Introduction

Infections in health care services represent a global problem and constitute one of the main causes of morbidity and death associated with clinical, diagnostic and therapeutic procedures. Besides their range for patients, healthcare workers are at equal risk of occupational hazards.

Infections, arise in the hospitals are termed as hospital associated infections. Such infections have also been called as 'Nosocomial Infections' and sometimes 'Hospital Acquired Infections'. Nosocomial infections or hospital acquired infections are defined as infections acquired during or as a result of hospitalization. Any patient who develops an infection after 48 hours of hospitalization is considered to have nosocomial infection. As exposure is a constant premise for professionals as well as patients, intervention measures have been proposed to minimize this situation, with the implementation of Universal Safe precautions as one of the strategies.1 It may not be possible to eradicate all hospital-related infections. However, knowledge and compliance of Universal safe Precautions provides optimum protection for both the Healthcare Organization’s clientele and the staff.

Universal Precautions are vital measures that have been adopted to help prevent health workers from being occupationally infected as well as reduce nosocomial infection. These precautions should be followed in all patient care situations. Certain standard precautions should be taken in all healthcare settings such as hand washing, use of barriers (gloves, gown, cal, and mask), care with devices, equipment and clothing used, maintain environmental cleanliness, follow proper waste disposal practices, and patient’s accommodation in line with requirement levels as an infection transmission source.

Centre for Disease Control and Prevention (CDC) established these measures in 1996 but implementation of Universal Safe Precautions remains a challenge. One of the reasons is lack of knowledge and low adherence among professionals. Nurses are exposed each day to a variety of health and safety hazards. The use of appropriate infection control precautions to protect against transmission of blood-borne and other occupational microbial pathogens should be a routine component of healthcare provision. Centre for Disease Control and Prevention recommends that everyone should use standard precautions whenever come into contact with body fluids.

World Health Organization (2006) reports that among the 35 million health workers worldwide, about 3 million sustain percutaneous exposures to the blood borne pathogens each year, including 2 million to hepatitis B virus (HBV), 0.9 million to hepatitis C virus (HCV) and 170,000 to human immune deficiency virus (HIV). These injuries may result in 70,000 HBV, 15,000 HCV and 5,000 HIV infections.2 If these diseases are contracted by nurses, it may ruin their career, cause loss of interest in the profession and may stimulate nonchalant attitude in carrying out services. So, the present study was conducted to assess the knowledge of and compliance with Universal Safe Precautions among nurses of a Tertiary Care hospital and this information would be useful in identifying the specific areas that may need further improvement to provide safer practices.

Aims and Objectives

The study was conducted

Materials and Methods

Results

The study population comprised of one hundred nurses from various departments, ICUs and O.T of a Tertiary Care Hospital. The study population comprised of all females. The demographic details of the study population are shown in Table 1,Table 2. The data given in Table 1,Table 2 shows that the age of the nurses ranged from 24-50 years with mean of 30.53±7.07. Majority of the nurses; about 69% of the total were in the age group of 24-30 years.

The data given in Table 3 shows that the years of experience of the nurses ranged from 1.5-27 years with mean±SD of 7.3±6.3. Table 4 shows that 45% of nurses having experience between 2-4 years and 36% of nurses having experience between 5-10 years. Majority of the nurses are having work experience of 3-4 years.

The data shows that the knowledge score of the study population ranged from 11-15 marks out of total 15 marks which were expressed in percentage as 73-100% with mean ±SD of 88.13±5.26 (Table 5). Only 1% of nurses have average knowledge score i.e. < 80% which was 73% and 58 nurses have good knowledge i.e. 80-87%. Out of 100 nurses, 41 have very good knowledge score i.e. > 90%. Out of this 41, 2 nurses have excellent i.e. 100% knowledge score (Table 6).

The knowledge score of the nurses was calculated by their responses to the questionnaire which comprised of 15 questions based on knowledge regarding UPs. Every right response to the question carried 1 mark and then total percentage was calculated for each question by getting the responses of all the participants to that one particular question. From the below data it was observed that nurses have very poor knowledge about the main objective of the UPs i.e 14% only. For variable 2 and 12, nurses had average knowledge i.e. between 70-80% and for 6, 13 and 15 knowledge variables they had good knowledge (80-90%). The knowledge score for the rest variables was excellent approx. 100%. (Table 7)

Table 8 shows the percentage of the nurses’ response for the compliance to UPs. The compliance score was assessed as per their response on the questionnaire regarding compliance of UPs which was described in 5 point likert scale i.e. always, often, sometimes, seldom and never. It was observed that the compliance rate was low (<80%) for the variables 6, 9, 14, 15, and 18 which was 79, 69, 59, 69, and 79% respectively. It was also observed that the compliance for 20 variable was very low, only 5% study population was aware regarding the precautions to be taken after workplace accidents with potentially contaminated sharp materials. For rest of variables, compliance to UPs was satisfactory among nurses.

Discussion

Hospital acquired infection is a common problem all over the world. Therefore, up to date knowledge, awareness and practices can play important roles in prevention of these infections. Health care workers should have the opportunity to practice Universal Safe Precautions on a day to day basis as an integral part of patients care. That is why the current study was carried out to assess the knowledge of UPs among nurses in a Tertiary care hospital and also to check their compliance to UPs so that the safe work environment can be provided to all the stakeholders. Also, in India together with the few studies3,4,5,6 which have already been done on Universal safe Precautions knowledge and compliance, this study aims and contributes to determine knowledge and compliance of nurses towards Universal safe Precautions. Table 1,Table 2). Among the participants, 45% of nurses having experience between 2-4 years and 36% of nurses having experience between 5-10 years. Majority of the nurses are having work experience of 3-4 years (Table 3,Table 4).

All the participants were given a questionnaire that contained 15 questions regarding the knowledge of UPs, marks obtained ranged from 11-15 marks. Regarding the knowledge of Universal precautions, one participant got less than 80% scores. 58 nurses have good knowledge i.e. 80-87%. Out of 100 nurses, 41 have very good knowledge score i.e > 90%. Out of this 41, 2 nurses have excellent knowledge score (Table 6). It was observed from the present study that the nurses were aware of UPs and had good knowledge of UPs because among 100 nurses, 99 nurses scored ≥80% on knowledge based questionnaire. It was also observed from the study that nurses have very poor knowledge about the main objective of the UPs. The adherence to the UPs measures is for the safety of all the stakeholders like health workers, patients, attendants and surroundings. But only 14% could correctly state the objectives. This finding was in accordance with the study conducted by Zaveri J et al7 among medical laboratory technicians to assess the knowledge, attitude and practice of UPs. The author stated that only 37.5% know the objectives of UPs. 24% participants wrongly stated that Universal Precautions should only be used in patients diagnosed with infection or patients who are in the incubation period for a given infection while 76% nurses predict this statement false. 82% nurses were in favour of hand washing after removing gloves and 18% were of the view that there was no need to wash hands after removing gloves. Similar results were reported by Ogonia D et al.8 Among all, 79% nurses stated that in situations where blood splatters, body fluids, secretion or excretion may occur, disposable caps and hats should be used. 15% did not know about the proper disposal of needles while 13% didn’t know about the standard precautions to be taken during care of patients with intestinal infections or skin infections. The knowledge score for the rest nine variables was excellent 100% (Table 7). They were all well versed with hand hygiene performance while providing care to different patients, PPE should not to be shared, standard precautions to be taken while blood collection and in procedures where exposure to body fluids is possible. The study showed an overall good understanding and knowledge of UPs in certain areas. These findings were in accordance with the results observed by Bolaji-Osagie SO et al9 and Vaz K et al.10

In the present study, the compliance score was assessed as per their response on the questionnaire consist of 20 questions regarding compliance of UPs which was described in 5 point likert scale i.e always, often, sometimes, seldom and never. It was observed that the compliance rate was low (<80%) during the procedures involving the possibility of touching a patient’s non-intact skin. Only 79% nurses followed UPs always but 12% of them reported that they had stick to UPs not always but sometimes. Regarding the compliance of UPs during giving injections only 69% wear gloves while 9% nurses confessed that they were not wear gloves while giving injections. Strict compliance of wearing protection mask and glasses when there is possibility of touching drops of blood, bodily fluids or discharges was 59% and 69% respectively. It was also observed that only 5% study population was aware regarding the precautions to be taken after workplace accidents with potentially contaminated sharp materials. With regard to the practice of hand hygiene, 98, 97, and 100% always practiced hand hygiene in treating different patients, after taking off gloves and immediately after touching potentially-contaminated biological materials respectively. The similar findings were also observed in the study conducted by Ogoina D et al.8

In relation to sharp disposal, 100% had always disposed needles, blades and other sharp materials in puncture proof containers. The study revealed that the knowledge of universal precautions among nurses is satisfactory. The findings of this study also showed that the compliance of UPs is also good except few elements. This finding is consistent with Ferguson et al.11 Thus the knowledge and compliance of Universal safe Precautions among nurses was found to be overall good in the study conducted here. This was found to be similar to the findings reported in a study conducted by Alrubaiee G.12

Conclusion

The present study showed adequate knowledge and fair level of compliance among nurses towards Universal Precautions. This study points out that there is always scope for improvement in the Universal precautions to be followed. It should be beneficial for all health care workers to receive formal training regarding the same. Our findings indicate the need for institutional investments in nursing competency training for this purpose, using different strategies, particularly permanent and continuing education. It should be emphasized that making possible permanent and continuing education activities is not sufficient. There is need to review how these are realized. If the nurses have sufficient knowledge, it is obvious that the compliance for the same is increased with supportive supervision and continuous monitoring. Strengthening and integrating Universal Precautions with the routine services through provision of training and preparing and introducing HAI prevention standard of practice, protocol, rules, regulation and opportunities to promote the desired team spirit at all health facility levels are all measures which would prove useful.

Source of funding

None.

Conflict of interest

None.