understand the meaning of HAIs and had little knowledge of it.
The respondents were again asked to indicate how the heard of HAIs, majority of the
respondents which is 33(34.74) said they heard it from Health Officer, it was
followed by respondents who have heard about it on the internet which is
27(28.42%), from radio or reading also recorded equal tilly of 14 representing
14.74%. television had the least which of 7(7.37). The outcome is presented in table
4.1.
Table 4.2 Knowledge Level of Patient about Hospital Acquired Infection
Statement
Option
Yes
Have you heard of HAIs?
If yes, what is HAIs?
If yes, where did you hear it?
Do you wash your hands within and
after leaving the hospital?
If yes, do you wash with soap?
Do you believe the hospital is free from
infections?
Source: Author’s fieldwork, 2019
25
Tally
95
%
82.61
No
20
17.39
Total
Correct
115
78
100.00
82.11
Wrong
17
17.89
Total
Radio
95
14
100.00
14.74
Reading
14
14.74
Internet
27
28.42
Health Officer
33
34.74
Television
7
7.37
Total
Always
95
44
100
46.32
Sometimes
30
31.58
Never
21
22.11
Total
Always
95
38
100
40.00
Sometimes
26
27.37
Never
31
32.63
Total
Yes
95
51
100
53.68
No
44
46.32
Total
95
100
Do you wash your hands within and after leaving the hospital was the next question
asked, it was presented in 3 likert scale, which was ‘Always’, ‘Sometimes’ and
‘Never’. Most of the respondent answered ‘Always’ which was 44 (46.32%),
sometimes and never had a frequency of 30 and 21 respectively as shown in Table
4.1. the results shows majority of the respondents have knowledge on how to prevent
contacting HAIs. This is consistent with work done by Parmeggiani et al (2010),
The respondent were again asked if they do wash their hands with soap, again
majority which is 38 representing 40% indicated they do always , never and
sometimes followed respectively with 31(27.37) and 26(27.37). This results is
presented in table 4.1, and by the result it mean most people do wash their hands with
soap after visiting the hospital.
They respondents were also asked to indicate if they do believe the hospital is free
from infections, majority which is 51 (53.68%) said ‘Yes’ and the rest of 44 which
is 46.32 said ‘No’. the results is found in Table 4.1.
4.3 Causes of Hospital Acquired Infection
The hospital is a large comprehensive hospital, in order to understand the
characteristics of HAIs, inpatient hospital infection, to provide a reliable basis for the
prevention and control of hospital infection, we use the hospital in two years in
patients in the hospital patients hospital infection survey. By means of retrospective
investigation, we observed the respondent of 95 patients with Hospital Acquired
Infections collected from September, 2017 to December, 2019 in the hospital.
The results showed that the nosocomial infection rate was 2.97% of the total admitted
patients in the hospital. Monitoring of nosocomial pathogens: 200 cases of
nosocomial infections occurred within the period of the study. The percentage in
Table 4.2 shows that the main pathogens of nosocomial infections are G-Bacteria
which is 47 representing 49.43%, G + Bacteria also recorded 23(24.21). Fungal
26
infections accounted for 27.35%, which was related to patients with low immunity,
hormones, immunosuppressive agents and widespread use of anti-infective drugs.
The study showed that the positive rate of nosocomial infection in at the hospital was
low. Most of the HAIs was caused by G-Bacteria
Table 4.2 Cause of HAIs
Bacteria
Tally
%
G-bacteria
47
49.47
Escherichia coli
7
7.37
Klebsiella pneumonia
3
3.16
Pseudomonas aeruginosa
15
15.79
Salmonella
4
4.21
Other Pseudomonas
10
10.53
Other G-bacteria
8
8.42
G+bacteria
23
24.21
Staphylococcus aureus
9
9.47
Streptococcus pneumonia
3
3.16
Staphylococcus epidermidis
3
3.16
Enterococcus
2
2.11
Other G + bacteria
6
6.32
Fungus
25
26.32
Total
95
100.00
Source: Author’s fieldwork, 2019
4.4 Preventive Measures of Hospital Acquired Infections
Prevention of nosocomial infections requires an integrated, monitored, programme
which includes the following key components:
1
Limiting transmission of organisms between patients in direct patient care
through adequate hand washing and glove use, and appropriate aseptic practice,
isolation strategies, sterilization and disinfection practices, and laundry
2
Controlling environmental risks for infection
27
3
Protecting patients with appropriate use of prophylactic antimicrobials, nutrition,
and vaccinations
4
Limiting the risk of endogenous infections by minimizing invasive procedures,
and promoting optimal antimicrobial use
5
Surveillance of infections, identifying and controlling outbreaks
6
Prevention of infection in staff members
7
Enhancing staff patient care practices, and continuing staff education.
8
Infection control is the responsibility of all health care professionals — doctors,
nurses, therapists, pharmacists, engineers and others.
Acquisition of nosocomial infection is determined by both patient factors, such as
degree of immunocompromise, and interventions performed which increase risk. The
level of patient care practice may differ for patient groups at different risk of
acquisition of infection. A risk assessment will be helpful to categorize patients and
plan infection control interventions.
Tables 4.3 and 4.4 provide an example of an approach which could be customized to
a particular facility. Table 4.3 stratifies the risk for different patient groups, and Table
4.4 provides a hierarchy of patient care practice for different levels of patient risk.
Table 4.3. Differential nosocomial infection risk by patient and interventions
Risk of infection Type of patients
Type of procedures
Minimal
Not immunocompromised; no Non-invasive, No exposure to
significant underlying disease
biological fluids *
Medium
Infected patients, or patients with Exposure to biological fluids or
some risk factors (age, neoplasm) Invasive non-surgical procedure
(e.g. peripheral venous catheter,
introduction of urinary catheter)
High
Severely immunocompromised
patients, (<500 WBC per ml);
multiple trauma, severe burns,
organ transplant
Source: WHO, 2002.
28
Surgery or High-risk invasive
procedures (e.g. central venous
catheter,
endotracheal
intubation)
The importance of hands in the transmission of hospital infections has been well
demonstrated and can be minimized with appropriate hand hygiene. Compliance with
hand washing, however, is frequently suboptimal. This is due to a variety of reasons,
including: lack of appropriate accessible equipment, high staff-to-patient ratios,
allergies to hand washing products, insufficient knowledge of staff about risks and
procedures, too long a duration recommended for washing, and the time required.
Table 4.4 Aseptic measures appropriate for different levels of risk of infection
Risk of Asepsis Antiseptics
infection
Hands
Clothes
Devices*
Clean or
disinfected
at
intermediate
or low level
Minimal
Clean
None
Simple hand
washing or hand
disinfection by
rubbing
Street clothes
Medium
Asepsis
Standard
antiseptic
products
Hygienic hand
washing or hand
disinfection by
rubbing
Protection
Disinfected
against blood at sterile or
and biological high level
fluids,
as
appropriate
High
Surgical Specific
asepsis major
products
Surgical hand
washing or
surgical hand
disinfection by
rubbing
Surgical
Disinfected
clothes: dress, at sterile or
mask, caps, high level
sterile gloves
Source: WHO, 2002.
To minimize the transmission of microorganisms from equipment and the
environment, adequate methods for cleaning, disinfecting and sterilizing must be in
place. Written policies and procedures which are updated on a regular basis must be
developed for each facility. Routine cleaning is necessary to ensure a hospital
environment which is visibly clean, and free from dust and soil.
Ninety per cent of microorganisms are present within “visible dirt”, and the purpose
of routine cleaning is to eliminate this dirt. Neither soap nor detergents have
29
antimicrobial activity, and the cleaning process depends essentially on mechanical
action.
There must be policies specifying the frequency of cleaning and cleaning agents used
for walls, floors, windows, beds, curtains, screens, fixtures, furniture, baths and
toilets, and all reused medical devices.
30
CHAPTER FIVE
SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATIONS
5.0 Introduction
This phase begins by summarising the key findings of the collected data. The chapter
also provides conclusions and recommendations in line with the research objectives.
It also highlights study limitations and finally provides proposals for future research
studies.
5.1 Summary of Findings
Knowledge of HAIs and compliance to methods in preventing them such as proper
practice of aseptic precautions could lead to reductions in healthcare associated
infections in the hospital. Results from the study indicated that majority 82.61% of
HCWs have heard of HAIs, 78 (82.11%) understood what it was and had the requisite
knowledge on how it can be prevented through hand. Comparatively, 82.61% of
patients have heard of HAIs of which 78 (82.11%) understood what it was. Majority
of patients who knew about HAIs had obtained information from health officers.
Who noted that knowledge about hospital infection from trained HCWs such as
nurses, doctors, and biomedical scientists was generally high and consistent with
current scientific evidence.
Considering the important safety and medico-legal implications for staff and patients,
the HCW management practices in the hospital were good, with more participant
having excellent practice and demonstrating good practice. The large number of
respondent with good HAIs practice reported.
The present survey shows that the most infectious sites are the respiratory system,
which is consistent with domestic reports of nosocomial infections. The hospital is a
large-scale comprehensive hospital. It treats more critically ill patients, and the
31
patients are more complicated, with low immune function, more invasive
examinations and treatment operations, such as tracheal intubation and use of
ventilator. Infectious drugs are prone to cause imbalance in flora and cause double
infection. In addition, there are more advanced students and teaching students in the
hospital, and the mobility of personnel is large, which is likely to cause cross
infection among patients, medical care, visiting staff, and escorts, which are all
important causes of respiratory infections. Therefore, strictly abide by the principles
of aseptic technology, strict aseptic technique operation procedures and disinfection
and isolation systems, strengthen the disinfection management of sputum suction,
atomized inhalation, ventilator, oxygen humidification bottles, connecting pipes and
other devices, and strictly prevent pathogens through management directly Enter the
patient's airways; minimize procedures.
Investigation showed that the positive rate of nosocomial infection in our hospital
was low. Therefore, strengthen the management of nosocomial infections, increase
the awareness of clinicians, attach importance to the cultivation and drug sensitivity
of pathogenic bacteria, avoid the blindness and irrationality of drug use based on
experience, and promptly send samples for which anti-infective drugs have not been
applied in order to increase the positiveness of the samples submitted. The detection
rate and accuracy rate provide a reliable basis for the rational use of anti-infective
drugs in the hospital. It is very important to strictly grasp the indications for the use
of anti-infective drugs, timely and accurately understand the dynamics of pathogenic
bacteria and the changes of drug-resistant strains, and to regulate the use of antiinfective drugs reasonably. Extending the length of hospital stay, causing
unnecessary suffering to patients, and correspondingly increasing medical expenses,
increasing the burden on patients, and even causing medical disputes. Therefore, we
must strengthen nosocomial infection management, carry out nosocomial infection
32
training, improve medical staff's awareness of nosocomial infections, and implement
effective preventive measures to reduce nosocomial infections.
Without additional infection control measures, an increased rate of nosocomial
infection can be expected in these patients. Therefore, prevention of nosocomial
infections remains of the utmost importance. In addition, as the prevention of
nosocomial infection improved with chlorhexidine gluconate, a shorter mean hospital
stay was observed.
5.2 Conclusion
In conclusion, majority of HCWs have knowledge and understanding of HAIs'
preventive methods However, implementation of these knowledge through
compliance of preventive methods must be encourage among patients More than half
of patients have some information on HAIs having been informed by a health officer,
46.32% with always washing their hands and 31.58% washing always with soap.
Majority believe the hospital is free from infection with 44.8% believing they had
had HAIs. Thus in patients, increased information on HAIs will lead to a reduction
whereas in HCWs strict adherence and monitoring of compliance to hospital
regulations on HAIs will instil the desired attitudinal change that will result in
reduction in HAIs.
The high risk factors of hospital acquired infections are immunosuppression, more
invasive examinations and treatments and long-term using antibiotics. Therefore, we
must strengthen nosocomial infection management, carry out nosocomial infection
training, improve medical staff's awareness of nosocomial infections, and implement
effective preventive measures to reduce nosocomial infections.
It is the responsibility of all health care providers to enact principles of care to prevent
health care–associated infections, though not all infections can be prevented. Certain
patient risk factors such as advanced age, underlying disease and severity of illness,
33
and sometimes the immune status are not modifiable and directly contribute to a
patient’s risk of infection. Depending on the patient’s susceptibility, a patient can
develop an infection due to the emergence of their own endogenous organisms or by
cross-contamination in the health care setting. Benefits of antimicrobial therapy will
alter the microbial flora by reducing one microbial presence but may allow the
emergence of another, causing a new infection (e.g., antibiotic-associated diarrhea).
Nurses can reduce the risk for infection and colonization using evidence-based
aseptic work practices that diminish the entry of endogenous or exogenous organisms
via invasive medical devices. Proper use of personal protective barriers and proper
hand hygiene is paramount to reducing the risk of exogenous transmission to a
susceptible patient. For example, microorganisms have been found in the
environment surrounding a patient and on portable medical equipment used in the
room. Environmental surfaces around a patient infected or colonized with a
multidrug-resistant organism can also become contaminated. Health care workers
should be aware that they can pick up environmental contamination of
microorganisms on hands or gloves, even without performing direct patient care.
Proper use and removal of PPE followed by hand hygiene will reduce the transient
microbial load that can be transmitted to self or to others. Identified aseptic and
infection control practices have been proven to reduce the dissemination of
organisms to a single patient, to prevent repeated transmissions that contribute to an
outbreak situation among multiple patients, or to become established in the health
care environment as endemic hospital flora.
It has been demonstrated that nursing and medical practices can pick up transient
microorganisms from intact patient skin and from environmental surfaces. Although
the amount of contamination is not quantified and the exact incidence is not apparent,
34
it does occur. Hand hygiene and aseptic practices before caring for a susceptible
patient can reduce the transient carriage and transfer of microorganisms. The
protective benefits of infection control using evidence-based practices are cost
effective and numerous: they not only contribute to the best individual patient care
outcome, but also protect health care workers, increase public awareness in all health
care settings about infection control issues, and maintain the highest standards in
nursing, which positively contributes to our goal for the best possible patient and
public health outcomes.
5.3 Recommendation
Basing on the finding of this survey, the following recommendations were made
1
Radio interviews should be done on HAIs so to increase the knowledge level of
the general public.
2
Gloves Sterile gloves should be worn after hand hygiene procedure while
touching mucous membrane and non-intact skin and performing sterile
procedures e.g. arterial, central line and Foley catheter insertion
3
Gown Wear a gown to prevent soiling of clothing and skin during procedures that
are likely to generate splashes of blood, body fluids, secretions or excretions. The
sterile gown is required only for aseptic procedures and for the rest, a clean, nonsterile gown is sufficient (2A). Remove the soiled gown as soon as possible, with
care to avoid contamination.
4
Mask, eye protection/face shield Wear a mask and adequate eye protection
(eyeglasses are not enough), or a face shield to protect mucous membranes of the
eyes, nose and mouth during procedures and patient care activities that are likely
to generate splashes/sprays of blood and body fluids, etc.
5
Patients, relatives and health care workers (HCWs) presenting with respiratory
symptoms should also use masks (e.g. cough).
35
REFERENCES
Allegranzi, B. and Pittet, D., 2009. Role of hand hygiene in healthcare-associated
infection prevention. Journal of hospital infection, 73(4), pp.305-315.
Aragon, D., Sole, M.L. and Brown, S., 2005. Outcomes of an infection prevention
project focusing on hand hygiene and isolation practices. AACN Advanced
Critical Care, 16(2), pp.121-132.
Archibald, L., Phillips, L., Monnet, D., McGowan, J.E., Tenover, F., Gaynes, R.
(1997). Antimicrobial resistance in isolates from inpatients and outpatients in the
United States: increasing importance of the intensive care unit. Clinical Infectious
Diseases; 24:211-215
Badia, J.M., Casey, A.L., Petrosillo, N., Hudson, P.M., Mitchell, S.A. and Crosby,
C., 2017. Impact of surgical site infection on healthcare costs and patient
outcomes: a systematic review in six European countries. Journal of Hospital
Infection, 96(1), pp.1-15.
Bennett, J.V. and Brachman, P.S. eds., 1998. Hospital infections. Philadelphia:
Lippincott-Raven.
Bereket, W., Hemalatha, K., Getenet, B., Wondwossen, T., Solomon, A., Zeynudin,
A. and Kannan, S., 2012. Update on bacterial nosocomial infections. Eur Rev Med
Pharmacol Sci, 16(8), pp.1039-44.
Bickley, L. and Szilagyi, P.G., 2012. Bates' guide to physical examination and
history-taking. Lippincott Williams & Wilkins.
Block, S.S. ed., 2001. Disinfection, sterilization, and preservation. Lippincott
Williams & Wilkins.
File Jr, T.M., 1999. Overview of resistance in the 1990s. Chest, 115(3), pp.3S-8S.
Fitzpatrick, T.B., 1988. The validity and practicality of sun-reactive skin types I
through VI. Archives of dermatology, 124(6), pp.869-871.
Frank, J.F. and Chmielewski, R.A., 1997. Effectiveness of sanitation with quaternary
ammonium compound or chlorine on stainless steel and other domestic foodpreparation surfaces. Journal of Food Protection, 60(1), pp.43-47.
Garland, J.S. and Uhing, M.R., 2009. Strategies to prevent bacterial and fungal
infection in the neonatal intensive care unit. Clinics in perinatology, 36(1), pp.113.
Garner, J.S. and Hospital Infection Control Practices Advisory Committee, 1996.
Guideline for isolation precautions in hospitals. Infection Control & Hospital
Epidemiology, 17(1), pp.54-80.
Garner, J.S., Simmons, B.P. and Williams, W.W., 1983. CDC guideline for isolation
precautions in hospitals.
Gikas, A., Pediaditis, J., Papadakis, J.A., Starakis, J., Levidiotou, S., Nikolaides, P.,
Kioumis, G., Maltezos, E., Lazanas, M., Anevlavis, E. and Roubelaki, M., 2002.
36
Prevalence study of hospital-acquired infections in 14 Greek hospitals: planning
from the local to the national surveillance level. Journal of hospital infection,
50(4), pp.269-275.
Girou, E., Chai, S.H.T., Oppein, F., Legrand, P., Ducellier, D., Cizeau, F. and BrunBuisson, C., 2004. Misuse of gloves: the foundation for poor compliance with
hand hygiene and potential for microbial transmission?. Journal of hospital
infection, 57(2), pp.162-169.
Gordts, B., Vrijens, F., Hulstaert, F., Devriese, S. and Van de Sande, S., 2010. The
2007 Belgian national prevalence survey for hospital-acquired infections. Journal
of Hospital Infection, 75(3), pp.163-167.
Hecker, M.T., Aron, D.C., Patel, N.P., Lehmann, M.K. and Donskey, C.J., 2003.
Unnecessary use of antimicrobials in hospitalized patients: current patterns of
misuse with an emphasis on the antianaerobic spectrum of activity. Archives of
Internal Medicine, 163(8), pp.972-978.
Isbary, G. And Stolz, W., 2012. Common healthcare challenges. Plasma Medicine:
Applications of Low-Temperature Gas Plasmas in Medicine and Biology, p.117.
Kelly, K.N. and Monson, J.R., 2012. Hospital-acquired infections. Surgery (Oxford),
30(12), pp.640-644.
Madeo, M., Shields, L. and Owen, E., 2008. A pilot study to investigate patients
reported knowledge, awareness, and beliefs on health care–associated infection.
American journal of infection control, 36(1), pp.63-69.
Madkour, A.E., Dabkowski, J.M., Nüsslein, K. and Tew, G.N., 2008. Fast
disinfecting antimicrobial surfaces. Langmuir, 25(2), pp.1060-1067.
McAlister, F.A., Graham, I., Karr, G.W. and Laupacis, A., 1999. Evidence‐based
medicine and the practicing clinician. Journal of General Internal Medicine, 14(4),
pp.236-242.
Murni, I.K., Duke, T., Kinney, S., Daley, A.J. and Soenarto, Y., 2015. Reducing
hospital-acquired infections and improving the rational use of antibiotics in a
developing country: an effectiveness study. Archives of disease in childhood,
100(5), pp.454-459.
Ocran, I. and Tagoe, D.N.A., 2014. Knowledge and attitude of healthcare workers
and patients on healthcare associated infections in a regional hospital in Ghana.
Asian Pacific Journal of Tropical Disease, 4(2), pp.135-139.
Peleg, A.Y. and Hooper, D.C., 2010. Hospital-acquired infections due to gramnegative bacteria. New England Journal of Medicine, 362(19), pp.1804-1813.
Raka, L., Kalenc, S., Budimir, A., Katić, S., Mulliqi-Osmani, G., Zoutman, D. and
Jaka, A., 2009. Molecular epidemiology of Acinetobacter baumannii in central
intensive care unit in Kosova teaching hospital. Brazilian Journal of Infectious
Diseases, 13(6), pp.408-413.
37
Razzak, J.A. and Kellermann, A.L., 2002. Emergency medical care in developing
countries: is it worthwhile?. Bulletin of the World Health Organization, 80,
pp.900-905.
Sarani, H., Balouchi, A., Masinaeinezhad, N. and Ebrahimitabs, E., 2016.
Knowledge, attitude and practice of nurses and patients about standard
precautions for hospital-acquired infection in teaching hospitals affiliated to Zabol
University of Medical Sciences (2014). Global journal of health science, 8(3),
p.193.
Schmidt, M.A., Smith, L.H. and Sehnert, K.W., 1994. Beyond antibiotics: 50 (or so)
ways to boost immunity and avoid antibiotics. North Atlantic Books.
Sherwood, L.M., Parris, E.E. and Feingold, D.S., 1970. Hospital-acquired infections.
New England Journal of Medicine, 283(25), pp.1384-1391.
Shurland, S., Zhan, M., Bradham, D.D. and Roghmann, M.C., 2007. Comparison of
mortality risk associated with bacteremia due to methicillin-resistant and
methicillin-susceptible Staphylococcus aureus. Infection Control & Hospital
Epidemiology, 28(3), pp.273-279.
Spilka, B., 2002. Psychology of religion: Empirical approaches. In Religion and
Psychology (pp. 42-54). Routledge.
Streiff, M.B., Lau, B.D., Hobson, D.B., Kraus, P.S., Shermock, K.M., Shaffer, D.L.,
Popoola, V.O., Aboagye, J.K., Farrow, N.A., Horn, P.J. and Shihab, H.M., 2016.
The Johns Hopkins Venous Thromboembolism Collaborative: multidisciplinary
team approach to achieve perfect prophylaxis. Journal of hospital medicine, 11,
pp.S8-S14.
Thompson, R.L., Cabezudo, I. And Wenzel, R.P., 1982. Epidemiology of nosocomial
infections caused by methicillin-resistant Staphylococcus aureus. Annals of
Internal Medicine, 97(3), pp.309-317.
Trampuz, A. and Widmer, A.F., 2004, January. Hand hygiene: a frequently missed
lifesaving opportunity during patient care. In Mayo clinic proceedings (Vol. 79,
No. 1, pp. 109-116). Elsevier.
Twitchell, K.T. and Wachs, J.E., 2003. Bloodborne pathogens: What you need to
know—Part I. Aaohn Journal, 51(1), pp.38-47.
Weinstein, R.A. (1991). Epidemiology and control of nosocomial infections in adult
intensive care units. American Journal of Medicine; 91: 179-84.
Weinstein, R.A. and Fridkin, S.K., 2003. Routine cycling of antimicrobial agents as
an infection-control measure. Clinical infectious diseases, 36(11), pp.1438-1444.
Wiredu. R., 2019. Matters of researching and interpreting. Gile, Daniel; Gyde
Hansen & Nike K. Pokorn (eds.), pp.3-13.
World Health Organization, 2009. World health statistics 2009. World Health
Organization.
38
Yasir, A.A., 2009. Nosocomial Infection in Al-Hilla City Hospital.
Zhu, Y.G., Johnson, T.A., Su, J.Q., Qiao, M., Guo, G.X., Stedtfeld, R.D., Hashsham,
S.A. and Tiedje, J.M., 2013. Diverse and abundant antibiotic resistance genes in
Chinese swine farms. Proceedings of the National Academy of Sciences, 110(9),
pp.3435-3440.
Zimlichman, E., Henderson, D., Tamir, O., Franz, C., Song, P., Yamin, C.K.,
Keohane, C., Denham, C.R. and Bates, D.W., 2013. Health care–associated
infections: a meta-analysis of costs and financial impact on the US health care
system. JAMA internal medicine, 173(22), pp.2039-2046.
39