Nurses' Knowledge and Practice about Infection Control In Outpatient Clinics of Governmental Hospitals at Al-Mukalla City – Yemen

Background: The role of the nurse is very important in breaking the chain of infection, and they can do this by applying proper infection control practices. The study aimed to assess the knowledge and practice of outpatients Nurses about infection control. Subjects &Methods: Descriptive research design was carried out in this study at Ibn seena hospital, Almukalla and University Hospitals for Maternity and childhood that located in Almukalla city. The total number was 50 nurses selected as a convenient sample. Two tools were used in data collection The First tool is the structured questionnaire it content Participants’ knowledge related to nosocomial infection the Second tool was the observation checklists to assess the nurses practice. Results: revealed that 80% of the studied sample has not attended seminars or conferences about infection control and 54% of them was given vaccine for hepatitis, and 90% had poor knowledge and practice. There was no statistically significant difference between knowledge and practice Conclusion: It is concluded that the studied nurses had poor knowledge and practice. Also, there is positive correlation between knowledge and practice about infection control. Recommendation: Should be apply in services programs about infection control to all nurses in outpatient’s clinics, also establish national guidelines for infection control practice in outpatient clinics. Keyword: Infection Control, Knowledge, Practice, Nurses, Outpatients Clinics. Introduction Hospital acquired infections (HAIs) are significant problems throughout the world and are increasing in developing countries. WHO’s report revealed that health-care settings with limited resources reported Health Care Associated Infections rates higher than in developed countries. Hospital acquired infections can be caused by bacteria, viruses, fungi or parasites. This organism may already be present in the patient’s body or may come from the environment, contaminated hospital equipments, Healthcare workers or other patients (Fijan & Turk, 2012) NIs have significant consequences on patients, their families, and the community as a whole. The most common consequences of NIs are increased morbidity, mortality, and length of hospitalization [4, 8]. Such consequences contribute substantially to raise both the direct and indirect cost of the health care services, which result in additional costs to treat infected cases. Hence, such issue wastes the available resources which are not already enough, especially in developing countries (Iliyasu et al., 2016) Universal precautions and infection control are designed to reduce the risk of transmission microorganisms from both recognized and unrecognized sources of infections. These precautions promote hand washing and use of gloves, masks, eye protection, and gowns when appropriate for patient contact (Allegranz et al., 2010) About 4.9% of health care workers are exposed to needle stick per year and it is calculated that24, 000 and 8600 Egyptian health care team are infected yearly with hepatitis C virus and/or hepatitis B virus, respectively). Because health team workers are more susceptible for blood borne pathogens so, it is important to prevent them from infection (Rosenthal et al., 2012). The rate of (HAIs) In Yemen is up to almost 60%, according to some studies, 80% of infected people are dying because of such infection (MOHP 2014) Prevention and control of infections are important concerns for all types of health care agencies. Several studies have demonstrated that there are cost savings to health care facilities that practice good infection control. Acute care hospitals have organized infection control programs. The infection control practitioner is usually a nurse with advanced training in infection control practice and methods for tracking the source and spread of infection. Each department in the hospital must have written policies and manual procedures for the control of infection, usually updated annually (Van der Berg & Daniels 2013) The infection control nurse has multi-faceted duties. She is involved in planning, monitoring, evaluating, updating, and educating the staff infection control measures, risk of infection and major infectious diseases in the work. She sets general infection Assiut Scientific Nursing Journal El-Hebshi et al., Vol , (6) No , (14) August 2018 64 control policy, provides input into specific infection control issues and preventing outbreaks of infection in healthcare settings and the community (Mohamed, 2013) Significance of the study In Hadhramout Almukalla city, the infectious diseases at governmental hospitals become increasingly high during 2012, including respiratory diseases 33840 cases, as well as both hepatitis B&C 176 cases and diarrhea 28271cases (Ministry of health and populationYemen 2014) As a result for the events and war in Yemen, the number of patients entering to outpatient’s hospital has increasing rapidly causing the probability of occurrence of infections in the hospitals. Aim of the study The study aimed to Assess the knowledge of nurses about infection control Assess the practice of nurses about infection control. Research questions Do nurses have good knowledge about infection control? Do nurses have good performance about infection control? Is there a relation between nurse’s knowledge and practice? Subjects & Methods Study Design Descriptive research design was used in this study. Setting & Sample The study was carried out for nurses in outpatient clinics at Hadhramout Governmental Hospitals as Ibn seena, Almukalla and University Hospitals for Maternity’ childbirth & childhood that are located in Almukalla city-Yemen. The study was conducted for 50 nurses are who working in these hospitals as a convenient sample. Tools for Data collection Three tools were used in this study: Tool I: Part I: The structured questionnaire which was developed by the researcher after reviewing the relevant literature to collect information from the nurses including personal characteristic: as name, age, sex, residence, qualifications and years of experience. Part II: Nurses’ knowledge related to nosocomial infection as definition causes, chain of infection, measures which will used to control nosocomial infection among patients in the outpatient clinics and any previous infection control courses. It contains 60 items about infection control, vaccination, sterilization &most common diseases that affect nurses in outpatients and general precautions that prevent the spread of infection. Scoring system The knowledge questionnaire contains 2 types of questions; the first type was statements to which respondents answer with either true or false, the second type was open ended questions where the respondents freely reply to the questions. The model answers where extracted from all answers after summarizing them. The scoring system was developed. For each item two grades were awarded for the complete correct answer and one grade for none complete and zero for an incorrect answer. The total knowledge score was determined by (Kotb, 2004 & Alhanshi, 2010) who estimate the answer by taking points as the following: Poor > 50% Fair 50%>70% Good 70% and more Tool: II Observation checklists were used by the researchers to collect data related to nurse's practices as regard the application of infection control measures, it includes universal precautions as hand washing, wearing and removing sterile gloves, wearing mask and applying gown. The Observation checklists include done, not done and. A scoring system of practice was one grade for done practice and zero for not done. Unsatisfactory > 80% Satisfactory 80% + Pilot study A pilot study was carried out for10% of nurses who were included in the sample to test the clarity of the questionnaire and the responses of nurses and to estimate the length of time which is required to complete the questionnaire. Validity of the study The tools were reviewed to ascertain their validity by five experts in medical and nursing sciences, who reviewed the instrument for their clarity, relevance, comprehensives, understanding and applicability. Reliability Reliability of tool I & tool II was assessed using alpha – cron-bach test the internal consistency r1 =0.842 & r2 0.7889. Field work Under agreement letters from faculty of nursing to the hospitals the researcher started to collect data from 15 th of April, to 25 th July 2015. The researcher met the nurses in the health education room at each hospital in the morning shift . Then he explained the aim of the study to the nurses and after that he read the questionnaire carefully and distributed it to the nurses to fill it. The researcher was available in the class to answer any question and for further Assiut Scientific Nursing Journal El-Hebshi et al., Vol , (6) No , (14) August 2018 65 explanation. The length of the time needed to fill the sheet was ranging from 15-20 minute. After that, the nurses’ performance was assessed and observed by the researcher at outpatients’ clinics in 2 days/ week every 3-5 nurses were assessed/ day. Ethical consideration The purpose of this study was explained for nurses of the studied sample. Nurses have ethical rights to participate or refuse participation in the study; oral consent was taken from all nurses who participated in the study to ensure active participation and cooperation during implementing of the program and informed that the information obtained will be confidential and used only for the purpose of the study. Statistical Analysis The obtained data were reviewed, prepared for computer entry, coded, analyzed and tabulated. Descriptive statistics (frequencies, percentage, mean and standard deviation) were done using computer program SPSS version 20, Excel 2010. Chi square test were used to compare different variables and pear correlation coefficient. It was considered significant when P-values were less than 0.05.