KNOWLEDGE AWARENESS OF NOSOCOMIAL INFECTION AMONG

HEALTH WORKERS OF JIGAWA STATE

BY:

FIDDAUSI SANI

IBLT/PBH/19/052

AUGUST, 2022
 KNOWLEDGE AWARENESS OF NOSOCOMIAL INFECTION AMONG

HEALTH WORKERS OF JIGAWA STATE

BY:

FIDDAUSI SANI

IBLT/PBH/19/052

SUPERVISED BY

DR. MAHMUD JIQAMSHI

BEING A RESEARCH PRESENTED TO THE DEPARTMENT OF PUBLIC

HEALTH, INSTITUT SUPERIEUR BILINGUE LIBRE DU TOGO (IBLT

UNIVERSITY)

IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD

OF BACHELOR DEGREE OF SCIENCE (B.Sc) PUBLIC HEALTH

 AUGUST, 2022

ACKNOWLEDGEMENT

in the name of Allah the beneficent the merciful I wishes to extend my gratitude

and thanks to almighty Allah without whose endorsement everything would not

have been possible and achieved may benediction and situation of Allah be upon

his noble prophet Muhammad (S.A.W) members and his family his companion and

those who followed his with righteousness till the end of hours these that are not

ever mentioned they are not neglected but are heavily respected and recognized.

Thanks all those whose their names are not included due to time factors I love you

all special thanks goes to my friends and collegeous such as Aisha Sunusi Sani.

Amira Sanusi, Saratu Ahmad, Mujaddadi Kd, Salma Kd, M.Sharif, Aunty Hauwa,

Maman Sabir. Special thanks goes to my brothers and sisters and blood relatives

such as Yaya Lawan, Yaya Sanusi, Yaya Umar, Auty Uwani, Aunty Amina, Yaya

Nura, Yaya Sani.

 CHAPTER ONE

Introduction

1.0 Introduction

This chapter will be discussed under the following subheadings: Background of the study,

Statement of the problems, Purpose of the Study, Significance of the Study, Specific Objective,

Research Question and Research Hypothesis, Operational Definition of Terms.

1.1 Background of the Study

A nosocomial infection, also known as a hospital-acquired infection or HAI, is an infection

whose development is favored by a hospital environment, such as one acquired by a patient

during a hospital visit, or one developed among hospital staff. Such infections include fungal and

bacterial infections, and are aggravated by the reduced resistance of individual patients. In the

United States, the Centers for Disease Control and Prevention estimated roughly 1.7 million

hospital-associated infections, from all types of microorganisms (including bacteria), cause or

contribute to 99,000 deaths each year. In Europe, where hospital surveys have been conducted,

the category of gram-negative infections are estimated to account for two-thirds of the 25,000

deaths each year. Nosocomial infections can cause severe pneumonia and infections of the

urinary tract, bloodstream, and other parts of the body. Many types are difficult to attack with

antibiotics, and antibiotic resistance is spreading to Gram-negative bacteria that can infect people

outside the hospital. Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium

responsible for several difficult-to-treat infections in humans. It is also called multidrug-resistant

Staphylococcus aureus and oxacillin-resistant Staphylococcus aureus (ORSA). MRSA is any

strain of Staphylococcus aureus that has developed resistance to beta-lactam antibiotics, which

include the penicillins (methicillin, dicloxacillin, nafcillin, oxacillin, etc.) and the cephalosporins.

Strains unable to resist these antibiotics are classified as methicillin-sensitive Staphylococcus

aureus, or MSSA. The development of such resistance does not cause the organism to be more

intrinsically virulent than strains of Staphylococcus aureus that have no antibiotic resistance, but

resistance does make MRSA infection more difficult to treat with standard types of antibiotics,

and thus more dangerous. Hospital-acquired pneumonia (HAP), or nosocomial pneumonia, refers

to any pneumonia contracted by a patient in a hospital at least 48-72 hours after being admitted.

It is usually caused by a bacterial infection, rather than a virus. HAP is the second most common

nosocomial infection (urinary tract infection is the most common), and accounts for 15-20% of

the total. It is the most common cause of death among nosocomial infections, and is the primary

cause of death in intensive care units. (Iliyasu, 2016)

A nosocomial infection, also known as a hospital-acquired infection or HAI, is an infection

whose development is favoured by a hospital environment, such as one acquired by a patient

during a hospital visit or one developing among hospital staff. Such infections include fungal and

bacterial infections. They are aggravated by the reduced resistance of individual patients.

Numerous risk factors in the hospital setting predispose a patient to infection. These risk factors

can broadly be divided into three areas. People in hospitals are usually already in a ‘poor state of

health’, impairing their defense against bacteria. Advanced age or premature birth, along with

immunodeficiency (due to drugs, illness, or irradiation) present a general risk, while other

diseases can present specific risks; for instance, chronic obstructive pulmonary disease can
increase chances of respiratory tract infection. Invasive devices, for instance intubation tubes,

catheters, surgical drains, and tracheostomy tubes all bypass the body’s natural lines of defense

against pathogens and provide an easy route for infection. Patients already colonized at the time

of admission are instantly put at greater risk when they undergo invasive procedures. Patients’

treatments can leave them vulnerable to infection: immune suppression and antacid treatment

undermine the body’s defences, while antimicrobial therapy (removing competitive flora and

only leaving resistant organisms) and recurrent blood transfusions have also been identified as

risk factors. (Kamunge, 2014).

1.2 Statement of the Problem

With nearly 100 million procedures performed at hospitals each year, litigation arising from

nosocomial infections is increasing nationwide. These infections can be acquired in the hospital

contracted in the healthcare environment. Health care facilities - whether hospitals, nursing

homes, or outpatient facilities - can be dangerous places for the acquisition of infections. The

most common type of nosocomial infections are surgical wound infections, respiratory

infections, genitourinary infections, as well as gastrointestinal infections among health workers

in Jigawa state.

These infections are often caused by breaches, nursing home, rehabilitation centers, as well as

extended care facilities. Immuno compromised patients, the elderly and young children are

usually more susceptible than others. These infections are transmitted through direct contact

from the hospital staff, inadequately sterilized instruments, aerosol droplets from other ill

patients or even the food or water provided at hospitals. EHA provides litigation expertise in the

areas of infections of infection control practices and procedures, unclean and non-sterile
environmental surfaces, and/or ill employees. We have the experience to understand and

ascertain the facts behind these hospital acquired nosocomial infections.

1.3 Purpose of the Study

The primary purpose of the study is to determine the knowledge and perception of nosocomial

infection among health workers of Jigawa State.

1.4 Significance of the Study

The important of the research is to assist the government and individual and other concern

organization especially food and water handlers to have the information an making necessary

planning and policies for proper food and water handling. These researches will also serve as

essential are me for reducing the ignorance of people in the area of study about food poisoning in

relation to used unclear water for food preparation. This research is expected to provide a room

of awareness on how to ascertained the problem of food poisoning, promote health and will also

assists the government seminars work shop, non governmental organization library/source of

literature and researchers wherever they wish to conduct a similar research may be wider and

broader in scope.

1.5 Specific Objective

1. To determine the knowledge and awareness of nosocomial infection among health workers of

Jigawa State.

2. To identify the practice of nosocomial infection prevention among health workers of Jigawa

state.

1.6 Research Question and Research Hypothesis

Research Question I

What is the level of knowledge of nosocomial infection among health workers of Jigawa State?

What are the practice of nosocomial infection among/Do apply preventive measures of

nosocomial infection the health workers of Jigawa State?

Research Hypothesis I

There are no significant knowledge of nosocomila infection prevention among health workers

Jigawa state.

There is no significance practice of nosocomial infection prevention among health workers of

Jigawa state.

1.7 Operational Definition of Terms

 Nosocomial infection: Is an infection whose development is favoured by a hospital

environment, such as one acquired by a patient during a hospital visit, or one developed

among hospital staff.

 Knowledge: Is - the fact or condition of knowing something with familiarity gained

through experience or association. How to use knowledge in a sentence. Synonym

Discussion of knowledge.

 Prevention: Hospitals have sanitation protocols regarding uniforms, equipment

sterilization, washing, and other preventive measures. Thorough hand washing and/or use

of alcohol rubs by all medical personnel before and after each patient contact is one of the

most effective ways to combat nosocomial infections. More careful use of antimicrobial

agents, such as antibiotics, is also considered vital. Despite sanitation protocol, patients
 cannot be entirely isolated from infectious agents. Furthermore, patients are often

prescribed antibiotics and other antimicrobial drugs to help treat illness; this can increase

the selection pressure for the emergence of resistant strains.

 Surgical drain: Surgical drain on the left hand after surgery of Bennet’s fracture basis

MTC primi manus 1. sin (S62.20) which was treated by alignment of a fracture and

inside fixation by two titanium screws MS.

 Infection: An uncontrolled growth of harmful microorganisms in a host.

 Defense: The action of defending or protecting from attack, danger, or injury.

 Invasive: Invasive species, also called invasive exotics or simply exotics, is a

nomenclature term and categorization phrase used for flora and fauna, and for specific

restoration-preservation processes in native habitats, with several definitions.

 Perception is the organization, identification, and interpretation of sensory information

in order to represent and understand the presented information, or the environment. All

perception involves signals that go through the nervous system, which in turn result from

physical or chemical stimulation of the sensory system. For example, vision involves

light striking the retina of the eye, smell is mediated by odor molecules, and hearing

involves pressure waves.

 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction

This chapter will be discussed under the following subheadings: Concept of Nosocomial

Infection, Transmission of nosocomial infection, Prevention and Control of Nosocomial

Infection, Knowledge and Practice of Noscomial infection among health care workers,

Summary.

2.1 Concept of Nosocomial Infection

A nosocomial infection, also known as a hospital-acquired infection or HAI, is an infection

whose development is favoured by a hospital environment, such as one acquired by a patient

during a hospital visit, or one developed among hospital staff. Such infections include fungal and

bacterial infections, and are aggravated by the reduced resistance of individual patients. In the

United States, the Centers for Disease Control and Prevention estimated roughly 1.7 million

hospital-associated infections, from all types of microorganisms (including bacteria), cause or

contribute to 99,000 deaths each year. In Europe, where hospital surveys have been conducted,

the category of Gram-negative infections are estimated to account for two-thirds of the 25,000

deaths each year. Nosocomial infections can cause severe pneumonia and infections of the
urinary tract, bloodstream, and other parts of the body. Many types are difficult to attack with

antibiotics, and antibiotic resistance is spreading to Gram-negative bacteria that can infect people

outside the hospital. The drug-resistant Gram-negative germs for the most part threaten only

hospitalized patients whose immune systems are weak. The germs can survive for a long time on

surfaces in the hospital and enter the body through wounds, catheters, and ventilators. Main

routes of transmission Route Description Contact the most important and frequent mode of

transmission of nosocomial transmission infections, occurs when droplets are generated from the

source person mainly during coughing, sneezing, and talking, and during the performance of

certain Droplet procedures such as bronchoscopy. Transmission occurs when droplets

transmission containing germs from the infected person are propelled a short distance through

the air and deposited on the hosts body, occurs by dissemination of either airborne droplet nuclei

(small-particle residue {5 µm or smaller in size} of evaporated droplets containing

microorganisms that remain suspended in the air for long periods of time) or dust particles

containing the infectious agent. Microorganisms carried in this Airborne manner can be

dispersed widely by air currents and may become inhaled by a transmission susceptible host

within the same room or over a longer distance from the source patient, depending on

environmental factors; therefore, special air handling and ventilation are required to prevent

airborne transmission. Microorganisms transmitted by airborne transmission include Legionella,

Mycobacterium tuberculosis and the rubeola and varicella viruses. Common applies to

microorganisms transmitted to the host by contaminated items vehicle such as food, water,

medications, devices, and equipment. Transmission Vector borne occurs when vectors such as

mosquitoes, flies, rats, and other vermin transmission transmit microorganisms. Contact

transmission is divided into two subgroups: direct-contact transmission and indirect-contact

transmission. Routes of contact transmission Route Description involves a direct body surface-

to-body surface contact and physical transfer of microorganisms between a susceptible host and

an infected or colonized person, such as occurs when a person turns a patient, gives a patient a

bath, or Direct-contact performs other patient-care activities that require direct personal contact.

Transmission Direct-contact transmission also can occur between two patients, with one serving

as the source of the infectious microorganisms and the other as a susceptible host, involves

contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as

contaminated instruments, needles, or Indirect-contact dressings, or contaminated gloves that are

not changed between patients. In transmission addition, the improper use of saline flush syringes,

vials, and bags has been implicated in disease transmission in the US, even when healthcare

workers had access to gloves, disposable needles, intravenous devices, and flushes. Nosocomial

infection affects huge number of patients globally, elevating mortality rate and financial losses

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

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

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

incidence is high enough in high income countries i.e. between 3.5% and 12% whereas it varies

between 5.7% and 19.1% in middle and low income countries. The frequency of overall

infections in low income countries is three times higher than in high income countries whereas

this incidence is 3–20 times higher in neonates. Risk factors determining nosocomial infections

depends upon the environment in which care is delivered, the susceptibility and condition of the

patient, and the lack of awareness of such prevailing infections among staff and health care

providers. (Raja’a, 2017).

Nosocomial infections, also known as hospital-acquired infections, are newly acquired infections

that are contracted within a hospital environment. Transmission usually occurs via healthcare

workers, patients, hospital equipment, or interventional procedures. The most common sites of

infection are the bloodstream, lungs, urinary tract, and surgical wounds. Though any bacteria

may cause a nosocomial infection, there is an increasing incidence of multidrug-resistant (MDR)

pathogens causing hospital-acquired infections. This rise can be explained by indiscriminate use

of antibiotics and lacking hygiene measures, especially among medical staff. Commonly seen

multidrug-resistant pathogens include methicillin-resistant Staphylococcus aureus (MRSA),

extended-spectrum beta-lactamase-producing bacteria (ESBL), and vancomycin-resistant

enterococci (VRE). The choice of antibiotic for treating infections with these pathogens is based

on the individual resistance profile and often requires additional strict isolation methods for the

patient. (Sarani H, 2015).

Hospitals have sanitation protocols regarding uniforms, equipment sterilization, washing, and

other preventive measures. Hospitals have sanitation protocols regarding uniforms, equipment

sterilization, washing, and other preventive measures. Thorough hand washing and/or the use of

alcohol rubs by all medical personnel before and after each patient contact is one of the most

effective ways to combat nosocomial infections. More careful use of antimicrobial agents, such

as antibiotics, is also considered vital. Despite sanitation protocol, patients cannot be entirely

isolated from infectious agents. Furthermore, patients are often prescribed antibiotics and other

antimicrobial drugs to help treat illness; this may increase the selection pressure for the

emergence of resistant strains. Sterilization goes further than just sanitizing. It kills all

microorganisms on equipment and surfaces through exposure to chemicals, ionizing radiation,

dry heat, or steam under pressure. Isolation precautions are designed to prevent transmission of
microorganisms by common routes in hospitals. Because agent and host factors are more

difficult to control, interruption of transfer of microorganisms is directed primarily at

transmission. Antibiotics are medications that fight bacterial infections. They work by disrupting

the processes necessary for bacterial cell growth and proliferation. It's important to take

antibiotics exactly as prescribed. Failure to do so could make a bacterial infection worse.

Antibiotics don't treat viruses, but they're sometimes prescribed in viral illnesses to help prevent

a "secondary bacterial infection." Secondary infections occur when someone is in a weakened or

compromised state due to an existing illness. (Johnson O, 2013)

Antibiotic Resistance

Overuse and misuse of antibiotics has led to a rise in antibiotic resistance. Antibiotic resistance

occurs when bacteria are no longer sensitive to a medication that should eliminate an infection.

Antibiotic-resistant bacterial infections are potentially very dangerous and increase the risk of

death. About 2 million people in the U.S. suffer from antibiotic resistant infections each year and

23,000 die due to the condition. The CDC estimates 14,000 deaths alone are due to Clostridium

difficile (C. difficile) infections that occur because of antibiotic suppression of other bacteria
allow C. difficile to proliferate. Most deaths due to antibiotic resistant infections occur in

hospitalized patients and those who are in nursing homes. Beneficial bacteria live in the human

gastrointestinal (GI) tract and play an important role in digestion and immunity. Most people

know it's smart to eat yogurt after completing a course of antibiotics to repopulate the GI tract

with helpful bacteria that were wiped out from the antibiotics. Some studies have shown

probiotics can shorten the duration of infectious diarrhea. They may also reduce the risk of

developing diarrheal illness due to antibiotic use. Probiotics seem to reduce gas, bloating, and

abdominal pain associated with irritable bowel syndrome (IBS). Ongoing research seeks to

determine the types and dosages of bacteria that are most beneficial to human health.

(Fashafsheh I, 2014).

Hand washing is the single most important measure to reduce the risks of transmitting skin

microorganisms from one person to another or from one site to another on the same patient.

Washing hands as promptly and thoroughly as possible between patient contacts and after

contact with blood, body fluids, secretions, excretions, and equipment or articles contaminated

by them is an important component of infection control and isolation precautions. (Fashafsheh I,

2014).

Hand washing with soap: Hand washing is the single most important measure to reduce the

risks of transmitting skin microorganisms from one person to another or from one site to another

on the same patient. The spread of nosocomial infections among immune compromised patients

is connected with health care workers’ hand contamination in almost 40% of cases. This presents

a challenging problem in the modern hospitals. The best way for workers to overcome this

problem is by conducting correct hand- hygiene procedures; this is why in 2005 the WHO

launched the GLOBAL Patient Safety Challenge. Two categories of micro-organisms can be
present on health care workers’ hands: transient flora and resident flora. The first is represented

by the micro-organisms taken by workers from the environment, and the bacteria in it. These are

often capable of surviving on the human skin and sometimes to grow. The second group is

represented by the permanent micro-organisms living on the skin surface, on the stratum

corneum or immediately under it. They are capable of surviving on the human skin and of

growing freely on it. They have low pathogenicity and infection rate, and they create a kind of

protection from the colonization from other more pathogenic bacteria. The main problems found

in the practice of hand hygiene are connected with the lack of available sinks and the time-

consuming performance of hand washing. An easy way to resolve this problem could be the use

of alcohol-based hand rubs, because of faster application compared to correct hand washing.

Bacteria are the most common pathogens responsible for nosocomial infections. Some belong to

natural flora of the patient and cause infection only when the immune system of the patient

becomes prone to infections. Acinetobacter is the genre of pathogenic bacteria responsible for

infections occurring in ICUs. It is embedded in soil and water and accounts for 80% of reported

infections. Bacteroides fragilis is a commensal bacteria found in intestinal tract and colon. It

causes infections when combined with other bacteria. Clostridium difficile cause inflammation

of colon leading to antibiotic-associated diarrhea and colitis, mainly due to elimination of

beneficial bacteria with that of pathogenic. C. difficile is transmitted from an infected patient to

others through healthcare staff via improper cleansed hands. Enterobacteriaceae (carbapenem-

resistance) cause infections if travel to other body parts from gut; where it is usually found.

Enterobacteriaceae constitute Klebsiella species and Escherichia coli. Their high resistance

towards carbapenem causes the defense against them more difficult. Methicillin-resistant S.

aureus (MRSA) transmit through direct contact, open wounds and contaminated hands. It causes
sepsis, pneumonia and SSI by travelling from organs or bloodstream. It is highly resistant

towards antibiotics called beta-lactams. (Taneja J, 2015).

Besides bacteria, viruses are also an important cause of nosocomial infection. Usual monitoring

revealed that 5% of all the nosocomial infections are because of viruses. They can be transmitted

through hand-mouth, respiratory route and fecal-oral route. Hepatitis is the chronic disease

caused by viruses. Healthcare delivery can transmit hepatitis viruses to both patients and

workers. Hepatitis B and C are commonly transmitted through unsafe injection practices . Other

viruses include influenza, HIV, rotavirus, and herpes-simplex virus. Fungal parasites act as

opportunistic pathogens causing nosocomial infections in immune-compromised individuals.

Aspergillus spp. can cause infections through environmental contamination. Candida albicans,

Cryptococcus neoformans are also responsible for infection during hospital stay. Candida

infections arise from patient's endogenous microflora while Aspergillus infections are caused by

inhalation of fungal spores from contaminated air during construction or renovation of health

care facility. Gloves play an important role in reducing the risks of transmission of

microorganisms. Gloves are worn for three important reasons in hospitals. They are worn to

provide a protective barrier and to prevent gross contamination of the hands when touching

blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin. In the USA,

the Occupational Safety and Health Administration (OSHA) has mandated wearing gloves to

reduce the risk of blood-borne pathogen infections. Gloves are worn to reduce the likelihood

microorganisms present on the hands of personnel will be transmitted to patients during invasive

or other patient-care procedures that involve touching a patient’s mucous membranes and

nonintact skin. They are worn to reduce the likelihood the hands of personnel contaminated with

micro-organisms from a patient or a fomite (contaminated object) can be transmitted to another

patient. In this situation, gloves must be changed between patient contacts, and hands should be

washed after gloves are removed. Sanitizing surfaces is an often overlooked, yet crucial,

component of the strategy for the cycle of infection in health care environments. Modern

sanitizing methods such as NAV-CO2 have been effective against gastroenteritis, MRSA, and

influenza agents. Use of hydrogen peroxide vapor has been clinically proven to reduce infection

rates and risk of acquisition. Hydrogen peroxide is effective against endospore-forming bacteria,

such as Clostridium difficile, where alcohol has been shown to be ineffective. Microorganisms

are known to survive on inanimate “touch” surfaces for extended periods of time. This can be

especially troublesome in hospital environments, where patients with immunodeficiencies are at

enhanced risk for contracting nosocomial infections. Wearing an apron during patient care

reduces the risk of infection. The apron should either be disposable or be used only when caring

for a specific patient. Nosocomial infections (Hospital-acquired infections) (Isara A, 2012).

2.2 Transmission of nosocomial infection

Infections can be transferred from healthcare staff. It is the duty of healthcare professionals to

take role in infection control. Personal hygiene is necessary for everyone so staff should maintain

it. Hand decontamination is required with proper hand disinfectants after being in contact with

infected patients. Safe injection practices and sterilized equipments should be used. Use of

masks, gloves, head covers or a proper uniform is essential for healthcare delivery. Although the

aim of infection prevention and control program is to eradicate nosocomial infections but

epidemiological surveillance for demonstration of performance improvement is still required to

accomplish the aim. The efficient surveillance methods include data collection from multiple

sources of information by trained data collectors; information should include administrative data,
demographic risk factors, patients' history, diagnostic tests, and validation of data. Following the

data extraction, analysis of the collected information should be done which includes description

of determinants, distribution of infections, and comparison of incidence rates. Feedback and

reports after analysis should be disseminated by infection control committees, management, and

laboratories keeping the confidentiality of individuals. The evaluation of credibility of

surveillance systems is required for effective implementations of interventions and its continuity.

Finally the undertaking of data at regular intervals for maintenance of efficiency of surveillance

systems should be made compulsory. Efficient methodology for appropriate surveillance

approach is given in Figure 2.

2.3 Prevention and Control of Nosocomial Infection

Controlling nosocomial infection is to implement QA/QC measures to the health care sectors,

and evidence-based management can be a feasible approach. For those with ventilator-associated

or hospital-acquired pneumonia, controlling and monitoring hospital indoor air quality needs to

be on agenda in management, whereas for nosocomial rotavirus infection, a hand

hygiene protocol has to be enforced. To reduce HAIs, the state of Maryland implemented the
Maryland Hospital-Acquired Conditions Program that provides financial rewards and penalties

for individual hospitals based on their ability to avoid HAIs. An adaptation of the Centers for

Medicare & Medicaid Services payment policy causes poor-performing hospitals to lose up to

3% of their inpatient revenues, whereas hospitals that are able to avoid HAIs can earn up to 3%

in rewards. During the program’s first 2 years, complication rates fell by 15.26 percent across all

hospital-acquired conditions tracked by the state (including those not covered by the program),

from a risk-adjusted complication rate of 2.38 per 1,000 people in 2009 to a rate of 2.02 in 2011.

The 15.26-percent decline translates into more than $100 million in cost savings for the health

care system in Maryland, with the largest savings coming from avoidance of urinary tract

infections, sepsis and other severe infections, and pneumonia and other lung infections. If similar

results could be achieved nationwide, the Medicare program would save an estimated $1.3

billion over 2 years, while the health care system as a whole would save $5.3 billion. Hospitals

have sanitation protocols regarding uniforms, equipment sterilization, washing, and other

preventive measures. Thorough hand washing and/or use of alcohol rubs by all medical

personnel before and after each patient contact is one of the most effective ways to combat

nosocomial infections. More careful use of antimicrobial agents, such as antibiotics, is also

considered vital. As many hospital-acquired infections such as MRSA, Clostridium Difficile, and

MSSA, are caused by a breach of these protocols, it is common that affected patient makes a

medical negligence claim against the hospital in question. Despite sanitation protocol, patients

cannot be entirely isolated from infectious agents. Furthermore, patients are often prescribed

antibiotics and other antimicrobial drugs to help treat illness; this may increase the selection

pressure for the emergence of resistant strains. Teshager, (F. A., 2013)

2.3.1 Sterilization
Sterilization goes further than just sanitizing. It kills all microorganisms on equipment and

surfaces through exposure to chemicals, ionizing radiation, dry heat, or steam under pressure.

2.3.2 Isolation

Isolation is the implementation of isolating precautions designed to prevent transmission of

microorganisms by common routes in hospitals. (See Universal precautions and Transmission-

based precautions.) Because agent and host factors are more difficult to control, interruption of

transfer of microorganisms is directed primarily at transmission for example isolation of

infectious cases in special hospitals and isolation of patient with infected wounds in special

rooms also isolation of joint transplantation patients on specific rooms.

2.3.3 Hand washing

Hand washing frequently is called the single most important measure to reduce the risks of

transmitting skin microorganisms from one person to another or from one site to another on the

same patient. Washing hands as promptly and thoroughly as possible between patient contacts

and after contact with blood, body fluids, secretions, excretions, and equipment or articles

contaminated by them is an important component of infection control and isolation precautions.

The spread of nosocomial infections, among immune compromised patients is connected with

health care workers' hand contamination in almost 40% of cases, and is a challenging problem in

the modern hospitals. The best way for workers to overcome this problem is conducting correct

hand-hygiene procedures; this is why the WHO launched in 2005 the GLOBAL Patient Safety

Challenge. Two categories of micro-organisms can be present on health care workers' hands:

transient flora and resident flora. The first is represented by the micro-organisms taken by

workers from the environment, and the bacteria in it are capable of surviving on the human skin
and sometimes to grow. The second group is represented by the permanent micro-organisms

living on the skin surface (on the stratum corneum or immediately under it). They are capable of

surviving on the human skin and to grow freely on it. They have low pathogenicity and infection

rate, and they create a kind of protection from the colonization from other more pathogenic

bacteria. The skin of workers is colonized by 3.9 x 10 4 – 4.6 x 106 cfu/cm2. The microbes

comprising the resident flora are: Staphylococcus epidermidis, S. hominis,

and Microccocus, Propionibacterium, Corynebacterium, Dermobacterium, and Pitosporum spp.,

while transient organisms are S. aureus, and Klebsiella pneumoniae, and Acinetobacter,

Enterobacter and Candida spp. The goal of hand hygiene is to eliminate the transient flora with a

careful and proper performance of hand washing, using different kinds of soap, (normal and

antiseptic), and alcohol-based gels. The main problems found in the practice of hand hygiene is

connected with the lack of available sinks and time-consuming performance of hand washing.

An easy way to resolve this problem could be the use of alcohol-based hand rubs, because of

faster application compared to correct hand-washing. Improving patient hand washing has also

been shown to reduce the rate of nosocomial infection. Patients who are bed-bound often do not

have as much access to clean their hands at mealtimes or after touching surfaces or handling

waste such as tissues. By reinforcing the importance of hand washing and providing sanitizing

gel or wipes within reach of the bed, nurses were directly able to reduce infection rates. A study

published in 2017 demonstrated this by improving patient education on both proper hand-

washing procedure and important times to use sanitizer and successfully reduced the rate of

enterococci and "S. aureus". All visitors must follow the same procedures as hospital staff to

adequately control the spread of infections. Moreover, multidrug-resistant infections can leave

the hospital and become part of the community flora if steps are not taken to stop this
transmission. It is unclear whether or not nail polish or rings affected surgical wound infection

rates. In addition to hand washing, gloves play an important role in reducing the risks of

transmission of microorganisms. Gloves are worn for three important reasons in hospitals. First,

they are worn to provide a protective barrier for personnel, preventing large scale contamination

of the hands when touching blood, body fluids, secretions, excretions, mucous membranes, and

non-intact skin. In the United States, the Occupational Safety and Health Administration has

mandated wearing gloves to reduce the risk of blood borne pathogen infections. Second, gloves

are worn to reduce the likelihood that microorganisms present on the hands of personnel will be

transmitted to patients during invasive or other patient-care procedures that involve touching a

patient's mucous membranes and no intact skin. Third, they are worn to reduce the likelihood

that the hands of personnel contaminated with micro-organisms from a patient or a fomite can

transmit those micro-organisms to another patient. In this situation, gloves must be changed

between patient contacts, and hands should be washed after gloves are removed. Wearing gloves

does not replace the need for hand washing due to the possibility of contamination when gloves

are replaced, or by damage to the glove. Doctors wearing the same gloves for multiple patient

operations presents an infection control hazard.

2.3.4 Surface Sanitation

Sanitizing surfaces is part of nosocomial infection in health care environments. Modern

sanitizing methods such as Non-flammable Alcohol Vapor in Carbon Dioxide systems have been

effective against gastroenteritis, MRSA, and influenza agents. Use of hydrogen peroxide vapor

has been clinically proven to reduce infection rates and risk of acquisition. Hydrogen peroxide is

effective against endospore-forming bacteria, such as Clostridium difficile, where alcohol has
been shown to be ineffective. Ultraviolet cleaning devices may also be used to disinfect the

rooms of patients infected with Clostridium difficile or MRSA after discharge

2.3.5 Antimicrobial Surfaces

Micro-organisms are known to survive on inanimate ‘touch’ surfaces for extended periods of

time. This can be especially troublesome in hospital environments where patients

with immunodeficiency’s are at enhanced risk for contracting nosocomial infections.

Touch surfaces commonly found in hospital rooms, such as bed rails, call buttons, touch plates,

chairs, door handles, light switches, grab rails, intravenous poles, dispensers (alcohol gel, paper

towel, soap), dressing trolleys, and counter and table tops are known to be contaminated

with Staphylococcus, MRSA (one of the most virulent strains of antibiotic-resistant bacteria)

and vancomycin-resistant Enterococcus (VRE). Objects in closest proximity to patients have the

highest levels of MRSA and VRE. This is why touch surfaces in hospital rooms can serve as

sources, or reservoirs, for the spread of bacteria from the hands of healthcare workers and

visitors to patients.

There have been a number of studies evaluating the use of no-touch cleaning systems particularly

the use of ultraviolet C devices. One review was inconclusive due to lack of, or of poor quality

evidence. Other reviews have found some evidence, and growing evidence of their effectiveness.

2.3.6 Treatment

Two of the bacteria species most likely to infect patients are the gram-positive strains

of methicillin-resistant Staphylococcus aureus (MRSA), and gram-negative Acinetobacter

baumannii. While antibiotic drugs to treat diseases caused by MRSA are available, few effective
drugs are available for Acinetobacter. Acinetobacter bacteria are evolving and becoming immune

to existing antibiotics, so in many cases, polymyxin-type antibacterials need to be used. "In many

respects it’s far worse than MRSA," said a specialist at Case Western Reserve University.[34]

Another growing disease, especially prevalent in New York City hospitals, is the drug-resistant,

gram-negative Klebsiella pneumoniae. An estimated more than 20% of the Klebsiella infections

in Brooklyn hospitals "are now resistant to virtually all modern antibiotics, and those supergerms

are now spreading worldwide. The bacteria, classified as gram-negative because of their reaction

to the Gram stain test, can cause severe pneumonia and infections of the urinary tract,

bloodstream, and other parts of the body. Their cell structures make them more difficult to attack

with antibiotics than gram-positive organisms like MRSA. In some cases, antibiotic resistance is

spreading to gram-negative bacteria that can infect people outside the hospital. "For gram-

positives we need better drugs; for gram-negatives we need any drugs," said Dr. Brad Spellberg,

an infectious-disease specialist at Harbor-UCLA Medical Center, and the author of Rising

Plague, a book about drug-resistant pathogens. One-third of nosocomial infections are

considered preventable. The CDC estimates 2 million people in the United States are infected

annually by hospital-acquired infections, resulting in 99,000 deaths. The most common

nosocomial infections are of the urinary tract, surgical site and various pneumonias. An

alternative treatment targeting localised infections is the use of irradiation by ultraviolet C.

(Abdulraheem I, 2013).

2.4 Knowledge and Perception of Nosocomial among health care workers

Nosocomial infections (NIs), also known as a hospital-acquired infection, are defined as

infections which are acquired after 48 h of patient admission. Such infections are neither present
nor incubating prior to a patient’s admission to a given hospital. NIs represent a universally

serious health problem and a major concern for the safety of both patients and the health care

providers. Although the incidence rate for nosocomial infection vary from country to country, at

any given time, almost seven patients from developed countries to ten patients from developing

countries out of each100 patients admitted to hospitals gain at least one kind of nosocomial

infections. In Yemen, data regarding NIs are few, but the prevalence rate of NIs, specifically

surgical site infection, is high from time to time as it accounted for 8% in 2002 and 34% in 2013.

NIs have significant consequences on patients, their families, and the community as a whole. The

most common consequences of NIs are increased morbidity, mortality, and length of

hospitalization. Such consequences contribute substantially to raise both the direct and indirect

cost of the health care services, which result in additional costs to treat infected cases. Hence,

such issue wastes the available resources which are not already enough, especially in developing

countries. Nurses are responsible for providing medications, dressing, sterilization, and

disinfection. They are involved in more contact with patients than other health care workers

(HCWs). Therefore, they are more exposed to various NIs. Hence, nurses play a vital role in

transmitting NIs, and their compliance with infection control measures seems to be necessary for

preventing and controlling NIs. Accordingly, they should be aware of how to prevent

transmission of NIs and be knowledgeable of its potential risk to patients, other staff, and as

visitors. Although there are many previous cross-sectional studies which revealed that the levels

of nurses’ knowledge and practices are relatively poor and insufficient, to the researcher’s best of

knowledge, so far, no study has been conducted in Kazaure LGA which is the context of the

current study. Therefore, this study aimed to identify gaps in nurses’ knowledge and practices
regarding NI control measures in order to improve the current training courses and enhance

future good practice. Teshager, (F. A., 2013).

2.5 Summary

Nosocomial infections, also known as hospital-acquired infections, are newly acquired infections

that are contracted within a hospital environment. Transmission usually occurs via healthcare

workers, patients, hospital equipment, or interventional procedures. The most common sites of

infection are the bloodstream, lungs, urinary tract, and surgical wounds. Though any bacteria

may cause a nosocomial infection, there is an increasing incidence of multidrug-resistant (MDR)

pathogens causing hospital-acquired infections. A hospital-acquired infection (HAI), also

known as a nosocomial infection, is an infection that is acquired in a hospital or other health

care facility. To emphasize both hospital and nonhospital settings, it is sometimes instead called

a health care–associated infection (HAI or HCAI). Such an infection can be acquired in

hospital, nursing home, rehabilitation facility, outpatient clinic, diagnostic laboratory or other

clinical settings. Infection is spread to the susceptible patient in the clinical setting by various

means. Health care staff also spread infection, in addition to contaminated equipment, bed linens,

or air droplets. The infection can originate from the outside environment, another infected

patient, staff that may be infected, or in some cases, the source of the infection cannot be

determined. In some cases the microorganism originates from the patient's own skin microbiota,

becoming opportunistic after surgery or other procedures that compromise the protective skin

barrier. Though the patient may have contracted the infection from their own skin, the infection

is still considered nosocomial since it develops in the health care setting. (Allegranzi B, 2011)
Nosocomial’ or ‘healthcare associated infections’ (HCAI) appear in a patient under medical care in the

hospital or other health care facility which was absent at the time of admission. These infections can

occur during healthcare delivery for other diseases and even after the discharge of the patients.

Additionally, they comprise occupational infections among the medical staff . Invasive devices such as

catheters and ventilators employed in modern health care are associated to these infections .

Of every hundred hospitalized patients, seven in developed and ten in developing countries can acquire

one of the healthcare associated infections . Populations at stake are patients in Intensive Care Units

(ICUs), burn units, undergoing organ transplant and neonates. According to Extended Prevalence of

Infection in Intensive Care (EPIC II) study, the proportion of infected patients within the ICU are often as

high as 51% . Based on extensive studies in USA and Europe shows that HCAI incidence density ranged

from 13.0 to 20.3 episodes per thousand patient-days .

With increasing infections, there is an increase in prolonged hospital stay, long term disability,

increased antimicrobial resistance, increase in socio-economic disturbance, and increased mortality rate.

Spare information exists on burden of nosocomial infections because of poorly developed surveillance

systems and inexistent control methods. For instance, while getting care for other diseases many patients

probably get respiratory infections and it becomes troublesome to spot the prevalence of any nosocomial

infection in continuation of a primary care facility . These infections get noticed only when they become

epidemic, yet there is no institution or a country that may claim to have resolved this endemic problem .

We have discussed the control strategies of nosocomial infections in our previous study . In this review

article a brief description about the distribution of these infections across the globe, emerging causes,

brief control methods but more focus on current surveillance will be discussed.

2. Types of nosocomial infections

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

associated urinary tract infections, surgical site infections and ventilator-associated pneumonia. A brief

detail of these is given below:

2.1. Central line-associated bloodstream infections (CLABSI)

CLABSIs are deadly nosocomial infections with the death incidence rate of 12%–25% . Catheters are

placed in central line to provide fluid and medicines but prolonged use can cause serious bloodstream

infections resulting in compromised health and increase in care cost . Although there is a decrease of 46%

in CLABSI from 2008 to 2013 in US hospitals yet an estimated 30,100 CLABSI still occur in ICU and

acute facilities wards in US each year.

Catheter associated urinary tract infections (CAUTI)

CAUTI is the most usual type of nosocomial infection globally. According to acute care hospital stats in

2011, UTIs account for more than 12% of reported infections . CAUTIs are caused by endogenous

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

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

bacterial residence. CAUTI can develop to complications such as, orchitis, epididymitis and prostatitis in

males, and pyelonephritis, cystitis and meningitis in all patients .

Surgical site infections (SSI)

SSIs are nosocomial infections be fall in 2%–5% of patients subjected to surgery. These are the second

most common type of nosocomial infections mainly caused by Staphylococcus aureus resulting in

prolonged hospitalization and risk of death. The pathogens causing SSI arise from endogenous microflora

of the patient. The incidence may be as high as 20% depending upon procedure and surveillance criteria

used.
Ventilator associated pneumonia (VAP)

VAP is nosocomial pneumonia found in 9–27% of patients on mechanically assisted ventilator. It usually

occurs within 48 h after tracheal incubation. 86% of nosocomial pneumonia is associated with ventilation.

Fever, leucopenia, and bronchial sounds are common symptoms of VAP.

Nosocomial pathogens

Pathogens responsible for nosocomial infections are bacteria, viruses and fungal parasites. These

microorganisms vary depending upon different patient populations, medical facilities and even difference

in the environment in which the care is given.

Bacteria

Bacteria are the most common pathogens responsible for nosocomial infections. Some belong to natural

flora of the patient and cause infection only when the immune system of the patient becomes prone to

infections. Acinetobacter is the genre of pathogenic bacteria responsible for infections occurring in ICUs.

It is embedded in soil and water and accounts for 80% of reported infections . Bacteroides fragilis is a

commensal bacteria found in intestinal tract and colon. It causes infections when combined with other

bacteria. Clostridium difficile cause inflammation of colon leading to antibiotic-associated diarrhea and

colitis, mainly due to elimination of beneficial bacteria with that of pathogenic. C. difficile is transmitted

from an infected patient to others through healthcare staff via improper cleansed

hands. Enterobacteriaceae (carbapenem-resistance) cause infections if travel to other body parts from gut;

where it is usually found. Enterobacteriaceae constitute Klebsiella species and Escherichia coli. Their

high resistance towards carbapenem causes the defense against them more difficult. Methicillin-

resistant S. aureus (MRSA) transmit through direct contact, open wounds and contaminated hands. It
causes sepsis, pneumonia and SSI by travelling from organs or bloodstream. It is highly resistant towards

antibiotics called beta-lactams.

Viruses

Besides bacteria, viruses are also an important cause of nosocomial infection. Usual monitoring revealed

that 5% of all the nosocomial infections are because of viruses. They can be transmitted through hand-

mouth, respiratory route and fecal-oral route. Hepatitis is the chronic disease caused by viruses.

Healthcare delivery can transmit hepatitis viruses to both patients and workers. Hepatitis B and C are

commonly transmitted through unsafe injection practices. Other viruses include influenza, HIV, rotavirus,

and herpes-simplex virus.

Fungal parasites

Fungal parasites act as opportunistic pathogens causing nosocomial infections in immune-compromised

individuals. Aspergillus spp. can cause infections through environmental contamination. Candida

albicans, Cryptococcus neoformans are also responsible for infection during hospital

stay. Candida infections arise from patient's endogenous microflora while Aspergillus infections are

caused by inhalation of fungal spores from contaminated air during construction or renovation of health

care facility.

Epidemiology of nosocomial infections

Nosocomial infection affects huge number of patients globally, elevating mortality rate and financial

losses significantly. According to estimate reported of WHO, approximately 15% of all hospitalized

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

neonates, with incidence rate of 75% in South-East Asia and Sub-Saharan Africa. The incidence is high

enough in high income countries i.e. between 3.5% and 12% whereas it varies between 5.7% and 19.1%
in middle and low income countries. The frequency of overall infections in low income countries is three

times higher than in high income countries whereas this incidence is 3–20 times higher in neonates.

Determinants

Risk factors determining nosocomial infections depends upon the environment in which care is delivered,

the susceptibility and condition of the patient, and the lack of awareness of such prevailing infections

among staff and health care providers.

Environment

Poor hygienic conditions and inadequate waste disposal from health care settings.

Susceptibility

Immunosuppression in the patients, prolonged stay in intensive care unit, and prolonged use of

antibiotics.

Unawareness

Improper use of injection techniques, poor knowledge of basic infection control measures, inappropriate

use of invasive devices (catheters) and lack of control policies. In low income countries these risk factors

are associated with poverty, lack of financial support, understaffed health care settings and inadequate

supply of equipment’s.

Reservoirs and transmission

Micro flora of patient

Bacteria belonging to the endogenous flora of the patient can cause infections if they are transferred to

tissue wound or surgical site. Gram negative bacteria in the digestive tract cause SSI after abdominal

surgery.

Patient and staff

Transmission of pathogens during the treatment through direct contacts with the patients (hands, saliva,

other body fluids etc.) and by the staff through direct contact or other environmental sources (water, food,

other body fluids).

Environment

Pathogens living in the healthcare environment i.e. water, food, and equipments can be a source of

transmission. Transmission to other patient makes one more reservoir for uninfected patient.

Prevention of nosocomial infection

Being a significant cause of illness and death, nosocomial infections need to be prevented from the base

line so that their spread can be controlled.

Transmission from environment

Unhygienic environment serves as the best source for the pathogenic organism to prevail. Air, water and

food can get contaminated and transmitted to the patients under healthcare delivery. There must be

policies to ensure the cleaning and use of cleaning agents on walls, floor, windows, beds, baths, toilets

and other medical devices. Proper ventilated and fresh filtered air can eliminate airborne bacterial

contamination. Regular check of filters and ventilation systems of general wards, operating theatres and
ICUs must be maintained and documented. Infections attributed to water are due to failure of healthcare

institutions to meet the standard criteria. Microbiological monitoring methods should be used for water

analysis. Infected patients must be given separate baths. Improper food handling may cause food borne

infections. The area should be cleaned and the quality of food should meet standard criteria.

Transmission from staff

Infections can be transferred from healthcare staff. It is the duty of healthcare professionals to take role in

infection control. Personal hygiene is necessary for everyone so staff should maintain it. Hand

decontamination is required with proper hand disinfectants after being in contact with infected patients.

Safe injection practices and sterilized equipments should be used. Use of masks, gloves, head covers or a

proper uniform is essential for healthcare delivery.

Hospital waste management

Waste from hospitals can act as a potential reservoir for pathogens that needs proper handling. 10–25% of

the waste generated by healthcare facility is termed as hazardous. Infectious healthcare waste should be

stored in the area with restricted approach. Waste containing high content of heavy metals and waste from

surgeries, infected individuals, contaminated with blood and sputum and that of diagnostic laboratories

must be disposed off separately. Healthcare staff and cleaners should be informed about hazards of the

waste and its proper management.

Control of nosocomial infections

Despite of significant efforts made to prevent nosocomial infections, there is more work required to

control these infections. In a day, one out of 25 hospital patients can acquire at least a single type of

nosocomial infection.

Infection control programs

Healthcare Institutes should devise control programs against these infections. Administration, workers

and individuals admitted or visiting hospital must take into account such programs to play their role in

prevention of infections. An efficient infection control program is shown in Figure 1 [22].

Download : Download high-res image (154KB)

Download : Download full-size image

Figure 1. Infection control program.

Antimicrobial use and resistance

Microbes are the organisms too small to be seen with the eyes, yet they are found everywhere on earth.

Antimicrobial drugs are used against the microbes which are pathogenic towards living

organisms. Antimicrobial resistance occurs when the microbes develop the ability to resist the effects of

drugs; they are not killed and their growth does not stop.

Appropriate antimicrobial use

Antibiotics are greatly used to cure illness. Antimicrobial use should justify the proper clinical diagnosis

or an infection causing microorganism. The Centers for Disease Control and Prevention (CDC) estimates
that each year about 100 million courses of antibiotics are prescribed by office-based physicians, while

approximately 50% of those are unnecessary . The selection of antimicrobials should be based upon the

patient's tolerance in addition to the nature of disease and pathogen. The aim of antimicrobial therapy is to

use a drug that is selectively active against most likely pathogen and least likely to cause resistance and

adverse effects. Antimicrobial prophylaxis should be used when it is appropriate i.e. prior to surgery, to

reduce postoperative incidence of surgical site infections. In case of immunocompromised patients,

prolonged prophylaxis is used until immune markers are reinstate .

Antibiotic resistance

Antibiotic resistance is responsible for the death of a child every five minutes in South-East Asia region.

Drugs that were used to treat deadly diseases are now losing their impact due to emerging drug resistant

microorganisms. Self-medication with antibiotics, incorrect dosage, prolonged use, lack of standards for

healthcare workers and misuse in animal husbandry are the main factors responsible for increase in

resistance. This resistance threatens the effective control against bacteria that causes UTI, pneumonia and

bloodstream infections. Highly resistant bacteria such as MRSA or multidrug-resistant Gram-negative

bacteria are the cause of high incidence rates of nosocomial infections worldwide. South-East Asian

region reports reveal that there a high resistance in E. coli and K. pneumoniae for third generation

cephalosporin and more than quarter of S. aureus infections are methicillin resistant . “Immediate action

is needed to stop the world from heading towards pre-antibiotic era in which all achievements made in

prevention and control of communicable diseases will be reversed”, said Dr Poonam Khetrapal Singh,

Regional Director of WHO South-East Asia Region.

Antibiotic control policy

The worldwide pandemic of antibiotic resistance shows that it is driven by overuse and misuse of

antibiotics, which is a threat to prevent and cure the diseases. WHO's global report on antibiotic
resistance, preventing the infection from happening by better hygiene, clean water, and vaccination to

reduce the need of antibiotics. The development of new diagnostics and other tools is required in

healthcare institutes to stay ahead of evolving resistance. Pharmacists should play their role of prescribing

the right antibiotic when truly needed and policymakers should foster cooperation and information among

all stakeholders.

Surveillance of nosocomial infection

Although the aim of infection prevention and control program is to eradicate nosocomial infections but

epidemiological surveillance for demonstration of performance improvement is still required to

accomplish the aim. The efficient surveillance methods include data collection from multiple sources of

information by trained data collectors; information should include administrative data, demographic risk

factors, patients' history, diagnostic tests, and validation of data. Following the data extraction, analysis of

the collected information should be done which includes description of determinants, distribution of

infections, and comparison of incidence rates. Feedback and reports after analysis should be disseminated

by infection control committees, management, and laboratories keeping the confidentiality of individuals.

The evaluation of credibility of surveillance systems is required for effective implementations of

interventions and its continuity. Finally the undertaking of data at regular intervals for maintenance of

efficiency of surveillance systems should be made compulsory

The term "nosocomial" comes from two Greek words: "nosus" meaning "disease" + "komeion"
meaning "to take care of." Hence, "nosocomial" should apply to any disease contracted by a
patient while under medical care. However, common usage of the term "nosocomial" is now
synonymous with hospital-acquired. Nosocomial infections are infections that have been caught
in a hospital and are potentially caused by organisms that are resistant to antibiotics. A
nosocomial infection is specifically one that was not present or incubating prior to the patient's
being admitted to the hospital, but occurring within 72 hours after admittance to the hospital.
A bacterium named Clostridium difficile is now recognized as the chief cause of
nosocomial diarrhea in the US and Europe. Methicillin-resistant Staphylococcus aureus (MRSA)
is a type of staph bacteria that is resistant to certain antibiotics and may be acquired during
hospitalization.

CHAPTER THREE

METHODOLOGY

3.0 Introduction

This chapter will be discussed under the following subheadings:

3.1 Research Design

The research design employed for the conduct of this study is descriptive survey method,

3.2 Population of the Study

The population of this study comprised all the Jigawa state health workers. Available records

indicated that there are estimated 4,361 workers in Jigawa State.

3.3 Sample And Sampling Techniques

Simple random sampling techniques was used to select 253 as the sample of the study out of the

population.

3.4 Instrument For Data Analysis

For the purpose of this study the researcher used questionnaire that used it containing 15 test

items of agree and disagree. Mode of responses. The questionnaire constitute four (4) sections,

section A, B, and C.

3.5 Validity and Reliability of the Instrument

The questionnaire is valid and reliable after being thoroughly evaluated by experts, including the

researcher supervisor.

3.6 Administration of the Instrument

The researcher distributes the questionnaire to the sample that were selected for the study. And

allowed for maximum of seven days to ten days for the respondents to fill the questionnaire after

which will be collected back by the researcher.

3.7 Techniques for Data Collection

The data collected will be analyze using simple percentage procedure and its equivalent

frequency count.
 CHAPTER FOUR

DATA ANALYSIS

A total of hundred (253) questionnaires were distributed to the respondents in the study area and

the 250 of questionnaires returned and used for analysis as follows:

Table 4.1 Gender Table

S/N Items Response Frequency Percentage %

1. Sex Male 150 60%

Female 100 40%

Total 250 100%

Age Table:
 2. Age 18-25years 80 32%

26-30years 70 28%
31-40years
60 24%
41years –above
40 16%

Total 250 100%

Marital Status

3. Marital status Married 80 32%

Single 100 40%

Divorced 70 28%

Others 0 0%

Total 250 100%

Professional

4. Profession Physicians 85 34%

Nurse 100 40%

Lab staff
15 6%
Others
50 20%

Total 250 100%

Source: questionnaire

Table 4.1 result shows that from the table above which shows the demographic information of

the respondent it shows that male 150(60%) of the total sex which 100(40%) female of the

respondents. On the second stage is on age shows that those of 18-25 years are those with high
response with 80(32%) also from age 26-30years 70 (28%) also these of age 31-40years 60(24%)

and 41years -above are 40 (16%) of the total respondent. Marital status married with 80(32%)

followed by single with 100(40%) followed by divorced with 70(28%) followed by others with

0(0%) On profession physicians with 85(34%) followed by nurse with 100(40%) followed by

15(6%) followed by others with 50(20%) respectively.

TABLE 4.2: KNOWLEDGE OF NOSCOMIAL INFECTION AMONG HEALTH

WORKERS OF JIGAWA STATE

S/N Items Responses Respondents Percentages

1. Are you aware that some infectious are Yes 156 62.4%

acquired in the hospital? No 94 37.6%

Total 250 100%

2 Are you aware that nosocomial infection are Yes 140 56%

acquired in the hospital environment only? No 110 44%

Total 250 100%

3. Are you aware that most common site of Yes 186 74.4%

nosocomial infections are blood stream lungs No 64 25.6%

urinary tract and surgical woods? Total 250 100%

4. Are you aware that nosocomial infection are Yes 187 74.8%

caused by bacteria and other microorganisms? No 63 25.2%

 Total 250 100%

5. Are you aware that transmission of Yes 169 67.6%

nosocomial infections via health care No 81 32.4%

workers, patients, hospital equipment or Total 250 100%

interventional procedures?

Source: questionnaire

Table 4.3 above shows that 156 (62.4%) of the respondent agreed that some infectious are

acquired in the hospital while 94(37.6%) disagreed. 140(56%) of the respondent agreed that

nosocomial infection are acquired in the hospital environment only, while 110 (44%) disagreed.

186 (74.4%) of the respondent agreed that most common site of nosocomial infections are blood

stream lungs urinary tract and surgical woods while 64 (25.6%) disagreed. 187(74.8%) of the

respondents agreed that that nosocomial infection are caused by bacteria and other

microorganisms, while 81(32.4%) do not. 169(67.6%) agreed that transmission of nosocomial

infections via health care workers, patients, hospital equipment or interventional procedures,

while 81(32.4%) disagreed.

TABLE 4.3 PRACTICE OF NOSOCOMIAL INFECTION AMONG HEALTH

WORKERS OF JIGAWA STATE

S/N Items Responses Respondents Percentages

1. Do you observe hand washing to prevent Yes 168 67.2%

nosocomial infection? No 82 32.8%

Total 250 100%

 2. Do you use hand gloves to prevent Yes 190 76%

nosocomial infection? No 60 24%

Total 250 100%

3. Do you use sterile equipment to prevent Yes 157 62.8%

nosocomial infection? No 93 37.2%

Total 250 100%

4. Do you practice rontine hospital cleaning to Yes 170 68%

prevent nosocomial infection? No 80 32%

Total 250 100%

5. Do you use protective equipment to prevent Yes 175 70%

nosocomial infection? No 75 30%

Total 250 100%

Source: questionnaire

Table 4.3 above shows that 168 (67.2%) of the respondent agreed that observe hand washing to

prevent nosocomial infection while 82(32.8%) disagreed. 190 (76%) of the respondent agreed

that use hand gloves to prevent nosocomial infection, while 60 (24%) disagreed. 157 (62.8%) of

the respondent agreed that use sterile equipment to prevent nosocomial infection while
93(37.2%) disagreed. 170(68%) of the respondents agreed that practice rontine hospital cleaning

to prevent nosocomial infection, while 80(32%) disagreed. 175(70%) of the respondents agreed

that use protective equipment to prevent nosocomial infection 75(30%) disagreed.

 CHAPTER FIVE

Summary, Conclusion and Recommendation

5.1 Summary

The main purpose of this project was to determine the knowledge and practice of nosocomial

infection among Health Workers of Jigawa State. Were Concept of 2.1 Concept of Nosocomial

Infection, Transmission of nosocomial infection, Prevention and Control of Nosocomial

Infection, Knowledge and Practice of Noscomial infection among health care workers to archive

the objective of the study three research questions were developed. The study adopted the survey

design and a random sampling techniques to sample 250 respondents from the area of the study

data collection was quantitative using a self-structure questionnaire on knowledge and practice of

nosocomial infection among Health Workers of Jigawa State. For the purpose of reaching valid

conclusion data from 250 respondents who duly completed and returned the questionnaire. Data

were analyzed using frequency distribution and percentages. The data generated from the sample

population were analyzed quantitatively and used to back up the discussion of the findings. From

this process, the following major findings were made Majority of the respondents are aware of

noscomial infection, Respondents in the study area have a significant practice towards use of

noscomial infection control and prevention strategies, The Health workers have to be aware on

the evaluation of noscomial infection, adequate community mobilization; essential distribution of

health care services proper care of diseases infection essential obstruct care will prevent the

community from health risk, Also the Health workers in the study area have knowledge on the

noscomial infection in the study area.

5.2 Conclusion

Base on the finding this research the following conclusions are hereby made:

1. Majority of the respondents are aware of noscomial infection

2. Respondents in the study area have a significant practice towards use of noscomial

infection control and prevention strategies.

5.3 Recommendations

1. Government also should provide more infectious disease hospital center with modern

effective equipment to the hospital for prevention of noscomial infection.

2. Government and nongovernmental should support community members through

public enlighten on the adequacy and utilization of health services.

References

Abdulraheem I, Amodu M, Saka M, Bolarinwa O, Uthman M. Knowledge, awareness and

compliance with standard precautions among health workers in north eastearn Nigeria. J

Community Med Health Edu. 2012;2(3):1–5.

Allegranzi B, et al. Report on the burden of endemic health care-associated infection worldwide.

Geneva: World Health Organization; 2011.

Alwutaib A, Abdulghafour Y, Alfadhli A, Makboul G, El-Shazly M. Knowledge and attitude of

the physicians and nurses regarding blood borne infections in primary health care,

Kuwait. Greener J Med Sci. 2012;2(4):107–14.

Amin T, Al Wehedy A. Healthcare providers’ knowledge of standard precautions at the primary

healthcare level in Saudi Arabia. Healthcare Infect. 2009;14(2):65–72.

Ducel, G., Fabry, J., & Nicolle, L. (2002). Prevention of hospital acquired infections: a practical

guide. Prevention of hospital acquired infections: a practical guide(Ed. 2).

El-Sayed M, Gomaa M, Abdel-Aziz M. Nurses’ knowledge and practice for prevention of

infection in burn unit at a university hospital: suggested nursing guidelines. J Nurs Health

Sci. 2015;4(4):62–9.

Fashafsheh I, Ayed A, Eqtait F, Harazneh L. Knowledge and practice of nursing staff towards

infection control measures in the Palestinian hospitals. J Educ Pract. 2015;6(4):79–90.

Iliyasu G, Dayyab FM, Habib ZG, Tiamiyu AB, Abubakar S, Mijinyawa MS, et al. Knowledge

and practices of infection control among healthcare workers in a tertiary referral center in

North-Western Nigeria. Ann Afr Med. 2016;15(1):34.

Johnson O, Asuzu M, Adebiyi A. Knowledge and practice of universal precautions among

professionals in public and private health facilities in Uyo, Southern Nigeria—a

comparative study. Ibom Med. 2013;5(1):9–19.

Kamunge EW. Exploring knowledge, attitudes and practices of registered nurses regarding the

spread of nosocomial infections, in health and medical sciences. 2013, Seton Hall

University Dissertations and Theses (ETDs). New Jersey; 1865.

Kaushal G, Doke P, Shah A, Verma V. An analysis of knowledge, attitude and practices

regarding standard precautions of infection control and impact of knowledge and attitude
 of ICU nurses on self-reported practices of infection control. Int J Res Found Hosp

Healthcare Admin. 2015;2:79–85.

Labrague LJ, Rosales RA, Tizon MM. Knowledge and compliance of standard precautions

among student nurses. Int J Adv Nurs Stud. 2012;1(2):84–97.

Nasser AM, Zhang X, Yang L, Sawafta FJ, Salah B. Assessment of surgical site infections from

signs & symptoms of the wound and associated factors in public hospitals of Hodeidah

City, Yemen. Int J Appl. 2013;3(3):101–10.

Raja’a YA, Salam AR, Salih YA, Salman MS, Al-Baseer LS, Al-Kirshi NA, et al. Rate and risk

factors of surgical site infections with antibiotic prophylaxis. Saudi Med J.

2002;23(6):672–4.

Samuel S, Kayode O, Musa O, Nwigwe G, Aboderin A, Salami T, et al. Nosocomial infections

and the challenges of control in developing countries. Afr J Clin Exp Microbiol.

2010;11(2)

Sarani H, Balouchi A, Masinaeinezhad N, Ebrahimitabs E. Knowledge, attitude and practice of

nurses about standard precautions for hospital-acquired infection in teaching hospitals

affiliated to Zabol University of Medical Sciences (2014). Glob J Health Sci.

2016;8(3):193.

Shamaa E, Talaat E. Developing a control action plan for infection prevention at the endoscopy

unit. Int J Acad Res. 2010;2(4):218–27.

Shinde MB, Mohite VR. A study to assess knowledge, attitude and practices of five moments of

hand hygiene among nursing staff and students at a tertiary care hospital at Karad. Int J

Sci Res. 2014;3(2):311–

Taneja J, BibhaBati M, Aradhana B, Poonam L, Vinita D, Archana T. Evaluation of knowledge

and practice amongst nursing staff toward infection control measures in a tertiary care

hospital in India. Can J Infect Control. 2008;24(2):104–7.

Teshager, F. A., Engeda, E. H., & Worku, W. Z. . Knowledge, practice, and associated factors

towards prevention of surgical site infection among nurses working in Amhara regional

state referral hospitals, Northwest Ethiopia. Surg Res Pract. 2015;2015.

WHO. Health care-associated infections fact sheet. World Health Organization; 2014.
 QUESTIONNAIRE ON THE KNOWLEDGE AND PRACTICE OF NOSOCOMIAL
INFECTION AMONG HEALTH WORKERS OF JIGAWA STATE
CONSULTANCY SERVICE UNIT (CSU)

DEPARTMENT OF PUBLIC HEALTH,

Dear respondents,

My name is Fiddausi Sani with Registration IBLT/PBH/19/052 a final year student in the above

named institution undertaking a research on the knowledge and practice of nosocomial infection

among Health Workers of Jigawa State. The given information will be treated confidentially and

for research purpose only.

Tick the appropriate option in the column provided.

SECTION “A” Personal Information

1. Sex

a. Male

b. Female

2. Age

a. 18years – 25years

b. 26years – 30years

c. 31years – 40 years

d. 41 years - above

3. Marital status

a. Single
 b. Married

c. Divorced

d. others

4. Educational qualification

a. Primary

b. Secondary

c. Tertiary

d. Others

5. Profession

a. Physicians

b. Nurses

c. Lab Staff

d. Others

SECTION B: KNOWLEDGE OF NOSOCOMIAL INFECTION AMONG HEALTH

WORKERS OF JIGAWA STATE
1. Are you aware that some infectious are acquired in the hospital?

Yes No

2. Are you aware that nosocomial infection are acquired in the hospital environment only?

Yes No

3. Are you aware that most common site of nosocomial infections are blood stream lungs

urinary tract and surgical woods?

Yes No

4. Are you aware that nosocomial infection are caused by bacteria and other

microorganisms?
 Yes No

5. Are you aware that transmission of nosocomial infections via health care workers,

patients, hospital equipment or interventional procedures?

Yes No

SECTION C: PRACTICE OF NOSOCOMIAL INFECTION AMONG HEALTH

WORKERS OF JIGAWA STATE
1. Do you observe hand washing to prevent nosocomial infection?

Yes No

2. Do you use hand gloves to prevent nosocomial infection?

Yes No

3. Do you use sterile equipment to prevent nosocomial infection?

Yes No

4. Do you practice rontine hospital cleaning to prevent nosocomial infection?

Yes No

5. Do you use protective equipment to prevent nosocomial infection?

Yes No