See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/315807733

STUDY ON INFECTION CONTROL PRACTICES AMONG HEALTHCARE WORKERS

IN A SPECIALITY HOSPITAL, CHENNAI

Article  in  Pollution Research · June 2016

CITATIONS READS

0 10,842

2 authors, including:

Bhooma Devi A
Sri Ramachandra Institute of Higher Educaiton & Research
14 PUBLICATIONS   3 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Bhooma Devi A on 07 April 2017.

The user has requested enhancement of the downloaded file.

Poll Res. 35 (3) : 549-555 (2016)
Copyright © EM International
ISSN 0257–8050

STUDY ON INFECTION CONTROL PRACTICES AMONG

HEALTHCARE WORKERS IN A SPECIALITY HOSPITAL, CHENNAI
K. VINODHINI1* AND A. BHOOMA DEVI1
1
Department of Management Studies,
Sri Ramachandra College of Management, Sri Ramachandra University,
Porur, Chennai, Tamil Nadu, India
(Received 15 April, 2016; accepted 10 June, 2016)

ABSTRACT
Hospital Infection control is very essential for the safety and wellbeing of patients, hospital staffs
and visitors of the hospital. It affects various Departments of the hospital and it also involves
problems of quality risk management, clinical governance of health and safety. Hospital infection
control program with stable structure should be present in all institutions that provide health care
in order to create a managed environment. The study aims to assess and compare the infection
control practices and policies among the healthcare providers. The study will serve as a source of
finding the aspects of existing infection control practices and thus will be helpful in bridging the
gap between the current infection control practices. It also integrates the process with the
organization to maintain and improve the effectiveness of clinical services. It was evident that
infection control measures and practices were not up to the mark because of so many factors such
as inadequate biomedical waste management practices, inadequate practices in spill management,
inadequate practices in usage of sodium hypo chloride, recapping of the needle and document
regarding the needle stick injury and inadequate practices on the hand washing before touching
the patient. From the study it is evident that there was an inadequate infection control practice
among the health care workers and also compliance percent. Hence there is a need for continuous
and mandatory training, surveillance, infection control program.

KEY WORDS : Biomedical waste management, Hand washing, Healthcare workers,

Infection control practices, Needle stick injury

INTRODUCTION infection control may facilitate transmission. In spite

Infection control is the discipline which is concerned
with preventing health care associated infection; it is
a vital; though often non-supported and not
recognized as a part of the organization of the
healthcare.
Hospital Acquired Infections (HAI) is a major
global safety concern for both patients as well as
healthcare professionals. Many factors stimulate
infections among hospitalized patients – ‘decreased
resistance among patients’; ‘increasing variation of
medical procedures’ and ‘invasive techniques
crafting potential routes of infection’; and ‘the
transmission of drug-resistant bacteria’ are packed
among hospital populations’, where poor practice in
of development in community/public health and
care in hospitals, infections continue to grow in
hospitalized patients, and may also affect hospital
staffs. The burden of HAI is considerable in
developed countries, where it affects from 5 per cent
to 15 per cent of hospitalized patients in general
wards and as many as 50 per cent or more of
patients in intensive care units. In developing
countries, the degree of the problem remains
underrated or even unknown largely because
diagnosis of hospital acquired infection is
multifaceted and surveillance activities to guide
interventions require proficiency and resources.
Studies also shows that patients hospitalized in
Intensive Care Units are 5 to 10 times more

Corresponding author’s email: bhooma.ganesh@gmail.com

550 VINODHINI AND DEVI\
prospective to get nosocomial infections than other
hospital patients. While most of the existing
measures to prevent and control nosocomial
infections in the Hospital need modifications,
enhancements and refinements to these existing
measures may only help in further improving.
NEED OF THE STUDY
A hospital is one of the most likely places for
acquiring an infection because it harbours a high
population of micro-organisms, some of which are
resistant to certain antibiotics, which may lead to
hospital acquired infections. This study was found
necessary to intervene and get insights about the
problem of Healthcare associated disease and
constraints that arises due to inadequate infection
control practices, thereby finding an appropriate
solution for the occupational safety of the
employees. Thus focuses on improving the clinical
services and well-being of the patient’s and health
care provider. Information drawn from this research
can serve as guidelines to institute and improve
existing hospital services related to infection control,
make new ones to achieve excellence services.
OBJECTIVES
1. To assess the existing infection control practices
and the clinical indicators in the selected
hospital.
2. To compare various Safety Practices among the
respondents in the selected hospital.
3. To give suggestions to improve on various
safety practices to control Hospital Acquired
Infections.
METHODOLOGY
The research was done in Specialty hospital,
Chennai which come under ACME consulting
services. This project is based on Descriptive
research design since the author obtains information
concerning the current status from the respondents
to describe “what exists” with respect to the
variables in a situation. The method involved in the
study is to obtain wide range of data from the
survey which describes the existing state or
condition in the hospital. The correlation study
explores the relationship between variables, to
development studies which seek to regulate changes
over time. A structured validated questionnaire was
used to gather data from the respondents through
scheduling method and observation. The secondary
data was obtained from the hospital records, case
sheets, documents and registers. The sampling
techniques- Since the study population is finite and
it is around 150 (74 nurses, 48 paramedical staffs, 28
housekeeping) all the respondents were included in
the study. The sample size is 150, in which 74 are
nurses, 46 are paramedical staffs and 28 are
housekeeping.
The statistical tools used includes,
• Percentage is a kind of ratio analysis.
• Weighted average in which each quantity to be
averaged is assigned a weight.
• t-test is used and Paired difference test is used
to compare two sets of measurements and to
assess whether their population means differ.
• Analysis of variance is the technique used to
test the quality of means, when more than two
populations are considered.
• A chi-square test is used for testing
independence and goodness of fit.
The following null hypothesis is involved in the
study:
• There is no significant difference among the
respondents and their hand washing practices
• There is no significant difference among the
respondents and their personal protective
equipment practice
• There is no significant relationship between
hand washing practice and clinical indicators
of infection control.
• There is no significant relationship between
personal protective equipment practice and
clinical indicators of infection control.
• There is no significant difference between the
level of infection control practices among
respondents and their demographic variables.
Pilot study: The pilot study showed (30 patients) the
content validity and reliability of the questionnaire
(0.87). After reliability check and based on the
suggestions from experts in the field and analysis of
the pilot study the questionnaire was refined by
altering and removal of few questions. The approval
from institutional ethical committee was obtained.
REVIEW OF LITERATURE
Neha Malik and Satpal (2014) have done a study on
Management and Control of Nosocomial Infections
in Hospitals. Kiran Chawla and Arun Madan et. al,
 STUDY ON INFECTION CONTROL PRACTICES AMONG HEALTHCARE WORKERS 551

(2014) have done a study on Healthcare associated
infections: A menace-role of management at a multi-
super-specialty hospital in North West Region of
Delhi. The study was carried out at three ICU’s of
Hospital A in North-West Delhi-‘Surgical Intensive
Care Unit (SICU)’, ‘Respiratory Intensive Care Unit
(RICU)’ and ‘Medical Intensive Care Unit (MICU)’.
There is a significant correlation between mortality
and HAI with no significant correlation between
morbidity and HAI also no significant correlation in
ALOS and HAI. Hema Gogia and Jayanta K. Das
(2013) have done a study in two Intensive care units
of tertiary setup hospital, Delhi on the awareness
and practice of infection control among the doctors
and nurses. The study found various other factors
which are also responsible for the poor infection
control practices in hospital setup in spite of high
awareness among doctors and nurses. Tuhina
Banerjee (2013) has stated in her study that the
challenges in infection control practices still
continues because of the increasing emergence and
spread of multi-resistant bacteria in hospitals
worldwide. And stated that there is substantial risk
to patients still prevails in spite of all efforts to
improve hospital hygiene, and it is an added burden
to hospitals. Kanwalpreet Sodhi et al., (2013) have
done a study on Knowledge of infection control
practices among intensive care nurses in a tertiary
setup hospital which shows that there was fairly
good knowledge among nurses and there is an
opportunity for improvement with regular
educational programs and in-house training. The
below table shows around the maximum of 50
percent of the nurses are under the age group of 20
to 30 years of age, 48 percent of Para medicals fall
under the age group of 30 to 40 years of age and 50
percent of the housekeeping fall under 40 to 50 years
of age.
Among the respondents, the majority are female
i.e. nurses 74 percent, para medicals 56 percent,
housekeeping 68 percent.
Among the respondents, the majority of nurses
had 0-2 years of experience i.e. 53 percent. The
majority of the paramedical had 2-4 years i.e. 46
percent and housekeeping had 2- 4 years 46 percent.
ANALYSIS AND INTERPRETATION
The above table describes that Hand washing
practices among nurses were moderately adequate
of 77 percent, 58 percent had adequate practices in
Personal protective equipment, 58 percent had
moderately adequate practices in Disinfection of
equipment and sterilization, 100 percent had
moderately adequate practices in Pre and post
exposure prophylaxis, 72 percent had inadequate
practices in Biomedical waste management
practices, 86 percent had inadequate practices in
Spill management, 61 percent had moderately
adequate practices in Linen and laundry
management. The clinical indicators in infection
control according to NABH standards were
assessed. Around 51 percentage of nurses had
moderately adequate practices in Catheter assisted
urinary tract infection, 42 percentage had
inadequate practices in Surgical site infection.85
percentage had moderately adequate practices in
Ventilator associated pneumonia, 51 percentage had

Table 1. Percentage distribution of demographic variables of the samples

Demographic Variables Nurses (74) Paramedical (48) Housekeeping (28)
No. % No. % No. %
Age
(a) 20 - 30 years 37 50 15 31 4 14
(b) 30-40 years 26 35 23 48 6 22
(c) 40 -50 years 5 7 6 13 14 50
(d) Above 50 years 6 8 4 8 4 14
Gender
Male 0 0 21 44 9 32
Female 74 100 27 56 19 68
Experience
(a) 0-2 years 39 53 19 39 6 22
(b) 2-4 years 23 31 22 46 13 46
(c) Above 5 years 12 16 7 15 9 32
Source: Primary
552 VINODHINI AND DEVI\

moderately adequate practices in Intra-vascular

HK

50
36
54

25
21
39
catheter infection practices. The overall infection

0
0
control practices among the nurses were moderately
Adequate Practice

adequate of 59 percent.
Table 2. Percentage distribution of level of various safety practices among the respondents (Nurses, paramedical staffs and housekeeping staffs (HK))

Parameds
The hand washing practices among paramedical
(>75%)
N = 48

54
23
65

27

27

54
were moderately adequate of 67 percent. The

0
0
Personal protective equipment practices were
adequate of 65 percent. The Disinfection of
equipment and sterilization practices was adequate
Nurses

of 54 percent. The Pre and post exposure

37
16
58

30

16
8
0
0

prophylaxis practices were moderately adequate of

98 percent. The Biomedical waste management
practices were moderately adequate of 44 percent.
Moderately Adequate Practice

NA
HK

The Spill management practices were inadequate of

50
60
39

54
22
50

36
75

90 percent. The Linen and laundry management

practices were moderately adequate of 63 percent.
Parameds
(50 – 75%)

The overall infection control practice among the

N = 48

paramedical was adequate of 54 percent.

42
67
25

44
10
63

45
46
98

20
20
11

The hand washing practices among

housekeeping were moderately adequate of 60
percent. The Personal protective equipment
Nurses

NA
100
58
77
37

20
14
61

59

practices were adequate of 54 percent. The

Disinfection of equipment and sterilization practices
was adequate and moderately adequate of 50
percent. The Pre and post exposure prophylaxis
HK

21
57

51
64
25

51
38
85
11
0
4
7

practices were moderately adequate of 75 percent.

The Biomedical waste management practices were
Inadequate Practice

moderately adequate of 54 percent. The Spill

Parameds

management practices were inadequate of 57

(<50%)
N = 74

NA
10
10

29
90
10
4

0
2

percent. The Linen and laundry management

practices were moderately adequate of 50 percent.
The overall infection control practices among
Nurses

housekeeping were inadequate of 64 percent.

72
86

29

25
42
5
7
5

4
0

The above finding with regard to the comparison

of hand washing practice is statistically significant
(p<0.05) for housekeeping staff when compared to
Para medicals and nurses. Hence the null hypothesis
is rejected.
Disinfection of equipment and sterilization

With regard to the comparison of for personal

protective equipment practice is statistically not
Catheter assisted urinary tract infection

significant for paramedical staff when compared to

Pre and post exposure prophylaxis

nurses and housekeeping. Hence the null hypothesis

Ventilator associated pneumonia
Linen and laundry management

Intra-vascular catheter infection

Biomedical waste management
Personal protective equipment

is accepted.
The above finding with regard to the comparison
of disinfection of equipment and sterilization
Surgical site infection

practice is statistically not significant for

Spill management

housekeeping staff when compared to nurses and

Source: Primary
Hand washing

paramedical. Hence the null hypothesis is accepted.

Safety Practice

With regard to the comparison of pre and post

exposure prophylaxis practice, it is statistically
Overall

significant (p<0.05) for nurses when compared to

Para medicals, housekeeping (p<0.001). The
 STUDY ON INFECTION CONTROL PRACTICES AMONG HEALTHCARE WORKERS 553

comparison of pre and post exposure prophylaxis
practice is statistically significant (p<0.01) among
para medical and housekeeping. Hence the null
hypothesis is rejected.
With regard to the comparison of biomedical
waste management practice it is statistically
significant (p< 0.001) for nurses when compared
between housekeeping and Para medicals. Hence
the null hypothesis is rejected. The comparison of
biomedical waste management practice among the
paramedical and housekeeping is statistically not
significant. Hence the null hypothesis is accepted.
With regard to the comparison of spill
management practice it is statistically significant
(p<0.001) for nurses when compared to Para
medicals and housekeeping. Hence the null
hypothesis is rejected.
With regard to the comparison of linen and
laundry management practice it is statistically not
significant for housekeeping when compared to
Nurses and Para medicals. Hence the null
hypothesis is accepted.
Null Hypothesis : There is no significant
relationship between hand washing practices and
the personal protective equipment practices of the
respondents and the clinical indicators.
The above table shows there is significant
relationship between hand washing practice and the
following clinical indicators that is Catheter
associated urinary tract infection (P < 0.001) and
Surgical site infection (P < 0.001). Hence the null
hypothesis is rejected. There is no significant
relationship between hand washing practice and the
following clinical indicators that is ventilator
associated pneumonia and Catheter associated
blood born infection.
With regard to personal protective equipment
practice, there is significant relationship between
personal protective equipment practice and the
following clinical indicators i.e. Catheter associated
urinary tract infection (P < 0.001) and Surgical site
infection (P < 0.001). Hence null hypothesis is
rejected. There is no significant relationship between
hand washing practice and the following clinical
indicators that is Ventilator associated pneumonia
and Catheter associated blood born infection.
Null Hypothesis: There is no significant association
between age, gender, years of experience and the
level of infection control practices among the
respondents (nurses, paramedical staffs and
housekeeping staffs)

Table 3. Comparison of Various Safety Practice Scores among the Respondents

Respondents Hand Personal Disinfection Pre and post Biomedical Spill Linen and
washing protective of equipment exposure waste management laundry
practice equipment and prophylaxis Management practice management
practice sterilization practice Practice practice
practice
Nurses 0.787 0.689 0.062 0.016* 0.000*** 0.000*** 0.216
Paramedical
Nurses 0.011 * 0.755 0.098 0.000*** 0.000*** 0.000*** 0.829
Housekeeping
Paramedical 0.011* 0.559 0.704 0.004** 0.835 0.001** 0.243
Housekeeping
Source: Primary data *p<0.05, **p<0.01, ***p<0.001 = significant

Table 4. Assessment of Impact of Hand Washing Practice and Personal Protective Equipment (PPE) Practice on Clinical
Indicators
Clinical Indicators Hand washing Personal protective
practice equipment practice
Catheter associated urinary tract infection 0.000*** 0.000***
Surgical site infection 0.000*** 0.000***
Ventilator associated pneumonia 0.741(N.S) 0.080(N.S)
Catheter associated blood born infection 0.071(N.S) 0.192(N.S)
Source: Primary data ***p<0.001, N.S – Not Significant
554 VINODHINI AND DEVI\
The above table depicts, there is significant
association between age and years of experience and
the level of infection control practices among nurses
(p<0.001). Hence the null hypothesis is not accepted.
There is significant association between age,
gender and years of experience and the level of
infection control practices among paramedical staffs
(p<0.001). Hence the null hypothesis is rejected.
There is significant association between age and
years of experience and the level of infection control
practices among housekeeping staffs (p<0.001).
Hence the null hypothesis is not accepted. There is
no significant association between gender and the
level of infection control practices among
housekeeping staffs. Hence the null hypothesis is
accepted.
FINDINGS AND SUGGESTIONS
The following suggestions are given based on the
findings:
• For the inadequate biomedical waste
management Practices the staffs can be
educated on disposal of waste on colour coded
bins, Posters can be displayed, regular audits
can be conducted by the hospital infection
control committee.
• For the inadequate practices in Spill
management the staffs can be educated on the
spill management techniques, Mock spill
management can be conducted and the
employees can be recognised.
• For inadequate practices in usage of sodium
hypochloride the staffs can be created
awareness on the importance of using the
sodium hypochloride.
• For pre and post exposure prophylaxis
practice, all the staffs should be immunised
with HbsAg vaccine,
• To avoid recapping of the needle and intimate
to respective in charge and document
regarding the needle stick injury and standard
Table 5. Chi-square for Demographic Variables on Level of Practice among the Respondents
Demographic Variables NURSES
Age - 20 - 30 years, 30 - 40 years, χ2 = 32.873
40 - 50 years, Above 50 years p = 0.001**
Gender - Male & Female NA (since all the
nurses are female)
Experience - 0 – 2 years, χ2 = 36.382
2 – 4 years, Above 5 years p = 0.001**
Source: Primary
Operating procedure have to be followed for
needle stick injury.
• For inadequate practices on the hand washing
before touching the patient, the staffs should be
trained and educated on Health care
Associated infection
• The staffs needed to be trained on
documentation and provide Catheter care
daily in Catheter associated urinary tract
infection and Antiseptic skin preparation and
Monitor the patients Post Discharge for
infection on surgical site infection.
• There should also be posters, charts, hand-outs
and snippets of these guidelines displayed on
Strategic places/points of the hospital for
ready reference in every department and ward.
• Hospital infection control measure guidelines
must be updated frequently as an essential
procedure. Proper isolation practices such as
separate cubicles for infected patients, negative
air pressure for isolated infected-patients to
prevent spread of infectious agents through
airborne route.
For improving the management and control of
nosocomial infections, hospitals should:
• Provide appropriate feedback of surveillance
data to clinicians and infection control
committee so that they should be encouraged
to take steps for control of hospital infections.
• Education programmes should be planned
time to time for health workers.
• Immunisation of all the health workers who
are at risk is also very necessary.
• Antibiotic prophylaxis should be given on
time.
Hospital Infection Control Programme:
• Monthly staff training sessions on infection
control.
• Frequent assessment of staff’s knowledge
regarding infection control and how infection
spreads.
PARAMEDICAL STAFFS HOUSEKEEPING STAFFS
χ2 = 28.386 χ2 = 14.726
p = 0.000*** p = 0.002 **
χ2 = 7.294 χ2 = 1.052
p = 0.007** p = 0.305 N.S
χ2 = 37.564 χ2 = 15.938
p = 0.000*** p = 0.000***
***p<0.001, **p<0.01, S – Significant
 STUDY ON INFECTION CONTROL PRACTICES AMONG HEALTHCARE WORKERS
• Regular meetings between ward in charges
and infection control nurse.
• Maintenance of registers (i.e. records regarding
sterilization activities, linen, housekeeping,
etc.)
• Detection of hospital acquired infections.
• Accurate data collection and statistics on
incidence of hospital acquired infections.
• Reporting and documentation of needle stick
injuries
Motivational activities for staff
For Involvement of staff in overall maintenance of
optimum standards of infection control the
following can be done:
• Quiz Contests for Clinicians, Nursing Staff,
Paramedical Staff
• Tamil Quiz for Sanitary Staff, Hospital
Attendants
• Test your IQ (Infection Quotient), Elocution,
Debate Competitions
• Poster Competition
• ‘I-keep-my-hands-clean’ Competition
• Best House Keeper Award
• Spillage management championship (Team of
Ward Nursing Supervisor and Housekeeper)
• Infection prevention championship (For
Critical as well as Non-Critical Areas)
• Challenger cup championship (Innovative idea
which has effectively challenged the Infection
Growth)
CONCLUSION
Quality in health care is no more unachievable goal
in the current healthcare setup. With growing
demand for Quality among Patients, hospitals are
now aiming at Accreditation under various
independent accreditation bodies. The hospital is
aiming at NABH Accreditation in the near future
and hence the management is striving to achieve
quality in every department of the hospital. Hence it
is very much essential to assess the hospital infection
control rate and so that corrective and preventive
action is taken to eliminate the cause of infection and
make health care delivery.
REFERENCES
Abdel-Hady, Gilany and Karima Badawy. 2012.
Knowledge of Health Care Providers of Standard
Precautions and Infection Control at Students’
Hospital, Mansoura University, Egypt. TAF
Preventive Medicine Bulletin. 11(1) : 23-28.
Adinma and Ezeama C. 2009. Knowledge and practice of
View publication stats
555
universal precautions against blood borne
pathogens amongst house officers and nurses in
tertiary health institutions in Southeast Nigeria.
Nigerian Journal of Clinical Practice. 12(4) : 398-
402.
Chaua, D.R. and Thompson. 2010. Infection control
practices among hospital health and support
workers in Hong Kong. Journal of Hospital Infection.
75 (4) : 299–303.
Chora, S.K. and Padab, 2012. Differences in the
compliance with hospital infection control practices
during the 2009 influenza H1N1 pandemic in three
countries. Journal of Hospital Infection. 81 (2): 98–
103.
Danchaivijitr, S. and Tantiwatanapaiboon, Y. 1995.
Universal precautions: knowledge, compliance and
attitudes of doctors and nurses in Thailand. Journal
of the Medical Association of Thailand. Suppl 2 :
S112-7.
Diekema, D.J. and Schuldt, S.S. 1995. Universal
precautions training of preclinical students: impact
on knowledge, attitudes, and compliance.
Preventive Medicine. 24(6) : 580-5.
Eesha Arora, and Dr. Prakash P. Dokehas. 2014.
Compliance Percentage Assessment to NABH
Standards for Capacity Building in a Tertiary Care
Hospital in India. PARIPEX - Indian Journal of
Research. 3 (4) : 186-192.
Galal, Yasmine, S. and Labib John, R. 2014. Impact of an
infection-control program on nurses’ knowledge
and attitude in pediatric intensive care units at Cairo
University hospitals. Journal of the Egyptian Public
Health Association. 89 (1) : 22–28.
Gershon, R.R. and Vlahov, D. 1995. Compliance with
universal precautions among health care workers at
three regional hospitals. American Journal of
Infection Control. 23 (4) : 225-36.
Hema Gogia and Jayanta K. Das. 2013. Awareness and
practice of infection control amongst doctors and
nurses in two ICUs of a tertiary care hospital in
Delhi. Population Health Forum. 36 (1 & 2): 1- 11.
Kanwalpreet Sodhi, Shrivastava, A., Arya, M. and Kumar,
M. 2013. Knowledge of infection control practices
among intensive care nurses in a tertiary care
hospital. Journal of Infection and Public Health. 6
(4): 269-275.
Kiran Chawla, Arun Madan, Rakesh K Chawla, Aditya K
Chawla. 2014. The Journal of National Accredi-
tation Board for Hospitals & Healthcare Providers. 1
(2) : 44-51.
Neha Malik and Satpal. 2014. Management and Control
of Nosocomial Infections in Hospitals. International
Journal of Scientific Research. 3(2) : 227-228.
Tuhina Banerjee, Joel Filgona and Shampa Anupurba.
2013. Comparative analysis of newly introduced
disinfectants in hospitals in India: An important
aspect of infection control policy. International
Journal of Infection Control. 9 (1) : 1-5.