Journal of International Academic Research for Multidisciplinary

www.jiarm.com

Editorial Board __________________________________________________________________________________________

Dr. Kari Jabbour, Ph.D

Curriculum Developer,

American College of Technology,

Missouri, USA.

Er.Chandramohan, M.S

System Specialist - OGP

ABB Australia Pvt. Ltd., Australia.

Dr. S.K. Singh

Chief Scientist

Advanced Materials Technology Department

Institute of Minerals & Materials Technology

Bhubaneswar, India

PROF.Dr. Sharath Babu,LLM Ph.D

Dean. Faculty Of Law,

Karnatak University Dharwad,

Karnataka, India

Dr.SM Kadri, MBBS,MPH/ICHD,

FFP Fellow, Public Health Foundation of India

Epidemiologist Division of Epidemiology and Public Health,

Kashmir, India

Dr.Bhumika Talwar, BDS

Research Officer

State Institute of Health & Family Welfare

Jaipur, India

Dr. Tej Pratap Mall Ph.D

Head, Postgraduate Department of Botany,

Kisan P.G. College, Bahraich, India.

Dr. Arup Kanti Konar, Ph.D

Associate Professor of Economics Achhruram,

Memorial College,

SKB University, Jhalda,Purulia,

West Bengal. India

Dr. S.Raja Ph.D

Research Associate,

Madras Research Center of CMFR ,

Indian Council of Agricultural Research,

Chennai, India

Dr. Vijay Pithadia, Ph.D,

Director - Sri Aurobindo Institute of Management

Rajkot, India.

Er. R. Bhuvanewari Devi M.Tech, MCIHT

Highway Engineer, Infrastructure,

Ramboll, Abu Dhabi, UAE

Sanda Maican, Ph.D.

Senior Researcher,

Department of Ecology, Taxonomy and Nature Conservation

Institute of Biology of the Romanian Academy,

Bucharest, ROMANIA

Dr.Damarla Bala Venkata Ramana

Senior Scientist

Central Research Institute for Dryland Agriculture (CRIDA)

Hyderabad, A.P, India

PROF.Dr.S.V.Kshirsagar,M.B.B.S, M.S

Head - Department of Anatomy,

Bidar Institute of Medical Sciences,

Karnataka, India.

DR ASIFA NAZIR, M.B.B.S, MD

Assistant Professor Dept of Microbiology

Government Medical College, Srinagar, India.

Dr.AmitaPuri, Ph.D

Officiating Principal

Army Inst. Of Education

New Delhi, India

Dr. Shobana Nelasco Ph.D

Associate Professor,

Fellow of Indian Council of Social Science

Research (On Deputation},

Department of Economics,

Bharathidasan University, Trichirappalli. India

M. Suresh Kumar, PHD

Assistant Manager,

Godrej Security Solution,

India.

Dr.T.Chandrasekarayya,Ph.D

Assistant Professor,

Dept Of Population Studies & Social Work,

S.V.University, Tirupati, India.

JIARM VOLUME 1 ISSUE 6 (JULY 2013) ISSN : 2320 – 5083

149 www.jiarm.com

A COMPARATIVE STUDY OF KNOWLEDGE ABOUT HOSPITAL ACQUIRED INFECTION CONTROL PRACTICES AMONGST NURSING, HOUSEKEEPING & ADMINISTRATIVE STAFF IN NABH & NON-NABH

ACCREDITED HOSPITALS IN PUNE

DR. SWAPNIL TAK* MS. SHEETAL KULKARNI**

MR. RAHUL MORE***

*Associate Professor & Head, School of Health Care Administration, M.U.H.S. Regional Centre, Pune, India **Assistant Professor, School of Health Care Administration, M.U.H.S. Regional Centre, Pune, India

***Assistant Professor, School of Health Care Administration, M.U.H.S. Regional Centre, Pune, India

INTRODUCTION

Hospital-acquired infection (HAI) is an infection occurring in a patient in a

hospital or other healthcare facility in whom the infection was not present or

incubating at the time of admission. This includes infections acquired in the hospital

but appearing after discharge, and also occupational infections among staff of the

facility.1 Although it is difficult to assess the exact incidence of hospital acquired

infections in our hospitals, ample evidence exists to indicate the magnitude of HAI

and related problems. HAI not only prolongs the hospital stay of patients but also

increases bed occupancy and therefore puts extra burden on already strained hospital

resources.2 the major mode of transmission of these hospital-acquired infections is by

pathogens transferred from one patient to another through healthcare workers (HCWs)

who do not follow standard precautions. 3

Inadequate knowledge among healthcare workers leads to this poor compliance with

hand washing.4 The World Health organization (WHO) Report estimates that 2.5% of

HIV and 40% of HBV is a result of occupationalexposure.5

HCWs must know the various measures for their own protection. They should comply

with infection control measures, improve organization of work, implement standard

precautions and dispose biomedical waste properly to prevent occupational exposure6

Thus, hospital acquired infection control is of prime importance in any hospital

offering comprehensive health care. Nurses being in direct contact with the patients

round the clock and performing various nursing procedures and assisting physicians

and surgeons in various procedures, play an important role in preventing and

controlling HAI.

JIARM VOLUME 1 ISSUE 6 (JULY 2013) ISSN : 2320 – 5083

150 www.jiarm.com

The objectives of the study were: To assess the level of knowledge and practice of

staff nurses on infection control measures and to find out the relationship between

knowledge and practice .2

Methodology

The study was conducted in a 500 bedded NABH accredited hospital & a 200

bedded non NABH hospital located in Pimpri-Chinchwad area .The data was

collected by conducting a structured interview comprising of questions to assess the

knowledge about practices of hospital acquired infection control & hand washing in

the hospitals on nursing, housekeeping and administrative staff working in various

departments of the hospitals .Only the staff present on the day of data collection was

included in the study. The data thus gathered was compared & presented in a tabular

format.

Results:

Table 1: Composition of the Study Group Sr.No Staff Category Hospital

NABH Accredited Non-NABH

1 Nursing 74 28

2 House Keeping 24 9

3 Administrative 13 5

Total 111 42

Out of the total study group of 153,111 respondents present on the day of data

collection were from a 500 bedded NABH accredited hospital and 42 from a 200

bedded non-NABH hospital. The nursing and assistant nursing staff interviewed was

from the wards and all intensive care units. The interviewed housekeeping staff was

from all the departments and OPDs of the hospitals; while the administrative staff was

from different cadres of the hospital administration team from supervisors, floor

managers to the chief administrator.

JIARM VOLUME 1 ISSUE 6 (JULY 2013) ISSN : 2320 – 5083

151 www.jiarm.com

Table 2: Knowledge about Standard Hospital Acquired Infection (HAI) Control Practices

Sr.

No

Knowledge Areas Correct Response in Numbers & Percentages

NABH Accredited Non-NABH

N (n=74) HK(n=24) A(n=13) N(n=28) HK(n=9) A(n=5)

1 Mode of Infection 61(82.43) 9(37.5) 11(84.61) 14(50) 2(22.22) 4(80)

2 Common Causative Agent 59(79.72) 4(16.67) 10(76.92) 7(25) 0(0) 3(60)

3 Common Transmission

Route

62(83.78) 5(20.83) 11(84.61) 13(46.43) 3(33.33) 4(80)

4 Patient Susceptibility 60(81.08) 7(29.17) 13(100) 15(53.57) 4(44.44) 5(100)

5 Sterilization 65(87.83) 7(29.17) 13(100) 13(46.43) 2(22.22) 4(80)

6 Sterilization Processes 68(91.89) 8(33.33) 11(84.61) 10(35.71) 1(11.11) 3(60)

7 Importance of Hand washing 67(90.54) 11(45.83) 12(92.30) 17(60.71) 4(44.44) 3(60)

Mean Percentage 85.33% 30.35% 89.01% 45.40% 25.40% 74.29%

*N-Nursing, HK-Housekeeping, Admin-Administration, Figures in parenthesis denotes percentages.

The above table shows comparison between knowledge about HAI in NABH

& non-NABH hospital staff. The type questions were to judge the response about

infection, patient susceptibility, sterilization and hand washing. The findings for

responses from nursing staff from NABH accredited hospital were consistent with the

findings of a study conducted in AIIMS*. Standard error of difference between two

proportions was calculated on mean percentages derived in nursing, housekeeping and

administrative staff for the two hospitals. It was found that the knowledge of the

nursing staff in the NABH accredited hospital was significantly more than that in non-

NABH hospital. The reason for this could be because the basic qualification of

nursing staff in NABH accredited hospital was BSc Nursing while that in the non-

NABH hospital was GNM & as a result of an on job training given to them. No

significant difference in knowledge was found when housekeeping staffs were

compared. This could be because the staff was less educated and thus lacked

understanding about the concepts. The level of knowledge of the administrative staff

in both study groups was on a higher side may be because most of them had some

qualification in hospital administration.

JIARM VOLUME 1 ISSUE 6 (JULY 2013) ISSN : 2320 – 5083

152 www.jiarm.com

Table 3: Practices Followed to Prevent HAI by the Nursing Staff Sr.

No

Practice Positive Responses about the Practices

Nurses in NABH

Accredited

Hospital(n=74)

Nursing Staff in Non-

NABH

Hospital(n=28)

1 Hand wash-Before & after glove use 61(82.43) 13(46.43)

2 Hand wash-On contact with

secretion/excretion

66(89.19) 18(64.30)

3 Hand wash-Before an invasive procedure 63(85.13) 16(57.14)

4 Hand wash-between two procedures 56(75.68) 12(42.86)

5 Hand wash-follow 6 steps 59(79.72) 11(39.29)

6 Wearing gloves-for I/V injections 55(74.32) 09(32.14)

Mean (Percentage) 81.08% 47.02%

The above table shows a comparison between correct hand washing and self

protection practices followed by the nursing staff in NABH accredited & non-NABH

hospitals. The nursing staff in NABH hospital followed significantly better practices

than non-NABH hospital nursing staff after application of standard error of difference

between two proportions. This difference could be because of training of nursing staff

about these practices under NABH.

CONCLUSION

From the results it is clear that knowledge about HAI control practices & hand

washing and self protection procedures in the nursing staff was significantly better in

NABH accredited hospital, while there was a lot of scope for proper training of the

housekeeping staff and improvement in their supervision by the administrative staff;

who in both the hospitals had better knowledge about standard HAI control practices.

RECOMMENDATIONS

• Both the hospitals should keep SSC as basic criteria for recruitment of the

housekeeping staff.

• Non-NABH hospital, if it cannot get NABH accreditation done, should at least

follow the standard HAI control practices and train their staff accordingly.

JIARM VOLUME 1 ISSUE 6 (JULY 2013) ISSN : 2320 – 5083

153 www.jiarm.com

• Hospital administrators should monitor the HAI control practices stringently

by continuous monitoring, supervision and guidance through appropriate

training to the concerned staff, especially in non-NABH hospital.

• Non-NABH administration should provide funding and basic facilities for

training of its staff so that ultimately the HAI rate is brought down as per

global standards.

REFERENCES:

1. Benenson AS. Control of communicable diseases manual. 16th ed.

Washington: American Public Health Association; 1995.

2. Horn WA, Larson EL, McGinley KJ, Leyden JJ. Microbial flora on the hands

of health care personnel: Differences in composition and antibacterial

resistance. Infect Control Hosp Epidemiol 1988; 9:189-93.

3. Meengs MR, Giles BK, Chisholm CD, Cordell WH, Nelson DR. Hand washing frequency in an emergency department. J Emerg Nurs 1994; 20:183-8.

4. Tetali S, Choudhury PL. Occupational exposure to sharps and splash: Risk

among health care providers in three tertiary care hospitals in South India.

Indian J Occup Environ Med 2006; 10:35-40.

5. Neill TM, Abbott AV, Radecki SE. Risk of needle sticks and occupational

exposures among residents and medical students. Arch Intern Med 1992;

152:1451-6.