Healthcare literature, especially those on preventive measures, are replete with issue relating to universal precaution, which has gained prominence since its documentation. Issues relating to preventive guideline date back to the 1970s. In 1970, according to Eftrathiou, Papastavrou, Rasfsaplous and Merkouns (2011) the first set of preventive guideline was issued by the CDC to help healthcare professionals protect themselves and patients from the transmission of microorganisms. It was followed by a review in 1983. 

In 1987, the universal precautions were released, they among other things, required health care professionals to treat every patient as potentially infectious (see Efstathious et al., 2011; Diaz, Mc Growder, Alexander- lindo, Gordon, Brown and living, 2010, Okoro Eze  and Ohagwu, 2010; Bissonnette, 2008; Twitchell, 2003; and uwakwe, 2000). Efstathiou et al., (2011) re-echoing the conceptualization by CDC stated that universal precautions refer to a set of guidelines to prevent exposure to infection. In their analysis, Hesse, et at., (2006) wrote that the term universal precaution (up) is the prevention of transmission of transmission of blood-borne pathogens like HIV through strict respect by healthcare workers of rules concerning care and nursing. “Anibue et al, (2010) here conceived universal precaution as “the routine use of appropriate barriers and techniques to reduce the likelihood of exposure to blood, other body fluid and tissues that may contain blood- borne pathogens”. According to the guidelines, up assumes anybody in a hospital, especially, patients are potent carriers of blood borne pathogens, therefore all patients are treated in the same way as though they were infected (Hesse et al., 2006; Jarvid, et al., 2009; and Anibue et al., 2010).     

In the same vein, Ofili, Asuzu and Okejie (2010) view up as a series of procedures proposed by CDC for preventing occupational exposures and for handling potentially infections materials such as blood and body fluids. Cichoki (2006) views it as “the protocols used to maintain an aseptic field and to prevent cross – contamination and cross- infection between healthcare providers, between healthcare provider and patients, between patients and patients” Obi (2010) held that “universal precaution refers to the practice in medicine of avoiding contact with patients body fluids and blood”.
The documentation and issuing of up were borne out of the realization of the fact that blood and other body fluid from patients are becoming increasingly hazardous to those who provide care for them. UP encompasses a wide range of step taken during regular work day by healthcare workers and must be adhered strictly to in order to protect self, patient and co- workers from infections (Okoro, Eze and Ohagwu, 2010). Izegbu, Anide and Ajayi (2006) have reiterated that UP apply to blood, other body containing visible blood, semen, and vaginal secretions. Up also apply to tissues and to the following fluids; cerebrospinal, synovial pleural, peritoneal, pericardial and amniotic fluids. But they do not apply to faces, nasal secretions, spectrum sweat, tears urine, and vomitus unless they contain visible trace  of blood. Up does not apply to saliva except when visibly contaminated with blood or in the dental setting where blood contamination in saliva is predictable (Izegbu et al., 2006; and Bamigboye and Adesanya, 2006).

Anibue, et al (2010) wrote that the recommendation of up include; wearing gloves, gowns and aprons when collecting or handling blood and body fluid contaminated with blood wearing  face shields when there is danger of blood splashing on mucous membranes. Others include disposing of all needles and sharp objects in puncture – resistant containers. Cichocki (2006) analyzed UP to include but not limited to the sterilization of instrument and goods, the isolation and disinfection of the immediate clinical environment; the use of disposable, scrubbing, masking, growing and gloving; and the proper disposal of contaminated waste. Aniebue, et al., (2010) emphasized that this recommendations are for doctors, nurses, patients and healthcare support workers who are required to come into contact with patient or body fluids (see also http:llen.wikepia.org/wiki). Remarkably UP require the sustained provision of protective materials proper training of health care providers and strict adherence to sterilization and disinfection protocols.

2.2       Theoretical framework
It would be worthwhile in a study of this magnitude to carry out an overview of the theoretical underpinning that underlies human behavior, especially in the healthcare field. Indeed they are many motives for observed behaviors. As postulated by behaviorist theorists, human beings adopt behavior they believe will result in the attainment of their desire goals, e.g. the operant conditioning human behavior can also be adjusted by modeling, i.e. the social learning theory (Omebe, 2005). Like every other discipline that involves Behavioural adjustment, the medical field in general, and universal precautions practice in particular, has underlying theories or models that explain the way human beings adjust their behaviors with respect to a particular concept.

Writing on standard precautions, Garcia- Zapata, et al., (2010) explained that “prompting compliance with UP measures implies behavioral changes”. They explained  that the dynamics of this change is complex and multifaceted, and involves many factor such as education, motivation and re- organization of the context of the working  environment.

Analysis on UP practice among healthcare workers is anchored on the health belief model (see Glanz, Rimer and  levis, 2002; Conner and Norman, 1996; and www.utwente.nl/cw/theoreenover zich/theory). The health belief model (HBN) is a psychological model that attempts to explain and predict health behavior. This is done by focusing on the attitudes and belief of individuals (Glanz, Rimer, and Levis, 2002). The model was first developed in the 1950s by social Psychologists, Hochbaum, Rosentock, Kegel and levanthal, working in the U.S public health service. The model was developed in response to the failure of a free tuberculosis (Tb) health screening programme. Since then the HBM has been adopted to explore a variety of long and short- term health behaviors, including sexual risk behavior and the transmission of HIV/AIDS, which features prominently on analysis involving universal precautions (Conner and Noman, 1996; and Glanz, Rimers and Levis, 2002).

Health belief model (HBM), according to Efstathiou et al., (2010), has been widely used and is considered as one of the most useful models in health care prevention and promotion, it offer the ability to understand the different behavior or attitudes people may develop under the same condition by following or not following certain guidelines or requirement (see also Roden, 2006, and Kartal and Ozsoy, 2007). The original model had four constructs, supplemented later by more (Becker, Janz, et al., 1990; and Vaz et al., 2011). The HBM is based on two axes: (1) the perceived threat for acquiring a disease, which incorporates the perceived susceptibility, the perceived severity constructs. This axis creates a pressure to an individual for action, nevertheless, this action may not necessarily take place; and (2) the enabling factors that trigger the behavior, which include the perceived barriers &benefits(Negad, werthein and Green wood, 2005). The additional constructs that supplemented the earlier four were self – efficiency and cues for action (Efsathiou, 2011).

In practical terms, the HBM suggests that the seriousness of a disease as perceived by an individual (perceived susceptibility) will prompt a behavior geared towards reducing the threat of the disease. This will lead to action that will be determined by the level of education attained, symptoms of the disease, media information, and other determinants, such as social and demographic factors. The individual will evaluate his action based on the benefits to be derived and the barriers that constrain his/her actions. The level of risk as perceived by the individual and the benefits of an action will result in a likelihood behavioral change.                                                              
The health Belief model (HBM)


(source: http://www.utwente.nl/cw/theeorieenoerzicht/theory )

The relevance of the HBM to our study on UP is that healthcare providers, patient and other clients attending healthcare facilities would readily adopt the precautions and adhere to the guild lines on UP if they perceived the disease to be serious and life – threatening, the risk of contacting the disease high, and the compliance with up guidelines a sure measure to reduce the risk of infection. Here, their action would be based on the their level of knowledge, the threat they face, the information they have, availability and convenience of protective equipment, the actions of colleagues and superiors (i.e. significant others), and the desire to reduce the prevalence of the disease and remain healthy and free from threats.

2.3       Factors influencing compliance with universal precaution
The conceptual model adopted in this study suggests that human behaviors are motivated and influenced by factors that are directly or indirectly related to the situation under review. There are records that explain that UP measures are not wholly adhered to by healthcare  workers in spite of the fact that their own safety depends on it. Ofili, Asuzu, and Okojie (2003) explained that studies have extensively reported sub optional and non- uniform adherence to UP guideline by healthcare workers in both developed and developing countries. The following are some of factors suggested by analysts that could influence healthcare workers’ adherence to universal precautions:

2.3.1     Availability:
Non-availability of equipment has been reported as an obstacle for implementing up, as they cannot be followed if the healthcare worker does not have direct and easy access to the them (Efsthiou et al, 2011, and Oliveira, Cardoso and mascarenhas,2010) studies have revealed that some healthcare workers complained that equipment are stored and even locked far away from the place nursing care is provided, making their use impossible under certain situations (for example under emerging situations). Gaidhane, Zahiruddin, khatib, shrivastar and Johrapurkar (2009) concurred that the lack of protective materials is the main reason for not applying UP in many healthcare facilities. In the same vein, Anbue, et al., (2010) noted that the inability of hospital and clinic administrators in resource – poor countries to provide the required protective equipment especially sufficient new examination gloves, remains a problem. It is therefore, vital for healthcare workers to have the protective equipment at their disposal for use when necessary.

2.3.2     Knowledge:
Practice goes with knowledge. We are familiar with the saying “how can the people know except they are tought?” healthcare providers must have an appreciable level of knowledge on UP before one could think of them practicing them. Anibue, et al., (2010) noted that, “the concept of UP is however, not a very familiar one, even among formal healthcare workers” (see also Janjua, et al., 2007; and Hesse et al 2006). Vaz et al  (2010) are of the view that: “it is very important that health care workers have good understanding about the risk of blood borne pathogens at work place and about the preventive measures for reducing risk. Jawaid, Igbal and Shahbaz (2009) stated that the knowledge, attitude and compliance among health care workers towards UP are usually inadequate. Garcir-Zapata et al (2010) emphasized that, “in addition to the negative influence on the part of the professional serving as a role model, some authors highlight that the origin of the low compliance, especially regarding the hand hygiene, lies in the academic training”.

2.3.3      Emergency Situations
Many participants in various studies described an emergency as a major obstacle in following precaution. Some health care workers were quoted saying “…. We had to rescue the patient, we neglected our own safety” (Osborne, 2003). It was explained that an emergency situation requires doing a lot of things at the same time, very fast and usually under heavy pressure. This situation, according to Efstathiou et al (2011), may influence health care workers not to follow the protective guidelines due to insufficient time (several conditions many be a matter of life and death). Hence lack of time has also been widely described as a factor not facilitating the implementation of precautions.

2.3.4     Patient’s discomfort:
Patients’ discomfort has been identified as a factor in the compliance with UP. Some healthcare workers explained that patients may experience distress, anxiety, or even sorrow when a nurse offers nursing care while covering him/self with a mask or gown or while using gloves. In addition, patients may anticipate these measures taken by nurses as an indication that their health status is not good or is getting worse (Osborne, 2003; Bissonnette, 2008, Oliveria, cardso and Mascarenhas, 2010).

2.3.5     Busy Schedule
Often healthcare workers come across many responsibilities to be fulfilled this leads nurses to avoid the use of UP, even when it is anticipated they may be exposed to microorganisms. Some healthcare workers also stated that following UP in many cases its time consuming, e.g. putting on a gown (Osborne, 2003; and Efstathiou et al, 2011).

2.3.6      Significant others:
Various studies (e.g. Efstathiou et al., 2011, Garcia-Zapata, 2010; Okaro, Eze and Ohagwu, 2010; Izegbu, Amole and Ajayi, 2006, and Osborne, 2003) explained that when universal precautions are followed by colleagues with more knowledge or by senior personal, the compliance will be high. (Izegbu, et al., (2006) emphasized that “a potentially effective safety programme that is ignored by top management will fail because others will certainly ignore it. They explained that the perception of senior management support for safety programmes has been shown as the most significant factor influencing compliance with universal precautions practices.

2.3.7      Previous Exposure
Health exposure personnel who have once been exposed to serious cases, e.g. HIV/AIDS as a result of their carelessness usually learn their lesson and adopt preventive measure in subsequent cases.

2.4       Patients’ Personal Characteristics:
Patients appearance, according to Osborne (2003), was believed to be a serious factor that may lead to healthcare workers to comply with UP. Some healthcare workers have complained that when a patient has tattoo in many places of his/her body, has low personal hygiene status or low educational level, them he/she would be considered as a high risk for carrying an infections disease (Efstathiou et al.,  2011).

2.4.1     Severity
Fear of being infected on the part of healthcare worker coupled with serious disease-death negative impact on life, and the cost from being infected will always compel a healthcare worker to implement safety measures while on duty (Okaro, Eze and Ohagwu, 2010).

2.4.2     Self-Efficacy
It has been established that it is difficult for some healthcare workers to change their behaviour even though they know that is not correct. Some would say “…… it is difficult to change after so many years” and “I don’t think that after so many year of practicing the way I do I will be able to change” (Oliveira, et al., 2010, Bissonnette, 2008, Izegbu, et al 2006, and Okoro, Eze and Ohagwu 2010).

2.4.3      Negative influence on healthcare workers
Some healthcare worker have stated that the use of protective equipment reduces their skills e.g. to perform venipuncture when wearing gloves. Some of them would say “……. Using gloves to draw blood from a patient reduces my dexterity, I can’t feel the vein because the gloves interfere.” Others would say “…. I cannot breathe normally when I wear a mask, it has an awful smell. I prefer not to wear a  mask  even when its use is necessary  (Osborne, 2003).
2.4.4     Influence on healthcare workers’ appearance:
Some female healthcare workers complain that protective equipment have negative impact on their appearance. Some of them stated “……my appearance is very important to me. If I wear a hair cap, this will destroy the look of my hair. I spend a lot of time making my hair look the way I want them to look. And I am not going to let anything damage this.” Others would like say “…. The use of face mask damage my lipstick and makeup. I prefer not to use it” (Efsthiou et al, 2011).

Knowledge, Attitude and Compliance:
2.5       An Empirical Review
There is the need for this study to x-ray some of the results obtained in previous research works in this field. A plethora of empirical findings exists in this area. This work will review some of them.

In a study conducted by Okoro, Eze and Ohagwu (2010) on awareness, knowledge, attitude and practice of blood and body fluid precautions among radiographers in Enugu, the findings showed that many radiographers practicing in the tertiary hospitals do not have knowledge of some aspects of universal precautions. Only a small proportion (37.5%) was right in their knowledge of not recapping needles. Anibue, et al ;(2010) also carried out a similar study on universal precautions with particular emphasis on awareness and practice of patent medicine vendor (PMVs) in Enugu  metropolis they found that  majority of the PMV(78%) are not aware so the concept of universal precaution, a situation that could be explained by their lack of formal education. Adinma, and Asuzu, et al.; (2009) studied the knowledge and practice of universal precautions against blood borne pathogen among house officers and nurses in tertiary health institutions in southeast Nigeria. They found that the knowledge of  UP measures was high for both categories of respondents- 97.0% for doctors and 92% for nurses, although practice was better for the nurses, 75.0% compared to the doctors 15.2%. The study reported a lack of provision of adequate protective equipment. Another study was carried out by Izegbu, et al; (2006) on attitude, perception and practice of workers in laboratory the two colleges of medicine and their teaching hospitals in Lagos state. The study revealed that the knowledge, attitude, perception and compliance with UP among these highly exposed laboratory workers are poor. They seem to have a poor perception of the risk of infection and are not compliant with the basic principles of UP. The study revealed that 47.0% of the laboratory workers stored foods water and drinks in the refrigerators meant for the storage of body fluids and chemicals. Sadoh & Fawole, et al; (2006) did a research on the practice of universal precautions among healthcare workers in Abeokuta metropolis. The result revealed that compliance with non- recapping of used needles was high among trained nurses and worst with doctors less than two- third (63.8%) of the respondents always used personal protective equipment, and more than (56.2%) of the respondents had never worn goggles during deliveries and at surgeries. The provision of sharps containers and screening of transfused blood by the institutions studied was uniformly high. Ofili, Asuzu and Obi (2003) who conducted a similar research wanted to ascertain the level of knowledge, and practice of UP among nurses in central hospital, Benin city, Edo state. They found that nurses there had a poor knowledge about universal precaution only 34.2% of them had heard about UP there was also a poor observance of universal precaution.

In a related development, Hesse et al  (2006) who sought to know the level of knowledge, attitude and practice of universal basic precautions by medical personal in a hospital in Ghana found that alleged knowledge did not match actual tested knowledge (92% versus 71%). Knowledge of all forms of HIV transmission was rather limited among medical personal. Practice of UP way also not universal as 44% preferred to rely on pre-op HIV testing of patients and knowledge of their status while 36% of the respondents admitted reluctance to perform an invasive procedure of an HIV positive patient.

Away from Nigeria and African context, Val et al (2010) carried out a study to determine the level of knowledge, awareness and compliance with UP among healthcare workers at the university hospital of the west Indies, Jamaica. The study revealed that there was adequate knowledge and a fair level of awareness among medical doctors, medical technologists and nurses towards up. More respondents (92.9%) who were employed in the health factor for 16 years and above reported high level of awareness of up than those who were employed for less than five years. Again 28.6% of males and only 6.2% of females reported that they do not use protective gear. Garcia-Zapata et al (2010) conducted a study on standard precautions with emphasis on knowledge and practice among nursing and medical students in a teaching hospital in Brazil. The result showed that, in spite of the fact that the students knew that they had to wash their hands before and after caring for a patient, 46.2% of nursing and 83.3% of medical students did not wash their hands neither before nor after any procedure, although in 75.0% of these instance, the necessary materials (water and soap) were available and ready to be used. Jawaid, Iqbal and Shahbaz (2009) did a study to find out the level of compliance with standard precautions in civil Hospital in Karachi, Pakistan, and found out that the knowledge, attitude and compliance among doctors toward standard precautions are inadequate. Majority of the doctors (52.5%) did not know anything about CDC guidelines for standard precautions, while 40% of the respondents had some idea and only 7.5% knew them all.                    

Here, 56.7% changed gloves for each patient and only 39.2% wash their hands before and after examining a patient. Most of the doctors (58.3%) said they always wear apron while dealing with patients while 20% wear them only when dealing with high risk patients. Protective goggles were not used by any of the respondents. The reasons given for non-compliance includes non-availability of protective modalities by 58.3% while 20% were of the opinion that it was not practical. Gaidhane et al., (2009) researched on the occupation exposure to HIV and practice of universal safety precautions among residents in Datta Meghe institute, medical science in India. They found that of the 93 residents involved in direct patient care/ laboratory services, 54 (58%) were exposed to potentially infections materials. Here, 63 (67.7%) of them were following dangerous procedures of either bending it against table/ wall or recapping (89.2%) used needles before disposal.

2.6       Summary of Review Related Literature
Relevant literature on this study explained universal precautions as a set of guidelines documented and issued by the centre for disease control and prevention (CDC), which must be strictly adhered to by healthcare workers in the course of discharging their duty of caring for patients so as to prevent or reduce cross-contamination and cross-infection between health care workers and patients, between patient and patients and between health care workers and patient, and between healthcare provider. It emphasized on the use of protective equipment which include gloves, goggles, non-recapping and proper disposed of used needles, wearing of grown, head gear, masks etc.

The health belief model (HBM) was adopted to explain the relationship universal precautions and the behaviour of health care workers with respect to compliance Here, health care workers adherence or compliance with up is a function of factors such as the benefits to be derived practicing safety precautions, the risky nature of a situation, the likelihood of a patient being infections, level of education, attitude of role models, the seriousness of the disease involved, etc
Findings obtained in previous research were also reviewed and their major results highlighted. Most of the results from these studies showed low level of knowledge, perception, awareness, attitude and practice among healthcare workers across different areas and countries. This study therefore seeks to unravel the situation as it is within FETHA1                                                           

Share on Google Plus


The publications and/or documents on this website are provided for general information purposes only. Your use of any of these sample documents is subjected to your own decision NB: Join our Social Media Network on Google Plus | Facebook | Twitter | Linkedin