RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

01 / NAME OF THE CANDIDATE AND ADDRESS / Mrs. DANESHWARI HIREMATH
M.Sc. NURSING 1ST YEAR.
PAEDIATRIC NURSING
SHRI. B.V.V.SANGHA’S SAJJALASHREE INSTITUTE OF NURSING SCIENCES, NAVANAGAR, BAGALKOT, KARNATAKA.
02 / NAME OF THE INSTITUTION / SHRI. B.V.V.V.SANGHA’S SAJJALASHREE INSTITUTE OF NURSING SCIENCES, NAVANAGAR, BAGALKOT, KARNATAKA.
03 / COURSE OF STUDY AND SUBJECT / M.Sc. NURSHING 1ST YEAR
PAEDIATRIC NURSING
04 / DATE OF ADMISSION TO COURSE / 16-05-2007.
05 / TITLE OF THE TOPIC / “A STUDY TO ASSES THE KNOWLEDGE AND PRACTICE OF STAFF NURSES IN RELATION WITH ASEPTIC PRECAUTION FOLLOWED AT THE TIME OF GIVING CARE TO NEONATES ADMITTED AT NICU OF SELECTED HOSPITALS OF BAGALKOT”.
6.0 / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY:
[ Today’s Children’s are Tomorrow’s citizen ]
India as a developing south east Asian country, have achieved many heights & success in many fields like Space research, Nuclear energy, Biotechnology, Computer science & in health sector also. It has made progress in reducing neonatal mortality.
However it still accounts for 3.1 million child deaths annually. Among which a significant number i.e. 1.4 million die during the neonatal period (about 43 deaths / 1000 live births) which remains a bare truth.
The neonatal period (birth to 28 days) can be divided into two distinct phases, first 7days (early neonate period) and remaining 3 weeks (late neonate period).About ¾ of all neonatal deaths occurs during early neonatal period i.e. mortality rate is high. Apart from maternal complications like birth asphyxia, premature births, a majority of deaths occur due to infections & tetanus taking place during late neonatal period.
In India the probable causes of high neonatal mortality are,
-High prevalence of LBW babies.
-Deficient Post Natal care,
- Prematurity.
- Referral care issues,
- Availability, Transportation, Cost.
- Socio cultural factors,
- Maternal education, Birth interval, Maternal nutritional status.
- Delayed breast feeding and cord care precautions.
The member states of WHO are also committed to achieve reduction in Child Mortality rate by 2/3, through its MDG-4 (Millennium Development Goal).
From previous data, it is evident that availability of referral care centers with well equipped NICU plays an important role in reducing the neonatal mortality rate.
NICU are the units in Pediatric dept which are capable of providing life support to critically ill babies with well equipped centralized oxygen, suction, incubators, ventilators and infusion pump etc.
Usually the neonates requiring NICU admission are:Very low birth weight babies of less than 1500gms, premature babies, cardiopulmonary monitoring, Surfactant therapy, severe birth asphyxia. Assisted ventilation, Total parenteral nutrition, Major surgery, Convulsions, O2 therapy, Large babies of more than 4 kgs, Muconium aspiration, Septicemia, Tube feeding etc. Since the neonatal care unit requires a team approach, apart from other facilities, they should have trained medical & paramedical personnel.
Among the paramedical personnel, a trained staff nurse plays vital role in NICU setup. Since she remains in constant contact with the neonate from it’s admission to recovery, looking after each & every aspect of neonatal treatment and maintenance of thermonutral temperature, IVinfusion, gavage feeding, phototherapy & exchange transfusion etc. Due to lack of up-to-date knowledge regarding the importance of aseptic precautions,the following conditions usually happen.
Infections like,
  • Pseudomonas auriginosa.
  • Other gm –ve bacteria like klebsiella, proteus,enterobacter etc
  • Staphylococcus aureus.
  • Pnumococcus etc.
  • Viral Infections.
All these may cause superficial & systemic infections and all above said conditions results into death.
Hence it is expected that the staff nurses working at NICU should follow all the possible aseptic precautionary measures strictly.
In India a major barrier for the neglected Neonatal Mortality in public health issues are the erroneous perception that only expensive, high level technology & health facility based care can reduce neonatal mortality .But in Western countries it is observed that neonatal mortality has been drastically reduced just by the introduction of Universal availability of antenatal care, improved care at child birth and quality antenatal care.
Hence the neonatal mortality rate can be reduced effectively, by following the simple aseptic measures in NICU while giving care to neonates, such as,
  • Meticulous hand washing.
  • Wearing sterilized mask, cap &gowns.
  • Cleaning & sterilizing the equipments.
  • Following standard techniques in administering IV fluids etc.
So the student investigator feels that it is important to assess the knowledge of the staff nurse regarding aseptic precautions.
6.2 REVIEW OF LITERATURE:
Afroza S. conducted study on neonatal sepsis. It is major health problem through out the world. Every year an estimated 30 million newborn acquire infection and 1 – 2 million of these die. The findings of the study showed that clean and safe delivery, early and exclusive breast feeding, strict post natal cleanliness following adequate hand washing and aseptic techniques during invasive procedures might reduce the incidence of neonatal sepsis. Prompt use of antibiotics according to slandered policy is warranted to save the newborn life from septicemia.
Mayhall et al conducted study on nasocomial clebsiella infection in a neonatal unit. Identification of risk factors for the gastrointestinal colonization. The sequential outbreaks of infection due to Gentamycine resistant clebsiella pneumonia types 30 and 19 occurred in the neonatal intensive care unit (NICU) at the medical college of Virginia in 1977 and 1978.The extensive epidemiologic investigations carried out included a case controlled study. The case controlled study showed a significant relationship between acquisition of GRKP by patients and oropharyngial and GI instrumentation, including use of bag resuscitation oropharyngial suctioning, and use of nasogastric feeding tubes. The findings of the case controlled study were supported by observation of the patient care techniques practiced by NICU staff. Institution of control measures based on results of the epidemiologic investigations of the first outbreak rapidly brought the second outbreak under control, eventhough cohorting or use of routine isolation was not possible.
Hazuka BT conducted study on prevention of infection in the nursery. The result revealed that neonatal intensive care unit have extraordinarily high infection rates. Most infants are on ventilators. Daily decontamination of respiratory equipments is essential. Regular monitoring of endotracheal cultures is useful, particularly when bacteria that are resistant to multiple antibiotics emerge.
Garci DC et al conducted study on an outbreak of multiple resistant pseudomonas auriginosa in a neonatal unit: plasmid pattern analysis. The result revealed that lack of sterilization of respirators and overcrowding were considered to be the cause of the outbreak and reinforcement of aseptic techniques helped in its termination.
Iroha EO conducted a perspective study in neonatal unit on bacterial eye infection in neonates The result revealed was varied in relation with predisposing factors noted were vaginal delivery, asphyxia neonatorum and prolonged rupture of membranes etc. Pathogens isolated were staphylococcus aureus (37.4%), coagilase negative staphylococcus (12.3%), clebsiella pneumonia (12.9%) and pseudomonas auriginosa (8.2%). Antimicrobial susceptibility results revealed varied degrees of susceptibility. The high incidence of bacterial eye infection should be minimized by the elimination of the risk factors and adoption of stringent aseptic measures in the care of neonates.
Fok TF et al conducted a case controlled study on risk factors for Enterobacter septicemia in a neonatal unit. The results by multivariate analysis showed that the preceding bladder catherization and ongoing parenteral nutrition were the only independent risk factors for enterobacter septicemia. Strict aseptic technique in the preparation of parenteral nutrition fluid and avoidance of bladder catherization are measures that may reduce the risk of enterobacter sepsis in newborns.
Maos A et al conducted study on central venous catheter related bacteraemia in critically ill neonates: risk factors and impact of a prevention programme. The result revealed that by using the Cox model proportional hazards, very low birth weight and the period before use of strict aseptic CVC care were found to be predictors of increased risk of catheter related bacteraemia after adjustment for duration of catherization. These data provide further evidence that strict aseptic precautions during the maintenance and utilization of CVC can contribute to lower the risk of catheter in critically ill neonates. Regular feedback of surveillance data was associated with a progressive in incidence of infection, suggesting that it improved staff compliance with aseptic precautions.
6.3 STATEMENT OF THE PROBLEM
“A STUDY TO ASSES THE KNOWLEDGE AND PRACTICE OF STAFF NURSES IN RELATION WITH ASEPTIC PRECAUTION FOLLOWED AT THE TIME OF GIVING CARE TO NEONATES ADMITTED AT NICU OF SELECTED HOSPITALS OF BAGALKOT”.
6.4 OBJECTIVES OF THE STUDY:
  1. To asses the knowledge about care of neonates among NICU nurses.
  2. To assess the practice about care of neonates among NICU nurses.
  3. To associate the knowledge and practice among NICU nurses.
  4. To associate knowledge and sociodemografic variables among NICU nurses.

6.5 OPERATIONAL DEFINITIONS:
  1. Aseptic Technique – In this study, aseptic technique refers to freedom from infection or prevention of contact with micro-organisms.
  2. New born - In the study new born refers to the time from birth to 4 weeks (28 days) of age.
  3. NICU – In this study NICU refers to Neonatal Intensive Care Unit.
  4. Staff Nurse – In this study staff nurse refers to the nurses working at NICU unit.
  5. New born Care – In this study new born care refers to care of the baby from birth to 4 weeks of age.
  6. Knowledge – In this study knowledge refers to range of information or awareness about care of neonates by the staff nurse.
  7. Practice: In this study practice refers to the utilization of staff nurses knowledge in Aseptic technique in NICU.

6.6 ASSUMPTIONS:
  1. It is assumed that the staff nurses have adequate knowledge about aseptic precautions to be followed in NICU while handling newborn.
  2. It is assumed that responses of staff nurses of NICU to the questionnaire based interview schedule will reflect their actual knowledge about aseptic precautions to be followed in NICU.

6.7 DELIMITATIONS:
The study is delimited to the staff nurses, who are working at NICU of various pediatric hospitals of Bagalkot.
6.8 PROJECTED OUTCOME:
The findings of the study will help the staff nurse of NICU to know the importance of aseptic precautions to be followed in NICU and their practices which help to prevent the neonatal sepsis and mortality of newborn.
7. / SOURCE OF DATA:
Research Design: Descriptive design.
Research Setting: The study will be conducted on staff nurses working in NICU at various pediatric hospitals of Bagalkot, Karnataka.
Sample Size: 50 – 60
INCLUSIVE CRITERIA:
Staff nurses working in NICU at varies Pediatric hospitals of Bagalkot.
EXCLUSIVE CRITERIA :
The NICU staff nurses who are not willing to participate in the study.
7.1 METHOD OF COLLECTION OF DATA:
  • Formal permission from Dean / M.O. of the hospital.
  • Investigator introduces herself to the staff of NICU.
  • Administer the questionnaire to asses the knowledge of staff nurse of NICU at Pediatric hospitals regarding aseptic precautions to be followed at NICU, while handling the neonates.
  • Use the observational checklist to assess the practices of aseptic practices at NICU.

7.2 DATA COLLECTION TOOLS:
Instruments:
  • Questionnaire to asses the knowledge regarding care of newborn.
  • Observational checklist.
SAMPLING TECHNIQUE: Purposive sampling.
DATA ANALYSIS PLAN: Descriptive & inferential statistical method will be used to analyse the collected data.
7.3 Does the study require any investigation or interventions to be conducted on
participants ?
-No.
7.4 Permission will be obtained from concerned authority ?
-Yes.
7.5 Has ethical clearance been obtained from institution in case of 7.3 ?
- Yes.
8. / LIST OF REFERENCES
  1. Lemarie C. et.al.: “Central-venous-catheter-related bacteremia in neonatology”, Med Mal Infect.2006 Apr;36(4);213-8.
  2. Ng Sp. et. al.: “Reduction of nosocomial infection in a neonatal intensive care unit (NICU), Singapore Med J. 1998 Jul; 39(7):319-23.
  3. Mass. A. et. al.: “Central-venous-catheter-related bacteremia in critically ill neonates”, Risk factors and impact of a prevention programme. J Hosp Infect. 1998 Nov; 40(3):211-24.
  4. Fok TF.et. al.: “Risk factors for Enterobacter septicemia in a neonatal unit”: Case-Control Study. Clin Infect Dis. 1998 Nov:27(5):1204-9.
  5. Iroha EO. et. al.: “Bacterial eye infection in neonates, a prospective study in a neonatal unit”. West Afr J Med. 1998, Jul-Sep:17 (3)168-72.
  6. Moro ML. et. al.: “Risk factors for nosocomial sepsis in newborn intensive and intermediate care units”. Eur J Pediatr. 1996 Apr: 155 (4): 315-22.
  7. GarciaDC. et. al.: “An outbreak of multiply resistant Pseudomonas aeruginosa in a neonatal unit: plasmid pattern analysis”. J Hosp Infect. 1989 Aug:14 (2):99-105.
  8. Hazuka BT.: “Prevention of infection in the nursery” Nurs Clin North Am. 1980 Dec;15 (4):825-31.
  9. Mayhall CG. et. al.: “Nosocomial klebsiella infection in a neonatal unit”, identification of factors for gastrointestinal colonization. Infect Control. 1980 Jul-Aug:1 (4):239-46.
  10. Afroza S. : “Neonatal sepsis a global problem an overview” My mensing Med J (2006) Jan:15 (1):108-14.

9. / SIGNATURE OF THE CANDIDATE
10. / REMARKS OF THE GUIDE / Thus study is Feasible and I forward it for acceptance.
11. / NAME AND DESIGNATION OF
11.1 GUIDE / Smt. J. Shantakumari
Professor and HOD
Dept. of Paediatric Nursing
Shri. B.V.V.Sangha’s Sajjalashree Institute of Nursing Sciences, Navanagar, Bagalkot, Karnataka
11.2 SIGNATURE
11.3 CO-GUIDE / Miss. Shivashankari
Asst. Professor
Dept. of Paediatric Nursing
Shri B.V.V.Sangha’s Sajjalashree Institute of Nursing Sciences, Navanagar, Bagalkot, Karnataka.
11.4 SIGNATURE
11.5 HEAD OF THE DEPT. / Smt. J. Shantakumari
Prof. & HOD
Dept. of Paediatric Nursing.
11.6 SIGNATURE
12. / REMARKS OF THE CHAIRMAN & PRINCIPAL / The topic is discussed with the members of the research committee and is finalized. She is permitted to conduct the study
12.1 SIGNATURE