CHAPTER I

BACKGROUND OF THE STUDY

Introduction

Nosocomial infections are also called hospital acquired infections which are acquired or
caught by a patient in a special location i.e. hospital and acquired after 48 hrs. On patient
admission, 3 days of discharge and 30 days after surgery. Hospital-associated infections
also include occupational infections, which occur in health care workers due to
occupational hazard. These are acquired infections caused by organisms, which are
resistant to antibiotics. One third of nosocomial infections are urinary tract infections,
surgical site infections and various pneumonias.

There are various sort of transmissions of these microorganisms and virus acquired
through direct contact between patient and doctor as well from patient to nurses and vice
versa associated with nursing infected surface, through air such as droplets, aerosols etc.
and also commonly through by common vehicles as food and water. Generally, infections
are most prevalent in patients upon admission; health care workers also act as potential
carriers for these infections causing microorganisms. Hospitals provide a pathway of
transmission for the spread of nosocomial infections, due to poor infection control practices
among health workers and overcrowding of patients in wards of hospitals.

Nosocomial infections go beyond its impact on morbidity and mortality ratios in any country,
and it has so many economic implications. Infection management should be a
part of implementations for all health care workers, not only for their health purpose but
also to decrease the prevalence of nosocomial infections and thus improve patient safety
and risks of acquiring infections. Hand washing process leads to complete hand hygiene
by healthcare staff has essential importance in the control of infections. Nosocomial
infections rise patients’ morbidity, mortality, and duration of patient staying in hospital
treatment prices.

Therefore, knowledge regarding frequency and distribution of nosocomial infections is

necessary to improve infection control measures also to develop implementing
preventive and curative strategies, which, in turn, will help in decreasing incidence,
morbidity and mortality. Support staff and health care staff in health care settings are
inundated with necessary training facilitated by accrediting bodies and institutional
mandates. Baker, C. J. (1981).

1
Nosocomial septicaemia and meningitis in neonates. The American journal of
medicine, 70(3), 698-701. Risk for nosocomial infections are related primarily to factors,
which enhance contact with these bacteria in combination. Preventive measures for the
prevention or reduction of these infections are aimed at reducing the contact
implementation in hand washing practices and sterilization of all equipment processes, ,
modification of some antibiotic practices in additional . Future efforts should be
directed toward better control measures. Stamm, W. E. (1978). Infections related to
medical devices. Annals of Internal Medicine, 89(5_Part_2), 764-769. Urinary catheters
and intravenous devices are major sources of nosocomial infections and septicaemia.

In most examples, control measures recommended to control infections that have not
been assessed with respect practicality, and further study and prevention of these
infections is needed Bello, A. I., Asiedu, E. N., Adegoke, B. O., Quartey, J. N., Appiah-
Kubi, K. O., & Owusu-Ansah, B. (2011). Nosocomial infections: knowledge and source
of information among clinical health care students in Ghana. International journal of
general medicine, 4, 571. Disinfection and sterilization in hospitals are of increasing
concern.

One reason is the growth of nosocomial infections, the second is the increase of
antibiotics resistant bacteria and the third is the transmission of such bacteria, even via
animals. The most effective method of containment is disinfection—of instruments and
especially hospital staff and visitors. The nurses disinfection procedure—hand rubbing
(3 min) or hand scrubbing (5 min)—has to be repeated many times a day, with a number
of negative side effects arising from the mechanical irritation, chemical and, possibly,
allergic stress for the skin , quite apart from the time required.

For the hospital staff, the issue of the hand disinfection is equally daunting. On typical
working days some 60–100 disinfections are necessary—each requiring 3 min—i.e. a total of
3–5 h! A similar issue prevails in all medical practices to a greater or lesser extent. A new,
more efficient, more benign and especially faster disinfection method is urgently needed.
(Morfill, G. E., et al. "Nosocomial infections—a new approach towards preventive medicine
using plasmas." New Journal of Physics 11.11 (2009): 115019.)

In general, contaminated drinking water is a cause of infections, and guidelines for prevention
of such infections have been established. Microorganisms or pathogens in hospital water can
also cause nosocomial infections, yet guidelines for preventing and reducing such infections
do not prevails yet. There should be a purpose of reviewing the assess of magnitude of the
problems caused by waterborne nosocomial infections and to plan for prompt actions for their
prevention and reduction. Anaissie, E. J., Penzak, S. R., & Dignani, M. C. (2002).

2
The hospital water supply as a source of nosocomial infections: a plea for action. Archives of
Internal Medicine, 162(13), 1483-1492. Patients in intensive care units are a small group
consisting all hospitalized patients, but they accounts for approximately 25% of all hospital
acquired infections. Nosocomial infections frequencies among ICU patients are 5–10 times
higher than among general ward patients. ICU infection frequency are higher because of
hard and composite interactions between the patients' suffering from which disease, severity
of illness, type of ICU, duration of stay, and invasive devices used etc. Antimicrobial
resistance is a major clinical problem despite potential antibiotics. Organisms that cause a
significant resistant problem among ICU patients include methicillin-resistant
staphylococci, enterococci, etc.

Former infection control measures include identification of reservoirs, cessation of

transmission between patients, stopping progression from increasing and developing into
infection and modifying host risk. In addition, selection procedures and guidelines for
antibiotics usage are necessary to control the spread of micro-organisms. Trilla, A. (1994).
Epidemiology of nosocomial infections in adult intensive care units. Intensive Care
Medicine, 20(3), S1-S4.

Nosocomial infections are estimated to include more than 2 million patients annually.
Negative results of nosocomial infections and their associated costs vary by type of infection.
Programs of surveillance, prevention, and control of nosocomial infections were developed
during the 1950s. However, questions regarding the efficiency and cost-effectiveness of these
programs still exist. That’s why, this shows that knowledge regarding the effectiveness of
nosocomial infection surveillance, prevention, and control is must. Centres for Disease
Control (CDC. (1992). Public health focus: surveillance, prevention, and control of
nosocomial infections. MMWR. Morbidity and mortality weekly report, 41(42), 783.

Need for study

Nosocomial infections are the common of all in affecting health workers in hospitals.
Different medical and nursing textbooks have mentioned that lack of proper usage of gloves,
masks and other aseptic techniques while providing care to the patients leads in enhancing
rates and risk factors for nosocomial infections among health workers. While reviewing
literature investigators found that healthcare workers have inadequate knowledge, poor
practices and a negative attitude regarding nosocomial infections. These findings have not
been reported from Punjab region therefore we felt the need to assess these criteria regarding
nosocomial infections among health care staff.

3
Gram-negative organisms are highly responsible for a high rate of infections in hospital, were
frequently from hands of health personnel, despite regular hand antisepsis. In sequential hand
cultures contamination of hands by gram-negative organisms was temporary in some nurses,
but active increase of the organisms occurred on the hands of others and in a few nurses
appeared, to exist. The results of this study suggest that the hands of health personnel may
serve not only as a passive vehicle in the nosocomial transmission of gram-negative bacteria,
but also may build up a reservoir of nosocomial organisms. (Kittle, Mary A., Donald V.
Eitzman, and Herman Baer. "Role of hand contamination of personnel in the epidemiology of
gram-negative nosocomial infections." The Journal of pediatrics 86.3 (1975): 433-437.)

Nosocomial acquired urinary tract infection is the most frequent nosocomial infection and a
particular problem in urology departments. The incidence of NAUTI has become an
important legal issue. Several characteristics related to the health care provider, the patient
and the procedures are known to increase the risk of infections. The single most important
risk factor for infection is an indwelling catheter. Infection may be prevented by good health
care facilities, evidence-based practices, wise patient selection and surgical skills. But the
most important factors are antibiotic prophylaxis and continuous monitoring of the incidence
and pathogens causing infections in each institution.

There is improvement in urinary catheter care in many hospitals, and the importance of
patient and risk factors for development of infection is not fully known.. (Johansen, Truls E.
Bjerklund. "Nosocomially acquired urinary tract infections in urology departments: Why an
international prevalence study is needed in urology." International journal of antimicrobial
agents 23 (2004): 30-34.) Organisms that cause nosocomial infections transmitted through the
hands of physicians, nurses. Hand washing is considered the first most important procedure in
preventing nosocomial infections, and it has been recommended after contact with every
patient. The risk of acquiring organisms, transmitting them to others, or causing a nosocomial
infection may vary with the susceptibility of the patient and the type of patient contact.
However, because patients in intensive-care units are highly susceptible to nosocomial
infections, this procedure must be done. Suggested Albert, Richard K., and Frances Condie.
"Hand-washing patterns in medical intensive-care units." New England Journal of
Medicine 304.24 (1981): 1465-1466.

Research problem

A study to assess the knowledge, attitude and practices regarding nosocomial infections and
their prevention among health care staff of selected hospitals

4
Objectives

1. To assess the knowledge, attitude and practice regarding nosocomial infection

and their prevention among health care workers.
2. To determine the relationship between knowledge, attitude and practice
regarding nosocomial infection and their prevention among health care
workers.
3. To find out association between the knowledge, attitude and practice regarding
nosocomial infection and their prevention among health care workers.

Assumptions

• The health care staff will have excellent knowledge regarding nosocomial infections
and their prevention.

• The health care staff will have positive attitude towards preventing nosocomial
infections and their prevention.

• The health care staff will have excellent practices for prevention of nosocomial
infections and their prevention.

Delimitations

1. The study is limited to health care staff of selected hospitals only.

2. The study is limited to health care staff present at the time of data collection and are
willing to participate in the study.

5
 CHAPTER II

REVIEW OF LITERATURE

Ashisbala Mohapatra & Lisa Sarangi (2018) conducted a descriptive study to assess the
knowledge and practice to control the nosocomial infection and also to find the association
between knowledge and practice to control nosocomial infection with selected demographic
variables. A total of 122 nurses were chosen using stratified sampling technique and data was
collected by using two standardized tools. Knowledge was assessed by scoring key and
practice by Likert Scale. The statistical analysis was done by using chi square test. The results
showed that, there was no significant association (p<0.05) between knowledge and practice
nor with different demographic variables.

Anita bag (2018) conducted a cross-sectional descriptive study to assess the knowledge and
prevention regarding nosocomial infections among the nursing students. Total 112 B.sc
nursing students were selected as study subject by non -probability convenience sampling
technique. A self-structured questionnaire was used for data collection. The results showed
that, only 0.89% had very good knowledge and 6.25% had good knowledge, 63.39% was
below average knowledge regarding nosocomial infection.

Goma Niraula Shrestha & Bandana Thapa (2018) conducted a descriptive study to find
out the knowledge and practice among nurses regarding infection prevention. Total 170
nurses were included in the study by probability systematic sampling technique. Semi-
structured self- administered questionnaire and observation checklist was used for data
collection. The results showed that, 57.1% of respondents had adequate knowledge and only
48.2% had good practice on infection prevention.

Anjan Data, Kaushik Nag, Nabarum Karmakar & Tamal Chakraborty (2018)
conducted a cross-sectional study to assess the knowledge, attitude and practices about
hospital acquired infections among health care workers. A total 191 health care workers were
selected randomly. Self- structured, self -designed questionnaire was used for data collection.
The results showed that, 87.4% health care personnel had good knowledge about prevention
of hospital-acquired infections.

6
Maria Jahangir, Muhammad Ali, & Muhammad Shahid Riaz (2017) conducted a cross-
sectional descriptive study to evaluate the knowledge and practice of nurses regarding the
spread of nosocomial infection. Sample size was 240 and the response of the participants
taken through simple random sampling technique. The results revealed that the nurses had
good knowledge about spread of the nosocomial infection. Out of 240 participants, 32.1%
agreed and 28.8% strongly agreed about infection control guidelines but their practices to
reduce the spread of nosocomial infection was not good that 33.8% were neutral and 30.0%
disagreed that they follow the recommended guidelines.

Zuwaira I Hassan (2017) conducted a cross- sectional study to assess the knowledge of
transmission and prevention of nosocomial infections and factors influencing them among the
primary health workers. The sample size 50 was selected by simple random sampling
technique and the data collection was done by the semi-structured interview questionnaire.
The results showed, that the 60.0% of the respondents could correctly explain the concept of
the nosocomial infection with little above 56.0% of the respondents had good knowledge of
the transmission and prevention of the nosocomial infections. Attendance of prior trainings on
infection prevention and control showed statistically significant influence on knowledge of
prevention and transmission of the nosocomial infections.

Chtimwango & Priscilla Chisanga (2017) conducted a quantitative study to determine the
knowledge, practices and attitude of nurses regarding infection prevention and control in a
tertiary hospital. Total 196 nurses were recruited in the study through a stratified random
sampling technique. The data was collected by using self -structured questionnaire tool. The
results of the study showed that the major of the participants had good knowledge in infection
prevention and control with mean score of 83.21. The attitude towards infection prevention
and control was good with mean score of 81.37. The practice in infection prevention and
control was poor with mean score of 48.88.

Vigy Elizebth Cherian & Rose Rajesh (2016) conducted a descriptive study to assess the
level of knowledge and practice on infection control measures and also correlate the
knowledge and practice on infection control measures among the nurses. The study was
conducted on 60 nurses. Convenience sampling technique was used to choose the variables
and self- structured questionnaire was used to assess the knowledge and observation checklist
for practice. The results revealed that among the 60 nurses, only 23.3% had adequate
knowledge. The rest 78% did not had adequate knowledge and for the practice of nurses, 57%
of nurses had adequate practice. About 43% did not have adequate practice. The correlation
showed there was a weak negative significant correlation between knowledge and practice
among nurses on infection control measures (p<0.05).

7
Gamil Alrubaiee, Anisah Baharom, Hayati Kadir Shahr, Shaffe Mohd Daud & Omar
Basalee (2016) conducted a descriptive cross-sectional study to assess the knowledge and
practice among the nurses. A total 100 nurses were selected as study participants by non -
probability sampling technique. A 45- item questionnaire tool was used to assess the
knowledge and practice regarding infection control measures among the study subject. The
results showed that, most of the nurses 87% had fair knowledge, while only 4% of them had a
good level of knowledge of preventive measures of nosocomial infection. The results also
revealed that, majority of nurses 71% had fair practices about nosocomial infection. Whereas
26% of them had good practices and only 3% of them had poor practices.

Priyanka joshi, Megha Bhaisora, Deepti Rawat, Gargi Sharma, Babita Thakur, payal,
Ruchi, Upsana M.Negi (2015) Conducted a descriptive study to assess the knowledge and
prevention of nosocomial infection among nursing staff. A total 50 nurses were selected as
study participants by non-probability convenient sampling technique. The data was collected
by using self-structured questionnaire tool. The results revealed that, majority of nurses
76.66% had good knowledge, 23.33% had average knowledge and no one had poor
knowledge.

Imad Fashafsheh, Ahmed Ayed, Faeda Eqtait, Lubana Harazneh (2015) Conducted a
cross-sectional study to assess the knowledge and practice of nursing staff towards infection
control measures. A total 271 nurses were selected as study participants by purposive
sampling technique. The data was collected using self -structured questionnaire tool. The
results showed that, half 53.9% of the studied sample had fair knowledge level >80%.
Majority 91.1% of studied sample had good practice >80%.

Farid Najafi, Zeinab Jafari Motlagh, Abdollah Dargahi, Soheila Reshadat & Mehdi
Moradi Nazar (2015) conducted a cross-sectional study for the investigation of knowledge,
attitude and practices of nurses from control methods of the nosocomial infections. The 200
nurses working in teaching hospital were investigated by using questionnaire tool. The data
was carried out using chi- square and exact fisher test. The investigation results showed, that
69.5% nurses had good knowledge, 61.5% mean attitude and 80% had good practice on
infection control. There was no significant difference between knowledge, attitude and
practice.

8
Hamed Sarani, Abbas Balouchi, Nosratollah Masinaeinezhad & Ebrahim Ebrahimitabs
(2014) conducted a descriptive study to analyse the knowledge, practice and attitude of
healthcare personnel about standard precautions for hospital acquired infection on 170 nurses
working in ICU of two teaching hospitals. The sample population was selected through
simple random sampling. A self-structured questionnaire tool was used for data collection.
The result concluded that 43% of the participants in this study had poor knowledge, 42% had
average practice and 37% had a moderate attitude about hospital acquired infection.

Mozhgan kalantarzadeh & Esmaeil Mohammadnadnejad (2014) conducted a cross-

sectional study aimed to evaluate the level of knowledge and practices on infection control
among nursing staff. In this study 224 nurses were selected by random sampling from three
teaching hospitals. A questionnaire tool was used to collect data. The results of the study
revealed that 41.07% of study subject had intermediate knowledge about the infection control,
75.8% of nurses had intermediate level of performance.

Kanwalpreet Sodhi, Anupam Shrivastava, Mukanjali Arya & Manender Kumar (2013)
conducted a study to assess the knowledge of the infection control practices among nursing
professionals. The data from 100 nurses were collected by the questionnaire tool. The results
showed that the overall knowledge and awareness regarding different infection control
practices was excellent (>90%positive response) in 5% of the nursing professionals, good
(80-90% positive responses) in 37%, average (70-80% positive response) in 40% and below
average (<70% positive responses) in 18%.

9
 CHAPTER 3
METHODOLGY

RESEARCH APPROACH
Quanitative Research Approach

RESEARCH DESIGN
Non Experimental Descriptive Design

RESEARCH SETTING
Selected Hospitals of Punjab

TARGET POPULATION
Healthcare Staff of Neelam and Behgal Hospitals

SAMPLING TECHNIQUE
Non Probability Convenient Sampling Technique

SAMPLE SIZE
n = 100

RESEARCH TOOL

Part 1- Socio- Part 4-

Part 2- Knowledge Part 3- Attitude
demographic Practice
Questionnaire Questionnaire
Performa Questionnaire

METHOD OF DATA COLLECTION

Paper and pencil Method

DATA ANALYSIS AND INTERPRETATION

Descriptive and Inferential Statistics

Figure 1. Depiction of the research methodology flowchart

10
RESEARCH APPROACH

A quantitative research approach was used, as it allows the investigator to collect and
cover data into numerical form to make statistical calculations and draw conclusions.

RESEARCH DESIGN

Research design is a plan of how, when and where data are to be collected and
analyzed.

For our study a non-experimental design was used to assess the knowledge, practice
and attitude regarding nosocomial infections among Health care workers in selected
Hospitals of Punjab.

RESEARCH SETTING

The research setting is the place where research is to be conducted.

In this study, the research setting was two hospitals namely; Neelam Hospital,
Rajpura and Behgal Hospital, Mohali.

TARGET POPULATION

Target population is the entire set of population or objects having common

characteristics.

In this study, the target population of study was all healthcare staff of selected
hospitals.

ACCESSIBLE POPULATION

Accessible population is a portion of the target population to which the researchers

have reasonable access.

In this study, the accessible population was the healthcare staff that was present at the
time of data collection

11
SAMPLE AND SAMPLING TECHNIQUE

Sample size

Sample may be defined as representative unit of target population, which is to work

upon by the researcher during their study.

In this study, 100 healthcare workers were selected from two hospitals as sample.

Sampling technique

Sampling is a process of selecting representative part of population under the study.

In this study Non Probability Convenient sampling technique was selected the 100
healthcare staff used to select a group who will be representative of the population
under study.

INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria

All the health care worker i.e. Doctors, Nurses, Physiotherapist, OT Technician, Lab
Technician, Radiologists who are in direct contact with the patient was selected for
this study.

Exclusion Criteria

Health care staff that were not willing to participate was excluded.

SELECTION AND DEVELOPMENT OF TOOL

After the extensive review of the literature of relevant topics and after discussion with
experts and guide a self-structured questionnaire was developed

Section A =Socio-Demographic profile

Section B= Self Structured knowledge Questionnaire

Section C =Self structured Practice checklist

Section D =Self structured Attitude Questionnaire

12
DESCRIPTION OF RESEARCH TOOL

In this study, the tool consisted of demographic variables, knowledge questionnaire,

and observational practice checklist and attitude questionnaire

SECTION A: Socio demographic variables. This part consists of variables such as

place of work, educational qualification, and number of years in health care practices
etc.

SECTION B: Self structured questionnaire to assess the knowledge regarding

nosocomial infection control and its prevention.

SECTION C: Self structured questionnaire to assess the practice regarding

nosocomial infection control and its prevention.

SECTION D: Self structured questionnaire to assess the attitude regarding

nosocomial infection control and its prevention.

VALIDITY OF RESEARCH TOOL

The tools were given to 05 experts of nursing fields and language expert for English
to ascertain the content appropriateness, clarity and relevance. The tools were
modified and corrections were made to certain questions as per the expert’s
suggestions and under guide's consultation.

RELIABILITY OF THE TOOL

Reliability is the degree of consistency with which the attributes or variables are
measured by the instrument. In this study the reliability of knowledge questionnaire
was checked by the split half method.

DATA COLLECTION METHOD

The data was collected in month of April 2019. Formal permission obtained from the
Medical superintendent after discussing the purposes and objectives of the study. The
participants were assured confidentiality regarding the data collected from them.

The procedure of data collection was carried out among health care staff of selected
hospitals. Information about assessment tool was given to subjects and data was
collected using paper and pencil.

13
 ETHICAL CONSIDERATION

 Ethical clearance was obtained from the Research Committee of the Chitkara
University, Rajpura.
 Permission from Medical Superintendent was taken for the study.
 Informed consent was taken for the study.
 Confidentiality of information of all participants was maintained.

PLAN FOR DATA ANALYSIS

Analysis and interpretation of data was done according to the objectives of the study
by using descriptive and inferential statistics.

14
 CHAPTER IV
ANALYSIS AND INTERPRETATION
Data collection for the A study to assess the knowledge, attitude and practices
regarding nosocomial infections and their prevention among health care staff of
selected hospitals was conducted in selected 2 hospitals of Mohali and Rajpura
Punjab. Data collection was conducted in the month of April 2019. The healthcare
workers were selected after checking the inclusion and exclusion criteria using non-
probability convenient sampling technique. The analysis and interpretation of data
was done to assess the knowledge, attitude and practices regarding nosocomial
infection among selected 100 samples. The data was analyzed according to the
objectives of the study using descriptive and inferential statistics.

The Sections are as follows:

Section A: Description of Socio Demographic Variable

Section B: Assessment of knowledge, attitude and practice scores of healthcare staff

regarding nosocomial infections and their prevention

Section C: Relationship between knowledge, attitude and practice scores of healthcare staff
regarding nosocomial infections and their prevention

Section D: Association between knowledge, attitude and practice scores of healthcare staff
regarding nosocomial infections and their prevention and Selected Socio
Demographic Variables.

15
 Section A

Description of Socio Demographic Variable

Table No: 1 Percentage and Frequency Distribution of Demographic variables

N= 100

Percentage Frequency
Variables
(%) (F)

21-25 Years 49% 49

26-30 Years 31% 31

Age
31-35 Years 13% 13

36-40 Years 7% 7

Male 61% 61
Gender
Female 39% 39

Master 40% 40

Graduate 43% 43
Highest Educational
Qualification
Diploma 8% 8

Others 9% 9

Less Than 1 Year 26% 26

1-5 Years 46% 46

Numbers Of Years In
Healthcare Practice
6-10 Years 15% 15

More Than 10 Years 13% 13

Have You Ever Received Yes 72% 72

Occupational Recently
Any Training On
Universal Precautions? No 28% 28

16
Table no. 1 revels the percentage and frequency distribution of demographic
variables. From the table it shows that 49 (49%)were in the group 21-25 years,
31(31%) in group 26-30 years, 13(13%) in-group 31-35 years and 7(7%) in-group 36-
40 years. 61 (61%) are male and 39(39%) were female. The majority 43(43%) of the
healthcare workers did their masters, 8(8%) did their diploma and 9(9%) others.
About 26(26%) had less than a years’ experience, 46(46%) had 1-5 years, 15(15%)
had 6-10 years and 13(13%) had more than 10 years of experience. 72(72%) of the
health care workers had received training on universal precaution whereas 28(28%) di
not receive any training.

17
 Section B

Objective 1: To assess the knowledge, attitude and practice regarding nosocomial

infections and their prevention among healthcare staff.

Table No 2: Percentage and Frequency Distribution of Knowledge scores of

healthcare staff regarding nosocomial infections and their prevention

N=100

Level of Knowledge Score Percentage Frequency Mean S.D.

Excellent Knowledge(9-12) 76% 76

Good Knowledge(4-8) 24% 24 9.64 1.77

Inadequate Knowledge(<4) 0% 0

Maximum Score=12
Minimum Score=0

Table no, 2 shows the percentage and frequency distribution of knowledge scores of
health care staff regarding nosocomial infections and their prevention. 76(76%) of
them had excellent knowledge, 24(24%) had good knowledge and 0(0%) had
inadequate knowledge.

18
 Table No 3: Percentage and Frequency Distribution of Attitude scores of
healthcare staff regarding nosocomial infections and their prevention

N=100

Level of Attitude Score Percentage Frequency Mean S.D.

Positive Attitude (9-12) 43% 43

Neutral Attitude (4-8) 51% 51 7.71 1.79

Negative Attitude (<4) 6% 6

Maximum Score=12
Minimum Score=0

Table no. 3 shows the percentage and frequency distribution of attitude scores of
health care staff regarding nosocomial infection and their prevention. 43(43%) had
positive attitude, 51(51%) had neutral attitude and 6(6%) had negative attitude.

19
 Table No 4: Percentage and Frequency Distribution of Practice scores of
healthcare staff regarding nosocomial infections and their prevention

N=100

Level of Practice Score Percentage Frequency Mean S.D.

Excellent Practice (9-12) 74% 74

Good Practice (4-8) 25% 25 10.01 2.06

Poor Practice (<4) 1% 1

Maximum Score=12
Minimum Score=0

Table no. 4 shows the percentage and frequency distribution of practice scores of
healthcare staff regarding nosocomial infection and their prevention. 74(74%) had
excellent practice, 25(25%) had good practice and 1(1%) had poor practice.

20
 Section C

Objective 2: To determine the relationship between knowledge, attitude and

practice regarding nosocomial infections and their prevention among healthcare staff.

Table No 5: Relationship between knowledge, attitude and practice regarding

nosocomial infections and their prevention among healthcare staff.

N=100

Relationship Between Mean S.D. Correlation P value Results

Knowledge 9.64 1.77

0.418* 0.000 Significant
Attitude 7.71 1.79

Knowledge 9.64 1.77 Not

0.139 0.167
significant
Practice 10.01 2.06
7.71 1.79
Attitude Not
0.025 0.802
10.01 2.06 significant
Practice
*Significant
NS
Not Significant

Table 5 reveals the mean, SD and Pearson's Correlation value of the knowledge,
attitude and practices of healthcare staff regarding nosocomial infections and their
prevention. The values show that knowledge score mean and SD was 9.64±1.77. The
attitude score mean and SD was 7.71±1.79. The attitude score mean and SD was
10.1±2.06. To assess the relationship between Knowledge and Attitude on applying
Spearman’s Correlation test, it was found to be significant at p< 0.05. The relationship
between Knowledge and Practice was found to be not significant at p< 0.05 and the
relationship between Attitude and Practice was found to be not significant at p< 0.05.

21
 Section D

Objective 3: To find out association between knowledge, practices and attitude of

healthcare staff regarding nosocomial infections and their prevention and selected
socio demographic variables.

Table No 6: Association between knowledge of healthcare staff regarding

nosocomial infections and their prevention and selected socio demographic
variables.
N=100
Level of Knowledge
Chi Table
Variable Opts Poor Good Excellent P Value df
Test Value
Knowledge Knowledge Knowledge
Age
21-25 years 0 10 39
26-30 years 0 8 23 0.809 0.847NS 3 7.815
31-35 years 0 4 9
36-40 years 0 2 5
Gender
Male 0 12 49 1.606 0.205 NS 1 3.841
Female 0 12 27
Highest Educational Qualification
Master 0 15 25
Graduate 0 4 39 9.904 0.019* 3 7.815
Diploma 0 3 5
Others 0 2 7
Numbers of years in Healthcare practice
Less than 1
0 4 22
year
1-5 years 0 12 34 1.890 0.595 NS 3 7.815
6-10 years 0 5 10
More than 10
0 3 10
years
Have You Ever Received Occupational Recently Any
Training On Universal Precautions?
Yes 0 19 53
0.805 0.370 NS 1 3.841
No 0 5 23
Maximum Score=12 *Significant
NS
Minimum Score=0 Not Significant

22
Table 6 shows that the association between the level of Practice and socio
demographic variables. Chi-square test was used to associate the level of Practice and
selected demographic variables. The Chi-square value shows that there is a
significance association between Knowledge and Highest Educational Qualification.
The calculated chi-square values were more than the table value at the 0.05 level of
significance. There is no significance association between the Knowledge and Age,
Gender, Numbers Of Years In Healthcare Practice and Any Previous Training. The
calculated chi-square values were less than the table value at the 0.05 level of
significance.

23
 Table No 7: Association between Attitude of healthcare staff regarding
nosocomial infections and their prevention and selected socio demographic
variables.
N=100
Level of Attitude
Chi Table
Variable Negative Neutral Positive P Value df
Test Value
Attitude Attitude Attitude
Age
21-25 years 3 25 21
26-30 years 2 19 10 6.880 0.332 NS 6 12.592
31-35 years 1 6 6
36-40 years 0 1 6
Gender
Male 4 27 30 2.863 0.239 NS 2 5.991
Female 2 24 13
Highest Educational Qualification
Master 5 21 14
Graduate 0 22 21 9.851 0.131 NS 6 12.592
Diploma 1 2 5
Others 0 6 3
Numbers of years in Healthcare practice
Less than 1
1 16 9
year
1-5 years 4 22 20 6.321 0.388 NS 6 12.592
6-10 years 1 9 5
More than 10
0 4 9
years
Have You Ever Received Occupational Recently Any Training On Universal
Precautions?
Yes 4 38 30
0.350 0.839 NS 2 5.991
No 2 13 13
Maximum Score=12 *Significant
NS
Minimum Score=0 Not Significant

Table 7 shows that the association between the level of Attitude and socio
demographic variables. Chi-square test was used to associate the level of Attitude and
selected demographic variables. There is no significance association between the level
of Practice and selected demographic variables. The calculated chi-square values were
less than the table value at the 0.05 level of significance.

24
 Table No 8: Association between Practice of healthcare staff regarding
nosocomial infections and their prevention and selected socio demographic
variables.
N=100
Level of Practice
Chi Table
Variable Poor Good Excellent P Value df
Test Value
practice practice practice
Age
21-25 years 0 10 39
26-30 years 1 8 22 4.150 0.656 NS 6 12.592
31-35 years 0 5 8
36-40 years 0 2 5
Gender
Male 0 15 46 1.617 0.446 NS 2 5.991
Female 1 10 28
Highest Educational Qualification
Master 1 5 34
Graduate 0 12 31 9.218 0.162 NS 6 12.592
Diploma 0 4 4
Others 0 4 5
Numbers of years in Healthcare practice
Less than 1
0 6 20
year
1-5 years 0 13 33 7.065 0.315 NS 6 12.592
6-10 years 1 2 12
More than 10
0 4 9
years
Have You Ever Received Occupational Recently Any Training On Universal
Precautions?
Yes 1 22 49
4.791 0.091 NS 2 5.991
No 0 3 25
Maximum Score=12 *Significant
NS
Minimum Score=0 Not Significant

Table 8 shows that the association between the level of Practice and socio
demographic variables. Chi-square test was used to associate the level of Practice and
selected demographic variables. There is no significance association between the level
of Practice and selected demographic variables. The calculated chi-square values were
less than the table value at the 0.05 level of significance.

25
 CHAPTER V

DISCUSSION

Discussion deals with the results of the study. In the discussion, the investigator ties
tighter all the loose ends of the study. The results and the discussion of the study are
investigators opportunity to examine the logic of theoretical framework, the methods
and analysis.

The present study was conducted to assess the knowledge, practice and attitude
regarding nosocomial infection and their prevention among health care staff in
selected hospitals. In order to achieve the objective of the study, a descriptive research
design was adopted and data was collected through self- reported paper and pencil.
Convenient sampling technique was used to select the subjects. Data was collected
from 100 health care staff which was analysed and interpreted therefore the finding
are discussed below along with references.

The first objective of the study was to assess the knowledge, practice and attitude
regarding nosocomial infection and their prevention among health care staff in
Neelam hospital and Behgal hospital. In current study out of 100 subjects 76(76%)
had excellent knowledge regarding nosocomial infection and their prevention and less
than half, 43(43%) had positive attitude regarding nosocomial infection and their
prevention. Also 74 (74%) had excellent practice regarding nosocomial infection and
their prevention. So this conclude that majority of the participants had excellent
knowledge and practice and less than half had positive attitude. This study is similar
to the cross sectional study conducted by Farid Najafi, et al (2015) among 200
nurses, the results showed that , 69.5% nurses had good knowledge, 61.5% mean
moderate attitude and 80% had good practice on infection control.

The second objective of the study was to determine the relationship between
knowledge, practice and attitude regarding nosocomial infection among health care
staff in Neelam hospital and Behgal hospital. In current study, on applying
spearman’s correlation test, relationship between knowledge and attitude was found to
be significant at p<0.05. The relationship between knowledge and practice and
attitude was found to be not significant at p<0.05. This study is similar to the study
conducted by the Diana Lobo et al (2019) among 80 nurses. The results showed that

26
there was a linear correlation between knowledge and attitude at p < 0.05. Overall,
there was no correlation between attitude and practice scores of individuals with
regard to nosocomial infection prevention and control.

The third objective was to find the association between knowledge, practice and
attitude regarding nosocomial infection and their prevention among health care staff
of Neelam hospital and Behgal hospital. In current study, the chi-square value showed
that there was a significant association between knowledge and highest educational
qualification. No significant association was seen between attitude and practice with
the selected demographic variables. This study is similar to the study conducted by Dr
Imad Fashafsheh, et al (2015) among the 271 nurses. The results showed that nurses
who had master degree displayed higher mean knowledge scores as compared to the
other two groups (diploma & bachelor). A significant statistical differences were
found in mean knowledge scores at p < 0.05.

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 CHAPTER 6

CONCLUSION

The study concluded that most of the healthcare staff 76(76%) had excellent
knowledge regarding nosocomial infection and their prevention. Less than half,
43(43%) had positive attitude regarding nosocomial infection and their prevention.
On the contrary, 74(74%) had excellent practice regarding nosocomial infection and
their prevention. On applying Spearman’s Correlation test, relationship between
Knowledge and Attitude was found to be significant at p< 0.05. The relationship
between Knowledge and Practice and the relationship between Attitude and Practice
was found to be not significant at p< 0.05. The Chi-square value showed that there
was a significant association between Knowledge and Highest Educational
Qualification. No significant association was seen between Attitude and Practice with
their selected Demographic variables.

SUMMARY OF THE STUDY

The present study was conducted to assess the knowledge, practice and attitude
regarding nosocomial infection and their prevention among health care staff of
Neelam hospital and Behgal hospital, Punjab. A descriptive research design was used
in the study. Sample size was 100 health care staff was chosen by non-probability
convenient sampling technique. Data was collected by self -structured questionnaire
tool with paper and pencil. Descriptive and inferential statistics were employed to
analyse the data.

NURSING IMPLICATION
The finding of this study have some very important implications for the nursing
practice, nursing education, nursing mass awareness programs, nursing research. In all
the areas, the role of nurse is to improve the knowledge and practice regarding
infection control measures.

In the view of the results obtained from the study, several implications are made
which are discussed in following areas.

Nursing Practice

28
There is need of awareness in knowledge, attitude and practices among health care
staff regarding nosocomial infections and their preventions for the better prevention of
infections.

Present study provides the data that mostly were males, are graduates and had
received training on occupational infections and 1-5 years of experienced who are
aware.

These findings result shows that there is need of awareness in knowledge, attitude
and practices.

Nursing Education

The nursing curriculum should put more emphasis in spreading the awareness in
knowledge, attitude and practices among health care staff regarding nosocomial
infections and their preventions for better prevention of infections.

The results of the study helps us to understand the concept that mostly health care
workers are aware of these infections preventive measures.

Nursing Research

Findings of the study will act as a catalyst to carry out most expensive research on a
large population sample.

Nosocomial infections is a very serious topic today, for extended and intensive
nursing research on this topic to eradicate the possibilities of infections occurring in
health care settings.

29
Nursing Administration

Nursing personnel should prepared by in service education programs to take

leadership role in educating the health care staff regarding nosocomial infection and
their prevention. Administrative support should be provided to conduct in service
education programs for health care staff to provide the knowledge and educating
about the infection controls measures to promote the patient’s health. Health
education and workshops can be organized to emphasize the knowledge and practices
regarding infection control measures to promote the awareness regarding nosocomial
infections.

Recommendations

Based on the finding of the study, the following recommendations are made:

 Similar study can be conducted with large sample to generalize the finding.
 Study can be replicated with different population in different settings.
 Experimental studies can be conducted to evaluate the effectiveness of
strategies for the infection control measures.
LIMITATIONS

 Non purposive sampling was done from the selected hospital which restrict the
generalization of the study of particular setting.
 Small number of sample subjects leads to difficulty in the generalization of the
study.
 Time duration for the conduction of the study was short.

30
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