ATTITUDE OF NURSES TOWARDS STANDARD PRECAUTIONS IN ISTH IRRUA EDO STATE

Abstract

This study investigated adherence to standard precautions among nurses at the Irrua Specialist Teaching Hospital (ISTH) in Nigeria. To achieve this, a quantitative survey research design was adopted. A structured questionnaire was developed to gather data from a sample of 133 respondents. Data analysis involved the use of frequency tables, simple percentages, mean, and standard deviation to summarize and describe the responses. T-tests were employed to test the hypotheses related to the nurses' knowledge, attitudes, and challenges regarding standard precautions. The findings revealed that nurses at ISTH Irrua demonstrated a comprehensive understanding of hand hygiene and personal protective equipment (PPE) guidelines. However, despite this knowledge, there were gaps in adherence to standard precautions. The availability of resources such as PPE and hand sanitisers significantly influenced nurses' attitudes toward adhering to these precautions. Challenges such as inadequate staffing levels and high workloads were identified as significant barriers to consistently following standard precaution protocols. The data indicated that regular training and educational workshops had a positive impact on nurses' adherence to standard precautions, suggesting that ongoing education is crucial for improving compliance. The study concluded that while nurses at ISTH Irrua possessed substantial knowledge about standard precautions, practical adherence was hindered by resource limitations and operational challenges. The recommendations emphasized the need for improved resource allocation, enhanced training programs, and strategic measures to address staffing issues. Ensuring adequate PPE availability and reducing workload pressures were identified as critical factors in promoting better adherence to standard precautions. The study highlighted the importance of continuous professional development and the need for comprehensive interventions to support nurses in maintaining high standards of infection control.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Healthcare-associated infections (HAIs) are a significant challenge for healthcare systems worldwide, particularly in developing countries like Nigeria, where resources are limited and healthcare facilities often operate under suboptimal conditions. Infections acquired in hospitals not only pose a serious risk to patient's health but also increase healthcare costs, extend hospital stays, and sometimes result in death. Healthcare workers (HCWs), especially nurses, who are in direct contact with patients, are at a higher risk of exposure to infectious agents, making adherence to standard precautions essential in preventing the transmission of infections (Kermode et al., 2021).

Standard precautions are a set of infection control practices that are used to prevent the transmission of diseases that can be acquired through contact with blood, body fluids, non-intact skin, and mucous membranes. These precautions include hand hygiene, use of personal protective equipment (PPE) such as gloves and masks, proper handling of sharps, and safe waste disposal. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have established guidelines for standard precautions that all HCWs are expected to follow (World Health Organization, 2020).

In Nigeria, the burden of HAIs is alarming, with many hospitals reporting high infection rates due to poor adherence to standard precautions. Nurses, who are often the frontline caregivers in hospitals, play a crucial role in infection control. However, various factors, including workload, lack of resources, insufficient training, and inadequate knowledge of infection prevention protocols, can influence their adherence to standard precautions (Isara & Ofili, 2020).

One of the critical components of infection prevention is hand hygiene, which is considered the most effective means of reducing the spread of infections. Despite the simplicity and effectiveness of hand hygiene practices, studies have shown that compliance among healthcare workers, particularly in developing countries, remains suboptimal (Luo et al., 2020).

Personal protective equipment (PPE) is another important aspect of standard precautions, providing a barrier between healthcare workers and infectious agents. Proper use of PPE, such as gloves, masks, and gowns, is essential to prevent the transmission of infections in healthcare settings. However, in many hospitals in developing countries, including Nigeria, the availability of PPE is often limited, leading to inconsistent use among healthcare workers (Adinma et al., 2021).

Sharps management is also crucial in preventing HAIs. Improper handling and disposal of sharps can lead to needlestick injuries, which pose a significant risk for the transmission of bloodborne pathogens such as HIV, hepatitis B, and hepatitis C. Despite established guidelines for safe sharps handling, adherence to these practices is often inconsistent, particularly in resource-limited settings (Kotwal & Taneja, 2020).

The safe disposal of medical waste is another critical element of standard precautions. Inadequate waste management can lead to the spread of infections both within and outside healthcare facilities. In many hospitals in Nigeria, poor waste disposal practices have been identified as a contributing factor to the high rates of HAIs (Allegranzi et al., 2021).

Training and education on infection control are key to improving adherence to standard precautions. Continuous education and training programs help healthcare workers stay updated on the latest infection control guidelines and protocols. However, in many healthcare facilities in Nigeria, limited access to training opportunities has been cited as a barrier to effective infection control (Vaz et al., 2020).

The attitude of healthcare workers toward standard precautions also plays a significant role in their compliance. Studies have shown that healthcare workers with positive attitudes toward infection control measures are more likely to adhere to standard precautions. Conversely, negative attitudes, often stemming from a lack of awareness or perceived inconvenience, can lead to poor compliance (Ibeziako & Ibekwe, 2022).

In addition to individual factors, organizational factors such as leadership, workplace culture, and the availability of resources can influence adherence to standard precautions. Hospitals that prioritize infection control, provide adequate resources, and foster a culture of safety are more likely to see better compliance among their staff (Cutter & Jordan, 2022).

Irrua Specialist Teaching Hospital (ISTH), located in Irrua, Edo State, is one of the leading tertiary healthcare institutions in the region. As a referral centre, it manages complex cases, making infection control a critical aspect of patient care. Despite the hospital's efforts to promote adherence to standard precautions, challenges remain, particularly in terms of resource availability and training for healthcare workers (Shuper et al., 2022).

In essence, healthcare-associated infections continue to pose a significant challenge to healthcare systems in developing countries like Nigeria. Nurses, as frontline caregivers, play a crucial role in infection prevention and control. However, a combination of factors, including resource limitations, insufficient training, and negative attitudes toward standard precautions, hinders their ability to adhere to infection control protocols. Addressing these challenges through improved training, resource allocation, and fostering positive attitudes toward infection control is essential in reducing the burden of HAIs and ensuring safer healthcare environments (Reda et al., 2020).

1.2 Statement of the Problem

Healthcare-associated infections (HAIs) continue to present a significant challenge to global healthcare systems, with developing countries like Nigeria being disproportionately affected due to limited resources and inadequate healthcare infrastructure. While several studies have highlighted the high prevalence of HAIs, there remains a gap in understanding the specific factors influencing healthcare workers' adherence to standard precautions in resource-limited settings. Previous research has often focused broadly on infection control in healthcare settings but has not adequately explored the unique barriers that nurses in developing countries face, such as inadequate personal protective equipment (PPE) and inconsistent training (Vaz et al., 2020).

One critical gap is the lack of comprehensive studies examining how organizational factors, such as workplace culture and leadership support, affect adherence to standard precautions in Nigerian hospitals. While Cutter and Jordan (2022) emphasize the importance of organizational culture in promoting infection control, there is limited research exploring this in the context of developing countries where resource constraints are more pronounced. Additionally, although hand hygiene is considered a cornerstone of infection prevention, there is insufficient research on the compliance rates among nurses in Nigerian hospitals and the specific barriers they encounter, such as inadequate access to handwashing facilities (Luo et al., 2020).

Furthermore, while some studies have explored the role of training in infection control, there remains a gap in assessing the effectiveness of continuous professional development programs for nurses in Nigerian healthcare facilities. This is particularly important given that continuous education has been shown to significantly improve adherence to standard precautions (Isara & Ofili, 2020). Addressing these gaps is essential for developing targeted interventions that can enhance infection control practices in resource-limited settings and ultimately reduce the prevalence of HAIs in Nigeria.

1.3 Objective of the Study

The purpose of this study is to examine the attitude of nurses toward standard precautions in Irrua Specialist Teaching Hospital (ISTH), Edo State. Specifically, the study aims to:

1. Assess the level of knowledge of nurses regarding standard precautions in ISTH.
2. Investigate the factors influencing nurses' attitudes toward adherence to standard precautions.
3. Identify the challenges faced by nurses in complying with standard precautions in ISTH.

1.4 Research Questions

To achieve the objectives of this study, the following research questions will guide the investigation:

1. What is the level of knowledge of nurses regarding standard precautions in ISTH Irrua?
2. What factors influence nurses’ attitudes toward standard precautions in ISTH Irrua?
3. What challenges do nurses face in complying with standard precautions in ISTH Irrua?

1.5 Research Hypotheses

Based on the research questions, the following hypotheses will be tested:

1. There is no significant relationship between nurses' level of knowledge and their adherence to standard precautions in ISTH Irrua.
2. There is no significant positive relationship between the availability of resources (such as PPE and hand sanitisers) and nurses’ attitudes toward standard precautions at ISTH Irrua.
3. There are no significant challenges faced by nurses in complying with standard precautions in ISTH Irrua.

1.6 Significance of the Study

This study holds significant importance for several key reasons. First and foremost, it aims to provide a comprehensive understanding of nurses' attitudes toward standard precautions, which is crucial for effective infection control within healthcare settings. By examining the attitudes of nurses at ISTH Irrua, this research will shed light on the underlying factors that may be contributing to lapses in adherence to these critical infection control practices. Understanding these attitudes is essential for identifying specific knowledge gaps and misconceptions that could lead to non-compliance with standard precautions. Such insights are invaluable for healthcare administrators, as they can utilize the findings to pinpoint areas where additional support, education, or resources are needed.

The study's results will enable administrators at ISTH Irrua to tailor interventions more effectively. For instance, if certain attitudes or knowledge deficits are identified, targeted training programs can be developed to address these issues directly. Additionally, the research may highlight the need for better resource allocation or changes in protocols to support nurses in adhering to standard precautions. This tailored approach to intervention development is likely to enhance compliance and, by extension, improve infection control practices within the hospital.

Moreover, this study will make a significant contribution to the existing body of literature on infection control in Nigerian hospitals. Although there is a growing body of research on infection control practices, specific empirical evidence regarding nurses' attitudes toward standard precautions in Nigerian healthcare settings is relatively sparse. By providing detailed insights into these attitudes, the study will offer valuable data that policymakers, healthcare providers, and educational institutions can use to refine infection control policies and training programs. This can lead to the development of more effective infection control strategies and educational curricula tailored to the unique needs of Nigerian healthcare workers.

The benefits of this research extend to the nurses at ISTH Irrua as well. By emphasizing the importance of standard precautions and identifying practical solutions to the challenges they face, the study aims to support nurses in improving their adherence to infection control measures. Ultimately, this will contribute to enhancing patient safety by reducing the incidence of healthcare-associated infections. Improved compliance with standard precautions not only protects patients but also creates a safer working environment for healthcare workers, fostering a culture of safety and quality care within the institution.

1.7 Scope of the Study

This study will focus on the attitude of nurses toward standard precautions in Irrua Specialist Teaching Hospital (ISTH), Edo State. The study will involve nurses working in various departments of the hospital, including outpatient, inpatient, surgical, and critical care units. It will examine nurses' knowledge, attitudes, and practices regarding standard precautions, as well as the challenges they face in adhering to these measures.

The study is limited to ISTH Irrua, and while the findings may provide insights into similar healthcare settings, they may not be generalizable to all hospitals in Nigeria. Furthermore, the study will focus specifically on nurses, excluding other healthcare workers such as doctors, laboratory technicians, and support staff, who also play a role in infection control.

1.8 Operational Definition of Terms

For this study, the following terms are defined as follows:

1. Standard Precautions: A set of infection control measures designed to prevent the transmission of infectious agents between healthcare workers and patients. These include hand hygiene, use of personal protective equipment, safe handling of sharps, and proper waste disposal.
2. Attitude: A psychological construct that reflects a nurse's positive or negative evaluation or feeling toward standard precautions. It can influence the level of compliance with infection control measures.
3. Healthcare-Associated Infections (HAIs): Infections that patients acquire while receiving treatment for medical or surgical conditions in a healthcare facility. These infections can also affect healthcare workers exposed to infectious agents in the hospital.
4. Compliance: The degree to which nurses adhere to standard precautions in their daily practice to prevent infection transmission.
5. Personal Protective Equipment (PPE): Equipment worn by healthcare workers to protect themselves from exposure to infectious agents. This includes gloves, masks, gowns, and face shields.
6. Infection Control: Measures and procedures implemented in healthcare settings to prevent the spread of infectious diseases, particularly those acquired in hospitals.
7. Nurses: Licensed healthcare professionals who provide direct patient care, including the administration of medications, monitoring patient progress, and implementing infection control measures in a hospital setting.
8. Knowledge: The level of understanding and awareness that nurses possess regarding standard precautions and their importance in preventing the transmission of infections in healthcare settings.