KNOWLEDGE, PERCEPTION AND STANDARD PRECAUTION AMONG HEALTH WORKERS IN NIGERIA

1.1 Introduction

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. Universal precautions are a set of guidelines that aim to protect health care workers (HCWs) from blood-borne infections (Bennett & Mansell 2004). 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 from human, human immunodeficiency virus (HIV) or hepatitis B virus (HBV) containing culture medium or other solutions (Standard/Universal Precautions 2007).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Limitations of the Study, Research Questions and Hypothesis and Definition of technical terms.

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1.2 Background of Study

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 et al., 2006). Health-care associated infection (HAI), also referred to as nosocomial infection and hospital acquired infection, is defined by Center of Disease Control and Prevention (CDC) as an infection caused by a wide variety of common and unusual bacteria, fungi, and viruses during the course of receiving medical care (CDC, 2012). It either occurs while patients receive care or may develop after discharge. It also involves occupation infection among staff. HAI can also be defined as an “infection occurring in patients during the process of care in a hospital or health care facility which was not present or incubating at the time of admission. This includes infection acquired in the hospital, but appearing after discharge and also occupational infections among staff or facility” (WHO, 2012). HAI is considered an important public health problem (WHO, 2012).

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).

Globally, hundreds of millions of patients are infected by HAI every year in both developed and developing countries. According to WHO, its prevalence in developed countries varied between 3.5% and 12%, while in developing countries it varied between 5.7% and 19.1% (WHO, 2012). The highest occurrences of HAI were in acute surgical, orthopedic wards and Intensive Care Unit (WHO, 2002). The prevalence rate of ICU-acquired infection in high-income countries was 30%, while in middle and low-income countries, it was at least 2-3 times higher than that in high-income countries(WHO, 2009; WHO, 2012).

The consequences of HAI at patients' level imply more suffering, more complications, more treatments, and increase in hospitalization periods. For example, in Europe duration of hospitalization increased to nearly 16 million extra days (WHO, 2012).This is in itself considered a risk factor for acquiring HAI, and it means an increase in costs (WHO, 2012). In addition, it increases economic burden on the health care systems of countries. For example, in England, the annual financial costs topped 1.3 billion euro's, while in the United States of America, the costs amounted to approximately 3.5 billion euro's and 7 billion euro's in Europe (WHO, 2012; WHO, 2012; Agozzino et al., 2012).

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to examine the Knowledge, Perception and Standard Precaution Among Health Workers.

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1.3 Statement of Problems

Investigation revealed that 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 et al., 2005).

Nurses get in contact with patients on a daily basis, so they are exposed to sharp injuries and many types of infections due to the nature of their occupation. It is important to follow standard precautions to reduce transmission of infections. In Palestine, despite of the availability of protocol for infection control in hospitals, it is applicable in varied degree from hospital to hospital.

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 et al., 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).

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1.4 Aim and Objectives of Study

The aim of the study is to examine the Knowledge, Perception and Standard Precaution among Health Workers in Nigeria. In achieving this aim, the specific objectives were set out as follows;

1. To determine the practice of standard precautions among health care workers in public secondary health facilities in Abuja;
2. To assess the knowledge of standard precautions among health care workers in public secondary health facilities in Abuja;
3. To describe the action taken by the health care workers when they are exposed to occupational hazards and injuries; and
4. To identify factors affecting the practice of standard precautions among health care workers in public secondary health facilities in Abuja.

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1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Does health worker have a good level of knowledge about standard precautions and those related to SI?
• Are there factors affecting the practice of standard precautions among health care workers in public secondary health facilities in Abuja?
• What is the practice of standard precautions among health care workers in public secondary health facilities in Abuja?
• What is the action taken by the health care workers when they are exposed to occupational hazards and injuries?
• What is the knowledge of standard precautions among health care workers in public secondary health facilities in Abuja?

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1.6 Research Hypotheses

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There are no significant factors affecting the practice of standard precautions among health care workers in public secondary health facilities in Abuja
• H1: There are significant factors affecting the practice of standard precautions among health care workers in public secondary health facilities in Abuja

Hypothesis Two

• H0: There is no significant knowledge of standard precautions among health care workers in public secondary health facilities in Abuja.
• H1: There is a significant knowledge of standard precautions among health care workers in public secondary health facilities in Abuja.

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1.7 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.

This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.

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1.8 Scope of Study

The scope of this research is focused on Knowledge, Perception and Standard Precaution among Health Workers in Nigeria using Gwarinpa General Hospital, Abuja as a case study.

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1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

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1.10 Definition of Terms

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.