RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1)

NAME OF THE CANDIDATE AND ADDRESS

TREESA P KURIAN

GAYATHRI COLLEGE OF NURSING

KOTTIGEPALAYA

BANGALORE- 91

2) NAME OF THE INSTITUTION GAYATHRI COLLEGE OF NURSING

3)COURSE OF STUDY AND SUBJECT: 1ST YEAR MSC NURSING.

MEDICAL-SURGICAL NURSING

4) DATE OF ADMISSION TO THE COURSE: 10-06- 2011

5) TITLE OF THE TOPIC

“A STUDY TO ASSES THE EFFECTIVENESS OF STUCTURED

TEACHING PROGRAM ON PREVENTION AND MANAGEMENT OF

HOSPITAL ACQUIRED MRSA INFECTIONS ASSOCIATED WITH

RESPIRATORY AIDS IN TERMS OF KNOWLEDGE AND PRACTICE

AMONG STAFF NURSES OF A SELECTED HOSPITAL BANGALORE”

6) BRIEF RESUME OF THE INTENTED WORK

INTRODUCTION

Methicillin-resistant Staphylococcus aureus (MRSA) is a type (strain) of staph

bacteria that does not respond to some antibiotics that are commonly used to treat

staph infections. Staph aureus is a common type of bacteria. In about 1 out of every 4

healthy people, the staph germ lives on the skin or in the nasal passages, but it does

not cause any problems or infections. This strain of staph is called MRSA, or

methicillin-resistant Staphylococcus aureus. MRSA infections often occur in people

who are in the hospital or other health care setting. Those who have been hospitalized

or had surgery within the past year are also at increased risk. MRSA bacteria are

causing a higher number of the staph infections that begin in the hospital.

There are several different types of respiratory aid, and each is used for a specific

purpose. Primarily, respiratory aid consists of medications and devices that help assist

a patient in breathing. Those with asthma, chronic respiratory failure, cystic fibrosis,

or another serious respiratory illness or injury are most likely to need assistance with

breathing. In some cases, respiratory aids may be a cause of spreading of infection

like MRSA.

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One of the most common types of respiratory aid is the nebulizer. Most consumers are

familiar with the compact inhaler, which is ultimately a mini version of a nebulizer

machine. Nebulizers are machines or devices that turn a liquid medication into fine

mist that is more readily accepted by the thin tissues of the lungs. So far the nebulizer

mask is so designed to avoid infection but infections like MRSA, H1N1 is still acting

as a risk in infection transmission.

Another type of respiratory aid is the use of oxygen with either a facial mask or tubing

that is inserted into the patient’s nose. This is commonly used for a variety of

ailments, as well as those who are suffering from a non-respiratory related issue but

who are temporarily out of breath. Settings like ICU and emergency lack time and

proper control strategy to prevent the transmission of MRSA.

The mechanical respirator is a type of respiratory aid that is used in extreme cases,

including severe illness in which the patient can no longer sufficiently breathe on his

own or in injuries where the lungs are too severely damaged to carry out respiration.

Respirators are machines which are attached to patients using tubing which goes into

the lungs. They creates a better option for infectious micro-organism to go inside by

breaking the external reparatory preventive measures and cause infection. Even

though pneumonia is the commonest disease among them, viral disease, MRSA and is

also there.

Because of longer duration of mechanical ventilation, longer stay in the ICU,

increased use of antibiotics, higher costs for healthcare, and most importantly,

increased mortality, the prevention of VAP is the major priority. But, despite the

advances in the pathogenesis of MRSA, intensivists still struggle with the prevention

strategy.

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Basic hygiene principles of infection control (hand washing/disinfection just before

and after each patient contact, the use of glove and sterile equipment) remain

important for the prevention of pulmonary induced MRSA infection. Healthcare

workers (HCW) can spread microorganisms from patient to patient by their hands

easily.

The internal machinery of mechanical ventilators is not an important risk factor for

MRSA infection. Therefore, using a filter between the aspiratory phase circuit and the

patient is not necessary. Furthermore, the importance of filters on the expiratory limb

of the mechanical-ventilator circuit in preventing cross contamination has not known

and needs further investigation.

6.1 NEED FOR STUDY

MRSA infections are an important public health problem that can no longer be

ignored,"

Among the highlights from the newly published study in USA (2005).

In the United States, the Centers for Disease Control and Prevention estimate that

roughly 1.7 million pulmonary infections, from all types of microorganisms,

including bacteria, combined, cause or contribute to 99,000 deaths each year and a

major parts takes by MRSA.

The most important risk factor for MRSA as a pulmonary infection is tracheal

intubation. It increases the risk by 1) causing sinusitis and trauma to nasopharynx

(nasotracheal tube), 2) impairing swallowing of secretions, 3) acting as a reservoir for

bacterial proliferation, 4) increasing bacterial adherence and colonization of airways,

5) requiring the presence of a foreign body that traumatizes the oropharyngeal

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epithelium, 6) causing ischemia secondary to cuff pressure, 7) impairing ciliary

clearance and cough, 8) causing leakage of secretions around the cuff, and 9)

requiring suctioning to remove secretions. Microorganisms can adhere to the surface

of the endotracheal tube. That microbial biofilm on the tube surface provides a

reservoir of microorganisms, and they are greatly resistant to the action of

antimicrobials and host defense. Also, the patient requiring mechanical ventilation

exposes to other devices, such as nebulizers, humidifiers, which can be the source of

microorganisms.

In different studies, the incidence of respiratory associated MRSA was reported

different, depending on the definition, the type of hospital or ICU, the population

studied, and the type of rate calculated and varies from 7% to 24%. In a large

database, 1-day point prevalence study, conducted in 1417 European ICUs, MRSA

accounted for 11% of nosocomial infections. In the National Nosocomial Infections

Surveillance System (NNIS), MRSA accounted for 9% of all nosocomial infections in

ICU and in another NNIS data in medical ICUs; it was accounted for 8%. The recent

studies reported the device-associated incidence rate 1.56 per 1000 ventilator days.

Generally, the rates of MRSA in surgical ICU were higher than in medical ICUs,

depending on the differences in the patient population, surgical disorders, and the

proportion of patients that needed mechanical ventilation and the duration of

ventilation. Kollef reported incidences of MRSA of 26% in patients admitted to a

cardiothoracic ICU, 14% in other surgical ICU, and 9.3% in a medical ICU.

MRSA may occur by four routes; haematogenous spread from a distant focus of

infection, contiguous spread, inhalation of infectious aerosols and aspiration.

Aspiration of the pathogenic gram-positive and gram-negative bacteria, colonized on

the oropharynx and gastrointestinal tract, is the main route. The role of other routes is

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very rare. The preventive measures prime motive is to tackle the spreading of

infection associated with respiratory aids.

6.2 REVIEW OF LITERATURE

Review of literature provides base for further investigation, justify the

need for study. It refers to an extension, exhaustive and systematic

examination of publications relevant to research projects.

Literature review of this study is classified in to following categories;

Studies related to incidence and prevalence of respiratory infection

associated with MRSA infection.

Studies related to respiratory aids associated with MRSA infection.

Studies related to knowledge and practice of staff nurses regarding

MRSA infection.

Prevention and management of MRSA infections.

STUDIES RELATED TO INCIDENCE AND PREVALENCE

OF RESPIRATORY INFECTION ASSOCIATED WITH

MRSA INFECTION.

Eili Klein (2005) Hospital-acquired infections with Staphylococcus aureus,

especially methicillin-resistant S. aureus (MRSA) infections from respiratory

aids, are a major cause of illness and death and impose serious economic costs on

patients and hospitals. However, the recent magnitude and trend of these

infections have not been reported. We used national hospitalization and resistance

data to estimate the annual number of hospitalizations and deaths associated with

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S. aureus and MRSA from 1999 through 2005. During this period, the estimated

number of S. aureus–related hospitalizations increased 62%, from 294,570 to

477,927, and the estimated number of MRSA-related hospitalizations more than

doubled, from 127,036 to 278,203. Our findings suggest that S. aureus and

MRSA should be considered a national priority for disease control8.

Brown ML (2011) found out Panton-Valentine leukocidin (PVL), encoded by the

lukSF-PV genes, is a putative virulence factor and marker for community-associated

methicillin-resistant Staphylococcus aureus. Here, we report the prevalence of

infection among a representative sample of 1055 S. aureus infection isolates from the

United States and describe the sequence variation of the lukSF-PV genes. Study

performed multi-locus sequence typing (MLST) on all isolates and sequenced

fragments of the lukSF-PV genes from a sample of 86 isolates. We assigned isolates

to a PVL R or H sequence type based on a polymorphism that result in an amino acid

change from arginine (R) to histidine (H). Overall, It is found out that 36% of S.

aureus were positive for lukSF-PV. Among the 86 we typed, we identified 72 R

variants and 14 H variants. Among the 47 MRSA, 43 isolates harbored the R variant

and among the 39 MSSA, 29 harbored the R variant. Almost all (97%) of the R

variants were found in MLST CC8, while the H variant was broadly distributed

among 6 CCs. Within CC8, all 38 MRSA (USA300) and all 28 MSSA isolates

harbored the R variant. Of the 20 isolates from blood and the lower respiratory tract,

19 (95%) harbored the R variant. While the R variant had been linked primarily to

USA300 MRSA, All CC8 MSSA isolates also contained the R variant, suggesting that

some strains of USA300 may have lost methicillin resistance as an adaptation in the

community.20

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Philippe Dufourl in 2002 conducted a study to characterize the clinical

and bacteriologic characteristics of community-acquired methicillin-resistant

Staphylococcus aureus (CA-MRSA) infections with mechanical ventilator as a risk

factor, we reviewed 14 cases that were diagnosed in previously healthy patients

during an 18-month period in France. Eleven patients had skin or soft-tissue

infections. Two patients died of MRSA necrotizing pneumonia. A case of pleurisy

occurred in a child who acquired MRSA from his mother, who had a breast abscess.9

Robert.L.Thompson in 1982 conducted a study on Epidemiology of Nosocomial

Infections Caused by Methicillin-Resistant Staphylococcus aureus. Outbreaks of

hospital-acquired infections caused by methicillin-resistant Staphylococcus aureus are

being recognized with increasing frequency in the United States. Two thirds of

outbreaks have been centered in critical care units. Infected and colonized inpatients

appear to be the major institutional reservoir, and transient carriage on the hands of

hospital personnel appears to be the most important mechanism of serial patient-to-

patient transmission.10

According to a study conducted by Melissa.M.Morrison in 2005, there were 8987

observed cases of invasive MRSA reported during the surveillance period. Most

MRSA infections were health care–associated: 5250 (58.4%) were community-onset

infections, 2389 (26.6%) were hospital-onset infections out of which its main mode of

transmission is assisted respiration; 1234 (13.7%) were community-associated

infections and 114 (1.3%) could not be classified.11

STUDIES RELATED TO RESPIRATORY AIDS

ASSOCIATED WITH MRSA INFECTION.

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Joseph Woodward in 2010 studied Disseminated Community-Acquired USA300

Methicillin-Resistant Staphylococcus aureus Pyomyositis and Septic Pulmonary

Emboli in an Immunocompetent Adult. The degree of dissemination in this patient

suggests an emerging level of virulence for community-acquired MRSA that has not

been reported previously.14

Ed Mangini in 2006 studied the Impact of Contact and Droplet Precautions on the

Incidence of Hospital – Acquired Methicillin – Resistant Staphylococcus aureus

Infection. The implementation of contact precautions significantly decreased the rate

of hospital- acquired MRSA infection and discontinuation of droplet precautions in

the ICUs led to a further reduction. Additional studies evaluating specific infection

control strategies are needed.15 According to a study conducted by David Schwartz

(2005), four adult patients who presented with septic pulmonary emboli and

community-acquired methicillin-resistant Staphylococcus aureus bacteremia

associated with deep tissue infections, such as pyomyositis, osteomyelitis, and

prostatic abscess. The patients lacked evidence of right-sided endocarditis or

thrombophlebitis. This association, previously described in children, may also be

important in adults.13

STUDIES RELATED TO KNOWLEDGE AND PRACTICE

OF STAFF NURSES REGARDING MRSA INFECTION.

Rachel Wolf MPH, Donna Lewis MSN (2008) conducted a study on nursing staff

perception of MRSA associated respiratory infection and control. In this study only

59% of participants perceived that MRSA posed a risk to patients. Consistency of

self-reported infection control practices varied by specific behavior. Lack of supplies

(26%) and lack of information/communication (24%) were reported as primary

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barriers to infection control(IC). All participants perceived patient behavior as a

barrier, and all were interested in additional education about MRSA and IC.

Comparing nurses with nursing assistants (NAs), nurses more frequently reported the

IC professional as the most trusted information source (60% versus 0%, P < .005);

NAs were more likely to trust the charge nurse. These results suggest that the

perceptions regarding the real threat of MRSA and infection transmission that would

drive IC prevention behaviors in this high-risk population vary among nursing staff,

as do nursing staff IC practices. This study provides insight into the complex

educational and other strategies needed to implement multilevel, multidimensional IC

in LTCFs.21

Phillips PS (2010) stated that Methicillin-resistant Staphyloccocus aureus (MRSA)

infection has received much attention in both the medical and non-medical press.

However, it is not widely encountered on ENT wards, given the profile of short-stay,

relatively well patients, although its impact seems to be increasing. He wished to

explore the knowledge and attitudes towards MRSA on general surgical and ENT

wards as it’s a source of respiratory infection, and see if there were any significant

differences between specialties, or between doctors and nurses. A 13-item

questionnaire with a Likert scale response with six knowledge questions and seven

attitude questions was prepared. It was completed anonymously by all nursing and

medical staffs on the ENT and general surgical wards of a large District General

Hospital. ENT doctors displayed the lowest knowledge and attitude scores; however,

this only attained significance in terms of the knowledge of the difference between

infection and colonization. Overall, nurses displayed significantly more positive

attitudes towards MRSA patients than doctors, but knowledge scores were not

significantly different between professions. The study suggests a lack of knowledge

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about and preponderance of negative attitudes towards MRSA amongst ENT doctors.

The difference between colonization and infection is not well understood. Reasons for

this may include the relative rarity of MRSA cases on ENT wards.12

M. Thorstad (2011) MRSA-exposed healthcare workers (HCWs) and patients are

tested. Carriage of MRSA leads to exclusion from work in healthcare institutions. In

this study, 388 staff members in 42 nursing homes in Oslo County responded to

questions about personal experience with MRSA and of own attitudes to challenges

associated with the control and treatment of MRSA patients. Half (52%) of the

nursing staff were concerned of becoming infected with MRSA and the consequences

of this would be for own social life, family, economy, and work restriction. The

concern was associated with risk factors like old buildings not suitable for modern

infection control work, low staffing rate (70% without specific training in healthcare

and 32% without formal healthcare education), defective cleaning and decolonization,

and lack of formal routines and capacity for isolation of MRSA patients. Since the

Norwegian MRSA guideline permits patients with persistent MRSA infections to

move freely around in nursing homes, the anxiety of the staff to become infected and

excluded from job was real.16

.According to a study conducted by P.M. Easton (2007) Knowledge on many aspects

of MRSA and its management was deficient, although the majority of participants

who felt that they required additional information about MRSA acknowledged this.

The survey confirmed that assumptions should not be made about adequate

knowledge and expertise of staff in relation to MRSA. Gaps in awareness of aspects

of care and management were highlighted and information and educational needs

identified.17

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Laurence Lines (2006)conducted a descriptive study to examine the extent to which

staff nurses feel that MRSA is out of control and that any attempts by them to control

it are unnecessary In the study, 60% of participants believe that MRSA is out of

control and state 'why should they bother worrying about it'. Furthermore, 80% of

participants commented that prescribed courses of nasal mupirocin were frequently

missed. The perception is that IV treatments were more important and effective than

topical agents.25

STUDIES RELATED TO PREVENTION AND MANAGEMENT

OF MRSA INFECTIONS.

Kohlenberg A (2011) benefit of screening for prevention of methicillin-resistant

Staphylococcus aureus (MRSA) 186 ICUs submitted data on MRSA cases for 2007

and 2008 and completed the questionnaire. During the period of analysis, 4935

MRSA cases occurred in these ICUs; of these, 3928 (79.6%) were imported and 1007

MRSA cases (20.4%) were ICU-acquired. Median MRSA IDs were 3.23 (IQR 1.24-

5.73), 2.24 (IQR 0.63-4.30) and 0.64 (IQR 0.17-1.39) per 1000 pd for all cases,

imported and ICU-acquired MRSA cases, respectively. MRSA IDs as well as

implemented MRSA screening and control measures varied widely between ICUs.

ICUs performing universal admission screening had significantly higher MRSA IDs

than ICUs performing targeted or no screening. Separate regression models for ICUs

with different screening strategies included the incidence of imported MRSA cases,

the type of ICU, and the length of stay in independent association with the number of

ICU-acquired MRSA cases. The analysis shows that MRSA IDs and structural

parameters differ considerably between ICUs. In response, ICUs have combined

screening and control measures in many ways to achieve various individual solutions.

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The incidence of imported MRSA cases might be helpful for consideration in the

planning of MRSA control programmes.22

Murray (2011) during combat operations, extremities continue to be the most

common sites of injury with associated high rates of infectious complications.

Overall, 15% of patients with extremity injuries develop osteomyelitis, and 17% of

those infections relapse or recur.

The bacteria infecting these wounds have included multidrug-resistant bacteria such

as Acinetobacter baumannii, Pseudomonas aeruginosa, extended-spectrum β-

lactamase-producing Klebsiella species and Escherichia coli, and methicillin-resistant

Staphylococcus aureus. The goals of extremity injury care are to prevent infection,

promote fracture healing, and restore function. In this review, we use a systematic

assessment of military and civilian extremity trauma data to provide evidence-based

recommendations for the varying management strategies to care for combat-related

extremity injuries to decrease infection rates. We emphasize postinjury antimicrobial

therapy, debridement and irrigation, and surgical wound management including

addressing ongoing areas of controversy and needed research. In addition, we address

adjuvants that are increasingly being examined, including local antimicrobial therapy,

flap closure, oxygen therapy, negative pressure wound therapy, and wound effluent

characterization. This evidence-based medicine review was produced to support the

Guidelines for the Prevention of Infections Associated With Combat-Related Injuries:

2011 Update contained in this supplement of Journal of Trauma.23

Edelstein (2011) described routine notification of Staphylococcus aureus producing

the Panton-Valentine Leucocidin toxin (PVL-SA) to the North East & Central London

Health Protection Unit, a communicable disease control unit covering a population of

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2.8 million, identified 115 cases in 2009-2010, including 99 skin and soft tissue

infections (SSTIs), 15 severe infections and one asymptomatic colonization. Most

cases occurred in children and young adults, unequally distributed geographically and

socio-economically. The majority of infections were community acquired and 60%

were caused by methicillin resistant strains. Overall, 27% of cases had previous

SSTIs, and 32% had contacts with SSTIs suggestive of PVL-SA albeit these were not

confirmed microbiologically. This suggests that characteristics of PVL-SA infection

in cases and their families are not recognized as such leading to delay in diagnosis and

low case ascertainment. A lack of governance around effective case management may

also be contributing to the burden of disease.24

Morris AC (2011) conducted a study on ventilator-associated infection is the

most common intensive care unit-acquired infection. Although there is widespread

consensus that evidenced-based interventions reduce the risk of ventilator-associated

pneumonia, controversy has surrounded the importance of implementing them as a

"bundle" of care. This study aimed to determine the effects of implementing such a

bundle while controlling for potential confounding variables seen in similar studies.

Implementation of a ventilator-associated infection prevention bundle was associated

with a statistically significant reduction in ventilator-associated pneumonia, which

had not been achieved with earlier ad hoc ventilator-associated pneumonia prevention

guidelines in our unit. This occurred despite an inability to meet bundle compliance

targets of 95% for all elements. Our data support the systematic approach to achieving

high rates of process compliance and suggest systematic introduction can decrease

both infection incidence and antibiotic use, especially for patients requiring longer

duration of ventilation.19

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6.3 STATEMENT OF THE PROBLEM

“A STUDY TO ASSES THE EFFECTIVENESS OF STUCTURED

TEACHING PROGRAM ON PREVENTION AND MANAGEMENT OF

HOSPITAL ACQUIRED MRSA INFECTIONS ASSOCIATED WITH

RESPIRATORY AIDS IN TERMS OF KNOWLEDGE AND PRACTICE

AMONG STAFF NURSES OF A SELECTED HOSPITAL BANGALORE”.

6.4 OBJECTIVES OF THE STUDY

6.4.1 To assess the level of knowledge of staff nurses regarding prevention and

management of hospital acquired MRSA infection associated with respiratory aids.

6.4.2 To assess the level of practice of staff nurses regarding prevention and

management of hospital acquired MRSA infection associated with respiratory aids.

6.4.3To evaluate the effectiveness of structured teaching program on prevention and

management of hospital acquired MRSA infection associated with respiratory aids

for staff nurses.

6.4.4To find out the relationship between the following.

a) Pre-test knowledge score and pre-test practices scores.

b) Post-test knowledge score and post-test practice scores.

6.4.5To find the association between the following.

a) Post-test knowledge score with selected demographic variables.

b) Post-test practice score with selected demographic variables.

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6.5 HYPOTHESIS

All hypotheses will be tested at (0.05) level of significance

H1- Mean post-test knowledge score of staff nurses who received teaching program

regarding prevention and management of hospital acquired MRSA infection

associated with respiratory aids will be significantly higher than the mean pre-test

knowledge score.

H2- Mean post-test practice score of staff nurses who received structured teaching

program regarding prevention and management of hospital acquired MRSA infection

associated with respiratory aids will be significantly higher than the mean pre-test

practice score.

H3-

a) There will be a significant relationship between pre-test knowledge score and pre-

test practice score of staff nurses who received structured teaching program

regarding prevention and management of hospital acquired MRSA infection

associated with respiratory aids.

b) There will be a significant relationship between post-test knowledge score and

post-test practice score of staff nurses who received structured teaching program

regarding prevention and management of hospital acquired MRSA infection

associated with respiratory aids.

H4-

a) There will be a significant association between post-test knowledge score and

selected demographic variables among staff nurses who received structured teaching

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program regarding prevention and management of hospital acquired MRSA infection

associated with respiratory aids.

b) There will be a significant association between post-test practice score and

selected demographic variables among school age staff nurses who received

structured teaching program regarding prevention and management hospital acquired

MRSA infection associated with respiratory aids.

6.6 OPERATIONAL DEFINITIONS

Effectiveness: In this study ‘effectiveness’ means the outcome of the

structured teaching program regarding hospital acquired MRSA

infection associated with respiratory aids which is measurable in terms

of improvement in staff nurses’s knowledge score based on given

questionnaire.

Structured Teaching Program (STP): It refers to well planned

teaching material regarding MRSA infection associated with

respiratory aids, given through lecture and discussion.

Knowledge: In this study, ‘knowledge’ refers to the written responses

of staff nurses, regarding MRSA infection associated with respiratory

aids as measured by knowledge quarantine.

Practice: Techniques followed by staff nurses while proceeding

treatment and management of MRSA infection and which will be

measured by practice questionnaire.

Prevention: It refers to the strategies taken to prevent and to block the

MRSA infection transmission.

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Management: It refers to the treatment and care modalities for a

patient with MRSA infection.

Hospital acquired: It refers to any infection which acquires after 2 to

3 days of hospitalization and the source as hospital.

MRSA infection: In this study, ‘MRSA infection’ is the infectious

disease occurred by Methillin Resistant Staphylococcus aureus.

Respiratory aids: In this ‘respiratory aids include the respiratory aids

which act as a risk factor for MRSA.

Staff nurses: In this study, the staff nurses are nurses those who are

working in a selected private hospital, Bangalore.

6.7 ASSUMPTIONS

The study is based on the assumption in cognitive performances

1. Education will alter the level of knowledge and practice.

2. Knowledge influences behavior.

3. Lack of practice leads to disorders.

6.8 DELIMITATIONS

Staff nurses who have completed General nursing and Midwifery

course.

Staff nurses who are willing to participate in the study.

Staff nurses who are working in emergency, ICU and wards.

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6.9 VARIABLES

Variables are an attribute of person on objects that varies, that takes on

different values

Dependant variable: Knowledge and practice of staff nurses

regarding Hospital Acquired MRSA infection associated with

respiratory aids.

Independent variable: Structured Teaching Program (STP) regarding

prevention and management of hospital acquired MRSA infection

associated with respiratory aids.

Extraneous variables: Gender, socio-economic status and previous

knowledge, source of knowledge and year of experience.

6.10 PROJECTED OUTCOME

It is expected that structured teaching regarding hospital acquired MRSA

infection associated with respiratory aids will help the nurses’ to gain

knowledge and practice those who underwent teaching programme.

7 MATERIALS AND METHOD

7.1) SOURSE OF DATA

The data will be collected from staff nurses working in selected

hospitals in Bangalore.

7.1.1 RESEARCH DESIGN AND APPROACH

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Evaluation approach will be used and this study will employ one group

pretest and posttest design.

7.1.2 SETTING

The study will be conducted in emergency, ICU and wards of a selected

private hospital.

7.1.3 POPULATION

Population of the study will be staff nurses from selected hospital and

are engaged in direct patient care.

7.2 METHOD OF COLLECTION OF DATA

7.2.1 SAMPLING PROCEDURE

The study will employ purposive sampling technique.

7.2.2 SAMPLE SIZE

The study will have 30 samples.

7.2.3 INCLUSION CRITERIA FOR SAMPLING

Staff nurses who have completed B.Sc (N) General Nursing

Midwifery course.

Staff nurses between the age group of 20 to 45 years.

Staff nurses who are willing to participate in the study.

Staff nurses who are engaged in direct patient care

Staff nurses of both genders.

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7.2.4 EXCLUSION CRITERIA FOR SAMPLING

Staff nurses who are engaged in administrative work such as

nursing supervisor and superintendent.

Staff nurses of other categories like ANM, and trained workers.

Staff nurses who are not willing to participate.

Staff nurses who are working in other unit like operation theatre.

7.2.5 DATA COLLECTION TOOL

TOOL 1: Structured knowledge questionnaire.

Part-1: It consists of demographic data.

Part 2: It consist of 25 multiple choice questions to assess

knowledge of staff nurses regarding MRSA infection as a

respiratory aids.

TOOL 2; Practice questionnaire.

Part 3: It will have 20 questions to assess the level of

practice of staff nurses regarding MRSA infection

associated with respiratory aid.

7.2.6 LIMITATIONS OF THE STUDY

This study will not use control group.

The study will limited for a period of four weeks only.

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The study will be conducted on a small sample of 30, hence

generalization may be done with caution.

7.2.7 PILOT STUDY PLAN

The pilot study will be conducted in the selected hospital to find

about the feasibility of the tool regarding MRSA infection associated

with respiratory aid. Five nurses who will meet inclusion criteria will

be selected for the study. Pre test will be done by using structured

questionnaire to assess the knowledge and practice. STP will be

given on the day of pretest. After five days posttest will be

conducted by using same questionnaire. The effectiveness will be

assessed by their written answers of the knowledge and practice.

7.2.8 DATA ANALYSIS PLAN AND PRESENTATION

The research will be in appropriate descriptive and Inferential

statistical analysis.

Personal data will be analyzed in terms of frequencies and

percentage.

The knowledge and practices of nurses regarding prevention and

management MRSA infection as a respiratory aids before and after

STP will be analyzed in terms of frequency, percentage, means and

standard deviation and will be presented in terms of figures and tables.

Paired t test will be used to test the significant difference between

two means in the pretest and posttest of knowledge and practice.

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Correlation coefficient r value will be used to find out the

relationship between the pretest knowledge score and pretest

practice score and between posttest knowledge score and posttest

practice score.

Chi-square test will be used to study the association between

posttest level of knowledge and demographic variables and

posttest level of practice and demographic variables.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR

OTHER HUMAN OR ANIMALS

Yes. The study require interventions in the form of a

supportive information programme, no other interventions which

cause any physical harm will be done for the subjects.

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED

Yes

Confidentiality and anonymity of the subject will be maintained.

A written permission from institutional authority will be obtained.

Permission from the authorities of the selected hospitals will be

obtained.

Informed consent from subjects who are willing to participate in

the study will be maintained.

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8) REFERENCE

1. Potter-Perry. Fundamental of Nursing. 7th ed. India; Mosby; 2009.

2. Joyce M Black. Medical Surgical nursing. 7th ed. India; Elsevier 2005.

3. Sr.Nancy. Principles And Practice of Nursing volume 1. 5nd ed.

India;Stephanie’s 2004.

4. Brunner and Suddarth’s. Medical Surgical nursing. 12th ed. Philadelphia

Lippincott; 2010

5) Lewis,Heitkemper,Dirksen,O’brien,Bucher,Medical Surgical Nursing,7th

edition, Elsevier Publications:p.1825-1827

6) Black M J,Text book of Medical Surgical Nursing 7th edition,Elsevier

Publications.p1737

7) Appendix A, CDC Guideline MMWR. Aug. 9 2002;51(RR10):27-28

8) Eili Klein , February 2005, Community-Acquired Methicillin-Resistant

Staphylococcus aureus Infections in France Oxford journals,

9) Philippe Dufourl. Thompson, 2002, Epidemiology of Nosocomial Infections

Caused by Methicillin-Resistant Staphylococcus aureus, www.annals.org,

10) Robert L. Thompson, 1980 ,Infection control & hospital epidemiology ,October 1982.

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1. SIGNATURE OF THE STUDENT:

2. REMARKS OF THE GUIDE:GOOD

3.

NAME AND DESIGNATION OF

GUIDE NAME:Mrs. Prof. Vanmathi

SIGNATURE:

4. CO-GUIDE NAME:

SIGNATURE:

5.HEAD OF THE DEPARTMENT: Mrs.Prof. Vanmathi

SIGNATURE:

6. REMARKS OF THE PRINCIPAL: GOOD

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