CHAPTER ONE

INTRODUCTION

Background to the Study

Standard precautions are the infection control measures that were recommended following the AIDS outbreak in the 1980s. That is why every patient is treated as if they are infected and therefore precautions are taken to minimize risk. Standard precautions are acceptable hygiene habits, such as hand washing and the use of gloves and other barriers, correct sharps handling, and aseptic techniques (NMRJ, 2010). More precautions are used in addition to standard precaution for patients who are known and suspected to have infectious condition, and vary depending on the infection control need of the patient. These are not needed in blood borne infection except there are complicating factors. Standard Precaution is recommended not only for doctors, nurses and patients, but for health care support workers. Some support workers, most notably laundry and housekeeping staff may be required to come into contact with patient’s body fluids. If so happened and precautionary measures are not taken, there will be spread of pathogens from the nurse to the patient and from one patient to another, resulting in hospital acquired infection, formerly known as nosocomial infection. If precautionary measures are taken there shall be no infection spread, no wound breakdown no environmental control. (Siegel, Rhinehart, Jackson &Chiarello2011).

All health care workers should routinely, use appropriate barrier precautions to prevent skin and mucous membranes exposure during contact with any patient’s blood or body fluids. Gloves should be worn for touching blood or body fluids, mucous membrane, or non intact skin of all patients and handling items or surfaces soiled with blood or body fluids, to which standard precaution apply. Gloves should be changed after contact with each patient. Hands and other skin surfaces should be washed immediately or as soon as patient safety permits. Hands should be washed immediately after gloves are removed during any surgical or medical procedure, but they cannot prevent penetrating injuries caused by needles or other sharp instrument. Health Care Associated Infections (HCAIs), or Hospital Acquired Infections (HAIs), are infections that were neither present nor incubating at the time of the patient’s hospital admission. The third national prevalence survey of HCAIs carried out in 2015 identified an infection rate of 8.2%. (Health Care Associated Infections, 2014)

The Centre for Disease Prevention and Control (2016) and World Health Organization (WHO, 2011) identified the components of standard precautions as the following; hand hygiene, personal protective equipment, gowns, mouth, nose and eye protection, respiratory care equipment and instruments/devices, care of environment, linens, waste disposal, safe injection practices and post exposure prophylaxis.

In recent years, attention to health care associated infections (HAIs) formerly referred to as nosocomial infections have grown. Since most people with blood borne viral infections such as Human Immune Virus (HIV) and Hepatitis B Virus (HBV) do not have symptoms nor can they be visibly recognized as being infected, standard precautions are designed for the care of all the clients and staff regardless of whether or not they are infected. The blood borne infections among nurses are often gotten from sharp injuries and blood splashes and these accounts for about 50% of cases (Offili, et al 2012).

Smeltzer, Bare, Henkel &Cheaver (2012) suggested that standard precaution is a set of protective behaviours which replace the previously recommended universal precautions and body substance isolation. According to them, the tenets of standard precautions are that all  patients are colonized or infected with microorganism without signs or symptoms and that a uniform level of caution should be used to care for all patients. It was against this background that this study assesses the knowledge, attitude and practice of standard precautions among nurses in University of Calabar Teaching Hospital as they attend to their patients.

Statement of Problem

Hazards among nurses can pose serious health problems. One of such hazards is the increased predisposition to infection and injury. This problem is universal and affects nurses all over the world. Patients are also to be protected from infection in the environment, from patient to patients and from medical practitioner to patient. In 2015, the Centre for Disease Control  through its Hospital Infection Control Practices Advisory Committee (HICPAC) came together to reduce the risk for exposure of health care workers to HIV through the development of standard precautionary measures. (Smeltzer, Bare, Henkel &Cheaver, 2012 ).

During the process of caring for patients, nurses are exposed to infections because of the procedures they perform. These put the nurses and patients at risk of being infected. For instance hepatitis B (HBV) and HIV/AIDS may be contracted by the health care worker or transmitted to patients through fluids and exudates from blood during the process of giving care if proper precautionary measures are not taken. (Centre for Disease Control, 2010).

Having worked as a trained nurse/midwife as well as peri-operative nurse for more than 20 years in the surgical unit, and other units of the hospital, the researcher observed that even though there are containers kept for sharps that should be separated from other refuse, most nurses as well as other care givers still derail in their outstanding performance.  It is therefore the intent of this research to investigate the knowledge, attitude and practice of standard precautionary measures among nurses in University of Calabar Teaching Hospital (UCTH) Calabar.

Purpose of the Study

This study is aimed at determining the knowledge, attitude and practice of standard precautionary measures among nurses in University of Calabar Teaching Hospital (UCTH). Cross River State.

Specific Objectives

Specifically, the objectives of the study are to: