PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
DISSERTATION PROPOSAL
“A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE REGARDING UNIVERSAL PRECAUTION AMONG NURSES WORKING IN PEDIATRIC WARDS IN SELECTED HOSPITALS AT TUMKUR WITH A VIEW TO DEVELOP INFORMATION BOOKLET”
SUBMITTED BY: - Mr. SUDHEENDRA. R. J.
1ST YEAR M.Sc. NURSING
CHILD HEALTH NURSING
SRI RAMANA MAHARSHI
COLLEGE OF NURSING
TUMKUR.
2011-2013
RAJIV GANDHI UNIVERSITY OF HEALTH
SCIENCES BANGALORE, KARNATAKA.
ANNEXURE-II
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR: DISSERTATION
1. / NAME OF THE CANDIDATE ANDADDRESS / Mr. SUDHEENDRA R. J.
1 YEAR M.Sc. NURSING
SRI RAMANA MAHARISHI COLLEGE OF NURSING TUMKUR
2. /
NAME OF THE INSTITUTION / SRI RAMANA MAHARSHI COLLEGE OF NURSING
3. / COURSE OF STUDY AND SUBJECT / 1ST YEAR MSc. NURSING
CHILD HEALTH NURSING
4. / DATE OF ADMISSION TO
COURSE / 15 JULY 2011
5. / TITTLE OF THE TOPIC / A STUDY TO ASSESS THE KNOWLEDGE
AND PRACTICE REGARDING UNIVERSAL
PRECAUTION AMONG NURSES WORKING
IN PEDIATRIC WARDS IN SELECTED
HOSPITALS AT TUMKUR WITH A VIEW TO
DEVELOP INFORMATION BOOKLET
6. BRIEF RESUME OF INTENDED WORK
INTRODUCTION
“Children are the bridge to heaven”
PERSIAN PROVERB
“Every child comes with the message that God is not yet discouraged of man”
RABINDRANATH TAGORE
Universal precautions refers to the practice, in medicine, of avoiding contact with patients' bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields. The practice was introduced in 1985–88. In 1987, the practice of universal precautions was adjusted by a set of rules known as body substance isolation. In 1996, both practices were replaced by the latest approach known as standard precautions (health care). Nowadays and in isolation, practice of universal precautions has historical significance.1
Universal precautions are standards of infection control practices designed to reduce the risk of transmission of bloodborne infections.
Protective equipment includes gloves, gowns, masks, and eyewear worn by health care workers to reduce the risk of exposure to potentially infectious materials.
Examination gloves are used for procedures involving contact with mucous membranes. They reduce the incidence of contamination to the hands, but they cannot prevent penetrating injuries from needles or other sharp instruments. Gloves are changed after each patient and discarded, and must never be washed or disinfected for reuse. Washing with surfactants may cause wicking.
Fluid-resistant gowns, laboratory coats, or uniforms should be worn when clothing is likely to be soiled with blood or other bodily fluids. Reusable protective clothing should be washed separately from other clothes, using a normal laundry cycle. Protective clothing should be changed daily or as soon as visibly soiled.
Masks and protective eyewear, or chin-length, plastic face shields should be worn when splashing or spattering of blood or other body fluids is likely. A mask should be changed between patients or during patient treatment if it becomes wet or moist. A face shield or protective eyewear should be washed with appropriate cleaning agents when visibly soiled.
Sharp disposable items, such as needles, saliva ejectors, rubber prophy cups and scalpels that cannot be sterilized and are contaminated with blood or other body fluids need to be discarded in puncture resistant containers. Special delivery companies pick up the containers once they are full and replace them with empty containers.
Universal precautions are designed to result in the reduction of the transmission of infectious diseases to patients and health care workers.2
Health care professionals and particularly nurses are often exposed to microorganisms, many of which can cause serious or even lethal infections. Nurses may acquire an infection during the provision of nursing care because of occupational exposure to microorganisms. Relevant literature reports that, compliance with Standard Precautions is low among nurses. Additionally, high rates of exposure to microorganisms among nurses via several modes (needle sticks, hand contamination with blood, exposure to air-transmitted microorganisms) occur.
Microorganisms are transmitted in hospitals by several routes, and the same microorganism may be transmitted by more than one route. There are five main routes of transmission -- contact, droplet, airborne, common vehicle, and vectorborne. For the purpose of this guideline, common vehicle and vectorborne transmission will be discussed only briefly, because neither plays a significant role in typical nosocomial infections.
Contact transmission, the most important and frequent mode of transmission of nosocomial infections, is divided into two subgroups: direct-contact transmission and indirect-contact transmission. Direct-contact transmission involves a direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person, such as occurs when a person turns a patient, gives a patient a bath, or performs other patient-care activities that require direct personal contact. Direct-contact transmission also can occur between two patients, with one serving as the source of the infectious microorganisms and the other as a susceptible host. Indirect-contact transmission involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated hands that are not washed and gloves that are not changed between patients.
Droplet transmission, theoretically, is a form of contact transmission. However, the mechanism of transfer of the pathogen to the host is quite distinct from either direct- or indirect-contact transmission. Therefore, droplet transmission will be considered a separate route of transmission in this guideline. Droplets are generated from the source person primarily during coughing, sneezing, and talking, and during the performance of certain procedures such as suctioning and bronchoscopy. Transmission occurs when droplets containing microorganisms generated from the infected person are propelled a short distance through the air and deposited on the host's conjunctivae, nasal mucosa, or mouth. Because droplets do not remain suspended in the air, special air handling and ventilation are not required to prevent droplet transmission; that is, droplet transmission must not be confused with airborne transmission.
Airborne Transmission occurs by dissemination of either airborne droplet nuclei (small-particle residue {5 um or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Microorganisms carried in this manner can be dispersed widely by air currents and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient, depending on environmental factors; therefore, special air handling and ventilation are required to prevent airborne transmission. Microorganisms transmitted by airborne transmission include Mycobacterium tuberculosis and the rubella and varicella viruses.
Common Vehicle Transmission applies to microorganisms transmitted by contaminated items such as food, water, medications, devices, and equipment
Isolation precautions are designed to prevent transmission of microorganisms by these routes in hospitals. Because agent and host factors are more difficult to control, interruption of transfer of microorganisms is directed primarily at transmission. The recommendations presented in this guideline are based on this concept.3
6.1 NEED FOR STUDY
“I brought children into this dark world because it needed the light that only a child can bring”
- Liz Armbruster
Although universal precautions guidelines have been in place since 1987, suboptimal adherence has been documented extensively despite evidence that failure to use barrier precautions increases the risk of mucocutaneous blood and body fluid exposure and adherence decreases risk. Correlational studies have shown that nonadherence among physicians and nurses is associated with inadequate knowledge, forgetfulness, workload, workplace safety climate, and the perception that colleagues also failed to adhere, while adherence is associated with seeing precautions as a way to avoid injury or exposure and with concern about protecting colleagues. Even the most effective intervention studies, however, have concluded that more work needs to be done to reduce exposures to blood-borne pathogens.
This paper describes the identification, categorization, and assessment of key recent incidents involving community hospital-based health care workers who did not follow standard precautions. As part of a larger study undertaken to determine the epidemiology and risk factors for needlestick injuries and mucocutaneous exposures, we asked respondents to describe a specific incident of nonadherence and to explain why it occurred. Hence it is needed to do study on it. 4
The Center for Disease Control and Prevention revised the infection control practice fromUniversal Precautionsto StandardPrecautionsin 1996. Although the practice of StandardPrecautionshas been implemented for almost 15 years in clinical settings, recent local research still adopts theUniversal PrecautionsScale to measure the compliance with the current infection control practice of general frontline nursing staff and students. Despite the scale's sound psychometric properties, that its items may not be sensitive and comprehensive enough to reflect the current compliance of frontline staff to StandardPrecautionsis questionable. The current study employed a recognized instrumentation design. In addition, a preliminary assessment of reliability and validity was described.
The CSPS was developed through the modification of theUniversal PrecautionsScale through five steps: reviewing the infection control guidelines, modifying the items of theUniversal PrecautionsScale, examining the relevance and adequacy of new items by an expert panel, verifying the linguistic and grammatical issues, and examining the understand ability of the items and acceptability of the entire instrument by stakeholders. Internal consistency was examined using Cronbach's alpha statistic. Result-The original 15-itemUniversal PrecautionsScale was revised to the 20-item CSPS, in which 13 items were revised in wording and concept, 2 items were deleted, and 7 items were added. The 20-item new scale obtained the overall content validity index of 0.90, and 100% understand ability and acceptability in face validity, and Cronbach's alpha of 0.73. 5
At present situation most of all Staff nurse are not following precautions and because of that both the Child and the nurse are getting infected by various infections, especially childrens have less immunity against infections but due to improper procedures or deficient of knowledge childrens admitted to hospital are getting infections. Nurses working their also suffering from various nosocomial infections.
6.2 REVIEW OF LITERATURE
1. Studies related to Universal precautions
Efstathiou G, et; al. was conducted a study on Compliance of Cypriot nurses with standardprecautionsto avoid exposure to pathogens in Limassol. Self-completed questionnaires that examined the frequency of the implementation of StandardPrecautionswere distributed to a convenience sample of 668 nurses. The response rate was 89.37%.The results showed inadequate compliance with StandardPrecautions. Full compliance with all the main aspects of StandardPrecautionswas reported by only 9.1% of the participants. Male nurses and those who had not been exposed previously to pathogens reported better compliance, in comparison to female nurses and those who had been exposed previously. Nurses who had participated previously in an educational program about StandardPrecautionsreported a higher frequency of implementing them than those who had not participated. The nurses' age and frequency of the implementation of StandardPrecautionswere found to be significantly and positively correlated. The results can be used to enhance nurses' safety by focusing on areas of non-compliance.6
Hamid MZ,Aziz NA, et; al. was conducted study onKnowledge of blood-borne infectious diseases and the practice ofuniversal precautions amongst health-care workers in a tertiary hospital in Malaysia. This study aimed to assess the knowledge of blood-borne diseases transmitted through needle stick injuries amongst health-care workers in a tertiary teaching hospital. A self-administered questionnaire assessing knowledge of blood-borne diseases anduniversal precautions, and actual practice ofuniversal precautionswas used. 215 samples participated in this study; 63.3% were staff nurses. The mean knowledge score was 31.84 (SD 4.30) and the meanuniversalpractice score was 9.0 (SD 2.1). There was a small, positive correlation between knowledge and actual practice ofuniversal precautions(r = 0.300, n = 206, p < 0.001) amongst the cohort studied. Factors such as age and years of experience did not contribute towards acquisition of knowledge about blood-borne illnesses or the practice of universal precautions.7
Salehi AS,Garner P. was conducted a study on Occupational injury history anduniversal precautionsawareness: a survey in Kabul hospital staff in Kabul. In five randomly selected governmenthospitalsin Kabul a total of 950 staff participated in the study. Seventy three percent of staff (72.6%, 491/676) reported sharps injury in the preceding 12 months, with remarkably similar levels betweenhospitalsand staff cadres in the 676 (71.1%) people responding. Most at risk were gynaecologist/obstetricians (96.1%) followed by surgeons (91.1%), nurses (80.2%), dentists (75.4%), midwives (62.0%), technicians (50.0%), and internist/pediatricians (47.5%). Of the injuries reported, the commonest were from hollow-bore needles (46.3%, n = 361/780), usually during recapping. Almost a quarter (27.9%) of respondents had not been vaccinated against hepatitis B. Basic knowledge aboutuniversal precautionswere found insufficient across allhospitalsand cadres. 8
Beghdadli B et; al. was conducted a study on Standardprecautions" practices among nurses in a university hospital in Western Algeria. A questionnaire was administered to 450 nurses in the hospital workplace setting. A total of 133 nurses, 81 women and 52 men, participated in the survey. Personal and professional data, hand-washing frequency, glove wearing practices were collected as data. A large majority (95%) of nurses reported washing their hands after removing their gloves, and 69% of them reported washing their hands between two patients. Male nurses wear gloves more often than females (respectively 77% and 53%). Sharp instruments were correctly disposed of in a puncture-resistant container more of the time. Recapping needles has been reported by two-thirds of survey respondents. Lack of liquid soap and alcohol-based washing solution were noted as major deficiencies as well as the lack of means to properly dry hands in many health care wards. 9
Motamed N, et; al. was conducted a study on Knowledge and practices of health care workers and medical students towardsuniversal precautionsinhospitalsin Mazandaran Province. This study investigated knowledge of and practices towardsuniversal precautionsamong 540 health care workers and medical students in 2 universityhospitalsin Mazandaran Province, Islamic Republic of Iran. Only 65.8% and 90.0% staff in the 2hospitalsand 53.5% of medical students had heard aboutuniversal precautions. Overall, there was a low understanding of precautions, except concerning disposal of sharps, contact with vaginal fluid, use of mask and gown or cleaning spilled blood. Health workers had difficulty distinguishing between deep body fluids and body secretions that are not considered infectious. Good practices were reported regarding hand-washing, disposal of needles, and glove, mask and gown usage.10