ABSTRACT

Background. Hospital acquired infections commonly known as Nosocomial infections are infections which are gotten from the hospital by patients who have admitted for other reasons. World health organization (WHO) reports that the most common types of HAI are urinary tract infections, respiratory tract infection, and surgical wound infections. Also, Nurses play a pivotal role in preventing hospital acquired infections (HAI), not only by ensuring that all aspects of their nursing practice is evidence based, but also through nursing research and practice education Method. This research employed a descriptive cross–sectional hospital-based research design for data collection. The targeted population of this study were mainly nurses who worked at the Regional Hospital Buea wards irrespective of their age, grade, and sex. Also a convenient sampling method was used to select the 60 participants who satisfied the selection criteria designed. In addition to this, the primary data used in conducting the study were collected through the administering of questionnaires in other to get together the necessary data for the study. Results. All participants completed their questionnaires and all nurses who enrolled in the study were staffs of the regional hospital of Buea with 78.3% being women and 21.7% men. On the occurrence of HAIs, Respiratory Tract Infection were the most occurring (46.7%). In addition, their knowledge on the most susceptible groups to hospital acquired infections, a majority of them 47(78.3%) said nurses were, followed by Doctors with 8(13.3%) and Lab technicians with 4(6.7%). Also, their knowledge on the recognized sources of infections, Mattresses and pillows were identified as the most common source of infection with an occurrence of 50(83.3%) followed by Nurses uniform 5(8.3%) and lastly by White coat 3(5. 0%). Conclusions. Based on the findings of this study, it can be concluded that nurses in this current study have adequate knowledge on this hospital acquired infections as well as their preventive measures but in spite of having the knowledge, they don’t have adequate practice in the prevention of this infection.

CHAPTER ONE

GENERAL INTRODUCTION

1.0 Introduction

This chapter presents the general introduction to this study. It consists of the background which interns talks of assessing nurse’s knowledge and practice in preventing Hospital Acquired Infections. In addition, the problem statement, objectives, research questions, justifications or rationales of the study, significance of the study and definition of terms are equally provided.

1.1 Background of the Study

A patient’s healthcare worker and visitors are the susceptible host in the hospital environment.

Hospital acquired infections commonly known as Nosocomial infections are infections which are acquired from the hospital by patients who are admitted for other reasons. Now in other for an infection to be considered as HAI, it should have been occurring for more than 48hours after patient’s admission. These infections are caused by any microorganism such as bacteria, virus, or any parasites that might have originated from the hospital environment or contaminated equipment, staffs or other patients. WHO reports that the most common types of HAI are urinary tract infections, respiratory tract infection, and surgical wound infections. Amongst all the multidisciplinary care providers, nurses are the ones who provide constant bedside care to the patients and are in close contact with them and are such, there’s a higher risk for HAIs to be transmitted to other patients through them. On the other hand, they have as a responsibility a unique opportunity in reducing the potential for HAIs in their health care facility.  (Riffat Mehboob in 2015)

Nurses play a pivotal role in preventing hospital acquired infections (HAI), not only by ensuring that all aspects of their nursing practice is evidence based, but also through nursing research and practice education.

Hospital Acquired Infections (HAI) are amongst the most difficult problems confronting clinicians who deal with severely ill patients. They are becoming more alarming in the 21^st century as antibiotic resistance spreads. By prolonging the hospital stay of patients. as patients advocates, nurses have a unique position to be able to improve patients care standard. He or she has the available tools to be able to create a safe environment for the patient. Now according to CDC (Control for Disease Centre) in 2010, some precautionary measures were put in place in order to prevent further transmission of this infections from nurses to patients such as, nurses must put on personal protective equipment when coming in contact with specific body fluids some of which are, blood, cerebrospinal fluid, semen, vaginal secretions. Also, handwashing is another most important and effect weapon used by nurses to prevent the spread of this infections. Now you are made to understand that an effective handwashing may be accomplished with antimicrobial soap and water and some specific guidelines are set in place by CDC on the use of alcohol-based rubs as acceptable substitutes. More so making best use of aseptic techniques, universal precaution techniques, patients’ education and cleaning and disinfection practice. Which will later be discussed in details. These therefor means that nurses play important role in preventing hospital acquired infections, not only ensuring that all aspects of their nursing practices are properly conducted, but also through nursing research, patient education and implementation of infection control practice. (American medical news)

The CDC (centre for disease control and prevention) estimates that nosocomial infections contribute to 0.7 to 10.1% of deaths and cause 0.1 to 4.4% of all deaths occurring in hospitals. These infections can be reorganized on clinical, biological, microbiological and radiological plans. They are a common cause of morbidity and mortality in the developed and developing countries. Furthermore, studies have proven that a minimum of 190 million people are hospitalized each year worldwide and at most 9 million of them get to acquire at least one episode of this hospital acquired infections. The prevalence of hospital acquired infections all depend on the level of development of the healthcare system, thus in France and USA; The prevalence of the HAIs is estimated to vary between 6 and 7% and between 3 and 5% respectively. In Africa this prevalence reaches 25% of hospitalized patients. (Jerome Ateudjiu in 2016)

These numbers are expected to be greater as no data is available for countries that are expected to have the highest burden of the problem. So therefore, in Cameroon a few investigations were made or have been conducted but an isolated study was done in 2010 which stated this prevalence at 20.74%. hence, to reduce the burden of the problem, the WHO recommended that hospital acquired infections surveillance and its prevention should be systematically integrated in all healthcare system, this recommendation have been implemented in by many countries worldwide, including USA, France and some developing countries thereby promoting the prevention of hospital acquired infections in the hospitals. This has allowed the identification of hospital acquired infections risk factors and effective interventions that has helped in reducing their incidence by 30% in some countries in the western world an 55% in Africa. It´s been estimated that the risk of healthcare associated infections is 2 to 20 times higher in developing countries as compared to developed countries. (WHO 2011) (Jerome Ateudjieu in 2016).

The transmission of infections agents within a healthcare setting requires three agents, a reservoir, susceptible host and a mode of transmission. The mode of transmission may equally vary given the type of organism because some of these organisms may be transmitted to more than one route. For infection to take place, the organism must be transferred from a reservoir to an acceptable site on a susceptible host in sufficient number for multiplication of agent to take place. The infection may be transferred either by direct contact i.e. direct transmission from another host or from an environmental reservoir by direct contact. Or by indirect transmission which is the most common mechanism of transfer of an agent of this infections. Now this mostly takes place by the transfer of an agent on hand and clothing of health care worker who is contaminated with the organisms either from their own body or from other patients. This infection may also be vehicle born i.e. from contaminated food, water, or biological fluids. Airborne transmission is another mechanism of transmission of these infections. (Ramji Rai)

In addition to this, Cameroon has not yet adopted a national policy of prevention and management of these infections and as such no data on the incidence of cases is asked from healthcare facilities during the routine national surveillance. the situation in which each facility depends on the knowledge of the health authorities on the issue, their motivation and availability of resources to integrate this activity in their action plan (Jerome Ateudjieu in 2016). In 2015, Dr. Riffat Mehboob in his article said, the situations in which infections are not believed as hospital acquired infections are; The infections that were present during the time of admission and become complicated, nevertheless, pathogens or symptoms change resulting to a new infection. Secondly, the infections that are acquired trans-placentally, due to some diseases like toxoplasmosis, rubella, syphilis or cytomegalovirus and appear 48 hours after birth. These hospitals acquired infections appeared before the origination of hospitals and then became a health problem during the antibiotic era (when antibiotics just came to existence)

1.2 Statement of the Problem

In the less developed countries, hospital acquired infections have been recognized as a problem affecting the quality of health care and a principal source of adverse health outcomes. It’s been documented in the literature that within a realm of patient safety, these infections have serious impact. There’s an increased hospital stay days, increased costs of healthcare, economic hardship to patients and their families and even death are amongst the many negative outcomes. These findings are indicative of the enormous burden associated with hospital acquired infections. Now we are made to understand that, findings from several epidemiological studies reveals that healthcare workers such as physicians, nurses and most times dentist are implicated in the transmission of HAIs in Cameroon and in the regional hospital Buea.

1.3 Research Questions

1. How knowledgeable are nurses in regard to hospital acquired infections in the Regional hospital of Buea?
2. What measures have nurses put in place to reduce hospital acquired infections in the Regional hospital of Buea?