CHAPTER ONE

• INTRODUCTION

1.1       BACKGROUD OF THE STUDY.

Health care professionals are constantly exposed to microorganisms. Many of which can causeserious or even lethal infections_. Nosocomial infection is an infection occurring in a patient during the process of care within a health care facility which was not present or incubating at the time of admission. This infections occurring more than 48 to 72 hours after admission and within 10 days to 30 days after hospital discharge⁽¹⁾_.        

Most infected patients are usually admitted into the hospitals and therefore hospitals become common settings for transmission of diseases. In hospitals, infected patients are a source of infection transmission to other patients, health care workers and visitors ⁽¹⁾. The admission of patients with different organisms, the hospital environment has become saturated with highly virulent organisms: Staphylococcus aureus, Streptococcus pyogenic, Escherichia coli, Pseudomonasaureginosa, Hepatitis viruses and Human Immune deficiency virus that survive in a hospital environment. These organisms cause diseases ranging from minor skin infections to life threatening conditions ⁽¹⁾.It has been estimated thatthe risk of health care-associated infection is 2 to 20 times higher in developing countries compared to developedcountries and 5% and 10% of patients admitted to hospitals in developed countries acquire these infections.Nosocomial infection, also known as hospital-acquired infections is one of the leading course of death and has much economic cost due to increased hospitalization and prognosis⁽²⁾. (Nosocomial Infections) are those infections acquired during the patient’s stay in hospital. They form a major worldwide public health problem despite advances in health workers understanding and control of these infections ⁽¹⁾. The best clinical care in the world can be worthless if patients/clients pick up other infections while they are in the hospital. Nosocomial infections also include occupational infection which occurs in health care workers due to occupational hazard or due to in adherence and non-compliance to standard precautions or practice of patient care ⁽³⁾.

Nosocomial infections increase patients’ morbidity, mortality, length of hospital stay and treatment cost ⁽⁴⁾. Therefore, knowledge about the frequency and distribution of nosocomial infections is important to improve infection control measures as well as to develop effective preventive strategies which, in turn, will help in decreasing incidence, morbidity and mortality⁽⁵⁾.Hospital provide a favorable transmission path-way for the spread of nosocomial infections, owing partly topoor of knowledge,bad attitude of infection control practice among health care on one hand and overcrowding of patients in most clinical settings (poor isolation practice) ⁽³⁾. The importance of health workers on nosocomial infections goes beyond its impact on morbidity and mortality figures in any country, and has profound economic implication. Prevention of health care associated infections (Nosocomial infections) is the duty of all health care workers. Infection control professionals require evidence-based educational content (knowledge) that facilitates reduction in nosocomial infections. Clinical and support staff in health care institutions are undated with required training regarding prevention and control. Standard precautions are designed to reduce the risk of acquiring hospital infection from both known and unknown sources in the healthcare settings⁽⁵⁾. Strict adherence by health care workers to standard precautions may prevent a percentage of these risks, for that, health care workers should have adequate knowledge, attitude and practice about standard infection control precaution ⁽⁶⁾.

Nosocomial infection continues to be a burden to the World Health Care system through increased risk to patients and employees. These infections have tremendous sheath and financial costs with an estimated incidence of 2,000,000 infection per year, 26,000 death per year and added costs of billion dollars per year. Effective infection control program are essential to controlling and preventing Nosocomial infection ⁽⁷⁾.

One of the most recurrent themes with regards to the prevention of Nosocomial infections in hospitals has been the issue of hand washing among medical personnel. Knowledge and practice of hand washing as well as Aseptic technique are very important in preventing the transfer of pathogenic micro-organisms by health care workers to their patients in the course of rendering care. Health workers may harbor micro-organisms that are harmless to them but potentially harmful to patients if they find route of entry. Some micro-organisms are normal resident’s flora, while others invade the body and cause infection and disease that could either be asymptomatic, subclinical or clinical. These features make them vary in their virulence, pathogenicity and sepsis ⁽⁸⁾.

Compliance on the part of health care workers with standard precautions has been recognized as an efficient means to prevent and control hospital infections or healthcare-associated infections. Such measure does not only protect the patient, but also Health care workers and the environment ⁽⁹⁾. Standard precautions are based on the principle that all blood, body fluids, secretions excretions (except sweat), non-intact skin and mucus membranes may contain transmissible infections agents. The term standard of precautions which is part of the role of the health care worker to undertake or observe while caring for a patient or client is replacing universal precautions as it expands the coverage of universal precautions by being recognized that any body fluid may contain contagious and harmful microorganisms. Many infection control measures, such as appropriate hand hygiene and the correct application of basicprecautions during invasive procedures are simple and of low-cost, but require staff accountability andbehavioral change, in addition to improving staff education, reporting and surveillance systems⁽¹⁰⁾. To utilize these precautions, the human element playsan important role in increasing or decreasing the chances of catching HCAI. Standard precautions include hand hygiene, use of appropriate personal protective equipment (PPE), use of aseptic techniques to reduce patient exposure to micro-organisms and management of sharps, blood spills, linen, and waste to maintain a safe environment ⁽¹⁰⁾.

On average, 1 in every 10 patients is affected by hospital acquired infections worldwide. In acute care hospitals, out of every 100 patients, 7 in developed and 15 in developing countries will acquire at least one hospital acquired infection. In high-income countries, up to 30% of patients are affected by hospital acquired infection. In intensive care units in developing countries the frequency is at least 2-3 times higher. On average, 61% of health workers do not adhered to recommended standard practices ⁽¹¹⁾.Lack of knowledge, bad attitude and poor practices amongst health care workers in the prevention of infections can lead to hospital acquired infections (Nosocomial infections)⁽¹²⁾.

1.2       Statement of the Problem