Abstract
This study
focused on evaluation of universal precautions practice in FETHAI. The work was
guided by three research questions and objectives. The descriptive survey
design was used in generating data through questionnaire, Simple percentage was
used to analyze the data generated from 200 health workers in FETHAI. After the
analysis, the researcher found that health workers at FETHAI have an
appreciably high level of knowledge of universal precautions; they are
favourably disposed towards universal precautions practices, and materials
needed for universal precautions are readily available at the health
institution.
The study recommended that, among other things, there is need for
relevant authorities and agencies to carry out further sensitization and
awareness programmes on universal precautions; all health workers must be made
to adopt the attitude of strict adherence to universal precautions practices
whenever they are on duty; there is need to monitor the level of compliance
with universal precautions among health workers in FETHAI, and there is need to
sustain the level of availability of materials needed for up in FETHAI and
insist that these materials are judiciously used. In ocnclusion, the researcher
stated that the practice of universal precautions in FETHAI is appreciably
high.
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background
of the Study
Health promotion and development have
remained at the centre stage of global discussions, especially as it concerns
developing countries, where the healthcare situations are usually in a
deplorable state. The commitment on the part of the global community to come up
with strategies to ensure the promotion and development of global health
condition is evident in the Millennium Declaration of September 6th-8th
2000, in New York, captioned the Millennium Development Goals (MDGs) (Mbam,
2006). The MDGs consist of eight (8) goals that were formulated as a structural
framework to facilitate development in developing countries, among the 8 goals
of the MDGs four (4) were geared towards the improvement of healthcare and
healthcare related conditions. These four goals are to reduce child mortality
(Goal 4); to improve maternal health (Goal 5); combat HIV/AIDS, malaria and
other diseases (Goal 6); and ensure environmental sustainability (Goal 7),
(Mbam, 2006; UNDP, 2006 and 2007). Remarkable health improvement can only be
attained if the possibilities of transmission from infected to uninfected are
reduced or eliminated, and the prevalence of disease conditions contained (Okaro
et al, 2010). Thus, health improvement can only be achievable if, in the
first place, measures or precautions are taken to protect the uninfected,
mostly health care workers from being infected, while the infected are
successfully treated of their disease conditions. Again, the emergence of
dreaded diseases like HIV/AIDS and other life-threatening infections made it
imperative that healthcare worker who comes into contact with those infected
are protected (Culter and Jordan, 2004). In this wise, interventional measures
have been proposed to minimize exposure of healthcare workers and patients to
infections with the implementation of universal precautions as one of the
strategies (Garcia-Zapata, et al 2010; Fawiad, et al., 2009, and
Sadoh, 2006).
In 1983, in line with the objective of
safeguarding the health of healthcare workers while on duty, the U.S. Centre
for Disease Control and Prevention (CDC) published a document that recommended
blood and body fluid precautions when a patient is know or suspected to be
infected with fluid precautions when a patient is known or suspected to be
infected with blood born pathogens (Beltrami, et al., 2000).According to
Vaz et al., (2010), the CDC recommended, that regardless of status, the
precautions must be consistently used. The extension of blood and body fluid
precautions of all patients is referred to as “universal blood and body fluid
precaution” or simply “universal precautions” (McCarthy, 2010).
In related accounts, it was stated that
almost from the moment these guidelines were issued and hospital and clinics
began implementing them, it was recognized that this new strategy, while
protecting hospital personnel (patient-to-personnel transmission), sacrificed
some measure of preventing patient-to-patient and personnel-to-patient
transmission. (Jawaid et al 2009) Also, because many people with blood
borne infections such as HIV/AIDs do not have symptoms, nor can they be visibly
recognized as being infected, universal precautions had to be modified to include
all person-patients and clients-attending healthcare facilities regardless of
whether or not they are infected (Twitchell, 2003; and Gerberding, 2003). In
line with this, compliance on the part of healthcare workers (HCWs,) including
nursing and medical students with whom standard precautions have been
recognized as efficient means to prevent and control health care-associated
infections. Such measures not only protect the patients, but also the
healthcare workers and the environment. Here, universal precautions include:
hand washing; use of barriers (e.g gloves, gowns, caps, masks, etc);
sterilization of devices, equipment and clothing used during care;
environmental control (e.g surface processing protocols, health service waste
handling); adequate discarding of sharp instruments including needles. Another
important measure is adequate professional immunization, as this guarantees
anticipated protection against immuned-preventable diseases (Pruss-ustun et
al, 2003).
Indeed, threats from infections and
disease–related complications, especially among healthcare workers handling
healthcare facilities and attending to patients, have remained a source of
nightmare to global population and relevant agencies: According to a World
Health Organization (WHO) estimate, as contained in 16,000 hepatitis C virus,
66,000 hepatitis B virus and 1,000 HIV infections in health care workers
worldwide. Recapping disassembly and inappropriate disposal increased the risk
of needle stick injury (Wang, et al, 2008). Here, the incidence rate of
these causative factors, according to Wang, et al (2008), is higher in
developing countries with higher rate of injections with previously used
syringes (Orji, 2002).
In Nigeria, According to Orji et al
(2000) needle stick injuries were reported as the most common occupational
health hazards in teaching hospitals. This heart-aching revelation is not
unconnected with the typical Nigeria factor’ which stems from either a
deliberate refusal to provide needed facilities even when the means to do so
are not lacking or the non-adherence to recommended guidelines on the part of
practitioners (Aniebue et al 2010).
In the Federal Teaching Hospital, Abakaliki (FETHA 1), where our study is
carried out, the same factors responsible for the situations in other parts of
Nigeria could very well be obtainable there, but there is need for a verifiable
evidence. This study, therefore arose from the researcher’s deep interest in
carrying out an evaluation of universal precautions practice in healthcare
facilities with particular emphasis on Federal Teaching Hospital, Abakaliki
(FETHA1).
1.2 Statement
of the Problem
Infection has remained one of the most
important problems in healthcare services worldwide. It constitutes one of the
most important causes of morbidity and mortality with clinical, diagnostic and therapeutic
procedures (Papstairou et al 2011) Healthcare workers at Federal Teaching
Hospital, Abakaliki, like every other healthcare workers anywhere, are at high
risks of needle stick injuries and blood borne pathogens as they perform their
clinical activities.
They are exposed to blood borne pathogens,
such as human immunodeficiency virus (HIV), hepatitis B and hepatitis C
viruses, from sharp injuries and contacts with blood and other body fluids.
It is disturbing that, sometimes,
healthcare workers may not even be provided with sufficient facilities to
facilitate the practice of universal precautions as is commonly found in some
of our hospitals. Here, factors beyond the control of these healthcare workers
and even their management may be responsible for this retrogressive situation (Okaro
et al 2010). In some cases,
negligence, carelessness and ignorance could make healthcare workers to engage
in health care practices without recourse to standard precautions. Situations
like this, invariably, expose these healthcare personnel to avoidable hazards
with their attendant threats on the continued fight to improve healthcare
situations and the achievements already recorded.
The
problem of this study, arises from the fact that:
(i) Adherence
to the standard universal precautions practice could be constrained by factors
that are entirely beyond the control of healthcare workers, its attendant
consequences not withstanding.
(ii) Sheer negligence, ignorance and lack of
low level of control could make healthcare workers refrain from adhering to universal
precautions practice as they discharge their duty.
(iii) The non-compliance, on the part of
healthcare workers, with universal precautions practice exposes them to grave
danger of contracting the same disease condition they strive to take care of, thereby
eroding the frame work for healthcare improvement and sustainability.
(iv)
Given
the complicated nature of infections, the non-compliance with universal
precautions practice will worsen the health situations of the patients in FETHA 1.
1.3 Objectives of the Study
Generally, this study strives to carry
out an evaluation of universal precautions practice in the Federal Teaching
Hospital, Abakaliki (FETHA1). Specifically, the study will seek.
(i) To ascertain the level of knowledge of
universal precautions guidelines among healthcare workers in FETHA1.
(ii) To determine the attitude of Healthcare
workers in FETHA1 to the practice of
universal precautions.
(iii) To assess the level of availability of
universal precaution facilities at FETHA1.
1.4 Research
Question
This study seeks to provide answer to
the following research questions.
(1) What is the level of knowledge on
universal precautions practice/guidelines among healthcare workers in FETHA1?
(2) What is the attitude of healthcare
workers in FETHA1 with respect to the practice of universal precautions?
(3) What is the level of availability of universal precautions facilities at FETHA1?
1.5 Significance of the Study
The findings of this study would be of
tremendous benefit to various stakeholders in the healthcare sector, and the
general public. The central position of health and healthcare-related issues in
human lives makes this study very imperative or very germane. The various
healthcare workers, patients and clients attending healthcare facilities would
benefit immensely from this study, policy makers, Ministry of Health and
relevant Agencies would find this study of great importance.
In the first place, healthcare workers,
through this study, would be able to understand the importance of universal
precautions practice and the danger that looms if it is flouted in the course
of duty. The study would serve as a reinforcement of universal precautions
practice among healthcare workers.
Again, this study would reveal to the
various relevant agencies, the level of compliance with universal precautions,
as practiced by healthcare worker in FETHA and provide a basis for policy
actions. The study would also serve as a clarion call for the relevant
agencies, government and management of healthcare facilities, to be pro-active
to healthcare-related complications by not only emphasizing on the compliance
with universal precautions guidelines, but also providing the facilities needed
for this all-important and life-preserving strategy.
Moreover, the study would be of help to
patients and clients attending healthcare facilities as they would be able to
appreciate the importance of universal precautions accept the practice when it
is suggested to them by health care workers, and even go ahead to demand for it
if the staff on duty failed to comply with it. The general public would also be
aware of this precaution and caution their loved ones visiting healthcare
facilities to ensure a strict adherence to universal precautions. This would
lay a veritable foundation for the prevention of the transmission of
infections, and a great step towards, reducing the deteriorating healthcare
situations in developing countries like Nigeria in general and Ebonyi State in
particular.
Furthermore, the study being a research
work, would add to the stock of knowledge in this field, and serve as a basis
of reference in future studies in this or related fields.
1.6 Scope
of the Study
This study focuses on carrying out an
evaluation of universal precautions practice as adopted in healthcare
facilities, with particular emphasis on Federal Teaching Hospital, Abakaliki
(FETHA1). The study will only consider the practice by healthcare workers in
FETHA1 exclusively. It must be made clear, this juncture that, other healthcare
facilities also operate in Abakaliki, but they do not form part of the study.
Also, healthcare personnel from other healthcare facilities will not be part of
the study. Hence the study does not extend beyond FETHA, and the healthcare
personnel therein.
1.7 Definition of Terms
Compliance
In
medical practice, this refers to a will to follow or observe a prescribed
course of treatment or actions to prevent the likelihood of being exposed to
disease to disease causing micro-organisms, such as bacteria, fungi, viruses, etc
Evaluation
Is a systematic, rigorous and meticulous
application of scientific methods to assess the design, implementation, improvement,
or outcomes of a program
Susceptibility
The tendency of an individual to be
infected by a disease, that ,the capacity to be affected by a particular form
of disease or
Being predisposed or sensitive to a
particular disease.
Pathogen
Otherwise called an infectious agent
pathogen is a biological agent i.e. microorganism in the widest sense, such as
a virus, bacteria, or fungus that causes disease in its host, and this host may
be an animal(including humans),a plant, or even another microorganism.
Universal
Precaution
An action taken in advance to protect an
individual against possible danger, failure, injury or exposure in the face of
a particular disease.
Infection
The invasion of a host organism bodily
tissues by disease causing organism ,their multiplication, and the reaction of host tissues to these organisms
and the toxins they produce.
Sterilization
A term referring to any process that
eliminates(removes)or kills all forms of microbial life, including transmission
agents(such as fungi, bacteria, viruses, etc)present on a surface, contained in
a fluid, in medication, or in a compound such