Full Project – Assessment of the utilization of standard precaution in the prevention of disease among health care workers

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CHAPTER ONE

INTRODUCTION

Background to the study

Universal precautions refer to a set of guidelines aimed at protecting health care workers (HCWs) from blood-borne and communicable infections (Bennett & Mansell, 2014). The Centers for Disease Control and Prevention (CDC) in 1987 proposed the concept of “universal precautions” which was originally designed to protect health care workers (doctors and nurses) from exposure to blood-borne pathogens and communicable infections. The CDC in 1996 gave the recommendation that universal precautions be changed to standard precautions, which is a combination of the major characteristics of the universal precautions as well as the body substance isolation (BSI). The precautions are attributed to all body fluids which include blood, secretions, and excretions (apart from sweat) regardless of the fact if they have visible blood or not, skin that is not intact, mucous membranes, any unfixed tissue or organ (besides intact skin) from human (whether dead or alive), tuberculosis, human immunodeficiency virus (HIV) or hepatitis B virus (HBV) which contain culture medium or other related solutions (Standard/Universal Precautions 2012).

Tuberculosis (TB) is a chronic infectious disease caused by bacteria generally referred to as mycobacterium tuberculosis; almost every organ in the body can be affected, but involvement of the lungs account for more than 80% of TB cases. Tuberculosis affecting the lungs is called Pulmonary Tuberculosis (PTB), while those affecting other organs are called Extra Pulmonary Tuberculosis (EPTB) (Federal Ministry of Health, 2010). The most important source of infection is an untreated Pulmonary Tuberculosis (PTB) patient. When such a person coughs, spits or sneezes, tiny droplet nuclei containing the tubercles are released. Transmission is through inhaling these droplet nuclei (Federal Ministry of Health 2010). Today tuberculosis remains a global public health problem of enormous dimension. It is estimated that there are I billion infected patients worldwide, with 10 million new cases and over 3 million deaths per year. Tuberculosis is responsible for more deaths than any other infectious disease (WHO, 2010).

It was estimated to cause a global emergency with estimates of 1.8 million deaths worldwide in 2008 out of over nine million cases. In the same year, the estimated global incidence rate fell to 139 cases per 100,000 populations after reaching its peak in 2004 at 143 per 100,000. However, this decline was not homogeneous throughout the World Health Organization (WHO) regions, with Europe failing to record a substantial decline, but rather appearing to have reached a stabilization rate (WHO, 2010). In the WHO African region with a population estimate of 836,670,000 as at 2010, TB incidence was 2,300,000, prevalence of 2,800,000 and deaths of 250,000 (World Health Organisation, 20I0). Nigeria ranking the tenth among the 22 high TB burden countries in the world has the prevalence of 133 per 100,000 and 93,050 cases were registered in 2010. (Federal Ministry of Health, 2011)

Hospitals are one of the most high-risk profile places to work. Within the US, 253700 work-related injuries and illnesses were recorded implying 6.8 work related injuries to every 100 full time employees. Medical laboratory health professionals are also a major part of the health providers who prone to the risk of exposure to pathogens from blood and body fluids emerging from occupational hazard. In Pakistan, studies by Janjua et al., (2014) to predict reasons for the non-adherence to Standard Precautions showed low level of knowledge and poor practice of the Standard Precautions. Yet another study by Aluko et al., (2016) on the safety amongst health care workers in Osun State, Nigeria revealed that knowledge was at variance with practice ot standard precautions. Therefore, it is imperative to assess the information health care providers and workers have and how to promote adherence to Standard Precautions, especially during outbreaks. Knowing that the outbreak of an infection is a major concern in public health; public health focuses on three major levels of controlling and alleviating the outbreak of infection, these levels are prevention, treatment and rehabilitation. Adherence, however, falls under the first level of infection control (prevention) which helps in the prevention of infection spread from patients to health care workers, and from the healthcare workers to the public.

In Nigeria, Tuberculosis is a major public health problem with an estimated prevalence of 616 cases per 100,000. Nigeria ranks first in Africa and fourth among the 22 high tuberculosis burden countries in the world, and no fewer than 460,000 cases of TB are reported annually in Nigeria (WHO Report, 2018). In a study carried out by Itah (2015), the findings revealed the prevalence rate of 38.5% tuberculosis in Imo state; while Nwanta () reported an overall prevalence rate of 37.9% in Enugu state, Nigeria. it becomes imperative to assess the prevalence of this disease not only in different geographical; zones, but also to understand the perspective of healthcare workers in relation to tuberculosis management, measures for control, knowledge and practice of disease management and factors affecting effective practice and management of tuberculosis outbreak.

Statement of problem

The practice of and adherence to standard precautions is widely promoted to protect health care providers from occupational hazards and exposure to body fluids and consequent risk of infection with blood-borne pathogens and communicable infections. Health care providers are potentially exposed to infections through contact with body fluids while carrying out their duties. The occupational health of the health care workers of about 35 million people worldwide, representing about 12% of the working population, has been left behind (Wilburn & Eijkemans 2014). About three million health care workers and providers globally receive percutaneous exposure to blood-borne pathogens annually. Globally, statistics show that about 40% of HBV and HCV infections and 2.5% of HIV infections in health care workers can be attributed to occupational sharps exposures, which could be prevented (WHO 2012). The health consequences of these infections are fatal and widespread.

An estimate of the Occupational Safety and Health Administration (2012) showed that 5.6 million health care workers globally, who make use of sharp devices, are at high risk of occupational exposure to these disease causing pathogens. Injuries stemming from needle stick were shown to be the most prevalent (75.6%) mechanism for occupational exposure to risk at a teaching hospital in Nigeria (Orji, Fasubaa & Onwudiegwu 2012). These injuries are mostly under-reported owing to a number of reasons, including stigma associated with an eventual infection with the disease in the affected health care provider. There is no immunization for tuberculosis, HIV and HCV, thus the most effective means of prevention is through the knowledge of and adherent practice of the standard precautions.

Compliance level to standard precautions is low in public health facilities, especially in rural communities which are oftentimes limited in resources, thus increasing the risk of health care workers exposure to infection. Occupational safety of health care workers is often disregarded in developing countries regardless of the higher risk level of infection due to greater prevalence of disease, low level of awareness of the risks associated with health care providers occupational exposure to blood and body fluids, insufficient supply of personal protective equipment (PPE), and limited support for safe practices by organizations (Sagoe-Moses, Pearson, Perry & Jagger 2011). There is therefore a need for adequate measures and strategies to ensure strict compliance to standard precautions for the reduction in risk of infection such as tuberculosis among healthcare providers (Bamigboye & Adesanya 2016). It is against this background that this study is carried out to assess the utilization of standard precaution in prevention of disease among health care workers.

Objectives of the study

This study has the general objective of assessing the utilization of standard precaution in prevention of disease among health care workers in Madonna University Teaching Hospital. The specific objectives are to:

1. Assess the level of knowledge on standard precautions among health care workers in Madonna University Teaching Hospital
2. Determine the practice of standard precautions among health care workers in Madonna University Teaching Hospital
3. Identify factors affecting the utilization of standard precautions among health care workers in Madonna University Teaching Hospital
4. Determine the measures to enhance standard precaution among health care workers in Madonna University Teaching Hospital

Research questions

The following research questions were formulated to guide the study;

1. What is the level of knowledge on standard precautions among health care in Madonna University Teaching Hospital?
2. How much do health care workers practice standard precautions in Madonna University Teaching Hospital?
3. What are the factors affecting the utilization of standard precautions among health care workers in Madonna University Teaching Hospital?
4. What are the measures to enhance standard precaution among health care workers in Madonna University Teaching Hospital?

Significance of the study

This study seeks to assess the utilization of standard precaution in prevention of disease among health care workers in Madonna University Teaching Hospital. It also examines the factors that promote or inhibit the practice of standard precautions. Findings from the study will be used by the Health authorities, stakeholders, and the hospital management, in planning and developing adequate measures of control and intervention to improve practice and adherence to standard precautions among health care workers. This study will be of most significance to the health care workers as it provides interventions and strategies that will result from the study findings.

Also, this research work will contribute to the existing body of literature and knowledge on the subject of standard precautions among health care workers and professionals. This study would also serve as a means of reference source for future researchers as well as educate the public on the results of the findings as well as recommendations made that will be of benefit to the health system and public health of the community and individuals.

Scope of study

This study is focused on assessing the utilization of standard precaution in prevention of disease among health care workers. The disease infection under consideration is tuberculosis, and the area of the study is Madonna University Teaching Hospital, which is in Rivers state. The Madonna University Teaching Hospital joint Hospital will be used as the centre of the study from which the respondents would be obtained. The study covers the level of knowledge of standard precautions, the practice of standard precautions, the factors affecting the utilization of standard precautions and the measures to enhance standard precaution for prevention of tuberculosis among health care workers in Madonna University Teaching Hospital.

Operational definition of terms

Knowledge: The Oxford Advanced Learners Dictionary (2011) 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 2011). 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.

Healthcare workers: refers to health care professionals who deliver care and services to the sick and ailing either directly as nurses and doctors or indirectly as laboratory technicians.

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Full Project – Assessment of the utilization of standard precaution in the prevention of disease among health care workers