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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
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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.
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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.
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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.
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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.
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• 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.