PERCEPTION AND PREVENTIVE PRACTICES TOWARDS INFECTION CONTROL AMONG HEALTH CARE WORKERS IN SECONDARY AND TERTIARY HOSPITALS IN IBADAN, OYO STATE: A COMPARATIVE STUDY

PERCEPTION AND PREVENTIVE PRACTICES TOWARDS INFECTION CONTROL AMONG HEALTH CARE WORKERS IN SECONDARY AND TERTIARY HOSPITALS IN IBADAN, OYO STATE: A COMPARATIVE STUDY

Abstract

Health Care Workers (HCWs) are at risk for occupational exposure to blood borne pathogens including hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV) and twenty other pathogens. HCWs in the developing countries especially are at a higher risk of mucocutaneous and percutaneous exposure to blood borne pathogens. This is a comparative cross-sectional study of secondary and tertiary health care workers conducted to establish the level of awareness and practices with regard to infection control, prevention and management of occupational injuries in Ibadan and also to assess the effect of existing policy in the area of infection control on HCWs.
A multi – stage sampling technique was used to select HCWs in two of the three secondary level hospitals and the only tertiary institution in Ibadan. Both quantitative and qualitative data were collected from HCWs using a standardized questionnaire and a focus group discussion guide. Data analysis was done using the SPSS software for the quantitative data and NUDIST version 6.0 for the qualitative data.
A total of 1275 HCWs – 928 (72.8%) in the tertiary facility group and 347 (27%) in the secondary facility group participated in the study. The majority, 839 (65.8%) were ≤ 40 years and most were female, 900 (70.8%) – 590 (63.8%) in the tertiary facility and 310 (89.6%) in the secondary facility group. Overall, 648 (50.8%) were nurse/midwives – 394 (42.5%) and 254 (73.25%) in the tertiary and the secondary facilities respectively.
On the whole, more than half of the participants in the focus group discussion from the tertiary facility group were aware of the current infection control guidelines in their workplaces, however those in the secondary facility group remarked that there was no workplace policy on infection control. HCWs in both facility groups were aware about universal precautions and there was no significant difference in the level of awareness on UP in the two groups, (p = 0.346). The most reported protective clothing used, was the glove used by 1245 (97.7%): 910 (98.2%) of tertiary HCWs and 335 (96.5%) of the HCWs in secondary facility (p = 0.034) followed by the face mask cited by 1034 (81.1%) – 799 (86.1%) of the tertiary HCWs and 235 (67.7%) of the secondary HCWs respectively (p < 0.001). HCWs in the tertiary facility were significantly more likely than those in the secondary facility group to use the sharp box for sharps disposal – 741 (80.2%) and 105 (30.3%) respectively (p < 0.001). Regarding exposure to blood and body fluids, a higher proportion of HCWs in the tertiary facility reported that they were exposed to blood and body fluids in the course of their work, 822 (88.6%) compared to those in the secondary facility, 294 (84.7%) (p = 0.064). HCWs in the tertiary facility were more likely than were those in the secondary facility to report for post – exposure prophylaxis following percutaneous blood exposure, 110 (17.9%) and 4 (1.75%) ( p < 0.001). The tertiary facility HCWs were more likely than those in the secondary facility to have gone for HIV screening, 402 (43.5%) and 121 (34.2%), (p = 0.005) also to have completed a full course of hepatitis B vaccination, 286 (30.9%) and 39 (11.2%); (p < 0.001). After adjusting for socio-demographic characteristics such as age, sex, occupation
and years worked in hospital, hospital type was not a significant predictor of awareness about universal precaution, (OR 0.853; 95% CI = 0.483 – 1.505), neither was it a predictor for sustaining sharps injury ( OR = 1.021, 95% CI = 0.762 – 1.366). However, hospital type was a predictor for use of the protective clothing (OR = 2.924, 95% CI =
5
1.044 – 8.184), use of the sharp box (OR = 14.5, 95% CI = 9.579 – 19.089), and history of contact with blood and body fluids ( OR = 2.033, 95% CI = 1.336 – 3.094).
Study revealed that though overall awareness about universal precaution was high among all the HCWs, infection control practices were less than optimal among all the HCWs but practices were better in the tertiary facility group. This might have been because an institutional policy on infection control is in place in the tertiary facility though it is not properly implemented while none was in place in the secondary facility group. It is recommended that the existing infection control policy in the tertiary facility group be strengthened and that one should be established in secondary facility group.

Title Page———i

Certification——–ii

Dedication———iii

Acknowledgement——-iv

Abstract ———vi

Table of Content——–vii

 

Chapter One

1.0 Introduction ——-1

1.1 Statement of Problem——4

1.2 Purpose of the Study——5

1.3 Significance of Study——8

1.4 Limitation——–9

1.5 Scope of Study——-11

 

Chapter Two

2.0 Review of Related Literature —-12

2.6 Summary of Literature Review—- 19

 

Chapter Three

3.0 Research Methodology and Procedure—22

3.1 Population ——–22

3.2 Sample and Sampling Technique—-22

3.3 Validation of the Instrument —-23

3.4 Reliability of the Instrument —–23

3.5 Data Analysis——-23

 

Chapter Four

4.0 Presentation and Discussion of Result—24

4.1 Analysis and interpretaion of Data—25

4.2 Discussion of Results——38

 

Chapter Five

5.0. Summary, Conclusion, and Recommendation  –40

5.1 Summary——–40

5.2 Conclusion——–41

5.3 Recommendation——42

References ———45

Appendix 1——–47

Appendix ———50

PERCEPTION AND PREVENTIVE PRACTICES TOWARDS INFECTION CONTROL AMONG HEALTH CARE WORKERS IN SECONDARY AND TERTIARY HOSPITALS IN IBADAN, OYO STATE: A COMPARATIVE STUDY

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