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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 4  |  Page : 840-846

Infection control awareness among healthcare providers in family health settings in Shebin El-kom district, Menoufia Governorate, Egypt


1 Department of Public Health and Community Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission26-Jan-2014
Date of Acceptance03-Mar-2014
Date of Web Publication22-Jan-2015

Correspondence Address:
Marwa Ahmed Abu Shady Dewidar
Gharbia Governorate, Tanta
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.149804

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  Abstract 

Objectives
The aim of the study was to assess the knowledge, the attitude, and the practice of healthcare providers in family health settings regarding infection control measures in Shebin El-kom district.
Background
Hospital-acquired infections are among the leading causes of death; prevention of hospital-acquired infection therefore must be cost effective, but achievable even with the limited resources for infection control programs in primary healthcare.
Participants and methods
This was a cross-sectional study conducted in two urban and two rural family health settings in Shebin El-kom district, Menoufia Governorate. Four different settings were selected from cluster sampling followed by stratified random sampling. The self-administered anonymous questionnaire was administered to 412 participants including physicians, nurses, and paramedical personnel. Each healthcare facility was observed for infection control measures by an observation checklist, followed by comparative analysis of different categories of participants.
Results
The knowledge scores were low to moderate among all participants; only 32.5% had a high level of knowledge, in comparison with 96.6% of the participants who had a positive attitude towards infection control measures. However, 54.3% of the physicians showed a high practice score in comparison with 32.6% of the nurses.
Conclusion
Standards of infection control practices were not optimum at family healthcare settings, although the reported practice was better than the reported knowledge. Further studies are required to determine the other factors associated with compliance of infection control practices, and training courses on hospital-acquired infection for such personnel would be required.

Keywords: Attitude, infection control, knowledge, practice, standards


How to cite this article:
Abu Salam ME, Anwar El-Shazly HM, Dewidar MA. Infection control awareness among healthcare providers in family health settings in Shebin El-kom district, Menoufia Governorate, Egypt. Menoufia Med J 2014;27:840-6

How to cite this URL:
Abu Salam ME, Anwar El-Shazly HM, Dewidar MA. Infection control awareness among healthcare providers in family health settings in Shebin El-kom district, Menoufia Governorate, Egypt. Menoufia Med J [serial online] 2014 [cited 2017 Dec 14];27:840-6. Available from: http://www.mmj.eg.net/text.asp?2014/27/4/840/149804


  Introduction Top


Healthcare or hospital-acquired infections are a worldwide problem. They represent infections acquired during or associated with delivery of care in contrast to infections present or incubating at the time of the care delivery episode. Hospital-acquired infections are among the leading causes of death and they cause significant morbidity among patients who receive healthcare. Prevention of hospital-acquired infections therefore must be cost effective and achievable, even if the resources are limited [1].

Within the realm of safety in the healthcare setting, nosocomial infections have the most substantial impact. A study was conducted to explore the costs associated with 18 patient safety indicators established by the Agency for Healthcare Research and Quality (AHRQ). Postoperative sepsis, postoperative wound dehiscence, and infection due to medical care were the three indicators associated with the highest costs in terms of the length of stay, charges, and mortality [2].

Of particular hazard are the several resistant strains of bacteria that have developed through their natural course of adaptation and the overuse of antibiotics. Nearly 70% of nosocomial infections are caused by drug-resistant strains of bacteria [3].

People receiving health and medical care, whether in a hospital or in a clinic, are at risk of becoming infected unless precautions are taken to prevent infection. Nosocomial (hospital-acquired) infections are a significant problem throughout the world and are increasing [4]. For example, nosocomial infection rates range from as low as 1% in a few countries in Europe and America to more than 40% in parts of Asia, Latin America, and sub-Saharan Africa [5].

Healthcare workers, including support staff (e.g. housekeeping, maintenance, and laboratory personnel), who work in these settings also are at risk of exposure to serious, potentially life-threatening infections. For example, in the USA, more than 800 000 needle-stick injuries occur each year despite continuing education and vigorous efforts aimed at preventing such accidents [6].

The principles of infection prevention and control are the same throughout the world. Most of the technical expertise and recommendations for infection control have been developed in countries with well-developed healthcare systems. Considerable time was spent in these countries in the training of specialists in infection control. Unfortunately, the discipline of infection control is poorly developed in countries such as Egypt, where the healthcare system is developing rapidly and there is little expertise in infection control training. Establishing a cost-effective program for Egypt is a leading priority for the ministry of health and is an essential component of efforts to improve the quality of healthcare [1].

Prevention of nosocomial infections is the responsibility of all individuals and services providing healthcare. Everyone must work cooperatively to reduce the risk of infection among patients and the staff.

This includes infection control programs for the personnel providing direct patient care, the management, the physical plant, provision of materials and products, and training of health workers [7].

Hand hygiene is therefore the most important measure to avoid the transmission of harmful germs and prevent healthcare-associated infections. Any healthcare worker, caregiver, or person involved in direct or indirect patient care needs to be concerned about hand hygiene and should be able to practice it correctly and at the right time [8].

The aim of this study was to prevent hospital-acquired infections among both healthcare providers and clients attending the family health centers and to assess the knowledge, the attitude, and the practice of healthcare providers in family health settings regarding infection control measures in Shebin El-kom district.


  Participants and methods Top


A cross-sectional study was conducted in four different family health centers in Shebin El-kom district, Menoufia Governorate, from 12 March to 10 April 2012, to evaluate the knowledge, the attitude, and practices of healthcare providers toward infection control measures. Two urban and two rural settings were selected by cluster sampling followed by stratified random sampling. The sample included 164 physicians, 141 nurses, and 107 paramedical personnel after oral consent was obtained from them. Data were collected through a predesigned self-administered questionnaire that assessed the knowledge, the attitude, and the practice of healthcare providers toward infection control measures related to the following items: basic principles and facts about HAIs, hand hygiene, and the use of personal protective equipment, environmental cleaning, waste disposal, sterilization of instruments. Also, data were collected through an observation checklist that assessed the basic infection control measures in healthcare settings concerned with waste disposal, sharp handling and disposal, handling and disposal of linen, and precautions with regard to the surrounding environment.

The total knowledge score was 15.8 ± 3.01: 13-19 was considered moderate, greater than 19 was high, and less than 13 was low.

The total practice score was 6.5 ± 1.2: 5-8 was considered moderate, greater than 8 was high, and less than 5 was low.

The total attitude score was 3.03 ± 0.22: greater than 3 was considered positive and less than 3 was negative.

The checklist percentage score was obtained by adding the total number of answers present and dividing it by the total number of questions answered including all present, partial, and absent answers multiplied by 100. The percentage score allocates the level of compliance categories as follows: high compliance 85% or above, partial compliance 76-84%, and low compliance 75% or below.

A pilot study was conducted in other family health settings (not included in the study) to evaluate the reliability and the validity of the questionnaire.

Statistical analysis

The data and answers were collected and analyzed using the Statistical Package for the Social Sciences (SPSS software version 20). Qualitative data were expressed as n (%). Quantitative data were expressed as mean and SD. The c2 -test was used to compare qualitative data and the t-test was used to compare normally distributed quantitative variables between two groups.


  Results Top


The total number of respondents were 412, which included 164 physicians (39.8%), 141 nurses (34.2%), and 107 workers and housekeeping personnel (26%). The healthcare providers studied were mostly from urban centers (68.2%). The majority of the healthcare providers in primary healthcare settings were female (75.5%) and most of them had more than 5 years of experience (65.5%) [Table 1].
Table 1: General characteristics of the healthcare providers studied in Shebin El-kom

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The study found that there was a significant difference between physicians and nurses regarding all parameters of knowledge, and the total knowledge score was better in physicians than in nurses. About 59.8% of the physicians had a good knowledge score compared with 44.7% of the nurses [Table 2].
Table 2: Comparison between physicians and nurses in their knowledge score levels about infection control measures

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Among workers and the housekeeping personnel, the total score of knowledge was low to moderate as 70.1% of them had a low knowledge score. It was noticed that the attitude of all healthcare providers was mostly positive (96.6%) [Table 3].
Table 3: The attitude of the studied group of healthcare providers toward infection control measures

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In accordance to the self-reported questionnaire, the level of healthcare providers' practice score of infection control measures was moderate to high. About 54.3% of the physicians had a high practice score compared with 32.6% of the nurses. About 96.5% of the nurses washed their hands before dealing with patients, whereas 65.2% of the physicians did so. It was found that the practice of disposal of medical and hazardous waste was 97.2% among nurses, even if their practice was imperfect, whereas 57.9% of physicians did not practice these measures at all. The practice of wearing protective gloves during dealing with patients was 94.3% among nurses, whereas 90.9% among physicians [Table 4].
Table 4: Comparative analysis of the practice of infection control measures among physicians and nurses

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  Discussion Top


This study was a cross-sectional survey conducted to assess the scores of the knowledge, practices, and the attitude of infection control standards practiced by healthcare providers employed in family health settings in Shebin El-kom medical sector.

It is easy to generally assume that health workers by virtue of their proximity to the health facility should have adequate knowledge about diseases and other health conditions. This assumption can be true for both tertiary and secondary levels, but adequate knowledge is poor among primary healthcare workers [9].

The majority of the participants had a low to moderate level of knowledge in all four healthcare settings. In the present study, 114 persons (27.7%) had a low knowledge score, whereas 63 persons (15.3%) had a moderate knowledge score. Only 134 persons (32.5%) had a good knowledge score. This agreed with another study conducted in PHC settings in Saudi Arabia by Amin and Al Wehedy [10], where the level of knowledge regarding HAIs by HCWs was found to be low, a finding that was attributed to the lack of resources and training opportunities and excessive workload.

In the present study, regarding sources of knowledge about infection control standards, 51.1% of the nurses reported attending training courses in comparison with 65.9% of the physicians, who reported that study curriculums were the main source of knowledge [Table 4]. This was in contrast to Alnoumas et al. [11], who found that the most commonly reported source of information about HAIs was educational courses, physicians, scientific journals, and lastly, mass media.

In our study, wearing protective gloves during dealing with patients was practiced by 94.3% of the nurses, compared with 90.9% of the physicians. The study of Angelillo et al. [12] found that most of the nurses wore sterile gloves (99%) and all of them reported changing gloves after surgical procedures, washing their hands before and after surgical procedures (98.2 and 95.4%, respectively), and wearing masks (98.1%), whereas 38.4% reported the use of protective eyewear.

There were points of strength in nurses' practices compared with that of physicians: for example, hand washing before dealing with patients was practiced by 96.5% of the nurses, whereas it was 65.2% among physicians. In contrast, physicians showed the highest compliance (37.5%) in comparison with nurses (36.4%) and housekeepers (22.6%). This was in contrast to Lipsett and Swoboda [13], who found that nurses showed a higher compliance (50%) than physicians (15%).

In the present study, although the attitude of healthcare providers towards hand washing between patients for infection control was 100% positive [Table 3], the practice of hand washing before dealing with patients was 39.4%. In the study of Alnoumas et al. [11] in Kuwait, it is observed that the proportion of physicians and nurses practicing infection control measurements was less than that reported when describing their positive attitude towards HAIs; that is, certain participants believed in these measures, but did not practice them.

In accordance with the observation of infection control standards in the present study, practices of healthcare providers with a checklist had some strengths; for example, sharp bins were available in essential places (79.4%), needles and syringes were discarded into sharp bins as one unit (93.9%), sharps were disposed directly into sharp containers (91.7%), there were policies for the management of monocular injuries (85.3%), and liquid soap was available on all sinks (75.5%). However, there were some points of weakness: for example, floors were clean (8.3%), waste bags were removed daily (40.3%), linens were changed periodically (32.3%), and protocols were accessible to all healthcare providers (45.1%) to a much lesser extent.

Alnoumas et al. [11] in Kuwait reported that placing needles in sharp containers was performed by 67.8% of the participants, whereas other protective measures, such as wearing protective eye wear (20.5%) or masks (31.5%) when in direct contact with a patient, recapping needles after use (36.8%), use of syringes with a retractable needle (38.5%), use of syringes with a protective shield (44.8%), and the use of intravenous cannulation with a retractable needle (36.6%), were encountered in lower percentages [Figure 1],[Figure 2] and [Figure 3].
Figure 1: The total knowledge score among healthcare providers.

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Figure 2: The total attitude score among healthcare providers.

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Figure 3: The total practice score among healthcare providers.

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  Conclusion Top


The majority of the participants had a low to moderate knowledge score, a positive attitude, and a moderate to high practices' score toward infection control measures. The weakest point in the knowledge was about using antibiotics in infection control, where 100% of the paramedical personnel agreed although this was wrong compared with 63% of the medical staff who disagreed. Although there were nonsignificant differences between urban and rural family health settings regarding the knowledge about infection control measures, there were points of strength in nurses' practice in comparison with physicians' practice: for example, hand washing before dealing with patients and disposal of medical and hazardous waste. Continuous training programs for the medical and the paramedical staff must be regularly conducted to develop and refresh their knowledge about infection control measures. The attitude of healthcare providers towards infection control measures is influenced directly or indirectly by their practice, and so testing their attitude can give red flags to improve training programs. Patient safety programs must be conducted in primary healthcare settings and be monitored by a quality committee.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

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World Health Organization (WHO). Hand hygiene: why, how & when? Report/patient safety/save lives. August 2009  Back to cited text no. 8
    
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Adebimpe WO, AsekunOEO, Bamidele JO, Abodunrin OL, Olowu A. Comparative study of awareness and attitude to nosocomial infections among levels of health care workers in south-western Nigeria Continental. J Trop Med 2011; 5 :5-10.  Back to cited text no. 9
    
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Amin T, AlWehedy A. Healthcare providers′ knowledge of standard precautions at the primary healthcare level in Saudi Arabia. Healthc Infect 2009; 14 :65-72.  Back to cited text no. 10
    
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Alnoumas SR, Enezi F, Isaeed MMA, et al. Knowledge, attitude and behavior of primary healthcare workers regarding health care-associated infections in Kuwait. Greener J Med Sci 2012; 2 :092-098.  Back to cited text no. 11
    
12.
Angelillo IF, Mazziotta A, Nicotera G. Nurses and hospital infection control: knowledge, attitudes and behaviour of Italian operating theatre staff. J Hosp Infect 1999; 42 :105-112.  Back to cited text no. 12
    
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Lipsett PA, Swoboda SM. Handwashing compliance depends on professional status. Surg Infect (Larchmt) 2001; :241-245.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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Abstract
Introduction
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