COVER PAGE

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE OF UNIVERSAL

SAFETY PRECAUTIONS AMONG HEALTH CARE GIVERS WORKING IN PUBLIC
HOSPITALS WITHIN MALUMFASHI METROPOLIS

A RESEARCH PROJECT

BY

USMAN ZAINAB

SCHOOL OF MIDWIFERY MALUMFASHI KATSINA STATE

MARCH, 2021
i
 TITLE PAGE

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE OF UNIVERSAL

SAFETY PRECAUTIONS AMONG HEALTH CARE GIVERS WORKING IN PUBLIC
HOSPITALS WITHIN MALUMFASHI METROPOLIS

A RESEARCH PROJECT

BY

USMAN ZAINAB

IN PARTIAL FULFILMENT OF THE REQUIREMENT OF NURSING AND

MIDWIFERY

COUNCIL OF NIGERIA FOR THE AWARD OF ''REGISTERED

MIDWIFE''CERTIFICATE

MARCH, 2021
ii
 DECLARATION
This is to declare that this project titled" Assessment of knowledge, attitude and practice of
universal safety precautions among health care givers working in public hospitals within
Malumfashi metropolis" was carried out by Usman Zainab is solely the result of my work except
where acknowledge as being derived from other persons or resources.

Examination Number________________________________________________________

Department_____________________ Date:___________________

Signature________________________

iii
 CERTIFICATION

This is to certify that this project titled ''ASSESSMENT OF KNOWLEDGE, ATTITUDE AND

PRACTICE OF UNIVERSAL SAFETY PRECAUTIONS AMONG HEALTH CARE GIVERS

WORKING IN PUBLIC HOSPITALS WITHIN MALUMFASHI METROPOLIS'' was carried

out by Usman Zainab with Examination number...................................... has been examined and

approved for the award of ________________________________________________________

Signature ___________________ Date ________________

Mal.Rashida Umar
(Project supervisor)

Signature ___________________ Date ________________

Mrs. Halima Kallah

(Director)

Signature ___________________ Date ________________

(Chief exam officer)

iv
 ABSTRACT
The research project was carried out on knowledge, attitude and practice of universal safety
precautions among healthcare givers working in public hospitals within Malumfashi
metropolis, with the aim of assessing the level of knowledge on universal precautions among
healthcare givers, to assess the attitude of health care givers towards standard precautions, to
identify the ways in which health care givers practice standard precautions and to identify the
factors affecting the practice of standard precaution among health care givers working in
public hospitals within Malumfashi metropolis. A descriptive design was adopted with a
sample size of 107 respondents. A simple random sampling technique was used. Well
structured close ended questionnaire which consists of 5 sections was administered,
information obtained was analysed and represented in frequencies, percentage table, mean
score and pie charts. The result shows that 88(88%) of the respondents have adequate
knowledge on standard precaution, most of the respondents have positive attitude towards
standard precaution by stating that following standard precaution keeps them safe from
contagious disease, 50(50%) uses gloves mostly as a measure of standard precautionary
practice, and 50(50%) lack of time as a factor affecting the practice of standard
precaution.Based on the findings of the study, the following recommendations were made; this
study suggest that more personal protective equipment should be provided in all health
Institution by the government. Seminars and workshops with special allowance should be
organized occasionally to highlight about the concept of universal safety precaution and their
utilization among health care workers. Implementation of policies on universal precautions for
strict adherence. Training programmes on universal precautions among health care workers
should be provided in all health care organizations.

v
 DEDICATION
This research project is dedicated to my beloved parents Alhaji Shehu Usman Danjuma and
Hajiya Asiya Usman.

vi
 ACKNOWLEDGEMENT
I thank almighty ALLAH (SWT) for the strength and wisdom granted to me in the course of this
project and my studies as well.

Thanks for your patronage, I will always pray for my project supervisor Mal. Rashida Umar who
utilized her time in making useful corrections, advice, suggestions throughout the research. I also
give thanks to my programme coordinator in person of Mal. Auwal Saleh, may ALLAH guide
you through. I also salute the effort of my humble Director Hajiya Halima Kallah and my Deputy
Director Hajiya Halima Ibrahim SS and the entire staffs of Nana Babajo School of Midwifery
Malumfashi.

My profound gratitude to my beloved parents Alhaji Shehu Usman Danjuma and Hajiya Asiya
Usman for their tireless effort physically, emotionally, financially, unique care,wonderful and
ultimate support and encouragement to see that this study is successful and completed May Allah
reward them abundantly.

My sincere appreciation to my siblings, Arc Saleem Sani, Yaya daddy, Yaya Aminu(Ogo),
Aunty Rukayya(Uwa), Kilishi, Baby, Baffa and Hafsa. Thanks for your prayers and support, may
ALLAH guide and protect you all.

The history of my success will be incomplete without mentioning my second mom in person of
Hajiya Rabi'atu Abdullahi, may ALLAH reward you abundantly.

My special thanks goes to, Rabi'atu Bature Abdullahi, Aisha Ibrahim Ayyuba(opponent)
Muhammad Ibrahim, Aminu Abubakar Halliru and Hassan Tahir for your advices, prayers and
supports, may ALLAH guide you through.

Lastly, my special thanks goes to my loving and caring roommates, Nusaiba Nasir Bawale and
Khadija S Haris, may ALLAH reward you for your tireless efforts and support. I will not forget
you my second besty and also my reading partner Habiba Abdulrahman(Anty), my best friend
fom day one Khadija Garba, Hassana and Hussaina, Asma'u Kurfi, Asma'u Hassan, Aisha
vii
Yusuf(my surro..), and the entire members of set 13. May ALLAH guide protect and grant us
100% in our National exams.

viii
 TABLE OF CONTENT

Contents
COVER PAGE.................................................................................................................................................i

TITLE PAGE...................................................................................................................................................ii

DECLARATION.............................................................................................................................................iii

CERTIFICATION............................................................................................................................................iv

ABSTRACT....................................................................................................................................................v

DEDICATION................................................................................................................................................vi

ACKNOWLEDGEMENT................................................................................................................................vii

TABLE OF CONTENT..................................................................................................................................viii

CHAPTER ONE..............................................................................................................................................1

1.0 INTRODUCTION...........................................................................................................................1

1.1 BACKGROUND OF THE STUDY:..........................................................................................................1

1.2 STATEMENT OF PROBLEM.................................................................................................................5

1.3 OBJECTIVES OF THE STUDY...............................................................................................................5

1.4 RESEARCH QUESTIONS................................................................................................................6

1.5 SIGNIFICANCE OF THE STUDY.....................................................................................................6

1.6 SCOPE OF THE STUDY:.......................................................................................................................7

1.7 OPERATIONAL DEFINITION OF TERMS...............................................................................................7

CHAPTER TWO.............................................................................................................................................9

LITERATURE REVIEW....................................................................................................................................9

2.0 INTRODUCTION:................................................................................................................................9

2.1. CONCEPTUAL REVIEW......................................................................................................................9

ix
 2.1.1 DEFINITION OF STANDARD PRECAUTION:..................................................................................9

2.1.2 HISTORICAL BACKGROUND.........................................................................................................9

2.1.3 AIMS OF STANDARD PRECAUTION............................................................................................11

2.1.4 THE BASIC CONCEPT OF STANDARD PRECAUTION...................................................................11

2.1.5 ELEMENTS OF STANDARD PRECAUTION...................................................................................12

2.1.7 CARE OF THE ENVIRONMENT..................................................................................................16

2.1.8 CARE OF THE EQUIPMENT AND INSTRUMENT/DEVICES..................................................17

2.2 KNOWLEDGE ON STANDARD PRECAUTION...............................................................................20

2.3 ATTITUDE AND PRACTICE OF UNIVERSAL PRECAUTIONS...........................................................22

2.4 FACTORS AFFECTING THE PRACTICE OF STANDARD PRECAUTION..................................................24

2.2 THEORITICAL FRAMEWORK.............................................................................................................25

2.3 EMPIRICAL REVIEW........................................................................................................................28

CHAPTER THREE........................................................................................................................................30

RESEARCH METHODOLOGY.......................................................................................................................30

3.0 INTRODUCTION..........................................................................................................................30

3.1 RESEARCH DESIGN.....................................................................................................................30

3.2 RESEARCH SETTING....................................................................................................................30

3.3 TARGET POPULATION................................................................................................................32

3.4 POPULATION SIZE......................................................................................................................32

3.5 SAMPLE SIZE....................................................................................................................................32

3.6 SAMPLING TECHNIQUE..............................................................................................................33

3.7 INSTRUMENT FOR DATA COLLECTION.......................................................................................33

3.8 VALIDITY OF THE INSTRUMENT.................................................................................................34

3.9 RELIABILITY OF THE INSTRUMENT.................................................................................................34

3.10 METHOD OF DATA COLLECTION............................................................................................34

x
 3.11 METHOD OF DATA ANALYSIS.................................................................................................34

3.12 ETHICAL CONSIDERATION......................................................................................................34

CHAPTER FOUR..........................................................................................................................................36

DATA PRESENTATION AND ANALYSIS........................................................................................................36

4.0 INTRODUCTION..........................................................................................................................36

4.1 RESULTS...........................................................................................................................................36

TABLE 4.1.1 SHOWING SOCIO DEMOGRAPHIC DATA OF THE RESPONDENTS.......................................36

TABLE 4.1.2 SHOWS KNOWLEDGE ON STANDARD PRECAUTIONS........................................................38

TABLE 4.1.3 shows the attitude of health care givers towards standard precaution.............................41

TABLE 4.1.4 Shows the practice of standard precaution.......................................................................42

TABLE 4.1.5 shows factors affecting the practice of standard precaution.............................................45

CHAPTER FIVE............................................................................................................................................47

5.0 INTRODUCTION...............................................................................................................................47

5.1 IDENTIFICATION OF KEY FINDINGS..................................................................................................47

5.2 IMPLICATION OF FINDINGS WITH LITERATURE SUPPORT................................................................48

5.3 ALIGNMENT OF FINDINGS WITH PREVIOUS STUDIES......................................................................50

5.2 IMPLICATION OF THE FINDINGS TO MIDWIFERY.............................................................................52

5.3 LIMITATION OF THE STUDY..............................................................................................................52

5.4 SUMMARY OF THE STUDY...............................................................................................................52

5.5 CONCLUSION OF THE STUDY...........................................................................................................54

5.6 RECOMMENDATIONS......................................................................................................................54

5.7 SUGGESTIONS FOR FURTHER STUDIES............................................................................................55

APPENDIX ‘A’.............................................................................................................................................56

QUESTIONNAIRE........................................................................................................................................56

REFERENCES..............................................................................................................................................60

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xii
 CHAPTER ONE

1.0 INTRODUCTION
This chapter consists of background of the study, statement of problem, objectives

of the study, research questions, and significance of the study, scope of the study

and operational definition of terms.

1.1 BACKGROUND OF THE STUDY:

Universal Precautions can be defined as an approach to infection control to treat

all human blood and certain body fluids as if they were known to be infectious for

HIV, HBV and other blood borne pathogens (National institution for occupational

safety and health [NIOSH], 2016)

There are abundant studies published in this area to assess the knowledge, attitude

and practice of health workers in different countries towards universal precaution

in various health cares setting worldwide (Aluko, 2016). Most of them have

reported a low level of knowledge about infection control precautions and poor

adherence with standard precaution among health professionals.

Health Care Workers (HCWs) are potentially exposed to infections while

performing their duties. Standard precautions is regarded as an effective means of

protecting HCWs, patients, and the public, thus reducing hospital acquired

infections(Wang, Fennie ,Burgess , Williams ,2015).Standard precautions are

1
designed to protect health care workers from being exposed to potentially infected

blood and body fluid by applying the fundamental principles of infection

prevention, through hand washing, utilization of appropriate protective barriers

such as gloves, mask, gown, and eye wear (Motamed, Mahmoodi, Khalilan,

Peykanheirati, Nozari, 2016).Standard precautions are also intended to protect the

patient by ensuring that healthcare personnel do not transmit infectious agents to

patients through their hands or equipment during patient care(Siegel, Rhinehert ,

Jackson, Chiarelo, 2015).

The practice of standard precautions is being widely promoted to protect HCWs

from occupational exposure to body fluids and consequent risk of infection

with blood-borne pathogens; however, the situation may be different in low-

income countries(Kermode, Jolley, Langkham, Thomas, Holmes, Gifford, 2015)

HCWs frequently provide care to patients who may be asymptomatic while being

infectious. WHO states that worldwide, about 40% of Hepatitis B and C Virus

infections and 2.5% of HIV infections to HCWs are attributable to occupational

sharps exposures, which are mainly preventable (WHO, 2015). The risk of

acquiring HBV infection from occupational exposure depends on the frequency of

percutaneous and per mucosal exposures to blood or body fluids containing blood

(Thomas, Factor, Gabon, 2014). Although percutaneous injuries are among the

2
most efficient modes of HBV transmission, percutaneous exposures probably

account for only a minority of HBV infections among HCWs. In several

investigations of nosocomial hepatitis B outbreaks, most infected HCWs could not

recall an overt percutaneous injury (Gabribaldi, Hatch, Bisno, Hatch, Greg, 2016).

However, in some studies, up to one-third of infected HCWs recalled caring for a

patient who was HBsAg-positive.8 In addition, HBV has been demonstrated to

survive in dried blood at room temperature on environmental surface for at least

one week (Shephard, Simar, Finelli, Fiore, Bell ,2016).Thus, HBV infections that

occur in HCWs with no history of occupational exposure or occupational

percutaneous injury might have resulted from direct or indirect blood or body fluid

exposures that inoculated HBV into percutaneous scratches, abrasions, burns, other

lesions, or mucosal surfaces(Francis, 2015).Because of the high risk of HBV

infection among HCWs, routine pre-exposure vaccination of HCWs against

hepatitis B and the use of standard precautions to prevent exposure to blood and

other potentially infectious body fluids have been recommended since 1980s

(CDC,2012).

Compliance to standard precautions is low in public health facilities, especially in

resource-limited settings such as Nigeria, thus exposing HCWs to the risk of

infection ( Sagoe - Moses, Pearson, Perry, Jagger, 2016) noted that occupational

3
safety of HCWs is often neglected in low-income countries in spite of the greater

risk of infection due to higher disease prevalence, inadequate supply of personal

protective equipment (PPE) and limited organizational support for safe

practices. Needle stick injuries have been shown to be the commonest (75.6%)

mechanism for occupational exposure in a Nigerian teaching hospital (Orji,

Fasubaa, Onwudiegu, 2015).These injuries are usually under-reported for so many

reasons, which include stigma that could be associated with an eventual infection

with HIV in the affected HCW. There is no immunization for HIV and HCV, thus

the most effective prevention is through regular practice of the standard

precautions. Health workers are exposed to a number of occupational hazards in

health care setting including biological, chemical, physical and stress/violence

(WHO, 2018).

Non availability of materials, limited organizational support and lack of knowledge

regarding infection control practices among HCWs were some of the factors

responsible for poor compliance to standard precaution (Sodhi, 2015)

Some studies highlighted that factors such as having an infection control policy,

periodic training programs on safety injections and precautionary practice, as well

as establishing a well developed infection reporting system in the health care

4
setting significantly affect the level of knowledge and compliance of health care

workers with the prevention strategies. (Alemie, 2019).

1.2 STATEMENT OF PROBLEM

Universal safety precaution is an effective precaution that can prevent patients and

health professionals from exposure to invading microorganisms during all nursing

and midwifery procedures. However, despite the important roles of these

precautions, cases of infections and nasocomial infections still exists in all health

institutions. Most surgical wounds and other infections do not heal by first

intervention leading to administration of high doses of antibiotics which most of

the time are unaffordable (Fairchild and Rowley, 2015).

Furthermore, there was high rate of morbidity and mortality worldwide among

health care givers in the year 2020 due to the incidence of Corona Virus despite the

use of standard precaution as observed by the researcher.

It is for the above mentioned problems that the researcher wishes to conduct study

to assess the knowledge, attitude and practice of standard precautions among all

health care givers working in public hospital Malumfashi.

5
1.3 OBJECTIVES OF THE STUDY
1. To assess the level of knowledge of universal safety precautions in public

hospitals within Malumfashi metropolis.

2. To assess the attitudes of health care givers working in public hospitals

Malumfashi towards standard precaution

3. Identify the ways at which health care givers practice standard precautions in

public hospitals within Malumfashi metropolis

4. To identify the factors affecting the practice of standard precaution among

health care givers working in public hospitals Malumfashi.

1.4 RESEARCH QUESTIONS

1. What is the level of knowledge on universal precautions among healthcare

givers working in public hospitals within Malumfash

2. What is the attitude of health care givers towards standard precautions in public

hospitals within Malumfashi metropolis?

3. What are the ways in which health care givers practice standard precautions in
public hospitals within Malumfashi metropolis?

4. What are the factors affecting the practice of standard precaution among health

care givers working in public hospitals within Malumfashi metropolis?

6
1.5 SIGNIFICANCE OF THE STUDY
1. The findings of the study will be beneficial to the health care givers working in

public hospitals Malumfashi by understanding the concept of Universal Precaution.

2. It will also highlight on the importance and needs for universal precautions

among health care workers.

3. The study will also help the health care givers to reduce the risk at which

infections are acquired in the clinical setting.

1.6 SCOPE OF THE STUDY:

The study was carried out among all the health care givers working in public

hospitals within Malumfashi metropolis.

1.7 OPERATIONAL DEFINITION OF TERMS

 KNOWLEDGE: Awareness of a particular fact or situation

 ATTITUDE: The position or way of carrying oneself posture.

 PRACTICE: Repetition of an activity to improve skills.

 UNIVERSAL: Common to all members of a group or class.

 SAFETY: the act of being protected from dangers, risk or injury in clinical

setting.

 PRECAUTION: These are cautions previously employed to prevent

mischief or secure good.

7
  HEALTH CARE GIVERS: A health care giver is one who delivers care

and services to the sick.

 BODY FLUIDS: they are liquids from the human body e.g saliva, semen,

blood.

 NOSOCOMIAL INFECTION: they are new infections acquired in the

hospital.

 PATHOGEN: a microorganism that causes disease e.g virus, bacteria etc.

 CDC: Center for Disease Control

 HIV: Human Immune Virus

 AIDs: Acquired Immune deficiency Syndrome

 HBV: Hepatitis B Virus

 HCV: Hepatitis C Virus

 PPE: Personal protective equipment

 HCWs: Health care Workers

8
 CHAPTER TWO

LITERATURE REVIEW

2.0 INTRODUCTION:
This chapter deals with the review of related literature, theoretical framework and

conceptual review.

2.1. CONCEPTUAL REVIEW

2.1.1 DEFINITION OF STANDARD PRECAUTION:

Standard Precautions are defined as "group of infection prevention practices that

apply to all patients, regardless of suspected or confirmed diagnosis or presumed

infection status" (Center for Disease Control, 2012). Universal Precautions can be

defined as an approach to infection control to treat all human blood and certain

body fluids as if they were known to be infectious for HIV, HBV and other blood

borne pathogens (NIOSH, 2016).

2.1.2 HISTORICAL BACKGROUND

The CDC first published a document in 1983 entitled ' Guidelines for Isolation

Precautions in Hospital', which contained a section on precautions for blood and

body fluids. The section recommended preventive measures to be taken when a

patient is known or suspected to be infected with blood-borne pathogens (Garner,

Simmons and Williams 1983: A8-8). In 1987, CDC published 'Recommendations

9
for Prevention of HIV Transmission in Healthcare Settings'. In contrast to the 1983

guidelines, the recommendations suggested that precautions should be consistently

used for all patients regardless of their blood-borne infection status. This extension

became known as the Universal Precautions and it was defined by CDC (1996) as

a set of precautions designed to prevent the transmission of HIV, HBV and other

blood-borne pathogens when providing first aid or health care. Under the universal

precautions, blood and certain body fluids of all patients were considered

potentially infectious for HIV, HBV and other blood-borne pathogens. Thus,

universal precautions replaced and eliminated the need for the isolation category

"blood and body fluid precautions" in the 1983 CDC Guidelines for Isolation

Precautions in Hospitals. The application of standard precautions during patient

care is determined by the nature of the health care worker-patient interaction and

the extent of anticipated blood, body fluid, or pathogens exposure. For some

interactions e.g performing venepuncture, only gloves may be needed, but for

others e.g intubation, use of gloves, gown and face shield or mask and googles is

necessary. Standard precautions are also intended to protect the patients by

ensuring that healthcare personnels do not transmit infectious agents to patients

through their hands or equipment during patient care (Siegel et'al and Health

Infection control Practices Advisory Committee 2015).

10
2.1.3 AIMS OF STANDARD PRECAUTION
The aims of standard precautions are the following: prevention and/ or reduction of

transmission of HAI, and, at the same time, protection of nurses from sharp

injuries. These aims can be achieved by the application of SP measures which

consist of the following elements: hand hygiene, personal protective equipment

(gloves, gown, google, facemasks, head protection, foot protection and wearing

face shields) and prevention of sharp injuries (Center for Disease Control, 2015)

2.1.4 THE BASIC CONCEPT OF STANDARD PRECAUTION.

Nursing and Midwifery Council of Nigeria (2010) considered the following as

concept of standard precautions:

i. Hand washing/Hand hygiene before and after the procedures.

ii. Wearing of personal protective equipment like gloves, mask, face mask, apron

and gown.

iii. Proper sharp management i.e proper disposal of sharp and needles.

iv. Proper cleaning, disinfection and sterilization of equipment before and after

procedures.

v. Isolation and barrier nursing of infectious cases.

11
vi. Proper handling, transporting and processing of patients material soiled with

blood, body fluids, secretion and specimen; to prevent contamination of clothing of

clothing or transfer of pathogens to other patients, and the environment.

vii. Prevent injuries with used needles, scalpels and other sharps objects (Snyder,

2015)

2.1.5 ELEMENTS OF STANDARD PRECAUTION

HAND HYGIENE: Hand washing is the most important element of SP measures.

This concept includes hand washing with soap (plain or antiseptic soap) and water

or rubbing hands by using alcohol-based products without using water.

Hand hygiene is recommended in following situations (World Health

Organization, 2013):

i. After direct contact with patients

ii. Before direct contact with patients.

iii. After exposure to blood, body fluids, secretions, excretions, non-intact

skin, and contaminated items.

iv. After contact with patients surrounding

v. Before doing aseptic tasks like using an invasive device.

12
 PERSONAL PROTECTIVE EQUIPMENTS (PPE):

The second part in the SP is PPE. It is defined as a group of barriers that are used

alone, or in combination, to prevent transmission of infectious agents to mucous

membrane, skin, airways and clothing of nurses when they are in contact with

infectious agents. It is also used when contamination or splashing with blood or

body fluids is anticipated and it is important to protect nurses from getting

infections during contact with patients. This PPE should be found in each hospital,

and the selection of this PPE is dependent on the nature of procedures, skills of

nurses, nature of patients and mode of transmission. PPE includes the following:

disposable gloves, face protection (masks, safety glasses, goggles and gowns or

aprons ) (WHO, 2012).

 GLOVES

Gloves are used while dealing with or touching blood, secretion, body fluids,

execration, impaired membranes and mucous membranes, handling contaminated

equipment and when in contact directly with patients who are infected with disease

transmitted by direct contact. After removing them, hand hygiene should be done.

In addition to this, nurses must know that gloves have to be changed if there was

risk of cross contamination when dealing with the same patient and before going to

13
another patient to prevent transmission of infections and prevent the occurrence of

HAI (WHO, 2010). Removal of gloves has to be considered.

 ISOLATION GOWN

This is worn to protect the clothes and skin of nurses from contact and

contamination with blood or body fluid. The gown covers the body from neck to

mid-thigh or below to prevent contamination of skin or clothe (World Health

Organization, 2010). Removal of gown has to be considered.

 FACE PROTECTION (MASK, GOGGLES AND FACE SHIELD)

 MASK: This must be used when there is a possibility for splashing or spraying

of blood or body substances, and when nurses are doing procedures requiring

sterile condition to prevent transmission of infection or infectious agents to

patients. In addition to this, sometimes patients must wear mask especially if

patient is suffering from coughing to limit spreading of his or her infection

World Health Organization, 2013).

 GOGGLES:

Infectious agents can enter body from mucous membrane in eyes, by direct route

through exposure to infectious agents from splash of blood or from cough, or by an

indirect way through touching of the eye by contaminated hands. Many types of
14
infectious agents are transmitted in this way including both viruses (for example,

adenovirus) and bacteria (for example, hepatitis C) (CDC, 2010).

 FACE SHIELD

Face protection can be used with other PPE if there is potential splashing of blood,

body and respiratory secretions. Face shield can be worn as an alternative to

goggles but face shield covers more face area than goggles which covers only the

eyes (CDC, 2010).Like other PPE, caution must be taken when removing face

protection, taking into account its removal after removing gloves.

 SHARP INJURIES (SI) :

SI are defined as “an exposure to event occurring when any sharp penetrates the

skin” (CDC, 2012). These include needles, scalpels, broken glass, and other sharps.

This term is interchangeable with percutaneous injury. It is considered a serious

hazard in hospitals because it may allow the contaminated blood that has pathogen

to be in contact with nurses. SI and NSI lead to infection. They expose nurses to

blood- borne pathogens which mean ” pathogenic microorganisms that are present

in human blood and can cause disease in humans. These pathogens include, but are

not limited to, hepatitis B virus” (CDC, 2012). SI and NSI are considered a major

source of Hepatitis C Virus ( HCV ) infection among HCWs. Nearly (39%) of

15
cases of HCV that occurred worldwide happened among HCWs, while hepatitis B

virus (HBV) formed (37%) (Goniewicz et al., 2012). Furthermore, needle stick

injuries can transmit more than twenty types of infections such as malaria, syphilis

and herpes (Elizabeth 2012).

2.1.7 CARE OF THE ENVIRONMENT

 SHARP DISPOSAL CONTAINERS (OR BOX):

Sharp objects must be disposed in separate containers in every hospital to prevent

risk of transmission of infection. These containers are called sharp disposal

containers and they must be puncture-resistant, liquid –proof, closed when not used

and sealed and when (75%) of them are filled. They should be put nearby work

place and close to place where sharp is used. This would reduce the occurrence of

recapping needles and needle-stick injuries that are associated with recapping

(WHO,2012).

 Staff who performs environmental cleaning should be dedicated to

Specific units to reduce the risk for cross-contamination.

 Thorough cleaning of commonly contaminated surfaces such as bedrails,

bedside charts, medical equipment, and door knobs is recommended.

16
2.1.8 CARE OF THE EQUIPMENT AND INSTRUMENT/DEVICES
Policies and procedures should be established for containing, transporting and

handling patient care equipment and instrument/devices that may be contaminated

with blood or body fluids. Organic materials should be removed from critical and

semi-critical instrument/devices using recommended cleaning agents before high-

level disinfection and sterilization processes (Siegel et'al 2015).

Cleaning, disinfection and sterilization are the basic tools of standard precautions

(Kozier, 2011).

 CLEANING: Is a mechanical process through which visible dirts and some

microorganisms are being removed from a surface or object. It is a basic

measure for maintenance of hygiene particularly in the hospital environment.

The nurses are said to be conversant with the local protocols governing the

cleaning of materials in the clinical area.

All visible soiled items should be cleaned before disinfection or sterilization, as

this hinders the proper growth of bacteria and fungi, rinsing in cold water, hot

soapy water and concentrated solution are used in some hospital settings

(Shehu, 2015).

17
 DISINFECTION: Disinfection is a process whereby pathogenic organisms,

but not necessarily all microorganisms or spores, are destroyed. Disinfection

may be accomplished by physical or chemical means.

1. Physical Methods of Disinfection: The three physical method of disinfection

are:

i. Boiling at 100°C for 15 minutes, which kills vegetative bacteria.

ii. Pasteurizing at 63°C for 30 minutes or 72°C for 15 seconds, which kills food

pathogens.

iii. Using nonionizing radiation such as ultraviolet (UV) light. UV rays are long

wavelength and low energy. They do not penetrate well and organisms must

have direct surface exposure, such as working surfaces of a biological safety

cabinet (BSC), for this form of disinfection to work.

2. Chemical method of Disinfection: When chemicals are used to destroy all life

forms they are called chemical sterilants or biocides; however, these same

chemicals used for shorter periods are disinfectants. Disinfectants are

chemicals that kill microorganisms and are used on inanimate objects.

Chemicals used on living tissue (skin) are called antiseptics.

18
 3. Chemical disinfectants can be classified into four groups based on their

microbicidal activity;

i. Low-level disinfectants

ii. Intermediate-level disinfectants

iii. High-level disinfectants

iv. Chemical sterilant (Madigan, Bender, Kelly, Bucklet, Daniel , Sattley,

Mathew, Stahl, David, 2018)

 STERILIZATION: Sterilization can be achieved by a combination of heat,

chemicals, irradiation, high pressure and filtration like steam under pressure,

dry heat, ultraviolet radiation, gas vapor sterilants, chlorine dioxide gas etc.

i. Heat Method: This is the most common method of sterilization. The heat is

used to kill the microbes in the substance. The extent of sterilization is

affected by the temperature of the heat and duration of heating.

ii. Filtration is the quickest way to sterilize solutions without heating. This

method involves filtering with a pore size that is too small for microbes to

pass through. Generally filters with a pore diameter of 0.2 um are used for

the removal of bacteria.

19
iii. Radiation sterilization: This method involves exposing the packed

materials to radiation (UV, X-rays, gamma rays) for sterilization.

iv. Chemical method of sterilization: Heating provides a reliable way to get

rid of all microbes, but it is not always appropriate as it can damage the

material to be sterilized. In that case, chemical methods for sterilization is

used which involves the use of harmful liquids and toxic gases without

affecting the material. Sterilization is effective using gases because they

penetrate quickly into the material like steam (Talip,2016)

2.2 KNOWLEDGE ON STANDARD PRECAUTION.

Universal safety precautions play an important role in minimizing and

preventing exposure of health care workers to pathogens. There is a need for

developing strategies to promote the use of universal safety precautions

which take into account of knowledge including its integration into practice.

The country needs an obligatory training programme on universal safety

precautions for Nurses and Midwives , involvement of senior health staff in

the policies and their implementation, and systems for monitoring the

appropriate use of equipment, and establishing post exposure reporting

system. Finally, routine immunizations of health care workers against

hepatitis B is required. The Ministry of Public Health should seek an

20
appropriate mechanism to vaccinate all health care workers throughout the

country ( Ahmad and Paul 2018).

A study by Yohanis and Asmar, (2015) has demonstrated good knowledge

of Universal Safety precaution against blood borne pathogens in both nurses

and midwives .Nurses and midwives exhibited a significantly higher

knowledge to universal safety precaution. Training staffs on standard

precautions, principles, and practice needs to be implemented to provide the

necessary knowledge on universal safety precaution . In addition, strict

supervision, operational guideline and on-job training courses and

orientation need to be implemented regularly

According to a study conducted by (Uche, Johnbull, Euzebus, Tochukwu,

2015), stated that the caliber of the health workers in the rural health centers

who were mainly CHEWs as well as the inclusion of the ward/clinic

orderlies may have contributed to the low knowledge of UP. Professional

training appears to have significant influence on the knowledge as a

greater proportion of the CHOs and Nurses showed more knowledge than

the CHEWs and the least knowledge was found among the ward/clinic

orderlies. Training on UP was expectedly discovered in this study to

increase the level of knowledge as 72% of those who had undergone some

21
 form of training on UP have adequate knowledge. This finding underscores

the importance of training and may explain why nurses and CHOs who must

have had more training on UP displayed more knowledge than the CHEWs

and ward orderlies.

This study also found out that the respondents who resided in the urban had

more knowledge about UP compared with those in the rural communities.

The difference in knowledge level (though not statistically significant

p>0.05) is not surprising as those in the urban areas are more exposed to

information through mass media, friends and colleagues who work in bigger

hospitals.

2.3 ATTITUDE AND PRACTICE OF UNIVERSAL PRECAUTIONS

Knowledge was fair with positive attitude toward use to Universal safety

precaution. However, practice was poor. Main reason for the poor practice

was the unavailability of required resources. Training was significantly

associated with the use of Personal Protective Equipments. It is therefore

recommended that regular SP training should be organized for Health Care

Workers and that resources for its full implementation should be regularly

supplied ( Arinze, Ndu, Modebe, Nwamoh,2018) .

22
Uche et al, (2015) also stated that the attitude of the respondents towards

general UP in his study was quite encouraging as majority of them (80%),

though without adequate knowledge agree that universal precaution is useful

and protective and 88.3% of the respondents would like to practice it. Such

positive attitude of the majority of the health workers may be attributed to

fear of contracting HIV infection, which most of the respondents understood

UP to prevent. Though, the attitude in this study is positive, the practice is

poor as positive attitude often times does not translate to good practice. Lack

of knowledge may have contributed as well in this regard. Among the few

(11.7%) that had negative attitude towards UP in this study, the majority

claimed lack of awareness and others felt the practice is time wasting or

that they have natural immunity against infections. This is a clear reflection

of misconception born out of ignorance, and thus underscores the need for

increase in public enlightenment and training on UP. The compliance to

practice of UP among the rural health workers in this study leaves much to

be desired. Most respondents (89.3%) concluded that wearing of only

gloves while conducting risky procedures on patients is the only way of

preventing blood borne infection. Only a few would wear other protective

materials such as gloves, apron, and eye goggle. Less than half of the

respondents (46%) would wash hands before and after attending to a patient.
23
 This practice negates the principles of UP which emphasizes the wearing of

self-protective devices and regular hand washing while caring for patients.

This poses a great threat to the care workers, particularly those practicing in

rural communities where manpower and facilities are low. Strict adherence

to the principles and practice of UP is thus very vital to reduce the spread.

2.4 FACTORS AFFECTING THE PRACTICE OF STANDARD

PRECAUTION
Lack of knowledge, lack of or inadequate supplies, time pressure, lack of

confidence in their own skills, organizational climate and forgetfulness that

staff have cited as their reasons for non adherence. Changing current

behavior requires knowledge of the factors that can influence HCWs'

compliance with SP and implementing programs and preventive actions that

contribute to the avoidance of occupational exposure (Efstathiou et'al, 2015).

Uche et'al (2015), stated that poor provision of amenities such as water,

electricity and lack of protective equipment were the major barriers

advanced by the respondents. The majority (>80%) complained about the

inadequate supply of hand gloves, over 60% reported inadequate water

supply, while about half (49.7%) of the respondents reported inadequate

supply of disposables such as syringes and needles. These problems have

made the practice of UP among these health care workers difficult and
24
 discouraging, thus exposing both the healthcare workers and the patients to

blood borne infections

However, there are strategies developed that facilitate effective

implementation of Universal Precautions which includes: educational,

behavioral or technical (Effective practice and organization of care, [EPOC],

2012). Interventions related to delivery of care can include providing access

to infection prevention and control expertise, or providing and placing

materials required to implement Standard Precautions. Implementation of

strategies can be directed to healthcare organizations, such as strategies to

change organizational culture, or they can be directed to healthcare workers.

Examples of the latter are audit and feedback, use of reminders and

checklists, and education. Educational approaches, such as campaigns,

instruction and training, and use of pamphlets or posters, may be targeted to

individuals or directed to groups ( Mukti, 2015).

2.2 THEORITICAL FRAMEWORK

This study is guided by the Health Believe Model. This theory was

developed by four psychologists; Hochbaum, Kegels, Rosenstock and

Leventhal in the 1950's. This theory has been used as a planning tool for

promoting adherence with preventive health behaviors and health care

25
 recommendations (Nutbeam and Harris, 2014). The Health Believe Model

has six construct; perceived susceptibility, perceived severity, perceived

benefits, perceived barriers, cues to action and self efficacy (Glanz et'al

2015).

i. Perceived Susceptibility: personal perception on the risk of acquiring a

certain diseases or condition.

ii. Perceived Severity: personal perception on the seriousness of a certain

diseases, behavior or condition.

iii. Perceived Benefits: personal perception on the effectiveness and positive

consequences when adopting a new behavior.

iv. Perceived Barriers: personal perception of the obstacles that may prevent

him/her to adopt new behavior.

v. Cues to action: Strategies to activate readiness.

vi. - Self-efficacy: Confidence in one's ability to take action.

26
APPLICATION OF THE THEORY

Perceived susceptibility: Health Care Workers are at risk of being exposed to

health associated infections.

Perceived severity: They are at risk of acquiring blood-borne infections such as

HIV, HBV, HCV e.t.c which have serious consequences to their health.

Perceived barriers: Lack of equipment and time are some of the barriers that

hinders the practice of standard precaution.

Cues to action: Strategies should be implemented in order to activate readiness

to practice of standard precaution.

27
2.3 EMPIRICAL REVIEW
According to a study conducted by Arinze et'al (2018), on knowledge and practice

of standard precautions by Health Care Workers in a Tertiary Health institution in

Enugu, Nigeria; Over 90% of the respondents have heard of S.P, 62% mainly from

formal training, 25% from colleagues. A total of 442 (70.3) could definitely

standard precaution and could identify most components of S.P. However 272

(43.2%) knew about respiratory etiquette and 21.9% knew of anal or perineal

hygiene.

A similar study conducted shows that there's positive attitude towards use of s.p:

Over 90% agreed that S.ps are useful in protecting against biohazards in the

workplace and that employers should provide S.p training for training their

workers. On the other hand, over 90% disagreed that S.ps are not necessary in

hospitals and that they are meant for only theater workers (Arinze et'al,2018).

A study by Agofure (2017), in Federal Medical Center Yanagoa, Nigeria states

that: Attitude of the respondents shows that majority of the respondents 172

(86.0%) agreed that S.P can prevent the spread of infectious diseases, while

183(91.50%) affirmed that they would report to the hospital following a needle

stick injuries and 133(66.50%) agreed that they will screen the patients for HIV

following a needle stick injury. According to a study conducted in Enugu

28
southeast, Nigeria on the knowledge, attitude and practice of Universal Precautions

among rural Primary Health Workers only 59 respondents (19.7%) observed

complete universal precaution while carrying out their duties and 268 (89.3%)

wear only gloves as a measure of standard precaution. About two-thirds (68.3) of

the respondents drop sharps in special containers for sharps, 23.7% drop it in the

general waste basket and very few (3.3%) throw them in the bush open dumping

site (Uche et'al,2015).

A study by Uche et'al (2015), stated that poor provision of amenities such as water,

electricity and lack of protective equipment were the major barriers stated by the

respondents. The majority (>80%) complained about inadequate supply of

disposables such as syringes and needles. These problems have made the practice

of Universal Precautions among these health care workers difficult and

discouraging, thus exposing both the health care workers and the patients to blood-

borne infections.

29
 CHAPTER THREE

RESEARCH METHODOLOGY

3.0 INTRODUCTION
This chapter deals with the research design, research setting, target population,

sample size, sampling technique, instrument for data collection, validity and

reliability of instrument, method of data collection, method of data analysis and

ethical consideration.

3.1 RESEARCH DESIGN

This research is a descriptive design method of study aimed at assessing the

knowledge, attitude and practice of standard precaution among all health care

givers working in public hospitals Malumfashi.

3.2 RESEARCH SETTING

The settings for this study are the public hospitals within Malumfashi town i.e

General hospital (Kwandala), Maternal and children hospital (MCH) and

comprehensive health center (Tsamiya).

Malumfashi is a local government area in Katsina State. It has been established in

1975 and has an area of 674km2 with a population of 182,920 at the 2006

population census. It has a postal code of 822. It is bounded to the South by Kafur
30
local government area, to the north by Bindawa, to the East by Gora and to the

West by Marabar Kankara.

There are about five private hospitals and three public hospitals in Malumfashi.

The public hospitals include:

 General hospital Malumfashi (Kwandala): which was established in 1996 and

located in Ward ‘B’ part of Malumfashi near Borin Dawa. It has health care

professionals of different speciality and also many units for the admission and

treatment of different cases. Consisting of doctors, midwives, nurses, chews, lab

technicians and ward attendants.

 Maternal and children hospital (MCH): which is located along Zaria road in

Malumfashi town. It is headed by assistant director nursing (ADNS). It came

into existence as a branch of Ahmadu Bello University Teaching Hospital

(ABUTH) and later in the year 2007, the hospital became under the control of

Katsina State. The hospital consist of maternity ward, pediatric ward,

laboratory, theater, antenatal clinic, immunization unit, pharmacy and out

patient department (OPD). Consisting of doctors, nurses, midwives and ward

attendants.

 Comprehensive health center (Tsamiya): which is located in Malumfashi

adjacent to Malumfashi Central Market. The unit consist of outpatient

31
 department, maternity ward, antenatal clinic, pediatric ward, and laboratory

department consisting of nurses, midwives, community health extension

workers, science laboratory technicians and ward attendants.

3.3 TARGET POPULATION

The target population of the study includes all health care givers working in public
hospitals within Malumfashi metropolis.

3.4 POPULATION SIZE

Available record from the hospitals shows that there are 146 health care givers

1 Health Facility Doctors Nurses Midwive Chews Total

s

2 Galadima 8 34 26 6 74
Abdullahi
General
hospital

3 Maternal and 3 24 11 00 38
children
hospital

4 Comprehensive 0 2 2 30 34
health center

TOTAL 11 60 39 36 146

3.5 SAMPLE SIZE

The sample size was determined using slovins (2016) formula which is as follows:

n=N/(1+Ne2)
32
N= Target Population

e= margin error 0.05

n= 146/1+146×(0.05)2

n= 146/1+146×0.0025

n= 146/1+0.365

n=146/1.365

n=106.9

n~107

3.6 SAMPLING TECHNIQUE

A purposive sampling technique was used in which target population of the sudy

were selected purposively. A simple random technique was used to distribute the

questionnaire to the respondents.

3.7 INSTRUMENT FOR DATA COLLECTION

The instrument for data collection in this study is a self constructed (close ended)

questionnaire that contains four sections (A,B,C,Dand E). Section A: socio-

demographic data, section B: knowledge on standard precaution. Section C:

attitude towards standard precautions, Section D practice of standard precaution.

Section E: factors affecting the practice of standard precaution.

33
3.8 VALIDITY OF THE INSTRUMENT
The questionnaire was designed based on the objectives of the study. It was be

taken to the supervisor for corrections, pilot testing and final corrections were

made.

3.9 RELIABILITY OF THE INSTRUMENT

The instrument was able to collect the same information within the 3 Hospitals

after a pilot study.

3.10 METHOD OF DATA COLLECTION

Information was collected using a structured close questionnaire, where 2 of my

friends helped me in distributing the questionnaire and filled questionnaire were

returned for final analysis.

3.11 METHOD OF DATA ANALYSIS

The data gathered from the questionnaire was analyzed using tabulation and

sorting out information using pie charts, frequency table, mean score and

percentage.

3.12 ETHICAL CONSIDERATION

A letter of introduction was obtained from the school and taken to the hospitals in

order to get access to the target population. Also during the research the culture

and norms of the respondents was respected and participation was on voluntary

34
basis and all information gathered from the respondents will be handled

confidentially.

35
 CHAPTER FOUR

DATA PRESENTATION AND ANALYSIS

4.0 INTRODUCTION
This chapter deals with the presentation of data obtained from various respondents

and the analysis of date using simple frequency table, percentage, pie chart and

mean score in which a score of 3 and below shows disagreement and score of 4

and above shows agreement.

107 questionnaires were distributed and 100 retrieved due to 7 staffs that were not

on duty.

4.1 RESULTS

TABLE 4.1.1 SHOWING SOCIO DEMOGRAPHIC DATA OF THE

RESPONDENTS

1 Age(years) Frequency Percentage (%)

A) 18-25 years 46 46
B) 26-35 years 26 26
C) 36-45 years 22 22
D) 46 years above 6 6
Total 100 100

2 Gender Frequency Percentage%

36
A Male 40 40
B Female 60 60
Total 100 100

3 Professional qualification

A RM 20 20
B RN 38 38
C Doctor 8 8
D CHEW 23 23
E RN/RM 6 6
F BNsc 5 5
Total 100 100

4 Years of working experience

A 1-5 years 58 58

B 6-10 years 26 26

C 11-15 years 14 14

D 16 years above 2 2

Total 100 100

TABLE 4.1.1 above shows that majority of the respondents were at the age range

of 18-25years, 26(26%) are within the age range of 26-35years, 22(22%) are

37
within the age range of 36-45years and 6(6%) are within the range of 46 years

above. Most of the respondents 60(60%) were females and 40(40%) were males.

Majority of the respondents were registered nurses 38(38%), 20(20%) are

registered midwives, 8(8%) are doctors, 23(23%) are chews, 6(6%) are RN/RM

and 5(5%) are those with BNSc. Most of the respondent 58(58%) have a working

experience of 1-5years, 26 (26%) have 6-10years, 14(14%) have 11-15years and

2(2%) have 16years and above.

TABLE 4.1.2 SHOWS KNOWLEDGE ON STANDARD PRECAUTIONS.

1 What do you understand by standard Frequency Percentage%
precaution?

a Are set of guidelines that aim to protect 88 88

health care workers from blood borne
infection
b Using gloves and apron only 12 12
c Using googles and mask only 0 0
TOTAL 100 100

2 Source of information on standard

precaution

38
a Radio 2 2

b Television 0 0

c Workshop/seminar 76 76

d From a colleague 22 22

TOTAL 100 100

3 Condition for which standard precaution

is mandatory

a Patient HIV/HBV 18 18

b Prevention of nosocomial infection 16 16

c For all patients 66 66

TOTAL 100 100

4 Standard precaution measures include

a Use of bedpan and urinals 0 0

b The use of gloves, mask, and apron 100 100

c Not discarding sharp instrument 0 0

TOTAL 100 100

The above table indicate that majority of the respondents 88(88%) define standard

precaution as set of guidelines that aim to protect health care workers from blood

borne infection, 2(2%) agreed that standard precaution entails the use of gloves and
39
aprons only. Most of the respondents 76(76%) obtained information on standard

precaution through attending workshop/seminar 22(22%) from a colleague and 2

(2%) from radio. Most of the respondents 66(66%) believed that standard

precaution is mandatory for all patient's care whereby, 18(18%) of the respondents

agreed that it is only applicable only when caring for patient with HIV/HBV,

16(16%) agreed only when you want to prevent nosocomial infection and

66(66%).According to all of the respondents 100(100%) standard precaution

entails the use of gloves, mask and apron while none of the respondents agreed on

the use of bed pans and urinals and discarding sharp instrument.

40
Figure 1: Condition for which standard precaution is mandatory a graphical pie

chart presentation of the conditions for which standard precaution is mandatory, it

showed that majority of the respondents use it for all patients.

TABLE 4.1.3 shows the attitude of health care givers towards standard
precaution.
NO QUESTION SA A UD D SD Mean Remark

1 Using standard precaution for 2 2 16 16 32 1.6 Disagreed

a patient with suspected
infectious disease is a waste
of time

2 In general, pressure of work 18 28 10 14 30 2.9 Undecided

makes me forget to use
protective barriers sometimes

3 Following standard precaution 76 14 4 2 4 4.5 Strongly

keeps me safe from agreed
contagious disease

4 Infectious disease can be 14 10 24 28 24 2.6 Undecided

treated hence protective
devices are not required

5 I can reduce my occupational 74 14 6 0 6 4.5 Strongly

risk for HIV/HBV infection agreed
by complying with standard
precaution

41
The above table shows that most of the respondents disagreed that using standard

precaution for a patient with infections disease is waste of time. Respondents were

undecided that general pressure of work makes them forget the use of protective

barrier sometimes. Most of the respondents strongly agreed that standard

precaution keeps them safe from contagious disease while some were undecided

that infectious disease can be treated hence protective device are not required.

Some of the respondents also strongly agreed that they can reduce occupational

risk for HIV/HBV infection by complying with standard precaution.

TABLE 4.1.4 Shows the practice of standard precaution

1 Do you comply with standard Frequency Percentage%
precaution?

a Yes 74 74

b No 0 0

c Not always 26 26

TOTAL 100 100

2 Which of the measures do you

use mostly?

a Use of mask 14 14

b Gloves 50 50

c Hand hygiene 36 36

d Apron 0 0

42
 TOTAL 100 100

3 Injection safety practice

a Recap needle after use 8 8

b Dispose needle and syringe 68 68

c Detach needle and syringe 24 24

TOTAL 100 100

4 Methods of handling re-usable

instrument

Washing with soap and water 22 22

a Soak in a disinfectant 48 48

b Put in an autoclave 30 30

c TOTAL 100 100

Majority of the respondents 74(74%) of the respondents comply with standard

precaution while 26 (26%) do not always comply with standard precaution. Half of

the respondents 50(50%) use gloves as a means of standard precaution, 36(36%)

use hand hygiene, 14(14%) use mask and none use apron. Majority of the

respondents 68(68%) dispose needles and syringe as a means of injection safety,

43
24(24%) detach needle and syringe while 8(8%) recap needle after use. According

to most of the respondents 48(48%) agreed that methods of rehandling re-usable

instrument entails soaking in a disinfectant, 30(30%) of the respondents put in

autoclave and 22 (22%) wash with soap and water.

Figure 2: measures for which standard precaution is used mostly in which majority

of the respondents use gloves.

TABLE 4.1.5 shows factors affecting the practice of standard precaution

1 What are the factors affecting the practice of Frequency Percentage%
standard precaution?

44
a Lack of knowledge 10 10
b Lack of time 50 50
c Lack of equipment 24 24
d
Lack of conducive working environment 16 16

TOTAL 100 100

2 How do you think the practice of standard

precaution can be improved?

a Through provision of adequate supply of 46 46

b materials in the facility 14 14
c Annual training of staffs on standard precautions 22 22
d There should be a policy governing the practice 18 18
of standard precaution 100 100
Through seminar/workshop
TOTAL

Half of the respondents 50(50%) reported lack of time as one of the factors

affecting the practice of standard precaution, 24(24%) of the respondents reported

lack of equipment, 16(16%) reported lack of conducive working environment and

10(10%) reported lack of knowledge. Most of the respondents 46(46%) reported

45
that provision of adequate supply of materials in the facility as one of the ways in

which standard precaution can be improved, 22(22%) reported that there should be

a policy governing the practice of standard precaution, 18(18%) reported through

annual training.

Figure 3: Shows the factors affecting the practice of standard precaution in which
majority of the respondents, respond to lack of time.

CHAPTER FIVE
DISCUSSION, SUMMARY AND RECOMMENDATION OF FINDINGS

5.0 INTRODUCTION
This chapter deals with identification of key findings, implication of key findings

with literature support, alignment of findings with previous study, limitations,

46
summary of the study, conclusion, recommendations, suggestions for further

studies and references.

5.1 IDENTIFICATION OF KEY FINDINGS.

As regard to the socio-demographic data, majority of the respondents 46% falls

within the range of 18-25years majority of the respondents 60% are female, also

most of the respond 38% are those with RN qualification and more than half of

the respondents 58% have a working experience of 1-5years.

The result shows that 88%of the respondents have adequate knowledge on

standard precaution and most of the respondents 76% obtained information on

standard precaution through seminar/work shop.

It also shows that the respondents have positive attitude towards standard

precaution in which most of the respondents strongly agreed that standard

precaution keeps them safe from contagious disease and also they disagreed that

using standard precaution for patient with infectious disease is a waste of time.

The findings also revealed how respondents practice standard precaution in

which majority of the respondents 74% comply with standard precaution and

50% of the respondents use gloves as a standard precautionary measure. Most of

the respondents 68% dispose needle and syringe as part of injection and 48%

soak re-usable instrument in a disinfectant.

47
The findings also revealed that most of the respondents 50% mentioned that lack

of the time as the main factor affecting the practice of standard precaution,

followed by lack of equipment (24%), lack of conducive working environment

and lack of knowledge (10%).

The findings also showed that most of the respondents 46% mentioned provision

of adequate supply of adequate supply of material as a way in which the practice

of standard precaution can be improved.

5.2 IMPLICATION OF FINDINGS WITH LITERATURE SUPPORT

Based on the research findings, it revealed that the respondents have adequate

knowledge towards standard precaution. This correlate with study conducted by

yohanis et al, (2015) reported that there's good knowledge on universal safety

precaution against blood borne pathogens in both nurse's and midwives also the

respondents have positive attitude towards standard precaution in which most of

respondents strongly agreed that standard precaution keeps them safe from

contagious disease and disagreed that using standard precaution for patient with

infections is a waste of time. This correlate with study conducted by Agu etal

(2015) which stated that the attitude of the respondents towards general universal

precaution in his study was quite encouraging as majority of them (80%) agree

that universal precaution is useful and protective and 88.3% of the respondent

48
would like to use it . The study also shows that majority of the respondent's 74%

comply with standard precaution and 50% use gloves as standard precautionary

measure. This is contrary with a conducted by Uche etal (2015) in which the

respondents felt the practice of standard precaution is time wasting or that they

have natural immunity against infections. Lack of knowledge, lack of time, lack

of equipment and lack of conductive working environment have been shown as

factors affecting the practice of standard precaution. This correlate with a study

conducted by efsthathion et'al, (2015) which stated reported that lack of

knowledge, lack of adequate supplies time pressure, lack of confidence in their

own skills ,organizational climate and forgetfulness that stuff have cited as their

reasons for non adherence towards standard precaution

49
5.3 ALIGNMENT OF FINDINGS WITH PREVIOUS STUDIES
Research Question 1: What is the level of knowledge on universal precautions

among healthcare givers working in public hospitals within Malumfashi

metropolis?

Based on the research findings, majority of the respondents 88(88%) have

adequate knowledge on standard precautions as set of guidelines that aim to

protect health care workers from blood borne infection while others 12(12%) do

not have knowledge on standard precautions. This is line with a study conducted

by Arinze etal (2018) on the knowledge and practice of standard precaution by

Health Care Workers in a Tertiary Health Institution in Enugu, Nigeria. Findings

revealed that (70.3%) of the respondents could define standard precaution and

identify most of standard precaution.

Research Question 2: What is the attitude of health care givers towards standard

precautions in public hospitals within Malumfashi metropolis?

The findings shows that most of the respondents strongly agreed that standard

precaution keeps them safe from contagious disease while some were undecided

that infectious disease can be treated hence protective device are not required.

This is in line with a study by Arinze etal (2018) in which over 90% of the

respondents agreed that standard precautions are useful in protecting against

50
biohazards in the workplace and on the other hand over 90% disagreed that

standard precautions are not necessary in the hospital and they are meant for only

theater workers.

Research Question 3: What are the ways in which health care givers practice

standard precautions in public hospitals within Malumfashi metropolis?

Based on the findings of the study most of the respondents 74 (74%) comply

with standard precaution while 26 (26%) do not always comply with standard

precautions. On the other hand 50 (50%) of the respondents use gloves as a

measure of standard precaution, 68(68%) dispose needles and syringe as part of

injection safety. This is in line with a study conducted by Uche etal, (2015) in

which only 19(19%) of the respondents observed complete universal precaution

and 89.3(89.3) wear only gloves as a measure of standard precaution,

68.3(68.3%) of the respondents drop sharps in special containers for sharps.

Research Question 4: What are the factors affecting the practice of standard

precaution among health care givers working in public hospitals within

Malumfashi metropolis?

Based on the findings of the study, half of the respondents 50 (50%) mentioned

lack of time, 24 (24%) reported lack of equipment, 16 (16%) reported lack of

51
 conducive working environment and 10 (10%) mentioned lack of knowledge.

This is contrary to a study conducted by Uche etal (2015) which stated that poor

provision of amenities such as water, electricity and lack of protective equipment

were the major barriers stated by the respondents.

5.2 IMPLICATION OF THE FINDINGS TO MIDWIFERY

1- It will help midwives to know the importance of standard precaution

2- It will motivate midwives to make good use of standard precautions

3- It will prevent midwives from being infected and therefore preventing cross

infection to the patients.

5.3 LIMITATION OF THE STUDY

The study is limited to only doctors, nurses, midwives and CHEWs working in

public hospitals within Malumfashi metropolis. There was time constraints and

insufficiency of funds.

5.4 SUMMARY OF THE STUDY

The research was conducted on the assessment of knowledge, attitude and

practice of universal precaution among health care workers working in public

hospitals within Malumfashi metropolis , five objectives were formulated to

guide the study, they include; to assess the level of knowledge on universal

safety precaution among health care givers working in public hospitals within
52
Malumfashi metropolis, to assess the attitudes of health care givers working in

public hospitals within Malumfashi metropolis towards standard precaution, to

identify the ways at which health care givers practice universal safety

precautions in public hospitals within Malumfashi metropolis and to identify the

factors affecting the practice of standard precaution among health care givers

working in public hospitals within Malumfashi metropolis. Several literatures

was reviewed for the study and health belief model was used as the theoretical

guide for the study. Descriptive research design was adopted for the study in

which 107 sample sizes were drawn and questionnaire was distributed out of

which 100 were retrieved, presented and analyzed. The findings revealed that

88%of the respondents have adequate knowledge on standard precaution and

most of the respondents 76% obtained information on standard precaution

through seminar/work shop. It also shows that the respondents have positive

attitude towards standard precaution in which most of the respondents strongly

agreed that standard precaution keeps them safe from contagious disease and also

they disagreed that using standard precaution for patient with infectious disease

is a waste of time.The findings also revealed how respondents practice standard

precaution in which majority of the respondents 74% comply with standard

precaution and 50% of the respondents use gloves as a standard precautionary

measure. Most of the respondents 68% dispose needle and syringe as part of
53
 injection and 48% soak re-usable instrument in a disinfectant. The findings also

revealed that most of the respondents 50% mentioned that lack of the time as the

main factor affecting the practice of standard precaution, followed by lack of

equipment (24%), lack of conducive working environment and lack of

knowledge (10%).The findings also shows that most of the respondents 46%

mentioned provision of adequate supply of adequate supply of material as a way

in which the practice of standard precaution can be improved.

5.5 CONCLUSION OF THE STUDY

In the course of the study, it was concluded that 88% of the respondents had
adequate knowledge on standard precaution, attitude and practice of standard
precautions among the respondents was good but the respondents reported some
factors affecting the practice of standard precaution such as lack of knowledge,
time, available equipment and lack of conducive working environment. The
respondents also mentioned some ways through which practice of standard
precaution can be improved such as provision of adequate supply of materials,
annual training of staffs on standard precautions, provision of policy governing
the practice of standard precaution and through seminar and workshop.

5.6 RECOMMENDATIONS
Based on the findings of the study, the following recommendations were made;

1. This study suggest that more personal protective equipment should be provided
in all health Institution by the government.

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2.Seminars and workshops with special allowance should be organized
occasionally to highlight about the concept of universal safety precaution and their
utilization among health care workers.

3.Implementation of policies on universal precautions for strict adherence.

4. Training programmes on universal precautions among health care workers

should be provided in all health care organizations.

5.7 SUGGESTIONS FOR FURTHER STUDIES

• Strategies that enhance adherence to standard precaution among health care
workers.

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 APPENDIX ‘A’

QUESTIONNAIRE

School of Basic Midwifery,

Malumfashi,
Katsina State.

Dear respondent,

I am a final year student of the above mentioned institution, conducting a research on

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE OF UNIVERSAL
SAFETY PRECAUTION AMONG HEALTH CARE GIVERS WORKING IN PUBLIC
HOSPITALS MALUMFASHI. Any answer given will be treated with confidentiality.

SECTION A- Socio-demographic data

1. Age of Respondents

a) 18-25 years c) 36-45 years

b) 26-35 year d) 46 years above

2. Gender

a) Male

b) Female

3. Professional qualification

a) RM c) Doctor

b) RN d) CHEW

e)RN/RM f)BNsc

4. Years of working experience

a) 1-5 years c) 11-15 years

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b) 6-10 years d)16 years above

SECTION B- KNOWLEDGE ON STANDARD PRECAUTION

5. Source of information of standard precaution

a) Radio c) workshop/seminar

b) Television d) From a colleague

6. What do you understand by standard precaution?

a) Are set of guidelines that aim to protect health care workers from blood borne
infections.

b) Using gloves and apron only

c) Using goggles and mask only

7. Condition for which standard precaution is mandatory

a) Patient with HIV/HBV b) Prevention of Nosocomial infection

d) For all patients

8. Standard precautionary measures include:

a) Use of bedpan and urinals

b) The use of gloves, mask and apron

c) Not discarding sharp instrument

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 SECTION C-ATTITUDE TOWARDS STANDARD PRECAUTION

Tick the appropriate column: Strongly Agree (SA), Agree(A), Undecided (UD), Disagree
(D), Strongly disagree (SD)

NO QUESTION SA A UD D SD

09 Using standard precaution for a patient with

suspected infectious disease is a waste of time

10 In general, pressure of work makes me forget to

use protective barriers sometimes

11 Following standard precaution keeps me safe

from contagious disease

12 Infectious disease can be treated hence

protective devices are not required

13 I can reduce my occupational risk for HIV/HBV

infection by complying with standard precaution

SECTION D-PRACTICE OF STANDARD PRECAUTION

14. Do you comply with standard precautions?

a) Yes

b) No

c) Not always

15. Which of the measures do you use mostly?

a) Use of mask c) Hand hygiene

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b) Gloves d) Apron

16. Injection safety practice

a) Recap needle after use

b) Dispose needle and syringe

c) Detach needle and syringe after use

17. Methods of handling used re-usable instrument

a) Washing with soap and water

b) Soak in a disinfectant

c) Put in an autoclave

SECTION E-FACTORS AFFECTING THE PRACTICE OF STANDARD

PRECAUTION

18. What do you think are the factors affecting the practice of standard precaution?

a) Lack of knowledge c) Lack of equipment

b) Lack of time d)Lack of conducive working environment

19. How do you think the practice of standard precaution can be improved?

a) Through provision of adequate supply of materials in the facility

b) Annual training of staffs on standard precautions

c) There should be a policy governing the practice of standard precaution

d) Through seminar/workshop

59
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