http://doi.org/10.33698/NRF0079 -Suksham Chopra, Indarjit Walia, Prem Verma , Jogindra Vati
Abstract : Health Care Workers (HCWs), are more prone to infections from patients’ blood borne diseases. Nurses can protect themselves from various kinds of Occupational health hazards when they comply with set guidelines of Universal Precautions (UPCs). The present study was carried out in seven selected wards of PGIMER, Chandigarh, during 2004-05 and 82 nurses (Sister Grade – II) were interviewed. More than three-fourths of them were in the age – group of 26 -45 years and were either Hindus or Sikhs. More than ninety five percent were aware that proper hand washing could limit the spread of microrganisms but in practice only 74.4 percent of them were washing their hands after caring each patient. Similarly, while more than forty five percent of them were aware about prevention of needlestick injuries by capping the used needles yet only thirty percent practiced capping the used needles. Nonavailability or lesser availability of articles affected their compliance with Universal Precautions. No wonder, only 31.7 percent felt satisfied with available articles in their wards. The challenge therefore lies not only in the provision of adequate articles for compliance with Universal Precautions, but also there is a need for well planned training programmes and proper supervision.
Key words :
Universal Precautions (UPCs), Nedlestick Injuries, Protective barriers.
Correspondence at : Suksham Chopra,
NINE,PGIMER,
Chandigarh.
Introduction
Health Care Workers (HCWs), including nurses are directly involved in patient care and are, therefore, more prone to acquiring infections from patients especially blood borne diseases including HCV, HBV, and HIV/AIDS. It has been estimated that worldwide, more than 170 million people are infected with Hepatitis C and about 40 million are living with HlV / AIDS 1. There is enough evidence showing that proper compliance with Universal Precautions (UPCs) can protect health care workers from various kinds of Occupational Blood Exposure (OBE), Hospital Acquired Infections (HAP) including pneumonia and intravascular catheter infections 2-4 Evidence suggests that the nurses do not consistently adopt protective barriers and thus they become more prone to contracting blood related diseases5. One report indicated that because of the fear of contracting HIV/AIDS the nurses were inclined to give up their profession. They also expressed the need to be informed about the HIV status of the patients and demanded that the HIV testing for all patients should be mandatory.6 A recent study revealed that though the professionals had adequate knowledge of hepatitis C, they were unwilling to treat patients of HCV because of fear of infection.7 Nurses need to protect themselves against such infections and this is possible only when they comply with the set guidelines of Universal precautions. There is paucity of data related to nurses’ knowledge and compliance with Universal precautions. The present study was undertaken to understand these aspects and to develop appropriate intervention strategies.
Materials and Methods
This study was carried out in seven selected wards * of the PGIMER, Chandigarh, during 2004-05. These wards were selected, assuming high prevalence of infections in these wards. All the nurses (Sister Grade – ll) were included in the study.
The objectives of the study were explained to them right in the beginning. Ultimately, a group of 82 nurses(respondents) who expressed their willingness to participate in the study, were interviewed with the help of a semi- structured interview schedule. The study was carried out with the following objectives: -1) To assess nurses’ present level of knowledge regarding Universal precautions ; and 2) To identify factors affecting their compliance with the Universal precautions. Certain salient findings of the study are discussed here.
Result
Majority of the respondents were in the age group ’26-45′ years (76.9%) and were either Hindus or Sikhs (74.4%). More than three-fourths of them were married and nearly sixty percent of them had joined the nursing profession after having attained a diploma in nursing midwifery (GNM). Interestingly, more than one-fifth of them (21.9%) had also acquired additional qualifications apart from obtaining a degree or diploma in nursing either through correspondence courses or as private candidates. Besides, more than eighty percent of them had acquired more than two years of experience (80.5%) of working as a nurse either within PGIMER, or outside. Only 57.3 percent of them were working within the wards for two to three years, and 37.8 percent worked there for less than two years (Table I).
*Male Medical Ward, Female Medical Ward, Cardio Thoracic Unit; Special Male Surgical Ward: Neuro Surgical Ward; Male Surgical Ward and Female Surgical Ward.
|
Table – 1 : Sociodemograpmc characteristics and Professional qualifications of nurses Characteristics No. ( %)
Total Number of Respondents = 82
Knowledge and practices related to compliance with universal precaution
Evidence shows that hand hygiene is an important measure for preventing cross transmission of microrganisms and reducing the incidence of health care – associated infections.8-9 Promotion of proper hand washing should, therefore, be a top priority. The finding revealed that barring three, the rest all were aware that proper hand washing was necessary for minimising the chances of spread of microrganisms and for proper hand washing, there was need of adequate water (95.1%), soap (87.8%) and Sink / Washbasin (81.7%). But regarding observation of Universal precautions, in all categories of patients suffering from blood or blood related diseases their responses were ‘mixed’. We noticed that while 59.7% percent of the nurses stated that they were aware that Universal precautions should be complied in all categories of patients and nearly 40 percent felt that the observation of Universal precautions should be restricted to patients suffering from HIV (40.2%) or HBV (37.8%). They also mentioned that needlestick injury was one of the occupational hazards exposing them to the risk of transmission of bloodbome pathogens (Table – 2). The nurses were indeed at risk of needle stick injury while performing procedures on patients. In this regard, 65.8 percent were aware of the possibility of breaking the needle tip and capping the needle after use to avoid needle stick injury. Despite this, only 45.1% percent stated that they were breaking the needle tip and 31.7 percent said that they were capping the used needle. Strangely enough, more than 95 percent of them were aware that proper handwashing could limit the spread of microrgansims but in practice only 74.3 percent of them were washing their hands after handling each patient. Moreover, covering cuts on the hands with water proof dressing was actually practiced by less than seventy percent of the respondents(69.7%). Another discouraging element of their practice was that the use of protective barriers, including gloves, aprons/ gowns and eye gear or goggles, to, protect oneself from splashes of blood and body fluids, was not being strictly adhered to. (Table – 3). Nonavailability or irregular supply of these articles including gloves, masks and gowns or aprons also had a bearing on their compliance with Universal precautions. This was apparent as nearly forty percent of them were of the view that nonavailability of eye gear/ goggles hindered performance of their work. Moreover, about one-fifith of them also complained of irregular supply of red, yellow and black (disposal) bags for disposing the waste material (Table – 4). Thus to some extent nonavailability of or lesser availability of basic material for proper hand washing drying of hands such as soap and Sterile papers affected their compliance with the universal precautions. No wonder only 31.7 percent of them expressed their satisfaction with the available material. The remaining who expressed their dissatisfaction in this regard gave the following reasons for non compliance with universal precautions. These are : heavy work load or no time (26.8%); irregular or nonavialbility of articles (21. 8%); lack of proper guidelines (14.8%) and lack of proper supervision (4.9%) (Figure I).
Table – 2 : Respondents’ knowledge about compliance with universal precautions and prevention of needlestick injuries and infection
For Hand WashingS.no. Respondents’ Knowledge No. ( %)
-
- Running Water 78 (95.1)
- b) Soap 72 (87.8)
- c) Sink/Wash Basin 67 (81.7)
- d) 10-15 seconds 49 (59.7)
- Observance of Universal Precautions
- For all Categories of Patients 49 (59.7)
- Only among HIV Patients 33 (40.2)
- Only among HBV Patients 31 (37.8)
- Prevention of Needlestick Injury by
- Breaking the Neede tip 54 (65.8)
- Capping the used needle 35 (42.7)
- Disposing the needle in a puncture resistant box 40 (48.8)
- Use of Protective Barriers
- Gloves 69 (84.1)
- Aprons/ Gowns 68 (82.9)
- c) Masks 55 (67.1)
-
Total number of respondents = 82
d) Eye Gear/Goggles 57 (69.6)
Table – 3 : Knowledge and practices of respondents related to universal precautions.
| Knowledge | Practices | |
| No. (%) | No. (%) | |
| 1. Washing of hands after caring each Patient | 79(96.3) | 61 (74.3) |
| 2. Covering cuts in the hand with water proof dressings |
78 (95.1) |
57 (69.7) |
| 3. Cleaning of Blood spills promptly with hypochloride solutions |
80 (97.6) |
62 (75.6) |
| 4. Sterlizations of Instruments after every use | 82 (100.0) | 72 (82.7) |
| 5. Ensure proper handling of soiled linen (self) | 78 ( 95.3) | 73 (89.1) |
| 6. Ensure about the following before Sending samples for testing about: | ||
| a) Labelling | 82 (100.0) | 67 (81.7) |
| b) Transportation | 79 (96.3) | 75 (94.4) |
| c) Proper handling (Other Staff) | 78 (95.1) | 68 (82.9) |
| 7. Ensure prevention of needlestick injuries by: | ||
| a) Breaking the needle tip | 54 (65.8) | 37 (45.1) |
| b) Capping the used needle | 35 (42.7) | 26 (31. 7) . |
| 8. Protecting self from infections by using protective barriers: | ||
| a) Gloves | 69(84.1) | 66 (80.4) |
| b) Aprons/Gowns | 6 8(82.9) | 50 (60.9) |
| c) Eye Gear/ Goggles | 67 (89.5) | 33 (40.2) |
Unlversal Precautions Subjects
Total Number of respondents = 82
Table – 4 : Availability of articles for practicing universal precautions
|
Articles |
Subjects Responses | ||
| Always
% |
Sometimes
% |
Never
% |
|
| a) Gloves
i) Reusable ii) Disposable b) Masks i) Reusable ii) Disposable c) Aprons/Gown i) Reusable ii) Disposable d) Eye Gear/Goggles i) Reusable ii) Disposable e) Waste Disposal Bags i) Red ii) Yellow iii) Black t) For Washing/ Drying Hands i) Soap ii) Towel iii) Sterile Papers |
30.5 |
39.1 |
30.4 |
| 51.2 | 30.5 | 18.3 | |
|
31.7 |
31.7 |
36.6 |
|
| 46.4 | 30.4 | 23.2 | |
|
28.1 |
32.8 |
39.1 |
|
| 36.6 | 20.7 | 42.7 | |
|
35.3 |
21.9 |
42.8 |
|
| 29.3 | 37.8 | 32.9 | |
|
58.6 |
23.1 |
18.3 |
|
| 51.3 | 21.9 | 26.8 | |
| 51.3 | 19.5 | 29.2 | |
|
71.9 |
6.2 |
21.9 |
|
| 40.2 | 25.6 | 34.2 | |
| 19.5 | 9.8 | 70.7 | |
Total Number of Respondents = 82
Figure – 1 : Satisfaction of subjects with available articles and reasons for non compliance with universal precautions N=82
Discussion
We hardly need to emphasise that adoption of universal precautions goes a long way in protecting the nurses from occupational hazards. Studies have shown that needlestick injuries have caused transmission of hepatitis B and C viruses (HBV and HCV) and also HIV among health care workers. Some studies from South East Asia and developed countries have also brought out that even surgeons. anasthestics and paramedical personnel were unaware of precautionary measures and that nearly fifty percent of the respondents had inappropriate attitude towards HIV patients. 10-12. In this study also revealed that nearly one- third of the repondents were not using
Total Number of Respondents = 82
protective barriers while handling the patients of unknown status. Adoption of protective barriers is an important measure to help the nurses to avoid needlestick injuries as well as splashes of blood and body fluids. In this regard, a study from Saudi Arabia shows that nurses were involved in 66 percent of the injuries and most of them had occurred during the recapping of the used needles.13 In the present study also, while more than for ty five percent of the nurses were knowledgeable about prevention of the needlestick injuries by capping the used needle, yet in practice, only thirty percent of them were capping the used needles.
Despite knowing that proper hand washing was necessary to limit the spread of microrganisms, only 74.4% percent of the respondents were washing their hands after caring each patient in their day-to-day practice. But their knowledge about advantages of hand washing was repor ted to be quite high (96.3%). These factors affecting their compliance with Universal precautions, may differ from one setting to another. Even in the US, adherence to hand hygiene was reported to be 40 to 60 percent. Moreover, two-thirds of these respondents had perceived that hand hygiene was a difficult task despite the availability of resources.14 Obviously there is a great need to adopt appropriate strategies that can help the nurses to avoid needlestick injuries and protect themselves against infections. Well planned training programmes are required to increase nurses’ existing knowledge as well as compliance with Universal precautions. The challenge therefore lies not only in the provision of adequate resources but also in making the nurses to make the best use of them in their day-to-day work.
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