WELWITCHIA HEALTH TRAINING CENTRE

KNOWLEDGE AND PRACTICES REGARDING INFECTION PREVENTION AND

CONTROL AMONG STUDENT NURSES AT ENGELA DISTRICT HOSPITAL

NAME: MIRJAM TWIIHALENI HALWOODI

STUDENT NUMBER: 2018193062

SUPERVISOR: MISS H. MUTULENI

A MINI RESEARCH SUBMITTED IN PARTIAL FULFILMENT FOR THE

BATCHELOR OF NURSING SCIENCE AT CLARA BARTON SCHOOL OF NURSING,

WELWITCHIA HEALTH TRAINING CENTER KOMBAT CAMPUS

MARCH 2023

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DEDICATION

I dedicate this work to my sister Miss EASTER HALWOODI who gave me strength to keep on
going, to my family, friends, and fellow students, and lecturers and all who assisted me from
commencement until completion of this project.

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ACKNOWLEDGEMENTS

All thanks are given to the Almighty God; it is only by his grace that am here.

All scholars and authors for the researches they have done that were useful in this research.

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 TABLE OF CONTENTS
DEDICATION...................................................................................................................................i
ACKNOWLEDGEMENTS..............................................................................................................ii
LIST OF FIGURES........................................................................................................................vii
LIST OF TABLES.........................................................................................................................viii
LIST OF ACRONYMS...................................................................................................................ix
ABSTRACT......................................................................................................................................x
CHAPTER ONE: INTRODUCTION AND BACKGROUND........................................................1
1.1. Introduction............................................................................................................................1
1.2. Background............................................................................................................................1
1.3. Problem statement..................................................................................................................2
1.4. Research question..................................................................................................................3
1.5. Purpose of the study...............................................................................................................3
1.6. Research objectives................................................................................................................3
1.7. Significance of the study........................................................................................................3
1.8. Operational definitions...........................................................................................................4
CHAPTER TWO: LITERATURE REVIEW..................................................................................6
2.1. Introduction............................................................................................................................6
2.2. Infection prevention and control............................................................................................6
2.3. Student nurses’ knowledge regarding infection prevention and control...............................6
2.4. Practices of student nurses regarding infection prevention and control................................7
2.5. Conclusion.............................................................................................................................8
CHAPTER THREE: METHODOLOGY.........................................................................................9
3.1. Research design and approach...............................................................................................9
3.2. Population..............................................................................................................................9
3.3. Sampling method...................................................................................................................9
3.3.1. Inclusion criteria.............................................................................................................9
3.3.2. The exclusion................................................................................................................10
3.4. Sample size..........................................................................................................................10
3.5. Study setting.........................................................................................................................10
3.6. Research instrument.............................................................................................................11

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 3.7. Data collection.....................................................................................................................11
3.8. Data quality..........................................................................................................................12
3.8.1. Validity.........................................................................................................................12
3.8.2. Reliability......................................................................................................................12
3.9. Data analysis........................................................................................................................12
3.10. Ethical considerations........................................................................................................12
3.10.1. Protecting the rights of the institutions (institutional clearance)................................12
3.10.2. Right to self-determination.........................................................................................13
3.10.2.a. Autonomy.................................................................................................................13
3.10.3. Right to privacy...........................................................................................................13
3.10.3.a. Data collection.........................................................................................................13
3.10.3.b. Data storage.............................................................................................................13
3.10.4. Right to anonymity and confidentiality......................................................................14
3.10.5. Right to fair treatment.................................................................................................14
3.10.5.a. Equitable distribution of study benefits...................................................................14
3.10.5.b. Participants selection (vulnerable populations).......................................................14
3.10.5.c. Refusal to participate (treatment).............................................................................14
3.10.5.d. Respect.....................................................................................................................14
3.10.6. Right to protection from discomfort or harm..............................................................15
3.10.6.a. Physical, emotional, social, financial.......................................................................15
3.10.7. Scientific integrity on the part of the researcher.........................................................15
3.11. Conclusion.........................................................................................................................15
CHAPTER FOUR: RESULTS......................................................................................................16
4.1. Introduction..........................................................................................................................16
4.2. Demographic Information....................................................................................................16
4.2.1. Gender Statistics...........................................................................................................16
4.2.2. Age group......................................................................................................................17
4.2.3. Nursing category...........................................................................................................18
4.2.4. Year of study.................................................................................................................18
4.2.5. Current department student attached............................................................................19
4.3. Knowledge regarding infection prevention and control......................................................20

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 4.3.1. Clinical waste bags for infectious or potential infectious waste...................................20
4.3.2. Attended in-service training..........................................................................................21
4.3.3. Statements to assess knowledge regarding infection prevention and control...............22
4.4. Practice regarding infection prevention and control............................................................25
4.5. Conclusion...........................................................................................................................28
CHAPTER FIVE: DISCUSSIONS.................................................................................................29
5.1. Introduction..........................................................................................................................29
5.2. Knowledge regarding infection prevention and control......................................................29
5.2.1. Clinical waste bags for infectious or potential infectious waste...................................29
5.2.2. Attended in-service training..........................................................................................29
5.2.3. Statements to assess knowledge regarding infection prevention and control...............29
5.3. Practice regarding infection prevention and control............................................................31
5.4. Conclusion...........................................................................................................................33
CHAPTER SIX: CONCLUSION, RECOMMENDATIONS AND LIMITATIONS....................34
5.1. Introduction..........................................................................................................................34
5.2. Conclusion...........................................................................................................................34
5.3. Recommendations to the findings........................................................................................34
5.4. Recommendation for future studies.....................................................................................35
5.5. Limitation to the findings.....................................................................................................35
5.6. Delimitations of the study....................................................................................................36
REFERENCES...............................................................................................................................37
LIST OF APPENDICES.................................................................................................................40
Appendix A: Research information to participants....................................................................40
Appendix B: Consent form.........................................................................................................41
Appendix C: Request for permission to conduct research at Engela District Hospital..............42
Appendix D: Research Instrument..............................................................................................43

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LIST OF FIGURES
Page

Figure 4.1: Gender statistics……………………………………………………...15

Figure 4.2. Age group of participants…………………………………………….16

Figure 4.3: Nursing category...................................................................................17

Figure 4.4: Year of study………………………………………………………….18

Figure 4.5: Current department student attached....................................................19

Figure 4.6: Clinical waste bag colours……………………………………………20

Figure 4.7: Attended in-service training for infection prevention and control……21

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LIST OF TABLES

Page

Table 4.1: Knowledge regarding infection prevention and control……………..22

Table 4.2: Practice regarding infection prevention and control…………………24

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LIST OF ACRONYMS

CDC-Centers for Disease Control

HAI-Hospital Acquired Infections

HIV-Human Immunodeficiency Virus

IPC-Infection Prevention and Control

KAP-Knowledge, Attitude and Practices

MoHSS-Ministry of Health and Social Services

TB-Tuberculosis

WHO-World Health Organization

WHTC- Welwitchia health training center

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ABSTRACT

The main thrust of this research was to explore the knowledge and practices regarding infection
prevention and control among student nurses at Engela District Hospital. The study aimed to
contributing better insights to strategies that can prevent the infection on patients and among
student nurses within the hospital particularly during practice. The study assessed and describe
the level of student nurses’ knowledge regarding infection prevention and control at Engela
District Hospital, assessed and described the level of student nurses’ practices regarding infection
prevention and control at Engela District Hospital and also formulated necessary
recommendation on infection prevention and control. The study was a quantitative approach with
cross-sectional descriptive design and close ended questionnaires were used to gather data. The
targeted population of this study were student nurses from second, third and fourth year; first and
second semester working in medical, surgical and maternity wards in Engela District Hospital. A
simple random sampling method. This ensures each participant has an equal chance of being
selected at a time. A total of thirty-seven (37) student nurses were reached as the sample of the
study and questionnaire were successfully self-administered to them. The study concluded that
the student nurses have knowledge of infection prevention and control but they all have poor
practices on infection prevention and control. It was recommended that the infection control team
should strictly observe student nurses as they practice.

Key words: knowledge, practices, infection prevention & control

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 CHAPTER ONE: INTRODUCTION AND BACKGROUND

1.1. Introduction
Infection prevention and control is a scientific approach and practical solution designed to
prevent harm caused by infection to patients and nurses. Infection prevention control occupies a
unique position in the field of patient safety and quality universal health coverage since it is
relevant to health workers and patients at every single healthcare encounter World Health
Organisation (WHO, 2019). Nurses and student nurses play a major role in providing quality care
to patients without introducing infections during health care delivery by using appropriate
personal protective equipment, practicing proper hand wash, and ensuring aseptic technique
during procedures to reduce infection transmission.

1.2. Background

Infection-related diseases are still the main cause of death in Namibia, according to the 2019
health profile acquired by (WHO, 2019) statistics. The burden of disease in Namibia includes
HIV, TB, Covid-19, Malaria, other infectious diseases and respiratory infections. Expansion of
the infection prevention and control movements occur due to the increase in infection
occurrences in the country.

Infected patients are admitted into hospitals and therefore hospitals have become common
settings for transmission of diseases. In hospitals, infected patients are a source of infection
transmission to other patients, health care workers and visitors (Sydnor & Perl, 2018).
Nosocomial infection, also known as hospital-acquired infections is one of the leading causes of
death and has much economic cost due to increased hospitalization and prognosis (WHO, 2019).
According to WHO (2019), Hospital acquired infection is defined as an infection occurring in a
patient during the process of care within a health care facility which was not present or
incubating at the time of admission.

Different studies have shown that most health care providers have inadequate knowledge and
practice (Cardo et al., 2019; Bhandari & Rairikar, 2016). A study conducted in Pakistan showed
that, a significant number of participants had inadequate practice on prevention of HAIs (Zaidi et
al., 2016). Similar study in Iran found that 43% of student nurses have inadequate knowledge and

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42% have conventional methods to prevent HAIs (Sarani et al., 2018). Another study in India
showed that the practice of student nurses on prevention of HAIs was 58% (Taneja et al., 2019).

Similarly, in a correlational descriptive study done by Darawad and Al-Hussami (2013) to

explore Jordanian nursing students' knowledge of, attitudes towards, and compliance with
infection control precautions participants were found to have inadequate knowledge about
infection control precautions 50%, positive attitudes 90%, and moderate compliance 76%.
Participants' attitudes toward infection control precautions. Special courses for infection control
precautions within nursing schools in Jordan are recommended with special focus on students'
attitudes.

Lack of knowledge among student nurses can increase the rate of hospital acquired infections.
This is supported by a study that was conducted in Zimbabwe by Trivanhu, Ancia and Petronella
(2014) who determined the barriers of infection prevention and control practices among student
nurses at the Bindura provincial hospital. The study revealed that the majority of student nurses
lack knowledge on infection control principles only 14 student nurses of 50 had excellent
knowledge on infection control principles.

Locally, a study done by Ojulong, Mitonga and Iipinge (2013) on knowledge and attitudes on
infection prevention and control among health science student at University of Namibia showed
that, 31.1% of student nurses had knowledge regarding infection prevention and control
compared to 68.9% without the knowledge. Ojulong et al., (2013) concluded that student nurses
had poor practice on infection prevention through hand hygiene, use of adequate personal
protective equipment, decontamination, cleaning of instruments, sterilization, and use of
antiseptics, disposal of sharps and waste disposal. Therefore, this study seeks to assess the
knowledge and practices regarding infection, prevention and control among student nurses at
Engela District Hospital.

1.3. Problem statement

Poor hospital hygiene has been widely publicized, including patients’ concerns about safety in
hospitals. This has made infection control a hot topic in clinical practice, the media and the
community at large (Shirley, 2019). During clinical practice at Engela District Hospital, the
researcher observed that student nurses do not apply infection prevention and control measures

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such as the use of personal protective equipment, hand wash, safe disposal of needles etc. Hayeh
and Esena, (2013) highlighted that lack of knowledge in infection prevention and control
contribute to high rates of hospital-acquired infections. Uncontrolled nosocomial infection
contributes to prolonged stay, morbidity and mortality that put stress on health care center under
review. Therefore, it prompted the researcher to undertake a scientific study to explore the
knowledge and practice regarding infection, prevention and control among student nurses at
Engela District Hospital.

1.4. Research question

What is the knowledge and practices of student nurses regarding infection prevention and control
at Engela District Hospital?

1.5. Purpose of the study

The purpose of the study is to assess and describe the knowledge and practices regarding
infection, prevention and control among student nurses at Engela District Hospital.

1.6. Research objectives

 To assess and describe the level of student nurses’ knowledge regarding infection
prevention and control at Engela District Hospital;

 To assess and describe the level of student nurses’ practices regarding infection
prevention and control at Engela District Hospital;

 To formulate necessary recommendation on infection prevention and control.

1.7. Significance of the study

Researcher

The researcher will gain knowledge on the infection prevention and control and research skills.

Training institution (WHTC)

The research will add information in the existing body knowledge and this will help students to
adhere to proper infection prevention and control during their clinical practice. The results of this
study will be used to increase knowledge prevention and control of infectious diseases.

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Study setting (The hospital)
Efficient knowledge and best practices by student nurse in infection prevention and control may
contribute to decreasing in infection rate in the hospital.

The Ministry of Health and Social Services

The findings from this study will add to the existing literature and will be used in developing

interventions to increase infection control practices by the Ministry of Health and Social

Services. Study population

This study will help students to adhere to proper infection prevention and control during their
clinical practice. It will increase the student nurses’ knowledge on infection prevention and
control, efficient knowledge on infection prevention and control may contribute to decreasing in
infection rate in all Hospital.

1.8. Operational definitions

Knowledge
Understanding of information about a subject, which has been obtained by experience or study,
which either in person’s mind or possessed by people? (Oxford 2013).

Practice
According to the Oxford Advanced learner’s dictionary (2013), practice is the actual application
rather than just ideas. It is the way of doing something that is usual or expected way in a
particular organization or situation.

Infection
Invasion and multiplication of microorganisms in body tissues. (Sydnor 2018)

Infection control
The policies and procedures of a health facility to minimize the risk of spreading nosocomial or
community acquired infections to patients and members of the staff.

Healthcare-associated infections
A patient acquires infections or adverse events after 48 hours of admission to a healthcare
setting, which was not present on the admission of the patient (WHO, 2019: HAI Fact Sheet).

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Prevention: Is the act of stopping something bad from happening (Oxford 2013)?

CHAPTER TWO: LITERATURE REVIEW

2.1. Introduction

In this chapter, an overview of existing literature on the hospital acquired infection and aspects
related to knowledge and practice of student nurses regarding infection prevention and control is
presented. The review includes relevant research findings on knowledge and practice of student
nurses on infection prevention and control. The chapter briefly deliberates on transmission of
infections, prevention strategies of hospital acquired infections and an overview of knowledge
and practice on infection prevention and control.

2.2. Infection prevention and control

According to Ojulong, Mitonga and Lipinge (2013), infection prevention and control are aimed
at reducing the incidence of nosocomial infections. Ojulong et al., (2013), evaluated knowledge
and attitudes of infection prevention and control among health science students at the University
of Namibia. The study revealed that knowledge about infection prevention and control and
awareness of its importance among health science students was poor. It was therefore concluded
that serious efforts are needed to improve or review curriculum so that health science students’
knowledge on infection prevention and control is imparted early, before they are introduced to
the wards (Ojulong et al., 2013).

2.3. Student nurses’ knowledge regarding infection prevention and control

According to the WHO (2017), knowledge is the information, understanding and skills that are
gained through education and experience in this case knowledge about infection prevention and
control. The surveillance of hospital acquired infections are regarded as an essential part of
infection control and prevention. In this regard, Razine., et al., (2018) determined the prevalence
of hospital-acquired infections (HAIs) in all institutions of Rabat University Medical Centre in
Morocco. The study showed that the prevalence of HAIs was high. Therefore, recommendations
for future control measures to focus on patients who stay longer in the hospital, patients with
invasive devices and irrational use of antibiotics were made. Sessa, Giuseppe, Albano &
Angelillo (2017) recommended education and training programmes for student nurses after their

5
study found that although student nurses level of knowledge was not principles, 21 (42%) of 50
student nurses did not utilize the infection control manuals.

Failure to apply infection control procedures favours the transmission of pathogens, and
healthcare settings can act as amplifiers of disease during epidemics, with a bearing on both
hospital and public health (WHO, 2019). According to WHO (2019), a huge gap exists between
the knowledge accumulated over the past decades and implementation of infection control
practices. This gap is even deeper in poor-resource settings with devastating consequences.
Breaches of infection control measures undermine every advance and investment in health care
(WHO, 2019). According to Eskanderl, Morsy and Elfeky (2019), critical care nurses have an
obligation to protect critically ill patients against infection. The study to assess critical care
nurse’ knowledge and evaluate their practice regarding infection control standard precautions
was performed. The study reviewed that two-thirds (63.6%) of the studied sample had
unsatisfactory Knowledge level. Hence recommendations were made of updating knowledge and
performance of critical care nurses through continuing in-service educational programs
(Eskanderl et al., 2019). El-Enein, Younis, Mahdy and Hala (2017) determined the degree to
which standard precautions were applied by nurses in a dialysis unit in terms of hand hygiene
and use of personal protective equipment. The study reviewed that less than half of the nurses
(47%) correctly knew that they had to wash their hands before and after caring for a patient.

2.4. Practices of student nurses regarding infection prevention and control

According to the Oxford dictionary (2020), to practice is to do something regularly as part of

your normal behaviour which in this case is infection prevention and control practices. It is,
therefore, important that all health workers strictly adhere to infection control guidelines,
especially nurses because they spend more time with the patients (NHS Professionals, 2019).

According to NHS Professionals (2019), good hand hygiene is the most important practice in
reducing transmission of infectious agents as well as health-care associated infections.
Respiratory hygiene or cough etiquette has been added to standard infection control precautions
due to a recent global Covid-19 pandemic (NHS professionals, 2019). Furthermore, general good
practices include ensuring that occupational immunisation and clearance are up to date for all

6
staff. All staff must dispose of clinical waste according to local policy with sharps in assembled
sharp container.

Assessing knowledge, attitudes and sources of information among Nursing Students towards
infection control and standard precautions, Ghalya and Ibrahim (2019), results revealed that the
overall knowledge scores for nursing students towards infection control and standard precautions
were acceptable. Students achieved the highest score in hand hygiene domain and lowest score in
sharps disposal and sharps injuries.

Good practices of nurses in infection prevention and control reduces the potential for nosocomial
infection thereby promoting patient safety. However, patient safety can be jeopardized if nurses
intentionally fail to comply with implemented infection control measures leading to
negligence/malpractice (Ghalya & Ibrahim, 2019),

2.5. Conclusion

To sum up, the literature has shown that hospital acquired infection is not only a problem in
Africa but also affect other countries globally. Literature has also indicated that inadequate
knowledge and practice regarding infection prevention and control is the main impact leading to
hospital acquired infection. Some suggestions made to tackle this challenge were pointed out in
the literature review. The next chapter is going to explain the methodology to be adopted in this
research.

7
 CHAPTER THREE: METHODOLOGY

3.1. Research design and approach

A research design is the overall plan for gathering data in a research study. Once the research
question is identified, the study must be then designed (Brink, et al., 2018). With this study, a
quantitative approach was used as it is concerned with gathering information from a
representative sample of the population. The researcher makes use of a cross-sectional
descriptive design because it provides descriptions and evaluate knowledge and practice
regarding infection prevention and control.

3.2. Population

The population is the entire group of persons or objects that is of interest to the researcher and
which meet the criteria into which the researcher wishes to investigate (Brink et al 2018). The
target population are all student nurses working in Engela district hospital. There are a total
number of ±100 student nurses. The study population was student nurses working at selected
wards such as medical, surgical and maternity wards. Student nurses working in these wards are
exposed to infection.

3.3. Sampling method

Sampling refers to the researcher's process of selecting the sample from a population in order to
obtain information regarding a phenomenon in a way that represents the population of interest
(Brink et al 2018). The researcher used a simple random sampling method. This ensures each
participant has an equal chance of being selected at a time (Brink et al, 2018). Fish bowl
technique was used whereby papers were put in a bowl and were written yes and no. Every
respondent that selects a yes paper was selected to participate for the study

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3.3.1. Inclusion criteria

All student nurses from second, third and fourth years first and second semester working in
medical, surgical and maternity wards in Engela District Hospital. These student nurses provided
rich data about infection prevention and control relevant to the research question.

3.3.2. The exclusion

The student nurses outside this health care center will not form part of this study. First year
student will be excluded. Those student nurse who are not working in medical, surgical and
maternity wards were excluded.

3.4. Sample size

A sample is a group of subjects selected from the total population (Brink et al 2018). Sample size
was calculated using the simplified Taro Yamane formula at 95% confidence level (Yamane,
1964).

n=

n=

n=

n=37 student nurses

Where;

n=sample size required

N=number of people in the population

e= level of precision / margin of error (%)

The margin of error for 95% confidence level is thus 0.05 (5%)

3.5. Study setting

The study was conducted in Engela District Hospital. The chosen hospital is one of the oldest
hospital in the northern part of Namibia. It was built in 1902. Engela District Hospital is located

9
in Ohangwena region. Engela serves as the primary health care of Ohangwena Region which has
a size of approximately 23000𝐾𝑚2. Engela is staffed with 150 nurses as well 15 doctors. It can
accommodate ±80 student nurses for clinical placement from different institutions. The hospital
has 320 beds, 6 different wards and 18 clinics under it. The services offered include treatment of
various conditions at primary health care services level, immunizations, antenatal care services
and treatment and admission of chronic and acute conditions. The researcher selected this
hospital amongst other hospitals in Namibia because its located closer to her residential area and
she used to do her clinical practices at this hospital.

3.6. Research instrument

The researcher used questionnaires as an instrument to collect data. The questionnaires were in
English because in Namibia, hospitals use English for official communication. Questionnaires
were self-administered to avoid losing them. The questionnaire consisted of 3 sections, whereby
section A was socio-demographic data, section B was based on knowledge regarding infection
prevention and control and C was based on practices regarding infection prevention and control.
The respondents were asked to tick the appropriate answer. The questionnaires were with closed
ended questions. Questionnaires when self-administered, allow privacy as respondents can
answer questions alone and respondents are more likely to answer questions truthfully.
Questionnaires are quicker to administer, are cheap instruments when intending to reach a
number of people (Brink et al 2018).

3.7. Data collection

This is the precise, systematic gathering of information relevant to a research purpose (Brink et
al, 2018). The researcher explained the purpose of the study verbally and participants signed
informed consents. In this study the data on knowledge and practices regarding infections
prevention and control among student nurses was collected using self-administered
questionnaires, whereby the questionnaires were administered to randomly selected student
nurses. The researcher distributes questionnaires per hand to participants and they completed
themselves by writing. The researcher collected data at the nurses’ station and in the staff board
room, from Monday to Friday during lunch time and knock of time at 16:00. The questionnaires
were collected the same day to prevent bias.

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3.8. Data quality

3.8.1. Validity

Validity is the ability of an instrument to measure what it is supposed to measure (Brink et al,
2018). The researcher ensured content validity by formulating the questionnaire based on the
objectives of the study and the literature gathered.

3.8.2. Reliability

The researcher conducted a pre-test study to ensure reliability; this was done by giving the
questionnaire to a small number of student nurses who did not take part in the study to detect
flaws in the research instrument.

3.9. Data analysis

Data analysis is a difficult process where a phenomenon is broken down into its essential parts
for it to be understood better (Lawrence & Tar, 2018). Data was analyzed using percentage
analysis with the help of Microsoft excel 2016. This enabled the researcher to organize,
summarise, evaluate, interpret and communicate quantitative data (Brink et al 2018). Data was
checked for clarity, completeness and then edited and coded to facilitate entering into the
computer. Descriptive statistics were used to summarize the data and provide answers to the
research objectives in the form of tables and graphs.

3.10. Ethical considerations

According to Polit and Beck (2018) these are systems of moral values concerned with the degree
to which research procedures adhere to professional, legal and obligations to study participants.
This study was guided by the following research ethics:

3.10.1. Protecting the rights of the institutions (institutional clearance)

The rights of the institutions were protected by the researcher since she only conducted the study
after getting clearance from the institution. Additionally, the researcher used various ethic
frameworks and codes from the institutions to conduct the study in a way that her conduct is in
line with research ethics. The data obtained will also not be shared with anyone outside the

11
institutions without the concern of the institution as the data will only be used for academic
purposes only.

3.10.2. Right to self-determination

Participation in the study was voluntarily with the respondents free to withdraw from partaking if
at any point they do not feel comfortable with proceeding with the study or it violates their
confidentiality in one way or another.

3.10.2.a. Autonomy

Autonomy was ensured by giving the respondents all the information they may need about the
study especially with regards to its aims. The respondents were also made to be aware of how
their contributions bring about positive change and help identify strategies to strengthen triage
systems. This gave them a sense of ownership that encouraged them to be as honest and unbiased
as possible in their responses.

3.10.3. Right to privacy

Privacy was maintained in the study by ensuring that all information is kept safely and not shared
with any parties that are not involved in the study. Responses from each respondent were also not
shared among respondents.

3.10.3.a. Data collection

Privacy during the data collection process was implemented by not requesting the respondents to
put any personal information on the questionnaires they fill in. Additionally, the researcher
avoids carrying the questionnaire sheets around whenever they are not being used so that they are
not misplaced or end up in the wrong hands.

3.10.3.b. Data storage

Data will be stored in a lockable safe whenever it is not being used. Soft copies will be kept in
google drive and external hard drives and also in computer folders to be all accessed with
passwords. Upon completion of the study the researcher will keep the data in the safe for about 5
years before they are disposed of through burning.

12
3.10.4. Right to anonymity and confidentiality

Researcher’s identity was concealed as to maintain anonymity of respondents in the study. The
information of the respondents will be kept private throughout the study and will not be disclosed
to unauthorized persons to ensure that the principle of confidentiality is maintained.

3.10.5. Right to fair treatment

Fair treatment in this study revolved ensuring that all the respondents go through the same
processes and procedures during the study.

3.10.5.a. Equitable distribution of study benefits

All the respondents will benefit by having equal access to the findings of the study. Meetings will
be arranged where the results of the study will share and or participants of the study will access
the institution library where the results will be kept upon completion. This is especially important
considering that this study is particularly relevant to them and their day to day duties as health
care workers.

3.10.5.b. Participants selection (vulnerable populations)

Participants were selected fairly by ensuring that all respondents are given the freedom to
participate in the study voluntarily.

3.10.5.c. Refusal to participate (treatment)

Respondents participated not in any way they were forced or coerced into participating in the
study and were also informed that their refusal will not in any way be reported or will they be
held responsible for it as participation was by free will.

3.10.5.d. Respect

All participants were treated fairly and with respect from how they were approached, requested to
partake and through the data collection process and beyond. The researcher ensured that all the
communication was formal and courteous and in line with the study with all the participant.

13
3.10.6. Right to protection from discomfort or harm

The data was collected in private spaces at the hospital to ensure that other people working there
do not intrude and make the respondents feel uncomfortable or their views are seen especially
those that might not be in support of the system at the hospital and may lead to prejudice. The
researcher also ensure that the responses from other respondents are not shared with the other
respondents in case there is especially some information digging as to who may have shared
negative views. Additionally, if at any moment any of the respondents feel uncomfortable or
unsafe they were given an option to stop the study and withdraw from it in cases where they feel
this was the best for them.

3.10.6.a. Physical, emotional, social, financial

Firstly, the data was collected in safe environments which was with well quipped offices
therefore avoiding any form of physical harm that could be expected. Secondly the researcher
allowed the respondents to skip any questions that may in any case be triggering however even
during the development of the questionnaire the researcher avoided including or structuring
question in such a way that they may be triggering. As highlighted above the study was carried
out privately so as to avoid any interruptions or conflict with others who may be tempted to
interrupt. Lastly the respondents were required to gain financial benefit from the study in any
way or capacity.

3.10.7. Scientific integrity on the part of the researcher

Credits were given and made through in text citations as well as referencing of any work by other
authors or contributors to the study. The researcher made all efforts to avoid any work from other
sources seem like it was for her.

3.11. Conclusion

The chapter has explained the research methodology, outlining the research sample, the sampling
method, the research design, the research instruments, and the research procedure and also
highlighted the ethical considerations observed during the study. The following chapter
summarized the study findings, analysis and discussions.

14
 CHAPTER FOUR: RESULTS
4.1. Introduction
This chapter presents the results and discussion of research findings obtained from the fieldwork.
The researcher conducted the study with one data collection instrument which was a
questionnaire to student nurses practicing at Engela District Hospital. The aim of the study was to
assess the knowledge and practices regarding infection prevention and control among student
nurses at Engela District Hospital. Data collection instruments were self-administered by the
researcher without the assistance of any third party.
4.2. Demographic Information

The researcher successfully self-administered thirty-seven (37) questionnaires on the knowledge

and practices regarding infection prevention and control among student nurses. All the
questionnaires were timely returned. The findings from the fieldwork were transcript and
presented as follows:
4.2.1. Gender Statistics

The respondents were asked to specify their gender as part of the data collection procedure and
the results on this perspective can be summarised as below by figure 4.1:

15
 Gender Statistics of the Respondents

Male
16%
Male
Female

Female
84%

Figure 4.1: Gender statistics

The findings revealed that, in a total of thirty-seven respondents selected from a student base of
+/-80 nursing students 84% were female while five 16% were male. Despite the fact that the
respondents of this study were randomly selected thus selecting giving all the student nurses an
equal chance to participate in this study, the findings of this study reveals that most of the student
nurses at this centre during the period under review were female. The researcher can suggest that
its not gender biased but it is more a care giver mentality, which is not a trait developed in many
men in our culture.
4.2.2. Age group

The participants of the study were asked to mention their age groups. The summary on this
perspective are shown below:

16
 Age group
50
45
40
35
Response rate (%)

30
25
20
15
10
5
0
20-24 yrs 25-29 yrs 30-34 yrs Above 35 yrs

Age groups in years

Figure 4.2: Age group of participants

The study revealed that 16% of the participants were in the age group of 20 to 24 years, 46% in
the age group of 25 to 29 years. A total of 27% indicated that they are in the age group of 30 to
34 years and lastly 11% specified that they are in the group above 35 years. The researcher sums
up that, the student nurses might be evenly spread across all age groups since they are from
different institutions and all the institution have different entry requirement which makes it
possible to have different age groups at the center under review. To this end, participants from
different age groups are ought to provide different views from their different experiences and
exposure by age to the problem under review.

4.2.3. Nursing category

The student nursing who participated in this study were asked to categories the nursing profession
they are partaking and the following response we found:

17
 Nursing category

22%

Bachelor of nursing science

Enrolled nurses

78%

Figure 4.3: Nursing category

The majority (78%) of the student nursing accessed under field work confirmed that they are
pursuing in Bachelor of nursing science while 22% indicated that they were practicing enrolled
nursing. This finding reveals that, the participants of this study have a possibility of being
allocated to different hospital departments and this help the researcher to accumulate information
from different exposure and or departments.
4.2.4. Year of study

The researcher asked the study participants to specify their year of study and the participants
indicated as follows:

18
 Students year of study
50
45
40
35
Response rate (%)

30
25
20
15
10
5
0
2nd year 3rd year 4th year

Year of study

Figure 4.4: Year of study

The majority of the participants (46%) indicated that they were in their third year while 38%
specified that they were in fourth year and lastly 16% were in second year. This finding reveals
that the student nurses at this health center are carrying out different practices since they are in
different years of study. Therefore, this finding supports the fact that they are allocated in
different departments and had different exposure. In this regards, the different exposure helped
the researcher to assess the student nurse’s knowledge and practices regarding infection
prevention and control.
4.2.5. Current department student attached

The researcher confirmed on the department the participants of the study are currently attached
and different response were given as follows:

19
 Current department student attached

19%
Medical
Surgical
49% Maternity

32%

Figure 4.5: Current department student attached

A total of 49% of the participants indicated that they were attached in maternity ward, 33% in
surgical ward while 19% were in medical ward. The researcher has full understanding that
students on clinical practice used to rotate department but considering this finding the researcher
rules that by the time data was collect, the nursing student at the hospital under review were in all
the department that might expose them to various infection. Therefore, this allowed the
researcher to assess the knowledge and practices of the students involved in such departments
regarding their prevention and control of infection.

4.3. Knowledge regarding infection prevention and control

The researcher assessed the knowledge of the student nurses under review and different levels of
awareness was established in relation to different criteria in question. The knowledge was
assessed using different statements and or questions and the responses are as summarized below:
4.3.1. Clinical waste bags for infectious or potential infectious waste

The participants of the study were asked about the specific bag for infectious or potential
infectious clinical waste in terms of the colour. The responses in this regards are as show below:

20
 Clinical waste bags colours

Do not know

Red
Waste bag colours

Yellow

Green

Black

0 10 20 30 40 50 60 70 80 90

Response rate (%)

Figure 4.6: Clinical waste bag colours

The majority of the participants (84%) specified that infectious or potentially infectious clinical
waste contaminated with chemicals or pharmaceutical or medicinal waste should be disposed in
yellow plastic backs. A total of 5% indicated that they are disposed in a green bag and 3%
devoted that they are disposed in a red bag. Additionally, 8% of the participants stated that the not
know exactly the colour of the bag to dispose infectious waste.

4.3.2. Attended in-service training

The participants of the study were asked to determine whether they attended any in-service
training about infection prevention and control. The results on this perspective are as below:

21
 Attended in-service training for infection prevention & control

35% Yes
No

65%

Figure 4.7: Attended in-service training for infection prevention and control

A total of 65% of the participants of the study confirmed that they attended an in-service training
on infection prevention and control while 35% denied that they never attended any in-service
training on infection control and prevention. In this regards, this confirms that the majority of the
student nurses have the knowledge on prevention and control of infection gained through the in-
service training at the hospital under review.

4.3.3. Statements to assess knowledge regarding infection prevention and control

The respondents of this study were given some statements to respond to using the three-point
Likert scale where (1) was agree, (2) Neutral and, (3) Disagree. The results are as summarized in
the table below where (S) are statements, (F) represents frequency, (%) is the response rate.

22
Table 4.1: Knowledge regarding infection prevention and control

Responses
Statements 1 2 3
F % F % F %
S1 31 84 6 16 0 0
S2 23 62 9 24 5 14
S3 37 100 0 0 0 0
S4 33 89 4 11 0 0
S5 1 2 5 14 31 84
S6 25 68 7 18 5 14
S7 27 73 6 16 4 11
S8 8 22 3 8 26 70
S9 32 86 3 8 2 6

The table above (table 4.1) summarizes the responses on the statements that were used to assess
the knowledge of student nurses regarding infection control and prevention. Various responses
were given by the participants and this can be summarized as below:

Statement 1: Healthcare workers are also at risk of getting a health care associated infection

The review on the subject whether the student nurses at the health care center under review are
aware that healthcare workers are also at risk of getting a health care associated infection showed
that, 84% of the student agreed, 16% remained neutral while none of them disagreed.

Statement 2: Healthcare workers can sterilize their hands by washing them

With regards to whether healthcare workers can sterilize their hands by washing them, the results
revealed that 62% of the participants agreed while 24% remained neutral and 14% disagreed on
this statement. In this consideration, these results reveals that amongst the student nurses
reviewed some of them do not believe that they can sterilize their hands by washing them
although the majority believe in this.

Statement 3: A patient in a critical clinical condition has a higher risk of acquiring healthcare
infections

The results revealed that all the participants of the study agreed on the notion that, a patient in a
critical clinical condition has a higher risk of acquiring healthcare infections.

23
Statement 4: Hands should be washed before and after examining the patient

With regards to the notion that, hands should be washed before and after examining the patient; a
total of 89% of the student nurses agreed while 11% remained neutral while none of them
disagreed. The researcher considered this as those who remained neutral are not following this
practice while the majority are aware of this practice. To this end much emphasis should be put
on the idea that hands should be washed before and after examining the patient to reduce patient
to patient infection.

Statement 5: Hands should only be washed when they are visibly soiled

The results revealed that 2% of the participants agreed that, hands should only be washed when
they are visibly soiled while 14% were neutral and 84% disagreed. This finding established that
most of the student nurses accessed during this study rejected the notion that hands should only
be washed when they are visibly soiled.

Statement 6: Gloves should be changed between patients

The study revealed that 68% of the student nurses agreed on the statement that gloves should be
changed between patients while 18% were neutral and 14% disagreed. This finding established
that the majority of the participants of the study are aware of preventing infection among patient
although they are few students who are not aware of this prevention practice.

Statement 7: The use of gloves, mask and apron reduces the risk of infection

With regards to the knowledge on whether the use of gloves, mask and apron reduces the risk of
infection, a total of 73% of the participants agreed while 16% remained neutral and 11%
disagreed. In this regards, the researcher was aware that it should be the proper use of gloves,
mask and apron reduces the risk of infection. Therefore, these findings confirm that only few
students’ nurses are familiar or are unaware of this notion, thus, those who disagreed and all those
who agreed do not have proper understand on how to reduce infection.

Statement 8: Wearing gloves eliminates the need to wash hands

24
The study explored that 22% of the participants agreed that on the idea that, wearing gloves
eliminates the need to wash hands while 8% remained neutral and 70% disagreed. This results
establishes that the majority of the participant knows that they need to wash their hands even they
use gloves although few of them do not know.

Statement 9: The patient’s urinary catheter bag should always hang lower than the patient’s hip

With regards to the statement that; the patient’s urinary catheter bag should always hang lower
than the patient’s hip, 86% of the participants agreed on this statement while 8% remained neutral
and 6% disagreed. This finding is related to the findings on statement 8 that the hospital under
review has some student nurses that do not know some of the preventive measure to avoid
occurrence of infection. In this regards, the patient’s urinary catheter bag should always hang
lower than the patient’s hip to avoid urine from flowing back to the bladder. Therefore, much
should be done to ensure that all the student nurses at the hospital under review has full
knowledge about infection prevention and control.

4.4. Practice regarding infection prevention and control

In determining the practices regarding infection prevention and control among student nurses at
Engela District Hspital, the respondents of this study were asked to comment on ten statements
using a three-point Likert scale, where the following numbers were used to represent the
responses: (1) always, (2) sometimes and (3) never. The results in this regard are as summarized
below where S, represents statement; F, represents frequency and %, is the response rate:

Table 4.2: Practice regarding infection prevention and control

Responses
Statements 1 2 3
F % F % F %
S10 31 84 1 3 5 13
S11 29 78 5 14 3 8
S12 6 16 2 5 29 79
S13 7 19 1 3 29 78
S14 0 0 0 0 37 100
S15 32 86 1 3 4 11
S16 34 92 3 8 0 0
S17 16 43 4 11 17 46

25
 S18 27 73 3 8 7 19
S19 35 95 2 5 0 0

The table above (Table 4.2) summarizes the responses to the statements (S) in connection with
the student nurses’ practices regarding infection prevention and control. The findings per
statement are as summarized below:

Statement 10: I only follow the infection control programme when my supervisor is watching me

With regards to the statement that I only follow the infection control programme when my
supervisor is watching me, 84% of the participant indicated always while 3% indicated
sometimes and 13% never.

Statement 11:Doing an aseptic procedure according to the manual takes up too much time

The majority of the participants (78%) indicated that they always do an aseptic procedure
according to the manual takes up too much time. A total of 14% of the participant specified that
sometimes while only 8% indicated never. This finding revealed that most of the student nurses
reached under this study do not want to follow the long aseptic procedures although they are
effective for infection control.

Statement 12: Infection control procedures should only be followed when working with a patient
with an infectious disease.

The researcher assessed on whether infection control procedures should only be followed when
working with a patient with an infectious disease, a total of 16% of the participant indicated
always on the statement while 5% specified that sometimes and 79% of the participant indicated
never.

Statement 13: I wash my hands after removing disposable gloves

A sum of 19% of the participants indicated that always on the statement that; I wash my hands
after removing disposable gloves while 3% of them mentioned that sometimes and 78% indicated
never.

Statement 14: I recap used needles

26
Neither one of the participant agreed nor remained neutral on the notion that, I recap used
needles. A total of 100% indicated never on the notion. In short, this reveals that the student
nurses under review have poor practices on the preventions and control of infections as they were
supposed to recap used needles but they are all not.

Statement 15: I change my usual care if the patient has infectious disease

In relation to the notion that, I change my usual care if the patient has infectious disease, a total of
86% of the participants indicated always while 3% mentioned that sometimes and 11% said
never. This finding showed that the participants of this study always give attention to infection
prevention and control when they knew that the patient they are treating has an infectious disease
and when they knew that the patient do not have an infectious disease that do not care. To this
end, this can be referred as poor practice as student nurses should just exercise care to prevent
and control infection despite the condition of the patient.

Statement 16: I protect myself against the blood and body fluids of all patients, regardless of
their diagnosis

With regards to the statement that; I protect myself against the blood and body fluids of all
patients, regardless of their diagnosis, a total of 92% of the participants indicated always to the
statement while 8% said sometimes and none indicated never. This finding reveals that the
student nurses under review do not expose their self to blood and body fluids of all patients
despite the condition of the patient and this showed a good practice in preventing and controlling
the spread of infectious diseases thus a good practice.

Statement 17:I perform hand hygiene each time before and after every time I come into contact
with a patient

A total of 43% of the participant indicated always while 11% said sometimes and 46% said never
on the statement that; I perform hand hygiene each time before and after every time I come into
contact with a patient.

Statement 18: I put used needles and other sharp objects into the designated sharp container

27
With regards to the statement that; I put used needles and other sharp objects into the designated
sharp container, 73% of the participants indicated always while 8% said sometimes and 19%
saying never. This finding revealed that the majority of the student nurse have a good practice
when it comes to putting of used needles and other sharp objects into the designated container for
sharp disposals.

Statement 19: I cover my broken skin before coming to work

Overly, on the statement that; I cover my broken skin before coming to work 95% indicated
always while 5% said sometimes and none of the participants says never. In short, the majority of
the participants of this study showed that they are covering their wounds whenever they come to
work and this was considered as a good practice. Only a few remained neutral that might means
that they never get hurt on the period when the conducted their clinical practices and the
researcher encourage them to cover their wound when they happen to have one some of the days.

4.5. Conclusion

This section presented the findings of the study and some brief analysis. It started with the
demographic statistics of the participants. The findings of this study reveals that most of the
student nurses at this center during the period under review were female and the majority of the
participants were in the age group of 25 to 29 years. It was also disclosed that the majority of the
student nursing accessed under field work confirmed that they are pursuing in Bachelor of
nursing science and were all in third year of study. The study also established that most of the
student nurses were in the department of maternity. The next chapter will discuss the findings of
this study.

28
 CHAPTER FIVE: DISCUSSIONS
5.1. Introduction

The researcher had made some discussion in line with the findings presented in the previous
chapter (chapter 4). The discussions were made in line with past studies considered in chapter
two to answer the objective of the objective of the study. This was expressed as follows:

5.2. Knowledge regarding infection prevention and control

The knowledge was assessed using different statements and or questions and the responses are as
summarized below:

5.2.1. Clinical waste bags for infectious or potential infectious waste

The researcher did a follow-up question to find out why they could not have the knowledge about
the correct bag and they all indicated that they knew about orange bags for infectious waste and
since the list given was not including orange they all indicated that they do not know. In this
consideration, the majority of the participants showed that they knew the correct bag to dispose
infectious waste and only few need refreshing courses on waste bags to prevent the occurrence of
hospital acquired infections.

5.2.2. Attended in-service training

The study revealed that the majority of the participants participated on in-service training.
However, the few that never attended any training are encourage to seek for one to reduce
incidents of infection. The idea of in-service training was supported by Eskanderl et al. (2019)
who recommended that critical care nurses need updating knowledge and performance through
continuing in-service educational programs.

29
5.2.3. Statements to assess knowledge regarding infection prevention and control

The study revealed that the majority of the participants agreed that as healthcare workers they are
also at risk of getting a health care associated infection. This finding reveals that the majority of
the student nurses have the knowledge on the statement assessed. This finding was supported by
Razine et al. (2018) who also found that that the prevalence of HAIs was high in health care
centers.

In addition, the study disclosed that the majority of the participants agreed that as healthcare
workers they can sterilize their hands by washing them. Therefore, these few nursing students
lack the required knowledge and it will lead to the spread of infection within the wards they are
practicing in. They are great needs to educate them to adhere to infection control measures.
Ojulong et al. (2013) also argued that health science students’ knowledge on infection prevention
and control need to be imparted early, before they are introduced to the wards.

The study also disclosed that, all the participants of the study agreed that a patient in a critical
clinical condition has a higher risk of acquiring healthcare infections. This finding revealed that
the all the student nurses accessed under this study has the knowhow of the motion in question. In
a contrary, this finding did not go in line with what Ojulong et al. (2013) discovered. Ojulong et
al. (2013) discovered that, knowledge about infection prevention and control and awareness of its
importance among health science students is poor.

The study established that, the majority of the participants disagreed that hands should only be
washed when they are visibly soiled. This finding revealed that the students have the knowledge
about infection as it has nothing to do with soiled hands and or unsoiled; hands just need to be
washed frequently if not after every procedure. This finding was supported by Ghalya and
Ibrahim (2019), who established that the overall knowledge scores for nursing students towards
infection control and standard precautions were acceptable. In short, the majority of the nursing
students have knowledge of prevention and control of infection

The majority of the participants agreed that gloves should be changed between patients. In short,
gloves should be changed between patients as a preventative measure and this finding was
supported by Eskanderl, Morsy and Elfeky (2019), who argued that critical care nurses have an
obligation to protect critically ill patients against infection. In a contrary, Eskanderl et al. also

30
indicated that the majority of student nurses had unsatisfactory knowledge level on prevention
and control of infection. To this end, what the current study discovery is not in line with
Eskanderl et al. (2019)’s finding in the sense that the current study found out that the majority of
the student nurse have the required knowledge and this was revealed whey agreed to the notion
that gloves should be changed between patients.

The study disclosed that the majority of the participants disagreed that wearing of gloves
eliminates the need to wash hands. Despite the fact that the sample under review were selected
randomly, these students are from different colleges and or universities and therefore, the hospital
under review should ensure that students nurses are trained before exposed to infectious wards
since some of them might be at high risk of infectious due to poor knowledge. The idea of
training nursing students before they are exposed to infectious ward was also supported by
Ojulong et al. (2013) who indicated that serious efforts are needed to improve or review
curriculum so that health science students’ knowledge on infection prevention and control is
imparted early, before they are introduced to the wards.

5.3. Practice regarding infection prevention and control

The majority of the participants indicated that they only follow the infection control programme
when my supervisor is watching them. This finding reveals that the majority of the students
nurses do not follow the infection control programme and this expose them to high risk of
spreading infections among themselves and also to the patients. This finding contradicted with
what NHS Professionals, (2019) emphasized when it indicated that it is important that all health
workers strictly adhere to infection control guidelines, especially nurses because they spend more
time with the patients.

The study disclosed that the majority of the participants indicated that they always do an aseptic
procedure according to the manual takes up too much time. In this consideration, Ghalya and
Ibrahim (2019) also argued that patients’ safety can be jeopardized if nurses intentionally fail to
comply with implemented infection control measures leading to negligence/malpractice. To this
end, the student nurses under review are neglecting doing aseptic procedures according to the
manual assuming that it too much of their time but yet resulting in them failing to practice the
infection prevention and control measures.

31
It have explored in the findings that one should not (never) only practice infection control
procedures when working with a patient with an infectious disease. Considering the majority rule,
this finding means that the student nurses under review are aware that infection control
procedures should not only be followed when working with a patient with an infectious disease.
This finding was supported by WHO (2019) which emphasized that, failure to apply infection
control procedures favours the transmission of pathogens, and healthcare settings can act as
amplifiers of disease during epidemics, with a bearing on both hospital and public health.

The findings established that the majority of the participants do not wash their hands after
removing disposable gloves. This finding revealed that most of the student nurses do not wash
their hands after the removal of disposable gloves and this can be considered as poor infection
prevention and control practice which might increase the risk of infection occurrence. In a
contrary, Ghalya and Ibrahim, (2019) discovered that good practices of nurses in infection
prevention and control reduces the potential for nosocomial infection thereby promoting patient
safety.

The study also established that students do not recap used needles. This was identified as a poor
practice. In support to this, WHO, (2019) devoted that breaching of infection control measures
undermine every advance and investment in health care. To this end, the issue of not recapping
used needles was considered as poor practices against prevention and control of infection.

Additionally, the majority of the participant indicated that they always protect themselves against
the blood and body fluids of all patients, regardless of their diagnosis. This practice was
supported by Ghalya and Ibrahim (2019) who disclosed that good practices of nurses in infection
prevention and control reduces the potential for nosocomial infection thereby promoting patient
safety.

The findings also revealed that the majority of the student nurses under review do not perform
hand hygiene each time before and after every time they come into contact with a patient. In this
regards, this practice has been considered as poor practice on preventing and controlling the
spread of infection since the student nurses need to perform hand hygiene regularly. In short, the
participants who agreed with the statement a few compared to neutral plus those who disagreed
which left the researcher to consider that the majority are not performing hand hygienic before
and after every time they come into contact with a patient. This poor practice by the student nurse
32
is in contradiction with what the NHS Professionals (2019) suggested when it indicated that good
hand hygiene is the most important practice in reducing transmission of infectious agents as well
as health-care associated infections.

On the other hand, only few participants need to be trained on good practices when it comes to
disposition of sharp wastes and or needles so that they hospital infectious waste management will
be improved. The idea of training was supported by Sessa et al. (2017) who recommended
education and training programmes for student nurses after their study found that although
student nurses level of knowledge was not principles, student nurses did not utilize the infection
control manuals. To this end, the researcher can rule that the participants who never practice
statement 18 might not be utilizing their infection control manuals and therefore they need
education and or in-service trainings to comply and or adhere to their infection control manuals.

5.4. Conclusion

The chapter provided the discussion of the findings in line with the objectives of the study and
literature review. The study established that the majority of the participant has the knowledge
regarding infection prevention and control. It was also established that most of the student nurses
are with poor practice regarding infection prevention and control. The next chapter will provided
the conclusions and recommendation to the findings.

33
 CHAPTER SIX: CONCLUSION, RECOMMENDATIONS AND LIMITATIONS

5.1. Introduction
In this last section of the report, the researcher shall summarize the conclusion and some
recommendations to the study. This study was thriving to explore the knowledge and practices
regarding infection prevention and control among student nurses at Engela District Hospital, with
the aim of contributing better insights to the strategies that reduce the infection. Several
discussions have been made and the researcher sum them up as follows:

5.2. Conclusion
The study concluded that the student nurses have knowledge of infection prevention and control
but they all have poor practices on infection prevention and control. Despite the student nurses
being knowledgeable towards infection prevention and control the practices were very poor.
However, if student nurses are knowledgeable on infection prevention and control, then the
practices of the same student nurses are expected to be good. Furthermore, the nurse plays an
important role in the translation of knowledge and practices to the clinical environment, it is
concluded that the patients are exposed to infection related diseases due to poor infection
prevention and control practices.

As a result of these findings the researcher has concluded that there could be barriers to good
practice in infection prevention and control which require further research. In conclusion, the
research question “what is the knowledge and practices regarding infection prevention and
control among student nurses at Engela District Hospital?” has been adequately addressed in this
setting.

34
5.3. Recommendations to the findings

 According to the current study, it is evident that the practices of student nurses in
infection prevention and control were poor. Therefore, the infection control team should
strictly observe student nurses as they practice. This includes auditing of hand hygiene
practices, observe the student nurses as they perform invasive procedures, a procedure
that requires aseptic technique, isolation of infectious conditions to prevent the spread of
infection and application of barrier nursing;
 The study disclosed that the student nurses have poor infection practices. Therefore, it is
recommended that provision of vaccination to all student nurses regarding infection
prevention and control;
 Nursing schools should emphasize the importance of infection prevention and control
(Hospital acquired infections) in the syllabus and or curriculum;
 Availability of personal protective equipment required for applying infection control
measures at all the times;
 The District Hospital should ensure that student nurses receive in-service training in
infection prevention and control as part of induction;
 Resources should be allocated for Infection prevention and control conferences locally
and internationally. This will enable infection control team/committee to attend such
conferences so that they are updated with the latest evidence-based information;
 The hospital under review should ensure that the resources allocated for infection
prevention and control are not deviated to other things. This can be achieved by
performing random infection control spot checks of the hospitals.

5.4. Recommendation for future studies

Future studies are recommended to take much emphasis on the following topics:

 Barriers affecting compliance to infection prevention and control measures among student
nurses;
 The role of policy makers, stakeholders and government leaders in infection prevention
and control in a clinical setup;

35
  The perceptions and knowledge of student nurses against Hepatitis B vaccinations with
regard to infection prevention and control;
 The wrong usage of antibiotic and its impact on infection prevention and control.

5.5. Limitation to the findings

This study was affected by several factors. Some participants were unwilling to provide the
necessary information to the researcher thinking that they are exposing their organisation to the
public. In this regards, the researcher explained to the respondents that the research is confidential
and that the information gathered will be used only for academic purpose. Some student nurses
may not be at the practical during data collection. In this regards, the researcher used all student
nurses working at Engela District Hospital regardless their institutions. The researcher collected
the questionnaire the same day she administered them to avoid them from getting lost since some
of the students’ nurse were anticipated not to return the questionnaires.

5.6. Delimitations of the study

Delimitation are choices made by the researcher on areas to be covered in the research
particularly the geographical location where the study was conducted together with the period
covered by the research, thus the boundaries that was set for the study (Creswell & John, 2018).
Engela hospital is where the research has done most of her practical and is where she resides and
the was no transport costs during data collection. The study was only conducted with student
nurses at Engela district hospital; specifically, in medical, surgical and maternity ward. These
wards were selected with the reason being that they mostly generate infectious wastes.

36
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Brink, H., van der Walt, C. & van Rensburg, G. (2018). Fundamentals of research methodology
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Cardo, D., Dennehy, P. H., Halverson, P., Fishman, N., Kohn, M., Murphy, C. L., & Whitley, R.
J. (2019). Moving toward elimination of healthcare-associated infections: A call to
action. Infection Control and Hospital Epidemiology, 31(11), 1101–1105.

Creswell, J. D., & John, W. (2018). Creswell, Research Design. Qualitative, Quantitative, and
Mixed Methods Approaches

Darawad, M.w.& Al-Hussami, M. (2013). Jordanian nursing students’ knowledge of, attitudes
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LIST OF APPENDICES
Appendix A: Research information to participants

Researcher: Mirjam T Halwoodi

Dear participant

I am Mirjam Halwoodi registered with Welwitchia Health Training Centre, doing Bachelor
Degree in Nursing science. I wish to conduct a research proposal entitled: Knowledge and
practice regarding infection, prevention and control among student nurses at Engela District
Hospital. The study will be conducted under the supervision and guidance of Miss Hilaria
Mtuleni.

The purpose of the study is to assess and describe the knowledge and practice of student nurses
regarding infection prevention and control at Engela hospital. Participation in this study will take
approximately 15-20 minutes. The procedure includes responding to questions on demographic
data and knowledge and practice on infections prevention and control.

Your participation in this study is voluntary and you have the right to withdraw at any time
should you feel so. You should feel free to ask the researcher to clarify the question where you
don’t understand. You will be expected to answer all questions. The study data will be coded so
that they will not be linked to your name. Your identity will not be revealed during the study or
when the study is being reported or published with the permission granted by the Ministry of

40
Health and Social Services. The researcher and the supervisor are the only people that will have
access to the data collected.

You are among the study population of the student nurses in the inpatient wards such as medical,
surgical and maternity wards. These wards are selected on the ground that they generate more
infectious wastes. Should you agree to participate, please sign your consent with full knowledge
of the nature and purpose of the study.

For any questions or concerns about this research please contact: Mirjam T Halwoodi (cell:
+264814970940) mhalwoodi93@gmail.com

Appendix B: Consent form

You may withdraw your consent at any time and discontinue participation without penalty.

Should you agree to participate, please sign the consent provided. If you have any question that

need clarification you are welcome to contact me.

I…………………………………………………………………...

Agree to participate in this study on my own will.

Signed at…………………………………………………….

Participant signature………………………………………....

Date ……………………………………………………………...

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Appendix C: Request for permission to conduct research at Engela District Hospital

P O Box 958
Ohangwena
12 August 2022
Secretary General
Republic of Namibia
Ministry of health and Social Services
Windhoek

12/08/2022

RE: PERMISSION TO CONDUCT A STUDY ON KNOWLEDGE AND PRACTICES

REGARDING INFECTION PREVENTION AND CONTROL AMONG STUDENT NURSES
AT ENGELA DISTRICT HOSPITAL

Dear Sir/Madam

I, Mirjam T Halwoodi and I am a 4 th year bachelor of Nursing Science at Welwitchia Health

Training Centre. am doing research under supervision of MS Hilaria Mtuleni. I am seeking for
permission to carry out a study entitled knowledge and practices regarding infection, prevention
and control among student nurses at Engela District Hospital

The purpose of the study is to assess and describe the knowledge and practices regarding
infection, prevention and control among student nurses at Engela District Hospital. Data will be

42
collected from consenting respondent student nurses from second year to 4th year. The researcher
will give questionnaires to 37 student nurses that are working at the selected ward at the time of
study. I have attached my proposal.

I am looking forward to your positive response.

Yours faithfully

Mirjam Twiihaleni Halwoodi (Student Nurse)

Appendix D: Research Instrument

Instructions:

The following questionnaire is part of a study to be conducted to assess and describe Knowledge
and practices regarding infection, prevention and control among student nurses at Engela District
Hospital.

To ensure confidentiality, please do not write your name on the questionnaire as this study is
anonymous. Answer all the questions.

Please tick in the appropriate box

SECTION A

1. Demographic data of the respondent

1.1. Gender of respondent
Male female other…………………………

1.2. Age
20-24 25-29 30-34 Above 35

1.3. Nursing category

Bachelor of nursing science enrolled nurse

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1.4. Year of study
2nd year 3rd year 4th year

1.5. Which department are you working?

Medical

Surgical

Maternity

SECTION B:

2. Knowledge regarding infection prevention and control

Pleases tick in the appropriate box

2.1. In which plastic bag do you put infectious wastes e.g. bandages, gauze, catheters and
urine drainage bags?

Black Yellow Green Red Do not know

2.3. Have you ever attended an in service training on infection prevention and control?

Yes No

2.4. For each of the following statements, please tick only one box indicating whether you agree,
disagree or neutral (1: agree 2: Neutral 3: Disagree).
Statements 1 2 3
1. Healthcare workers are also at risk of getting a health care associated
infection
2. Healthcare workers can sterilize their hands by washing them
3. A patient in a critical clinical condition has a higher risk of acquiring
healthcare infections

4. Hands should be washed before and after examining the patient

5. Hands should only be washed when they are visibly soiled

6. Gloves should be changed between patients
7. The use of gloves, mask and apron reduces the risk of infection

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 8. Wearing gloves eliminates the need to wash hands
9. The patient’s urinary catheter bag should always hang lower than the patient’s
hip

SECTION C

3. Practice regarding infection prevention and control

3.2. For each of the following statements, please tick your best option (1: Always, 2: Sometimes,
or 3: Never).

Statements 1 2 3
10. I only follow the infection control programme when my supervisor is
watching me
11. Doing an aseptic procedure according to the manual takes up too much time
12. Infection control procedures should only be followed when working with a
patient with an infectious disease.
13. I wash my hands after removing disposable gloves
14. I recap used needles
15. I change my usual care if the patient has infectious disease
16. I protect myself against the blood and body fluids of all patients, regardless
of their diagnosis
17. I perform hand hygiene each time before and after every time I come into
contact with a patient
18. I put used needles and other sharp objects into the designated sharp
container
9. I cover my broken skin before coming to work

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