CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Hospital acquired infection: originating or taking place in a hospital, acquired in a

hospital especially in reference to an infection. The term nosocomial come from greek

words, ‘nosus’ meaning disease + komeion meaning to take care of; hence nosocomial

infection should apply to any disease contacted by a patient while under medical care.

However, common usage of the term nosocomial is now synonymous with hospital

acquired infection.

Hospital acquired infection (nosocomial infection) are becoming increasingly common,

worldwide and occur during more than two million hospitalization in the united states

each year due to an increase in invasive procedures and growing resistance to antibiotics.

Nosocomial infections have increased by 36% in the last 20 years and are consuming

more health facilities each year. singh PK (2015).

Hospital acquired infection has been and still being a serious challenge in the world as

indicated in the patient profile, and in the health care working environment altering socio-

economic conditions and advances in science and information technology challenging the

nursing profession in particular the intensive nursing care in African continent. All these

changes will undoubtedly affect nursing practice in the near future.

1
A comprehensive understanding of these factor, is therefore essential if nursing is to meet

the challenges presented by tomorrows nursing care environment. As evidence, lack of

knowledge, negligence and breach of duty by nurses has contributed to the increase of

nosocomial infection.

Precisely, due to the expensive and high technology evaluation have occurred at rapid

pace and to be further expected, nosocomial infection have been increasing day after day.

A continued focus on the basic of nursing, the role of care as well as maintaining

confidence in the capacity to deliver safe, high quality and evidenced based patient care

will increasingly be a challenge to nurses. With evidence in health care system, the

threats of hospital morbidity are estimated to cause or contribute TO DEATHS

ANNUALLY in Nigeria Javis, (2016). Basic nursing skills and knowledge remain a key

prerequisite in the prevention of nosocomial infection which is a continuing major

complication and threat to patients and nurses in the hospital, Vandick, Labeue, Volglaers

and Blot (2017).

However nurses knowledge about evidence based consensus recommendations for

infection prevention and control has been found to be rather poor, it has nevertheless

been demonstrated that a meticulous implementations of such preventive bundles many

result in significantly better patient outcome after hospitalization.

2
 1.2 STATEMENT OF THE PROBLEM

Hospital setting or base is a place where disease conditions are being investigated,

diagnosed or treated, but yet studies has shown that infection are commonly contracted

by either the patients or the nurses taking care of the patients in the hospital base.

World health organization (WHO) is also of the view that hospital infections is on the

increase, hence there is need for the both professional nurses and related health workers

to cooperate in order to reduce the incidence of nosocomial infection in the hospital.

The researcher during the curse of his clinical experience observed that nosocomial

infection is alarming; this led her to choose the topic in order to find out the level of

knowledge and practice on prevention of nosocomial infection among nurses in state

specialist Maiduguri.

1.3 OBJECTIVES OF THE STUDY

The objectives of the study are:

i. To assess the level of knowledge on prevention of hospital acquire infection

among nurses in state specialist hospital Maiduguri.

ii. To find out the level of practice of prevention of hospital acquire infection

among nurses in state specialist Hospital.

iii. To identify the factors hindering the practice preventive measure of Hospital

acquire infection

1.4 SIGNIFICANCE OF THE STUDY

a. The research project serves as a model for future academic purposes.

3
 b. To attracts or draw the attention of health care managers to combat the rate of

hospital acquired infections.

c. To serve as a guide for public enlightenment on various ways of preventing

hospital acquired infections.

d. To improve the knowledge of nurses about the prevention of hospital acquired

infections.

e. To widen researchers knowledge about the prevention of hospital acquired

infections.

f. To create awareness to society about prevention of hospital acquired infection.

g. The study will help serve as a resource base to other researchers interested in

carrying out further research in this field.

1.5 RESEARCH QUESTIONS

 What is the level of knowledge on prevention of hospital acquire infection among

nurses in state specialist hospital Maiduguri?

 What is the level of practice of prevention of hospital acquire infection among

nurses in state specialist hospital Maiduguri?

 What are the factors hindering the practice of preventive measures of hospital

acquire infection?

4
1.6 SCOPE AND DELIMITATION OF THE STUDY

The scope of the study was only among registered nurses working in the wards of state

specialist hospital Maiduguri. Due to time frame and financial constraints, the study was

limited to only state specialist hospital Maiduguri (SSHM) rather than extending it to the

large community in Maiduguri metropolitan council.

1.7 OPERATIONAL DEFINITION OF TERMS

 Practice; Repetition of an activity to improve skills on something that is usually

done as a habit.

 Infection; invasion of pathogenic organisms into human system.

 Prevention; the act of preventing or hindering obstruction of action.

 Knowledge; general understanding or familiarity with a subject or information

about subject base on experience.

 Hospital acquire infection; infection acquired while in the hospital.

 Nurses: registered nurses working in the ward of state specialist Hospital

Maiduguri.

5
 CHAPTER TWO

LITERATURE REVIEW

2.1 CONCEPTUAL REVIEW

 CONCEPT OF HOSPITAL ACQUIRE INFECTION.

Hospital acquire infection appear in a patient under medical care in the hospital or other

health care facility which was absent at the time of admission this infection can occur

during health care delivery for other diseases and even after discharge of the patient

additional they comprises occupational infection among the medical staff WHO (2016)

hospital Acquired infection whose development is favored by a hospital environment

such as one acquired by a patient during hospital visit or one developing among hospital

staff, such infections includes fungal or bacterial infection and are aggravated by the

reduced resistance of individual patients, a dictionary of nursing oxford (2011).

Weller B.F. (2015) defined nosocomial infection as infection acquired in hospital, which

is new apart from the original disease that is caused or precipitated during hospitalization

at least 72 hours after admission. It is also called hospital acquired infection.

Epidemiology of hospital acquired infections: hospital acquired infection affects huge

number of patient’s glob-ally, elevating mortality rate and financial losses significantly.

According to estimate reported of WHO, approximately 15% of all hospitalized patients

suffer from these infections. These infections are responsible for 4%–56% of all death

causes in neonates, with incidence rate of 75% in South-East Asia and Sub-Saharan

6
 Africa. The incidence is high enough in high income countries i.e. between 3.5% and

12% whereas it varies between 5.7% and 19.1% in middle and low income countries. The

frequency of overall infections in low income countries is three times higher than in high

income countries whereas this incidence is 3–20 times higher in neonat

Types of hospital acquired infection

The most frequent types of infections include central line-associated bloodstream

infections, catheter-associated urinary tract infections, surgical site infections and ventilator-

associated pneumonia. A brief detail of these is given below:

1. Central line-associated bloodstream infections (CLABSI) are deadly nosocomial

infections with the death incidence rate of 12%–25%. Catheters are placed in central line to

provide fluid and medicines but prolonged use can cause serious bloodstream infections

resulting in compromised health and increase in care cost. Although there is a decrease of

46% in CLABSI from 2008 to 2013 in US hospitals yet an estimated 30,100 CLABSI still

occur in ICU and acute facilities wards in US each year.

2. Catheter associated urinary tract infections (CAUTI)CAUTI is the most usual type of

nosocomial infection glob-ally According to acute care hospital stats in 2011, UTIs account

for more than 12% of reported infections. CAUTIsare caused by endogenous native micro

flora of the patients. Catheters placed inside serves as a conduit for entry of bacteria whereas

the imperfect drainage from catheter retains some volume of urine in the bladder providing

stability to bacterial residence. CAUTI can develop to complications such as, orchitis,

epididymitis and prostatitis in males, and pyelonephritis, cystitis and meningitis in all patients

7
 3. Surgical site infections (SSI)SSIs are nosocomial infections be fall in 2%–5% of

patients subjected to surgery. These are the second most common type of nosocomial

infections mainly caused by Staphylococcus aureus resulting in prolonged hospitalization and

risk of death. The pathogens causing SSI arise from endogenous micro flora of the patient.

The incidence may be as high as 20% depending upon procedure and surveillance criteria

used.

4. Ventilator associated pneumonia (VAP) is nosocomial pneumonia found in 9–27% of

patients on mechanically assisted ventilator. It usually occurs within 48 h after tracheal

incubation. 86% of nosocomial pneumonia is associated with ventilation. Fever, leucopenia,

and bronchial sounds are common symptoms of VAP

SOURCES OF HOSPITAL ACQUIRED INFECTION

Maura (2017) stated that there are two main sources of nosocomial infections,

these include;

a) ENDOGENOUS SOURCE OR SELF INFECTION: these are infections that are

acquired from clients own body flora that means the cause of the infection originates from the

parents body. Bacteria are present on the skin, in the nose, mouth, throat, gastrointestinal tract

and in the female genital tract, whenever there is lowering of general or local resistance, these

organisms invade the tissue. Such opportunistic infections are difficult to treat, control and

prevent in susceptible individuals. Most nosocomial infection that appear to have endogenous

source includes;

 Escherichia coli (E-coli) and other members of the enterobacter; Escherichia coli

is genus of enterobacteriaceae normally present in the intestines of humans and

8
 other vertebrates as normal flora. It is the most common cause of nosocomial

urinary tract infection.

 Enterococcus species; is a streptococcus of the human intestinal normal flora, it is

the common cause of nosocomial urinary tract infection as well as wound and

blood infection when they are out of their normal habitat. Some strains are

resistant to all conventional antimicrobial drugs.

 Pseudomonas species; theses bacteria’s are genus of gram-negative motile bacilli

commonly found in decaying organic matter , it is also found in nutrient ,poor

environment such as water in the humidifier of a mechanical ventilator.

Pseudomonas species are resistant to many disinfectants and antimicrobial drugs.

They are common cause of hospital acquired pneumonia and infections of the

urinary tract.

 Staphylococcus aureaus; it is a common cause of nosocomial pneumonia, wound

sepsis and surgical site infections. It is also resistant to a variety of antimicrobial

drugs.

 b) EXOGENOUS SOURCE OR CROSS INFECTION; they are infections from

the hospital environment and hospital personnel, meaning the cause of the

infection originate from the outside environment and not from within the patient’s

body. From studies on staphylococcal carriage in the hospital have shown that

certain individuals shed large number of organism from their surface especially the

perineum and are referred to as dispersers, such individuals may also contaminate

their hands, clothing’s and other inanimate object.

9
 IMPACT OF HOSPITAL ACQUIRE INFECTION.

Hospital acquire infection adds to financial disability, emotional stress and in some cases lead

to disabling condition that reduced the quality of life. In addition nosocomial infections have

now become one of leading causes of deaths.

The impact of nosocomial infection takes on even more significance in resource poor

countries, especially those affected most by HIV/AIDS, because recent finding strongly

suggest that unsafe medical care may be an important factor in increase cost of health care in

the countries least able to afford them through increased;

 Length of hospitalization.

 Treatment with expensive medication example, antiretroviral drugs for HIV/AIDS,

and antibiotics.

 And use of other services example, laboratory test, x-ray and transfusion (Jayanthi

2014).

TRANSMISSION BASED PRECAUTION

Smelterzer, et al (2014) view that some microbes are so contagious or epidemiologically

significant that precaution in addition to standard precaution should be when such organisms

recognized. The center for disease control recommends a second tier of precautions called

transmission based precautions. The additional isolation categories are airborne, droplet and

contacted transmission.

 Airborne precaution: are reacquired for patients with presumed or proven

pulmonary tuberculosis, chicken pox, or other airborne pathogen. Airborne

10
 precautions are also advice if a patients is infected with small pox (example as a

result of bioterrorist attack). When hospitalized, patients should be in rooms with

negative air pressure, the door should remain closed and health care providers

should wear a protective mask at all times whole attaining to the patients.

 Droplet precaution: are used for organisms that can be transmitted by close face to

face contact, such as influenza or meningococcal meningitis while taking care of

patients requiring droplet precautions, the nurse should wear a safe and protective

face masks, but because the risk of transmission is limited to close contact the door

may remain open.

 Contact transmission: precaution are used for organisms that are spread by skin to

skin contacts such as antibiotics, resistant organisms or clostridium defficle

contact precautions are design to emphasize caution technique and the use of

barriers for organisms that have serious epidemiological consequences or those

easily transmitted by contact between health care workers and patients. When

possible, the patient requiring contact isolation is placed in a private room to

facilitate hand hygiene and deceased environmental contamination. Masks are not

needed and doors not need to be closed.

PREVENTION OF HOSPITAL ACQUIRE INFECTION;

 Aseptic technique should be practice always.

 Infectious cases should be isolated from another non-infectious cases

11
  Barriers such as gloves should be worn when contact is necessary or expected.

 Exposure to sharp instruments should be minimized especially contaminated

sharp.

 Single use of disposable items should be done where necessary and possible.

 Medical procedures that can lead to high probability of nosocomial infection

should be avoided.

 Frequent hand washing should be encouraged especially between patient contacts.

 There should be general awareness that prevention of hospital acquired infection

requires personal surveillance.

2.2 THEORETICAL REVIEW

 Environmental theory:

Florence nightingale’s in (1860) environmental theory defined nursing as the act of

utilizing the environment of the patient to assist him in his recovery. She linked health with

five environmental factors, pure or fresh air, pure water, efficient elimination, cleanliness,

light especially direct sunlight. Base on her theory deficiencies of these five actors can cause

nosocomial infection; the environmental factors attain significance when one considers that

sanitation in the hospitals is extremely poor and workers in the hospitals are often unreliable,

uneducated and incompetent to care for the sick. In addition to these factors, Nightingale also

stressed the importance of keeping the patient warm, maintaining a noise free environment

and attending to the patient or client in terms of assessing intake of food and its effects on the

patients. Her general concept about ventilation, cleanliness, quite warm, and diets remain an

integral part of nursing and health care today.

12
  CAUSES AND EFFECT THEORY:

Causality Kent (1856) (also referred to as cautions or cause and effect) is the agency of

efficiency that connects one process (the cause) with another process or state (the effect),

when the first is understood to be partly responsible for the second, and the second is

dependent on the first. In general, the process has many causes which are said to be causal

factor for it and lie in its past. Aristotle distinguished between the accidental (cause preceding

effect), and essential causality (one event seen in two ways). Aristotle example of essential

causality is like a builder building a house. The research work is on the knowledge and

practice of prevention of nosocomial infection. In relation to this theory above the (cause) is

the knowledge and the (effect) is the practice of prevention of nosocomial infection, therefore

if there is good knowledge definitely the practice will be good and vice versa. In relation to

these study improvements in the practice leads to decreased rate of nosocomial infection.

2.3 EMPIRICAL REVIEW:

Alexander (2010) stated that universal precautions are not well understood or implemented

by health care practitioner, though crucial in prevention of transmission of infectious

pathogens, the study was conducted in order to assess knowledge of universal precautions

among health care workers at the university hospitals of west India, result almost two third

of the respondents were very knowledgeable of universal precautions with significantly

more female (75.4%), than male (42.9%), and nurses (90.0%), medicals doctors (88.0%)

and medical technologies were very knowledgeable of universal precautions as a control

strategies of nosocomial infections.

13
Okechuku (2012) documented that healthcare workers are at risk of exposure of infection

during the course of carrying out their duties, the practice of universal precautions among

healthcare workers in public health facilities in Abuja Nigeria was evaluated.

A cross sectional survey of 277 healthcare workers was conducted using structure

questionnaire of 277 participants (29.96%) were doctors, (70.04%) were nurses, only

(16.6%) of the participants has knowledge of the basic concept of standard precaution and

(42.24%) knew potential sources occupational exposure and professional was significant

hand washing was practiced by (94.46%), (97.83&), reported regular use of hand gloves,

(88.44%) use gown and plastic apron (68.95%) use mask and eye protection. The major

factor reported for non-adherence was non availability of the materials; practice of

recapping used needles was more common among doctors than nurses.

WHO (2010) stated that critical moment in hand washing are before meals and snacks and

after defecations, around the world the observe rate of hand washing with soap at critical

moment range from (0-34%).

Lank ford et al (2009) stated that despite the simplicity of hand washing procedure there is

continues report of low hand washing compliance rate among healthcare workers.

Harnis et al (2016) documented that some of their constraint are beyond the control of

health care workers because of facilities such as soap and water are not provided, then

healthcare workers cannot be blamed for not washing their hands.

Qayyun, saltar and Waqas (2010) revealed in their study that nurses have sufficient

knowledge about nosocomial infection and its preventions, but certain weakness that was

observed during the study was that 32% out of 100% of the nurses do not know that the

14
hands should be washed in between patient contact. This weak knowledge can increase the

rate of nosocomial infections. They as well said that education of nurses in the prevention

and control of hospital associated infections, provision of materials and employment of

nurses are essential element in the prevention of hospital acquired infection.

Vandick, Labeau, and Volelaers (2007) have shown in their study that the general

knowledge of the preventive measures of nosocomial infection among nurses is very poor.

This can be improved by making a significant contribution in preventing nosocomial

infection by assuming full responsibility for quality improvement measures such as

evidenced based infection prevention and control protocols.

Reports from the national nosocomial infection surveillance (NNIS) system have revealed

that the urinary tract, respiratory tract, blood stream and wounds are most common

nosocomial infection sites.

Lynch and White (2017) studies showed that poor compliance of nurses is associated with

lack of Awareness among nurses. They also said nurses have stated multiple reasons for

non-compliance to the practice of prevention of nosocomial infection which include

dryness of skin due to frequent use of skin disinfectant, being too busy and wards being full

and understaffing.

Sharma et al (2016) stated that lack of soap and water are the most common constraints to

hand washing among nurses. Nosocomial infection has generated a great deal of concern

across North America and globally poses a significant threat to public health.

WHO (2018) stated that the relationship between knowledge and power helps to employ

and implement strategies to infection control and improve patient safety.

15
Gily Boy and Howard (2010) stated that there must be a policy regarding finger nails that

are long, artificial or with chipped nail polish. These are reservoirs for bacteria.

2.4 SUMMARY OF LITERATURE REVIEW:

This literature is based on three headings which comprises of conceptual review where

many aspects of the topic and authors were sited and documented, in empirical review,

related literatures were reviewed and theories of activities of daily living, environment

theory and cause and effect theory were used as a theoretical framework.

Nurses should be equipped with necessary knowledge, skills and attitudes for good

infection control practices. The infection control team should assess training needs of the

staff and provide required training through awareness programs, organize regular training

programs for the staff.

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 CHAPTER THREE

METHODOLOGY

3.1 RESEARCH DESIGN

The researcher used a descriptive survey research design to assess the level of knowledge

and practice on prevention of nosocomial infection in state specialist hospital Maiduguri.

3.2 SETTING OF THE STUDY

The setting of the study was state specialist hospital Maiduguri which was established in

1942 during the colonial era and was renovated into general hospital Maiduguri in 1976.

Later on the general hospital was upgraded to its present position or standard as a

specialist hospital where teaching and learning is taking place with different specialist in

medical fields in 1987. It is situated along the road leading to the shehus’ palace at the

center of Maiduguri town. It is surrounded with several commercial and private sectors

and structures, toward the east by hausari area, to the west is bank of the north/Jaiz bank,

to the west is Dandal police station and to the south is post office and Monday market.

The hospital has two major gates one entrance and one exit. Opposite to the entrance gate

is the administrative block. State specialist has one veranda that lead to all of its fourteen

(14) wards orthopedic ward, male medical ward, male surgical ward, female medical

ward, female surgical ward, pediatric ward, gynecological ward, labour ward, theatre

complex, nursery ward, accident and emergency unit, outpatient department, ante-natal

17
clinic and post natal clinic. There are other specialist like physiotherapy, radiology (x-

ray) and laboratory department.

State specialist hospital Maiduguri like other hospitals consist of various health

professionals, among them are medical doctor, surgeons, registered nurses and nurses

with other qualifications like perioperative nurses and registered midwives in conjunction

with auxiliary health workers, radiologist, physiotherapist, dieticians, and social welfare

offices among others.

3.3 TARGET POPULATION

Target population of this study was 238 registered nurses working in 14 ward in state

specialist hospital Maiduguri.

3.4 SAMPLE SIZE DETERMINATION

In determining the sample size of these studies Taro Yamane formula was used.

N
n=
1+ N ( e2 )
Definition of the formula
n = Sample size?
N = Target population
e = Margin of error 0.05
238
n =
238 ( 0.05 ) +1
2

238
n=
238 x (0.0025)+1

238
=
0.5875+1

18
 238
1.5875

n= 148
Therefore, the sample size is 148
3.5 SAMPLE SIZE

The sample size was 148 registered nurses. Stratified random sampling technique was

used. The cadre was used as a stratum. After which simple random sampling was used to

select nurses from each cadre.

3.6 SAMPLING TECHNIQUE.

A sample size of 148 was obtained using Toro Yamanes formular. The sampling

technique was convince or accidental sampling technique. Accidental sampling involves

the use of most readily available subject in the studies (Kale 2016).

3.6. INSTRUMENT OF DATA COLLECTION.

The instrument used was a self-designed close ended questionnaire of 17 questions. and

nature of questionnaire consist of section A is demographic data ,B ,C, and D

3.6 VALIDITY OF INSTRUMENT

The Validity of the questionnaire developed was ensured using face and content validity

by the reseacher supervisor and expert in the field of the subject matter who read through

to acetain it's construction and content.

3.7. RELIABILITY OF INSTRUMENT

19
The test -retest method was conducted on 10 respondent from state specialist hospital as a

pilot study in two weeks interval .the data analyzed shows strong degree of co-effcience

of internal consistency with a realiabity index of 0.7 using cronbach's alpha.

3.8 METHOD OF DATA COLLECTION.

The researcher distributed the questionnaire to the selected registered nurses in 14 wards

in the hospital and nature of questionnaire consist of section A IS DEMOGRAPHIC

DATA ,B ,C, and D by giving those on morning duty in the morning, those on afternoon

duty in the afternoon, and those on night duty were given early in the morning to be filled

appropriately.

3.9. METHOD OF DATA ANALYSIS.

A descriptive data collection was organized, compiled, tallied, before it was calculated in

percentages presented in tables.

3.10. ETHICAL CONSIDERATION.

All ethical rules and regulation were observed, an introduction letter from the college was

given for the purpose of carrying out this study. The letter was written to the office of the

medical director of state specialist hospital Maiduguri (SSHM) to ensure the researcher is

given due cooperation. Their consent was obtained voluntarily with complete anonymity

of their identity and information obtained was purely used for academic purpose. All

source of information or data or literature were acknowledged.

20
 CHAPTER FOUR

RESULTS

PRESENTATION OF RESULTS

The findings are presented based on the research questions. 148 questionnaires were

distributed to the selected nurses, but 138 questionnaires were returned correctly filled

while four (4) were wrongly filled and 6 missing. The total number used for the analysis

was 138 questionnaires.

21
Table 4.1 SHOWING THE DEMOGRAPHIC DATA OF THE RESPONDENTS

n=138

VARIABLE RESPONSES FREQUENCY PERCENTAGE

Marital status Married 108 63.44%
Single 22 30.36%
Widowed 8 5.8%
Divorced 0 0
TOTAL 138 100
Sex Male 22 15.9%
Female 116 84.1%
TOTAL 138 100
Level of Diploma (RN) 104 56.78%
qualification B.sc 24 35.21%
Masters 0 0
PhD 0 0
Others 10 7.2%
TOTAL 138 100
Cadre N.O 51 33.02%
S.N.O 5 6.9%
P.N.O 26 18.8%
A.C.N.O 15 10.88%
C.N.O 41 30.4%
TOTAL 138 100
Religion Christianity 60 43.47%
Islamic 78 56.52%
Traditional 0 0
TOTAL 138 100
Table 4.1 showed that 108 (63.44%) of the respondents were married, 22(30.36%) were
single, 8(5.8%) were widows.
Data on sex shows that 22(15.9%) were male, 116(84.1%) were females.
Data on level of qualification shows that 104 (56.78%) had diploma, 24(33.12%)
had B.Sc, 10 (7.2%) had other qualifications.
Data on cadre 51 (33.02%) were N.O, 5(6.9%) were S.N.O, 26(18.8%) were
P.N.O, 15(10.88%) were A.C.N.O, 41(30.4%) were C.N.O.

22
 Data on religion shows 60(43.47%) were Christians, 78(56.52%) Islam.
Table 4.2 Respondents knowledge on preventive measures of hospital acquired infection
N= 138
VARIABLE OPTION FREQUENCY PERCENT
AGE
What is hospital acquired a.Infection acquired in 90 65%
infection? hospital [ ].
b.AnInfection acquired by 20 14.5%
handling patients with bare
hands
c.Infection acquired by the 15 10.8%
use of non-porous articles
such as glove, aprons etc.
d.Infection that developed
as a result of negligence 13 9.4%
e.All of the above

Total 138 100%

Do nurses have knowledge Yes 96 69.6%
about hospital acquired No 42 30.4%
infection? TOTAL 138 100%

If yes where did you acquired School 70 50.6%

the information? Health talk 40 28.9%
Seminars 12 8.6%
Journals 16 11.5%
Total 138 100%
Can hospital acquired infection a. Yes 70 50.7%
be prevented? b. No 68 49.3%
Total 138 100%

Table 4.3 shows that majority of the respondents 90 (65%) said that nosocomail infection is an
infection acquired in the hospital,20 (14.5%) said that an infection acquired by handling the
patient with bare hand,while 15 (10.8%) said that is an infection acquired by the use of non
porous article such as glove and 96(69.6%) of nurses have knowledge about prevention of
nosocomial infection, while 42(30.4%) do not have knowledge and 70 (50.6%) said that they
acquired the knowledge in school,40 (28.9%) said through health talk, 12 (8.6%) said through
Saminars,16 (11.5%) said through journal and 70 (50.7%) said that hospital acquired infection

23
can be prevented while 68 (49.3%) said can't be prevented
Table 3: Showing Ways of Practicing Prevention of Nosocomial Infection N=138

VARIABLE OPTION FREQUENCY PERCENTAGE

How can hospital acquired Hand washing 86 62.3%

acquired Infection be
prevented? Dusting 20 14.5%

Sweeping 15 10.8%

Moping of the floor 9 6.5%

All of the Above 8 5.8%

Total 138 100%

Do nurses know how to a. Yes 108 78.3%

practice preventive measures b. No 30 21.7%
of hospital acquired
infection?

Total 138 100%

Do nurses practice the a. Yes 45 32.6%

preventive measure of b. No 93 67.4%
hospital acquired infection?
Total 138 100%

If yes in which way? a. Using of one glove 29 21%

throughout a procedure
b. Dressing a wound with 10 7%
one forceps through out 99 71.7%
c. Through hand hygiene

Total 138 100%

From the table 4.3 shows that 86(62.3%) said that nosocomial infection can be prevented

through hand washing, 20(14.5%) said nosocomial infection can prevented through

24
dusting, 15(10.8%) said through sweeping, 9(6.5%) said through moping of the floor

while 8(5.8%) said all of the above and 108 (78.3) said that they know how to practice

preventive measures of hospital acquired infection while 30 (21.7) didn't know 45

respondents (22.6%) of nurses practice prevention of nosocomial infection while 93

respondents (67.4%) said that they do not practice prevention of nosocomial infection

and 99 (71.7) said that through hand hygiene can be prevented, 29 (21%) said through

using of one glove throughout a procedure, 10 (7%) said through dressing a wound with

one forcept .

Table 4.4 : showing factors hindering the practice of preventive measures of hospital

acquired infection.

VARIABLE OPTION FREQUENCY PERCENTAGE

25
Does lack of a. Yes 115 83%
practicing ideal
standard of b. No 33 23.9%
universal precaution
hinder the practice
of preventive
measures of hospital
acquired infection?

Total 138 100%

Does improper of a. Yes 100 72.5%
personal protective b. No 38 27.5%
equipment hinder
the practice of Total
preventive measures
100%
of hospital acquired
infection?
Does lack of ideal a. Yes 90 65%
method of sterilizing b. No 48
hospital 34.8%
equipment 138
Total
/instructions hinder
100%
the practice of
preventive measures
of hospital acquired
infection?
Does unavailability a. Yes 85 61.6%
of dressing packs b. No 53 38.4%
and others
instruments hinder
the practice of
preventive measures
of hospital acquired
infection?
Total 138 100%
Table 4.4 shows that 115 (83%) of nurses said that factors hindering the practice of

preventive measure of hospital acquired infection is due to lack of practice the ideal

standard universal precautions , 100 (72.5%) said that is due improper use of PPE, 90

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(65%) of nurses is due lack of ideal method of sterilizing of hospital equipment and

85(61.6%) is due to unavailability of dressing packs and others Instrument hinder the

practice of preventive measures of hospital acquired infection.

ANSWERING RESEARCH QUESTIONS

Research question one : what is the level of knowledge on prevention of hospital acquired

infection among nurses in state specialist hospital Maiduguri, Borno State? From the

findings in table 4.2 shows that the majority of nurses 96 respondents have the

knowledge about hospital acquired infection and only 42 respondents didn't have the

knowledge.

Research question two: What is the level of practice of prevention of hospital acquired

infection among nurses in state Specialist Hospital? From the findings in table 4.3 shows

that 45 of respondents practice the prevention of nosocomial infections while 93 of

respondents are not practicing it.

Research question three : what are the factors hindering the practice of preventive

measures of hospital acquired infection? From the findings in table 4.4 which shows that

115 of the respondents said that is due to lack of practicing ideal standard universal

precautions hinder the practice of preventive measures of hospital acquired infection.

CHAPTER FIVE

5.1 KEY FINDINGS

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RESEARCH QUESTION ONE; what is the level of knowledge on prevention of

hospital acquired infection among nurses working in state specialist hospital Maiduguri?

96 respondents (69.6%) of nurses have knowledge about nosocomial infection this is in

line with Quayyum, Saltar, Waqas (2010) who said that nurses have sufficient knowledge

about prevention of nosocomial infection, this is expected from them because they

acquired the knowledge during the period of their training,

RESEARCH QUESTION TWO; what is the level of practice of prevention of

hospital acquired infection among nurses in state specialist hospital Maiduguri? 45

respondents (22.6%) of nurses said that nurses practice the prevention of nosocomial

infection. this is in agreement with the finding of Harnis, et al (2016) who said that

majority of nurses do no not practices the prevention of nosocomial infection because of

the lack of water and soap in the hospital and also due to their negligence to disease

contrary to disease control.

RESEARCH QUESTION THREE; what are the factors responsible for not

practicing preventive measures of hospital acquired infection? 70 respondents (50.7%) of

nurses said that their reasons for not practicing preventive measures of nosocomial

infection are because of negligence. Lynch and White (2016) which stated that nurses

have stated multiple reasons for non-compliance to the practice of prevention of

nosocomial infection which include negligence and understanding, dryness of skin due to

the frequent use of disinfectants, being too busy and wards being full. During this study,

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the researcher find out that majority of nurses said that they do not practice prevention of

nosocomial infection while few of nurses said that they practice it.

5.4 IMPLICATION FOR NURSING:

Illness related to nosocomial infection is a general problem in the country and very big

challenge to nursing practice. Therefore it needs to be looked into in order to reduce the

occurrence of nosocomial infection by creating awareness about prevention of

nosocomial infection and importance of practice of prevention of nosocomial infection.

 Nurses should also be encouraged for further their studies.

 Nurses should attend workshops and seminars to update themselves on prevention

of nosocomial infection.

 Nurses should ensure that there is consistent provision of materials for prevention

of nosocomial infection.

 Nurses should try to practice the correct measures they have learnt.

5.5 LIMITATION:

The limitation encountered during this study includes:

Difficulty in meeting some of the nurses due to the shift system of their job this was

resolved by informing the nurses in time about the questionnaire and meeting those in

morning duty in the morning and those on afternoon in the afternoon while those on night

duty early in the morning.

5.6 SUMMARY:

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This research is a descriptive study on the knowledge and practice of prevention of

nosocomial infection among nurses in state specialist hospital Maiduguri.

The target population was 238 registered nurses while the sample size was 148 (138

questionnaire was retrieved). The data was collected using a self-design closed ended

questionnaire; data was analyzed using frequency table. Major finding revealed that 96

(69.6%) of nurses have the knowledge of the prevention of nosocomial infection while 42

(30.4%) practice it.

5.7 CONCLUSION:

This research was carried out to assess the level of knowledge and practice of prevention

of nosocomial infection among nurses in state specialist hospital Maiduguri,

Nurse can make a significant contribution in preventing nosocomial infection by

assuming full responsibility for quality improvement measures such as evidence based

infection prevention and control protocols. However as general knowledge of the

preventive measures have shown to be rather poor, and nosocomial infection is on the

increase rate, nurses education should include supplementary support from evidence

based recommendation in order to reduced mortality and morbidity in patients.

5.8 RECOMMENDATIONS:

Based on the findings of the study knowledge and practice of prevention of nosocomial

infection in state specialist hospital Maiduguri

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 1. Nurses should be enlightened on the preventive measures of nosocomial infection

and encourage its practice through workshops and seminars.

2 There should be adequate provision of material and equipment’s to aid prompt

intervention of nosocomial infection.

2. Government also creates awareness on nosocomial infection through mass media.

3. Government should help to equip the hospital with necessary materials and

equipment needed in the hospital for the management of the patients who has

contacted nosocomial infection.

4. Formation of policies of institution of an infection control committee to monitor

their implementation in the hospitals.

5.9 SUGGESTION FOR FURTHER STUDIES:

 The effect of nosocomial infection on the patient

 The role of the nurses in the care and treatment of patient with nosocomial

infection.

 The incidence of nosocomial infection in hospital.

 A study to evaluate effectiveness of structural teaching program of prevention of

nosocomial infection among the student nurses.

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