|Year : 2014 | Volume
| Issue : 2 | Page : 34-38
A study on knowledge and awareness of standard precautions among health care workers at Nizam's institute of medical sciences Hyderabad
Sreenuvasu Mudedla, W Laxmi Tej, KT Reddy, M Sowribala
Department of Hospital Administration, NIMS, Hyderabad, Telangana, India
|Date of Web Publication||12-Feb-2015|
Dr. Sreenuvasu Mudedla
Department of Hospital Administration, NIMS, Panjagutta, Hyderabad - 500 082, Telangana
Source of Support: None, Conflict of Interest: None
Aim: The aim was to assess the knowledge and awareness of standard precautions among heath care workers that is, doctors, nurses, and technicians.
Setting and Design: A cross-sectional survey was conducted in September and October 2013 at Nizam's institute of medical sciences, Hyderabad.
Materials and Methods: A 40-item questionnaire was provided to 180 health care workers including doctors, medical technicians and nurses to assess their knowledge and awareness of standard precautions under seven divisions namely general information on standard precautions, care of skin and hand washing, personal protective equipment (PPE), procedure for the safe handling and disposal of sharps, postexposure prophylaxis, bio medical waste and linen disposal, knowledge on blood borne and other pathogens.
Statistical Analysis: Chi-square test has been used to compare the relevant groups.
Results: It was observed that 96 (53.3%) respondents are very knowledgeable and 84 (46.7%) were somewhat knowledgeable. In the very knowledgeable category, there were 38 doctors, 24 nurses and 34 technicians. 48 (57.1%) males and 48 (50%) female respondents were found to be very knowledgeable. With respect to length of service, 21 (53.8%) respondents in 0-5 years of service category, 18 (60%) in 5-10 years category and 57 (48.7%) in >10 years category were found to be very knowledgeable.
Conclusions: Knowledge of standard precautions was highest among doctors (63.3%), followed by technicians (56.6%) and nurses (40.0%). There is a significant difference in knowledge and awareness of standard precautions among studied health care professionals (P = 0.031). Knowledge and awareness of standard precautions did not vary significantly between males and females (P > 0.05). There is no significant difference in knowledge and awareness of standard precautions among groups, with respect to length of service (P > 0.05). The studied population was not very knowledgeable in division's namely PPE, sharps disposal and bio-medical waste disposal.
Keywords: Health care workers, knowledge awareness, standard precautions
|How to cite this article:|
Mudedla S, Tej W L, Reddy K T, Sowribala M. A study on knowledge and awareness of standard precautions among health care workers at Nizam's institute of medical sciences Hyderabad. J Nat Accred Board Hosp Healthcare Providers 2014;1:34-8
|How to cite this URL:|
Mudedla S, Tej W L, Reddy K T, Sowribala M. A study on knowledge and awareness of standard precautions among health care workers at Nizam's institute of medical sciences Hyderabad. J Nat Accred Board Hosp Healthcare Providers [serial online] 2014 [cited 2019 Oct 19];1:34-8. Available from: http://www.nabh.ind.in/text.asp?2014/1/2/34/151296
| Introduction|| |
Infection is an occupational risk for healthcare staff. Exposure to blood and body fluids from infected patients poses a risk of infection with hepatitis B, C or human immunodeficiency virus (HIV) to healthcare staff.
Patients may get infected mainly by transmission of contaminated blood or blood products. Infection through contaminated medical equipment is also possible. Health care workers are at a high risk of needle stick injuries and blood-borne pathogens as they perform their clinical activities in a hospital.  They are exposed to blood-borne infections by pathogens such as HIV, hepatitis B and hepatitis C viruses, from sharp injuries and contacts with blood and other body fluids. , According to the World Health Organization estimate, in year 2003, sharp injuries resulted in 16,000 hepatitis C virus, 66,000 hepatitis B virus and 200-5000 HIV infections in health care workers worldwide.  The incidence rate of these causative factors is higher in developing countries due to the higher rate of injection with previously used syringes and high prevalence rates of these diseases. 
In 1983, the US Center for Disease Control and Prevention (CDC) recommended blood and body fluid precautions when a patient was known or suspected to be infected with blood-borne pathogens. , In 1987, the CDC recommended that regardless of patient's infection status, the precautions must be consistently used. This extension of blood and body fluid precautions to all patients is referred to as "universal blood and body fluid precautions" or simply "universal precautions." ,
These precautions include set of precautions devised to prevent transmission of all known blood-borne pathogens including HIV, hepatitis B virus, and hepatitis C virus to/from health care personnel when providing first aid or other health care services. In 1996, the CDC included the universal precautions in a new prevention concept the so-called "standard precautions."  The "standard precautions," which are devised to be used for the care of all patients in hospitals regardless of their diagnosis or presumed infection status, now replace the "universal precautions." Standard precautions are the underpinning principles for routine safe practices. They are precautions that should be practiced by all clinical staff without exception, to limit the risk of potentially harmful organisms being transmitted to the patient, healthcare worker, visitor or the environment. Standard precautions include hand hygiene, Use of personal protective equipment (PPE), Safe management and disposal of sharps, Safe disposal of clinical waste, Cleaning and decontamination of re-usable equipment, Maintenance of a clean clinical environment, Safe management of laundry, Safe management of body fluid spillages. 
The level of practice of standard precautions may differ from one type of health care worker to another. The differences in knowledge of standard precaution by health care workers may be influenced by their type of training. Various studies carried out among different categories of health care workers found that the exposure to blood or other body fluids was approximately 9.3%. ,,
Standard precautions' awareness education has not been due importance among health care workers, particularly in developing countries. This study was conducted to assess the knowledge and awareness on standard precautions among health care workers at the Nizam's Institute of Medical Sciences, Hyderabad.
| Materials and Methods|| |
The Nizam's Institute of Medical Sciences has a bed strength of 985. The mean number of outpatients visiting the hospital per day is about 1275 and the mean number of inpatients admitted per day is about 80. The average bed occupancy is 89%.
A cross-sectional study was conducted in September 2013 using a questionnaire at Nizam's institute of medical sciences.
Out of approximately 2000 employees, there are 330 doctors, 540 nurses, and 155 technicians. The remaining constitutes supportive and clerical staff. This study was conducted on doctors, nurses, and technicians because of their greater involvement in patient care activities. 60 participants were recruited in each group. The total sample size was 180. Doctors nurses and technicians were selected by simple randomization method using computer generated random numbers assuming that all the groups come in contact with infectious blood and body fluids during their routine patient care.
The technicians were recruited from the laboratories of the Departments of Pathology, Biochemistry, Microbiology and other areas such as blood bank, Intensive Care Unit, operation theaters etc.
A structured questionnaire was prepared in consultation with senior professors of various departments and readability of it was assessed using readability scoring scales. After doing the necessary modifications, the final questionnaire consisted of 40-items regarding knowledge and awareness of standard precautions. The questions were either of multiple choice type or in a dichotomous format (yes or no).
Before administration of the questionnaire, the purpose of this study was explained to each respondent and confidentiality of the information assured. Demographic information such as occupation, age, gender, and years of service in the health sector was collected while the questionnaire assessed knowledge of standard precautions in the following seven areas:
- General information on standard precautions
- Care of skin and hand washing.
- Procedure for the safe handling and disposal of sharps.
- Postexposure prophylaxis (PEP).
- Bio medical waste and linen disposal.
- Blood borne and other pathogens.
A score of one was assigned for a correct answer and zero for an incorrect answer. Those who scored >30 were considered "very knowledgeable," 15-30 "somewhat knowledgeable" and <15 "least knowledgeable."
A comparative analysis was made among the groups to know the difference in their knowledge levels. The results were analyzed statistically with Chi-square test using MINITAB version 13 statistical software (State College, Pennsylvania).
| Results|| |
The response rate to the questionnaire was 100%.
Analysis was made under the following sections:
Analysis of demographic information of the studied sample
Analysis of scores
There is no significant difference in knowledge between male and female groups (P > 0.05). There is no significant difference in knowledge and awareness of standard precautions among the three groups with respect to length of service (P > 0.05).
There is a significant difference in knowledge among the three groups (P = 0.031). There is no statistically significant difference in the knowledge levels between doctors and technicians (P > 0.05) or between technicians and nurses (P > 0.05), but there is statistically significant difference in the knowledge levels between doctors and nurses (P < 0.01) [Table 1] and [Table 2].
Knowledge levels of the participant groups with respect to seven divisions of the questionnaire
The average (mean) of subtotals for each division was calculated with respect to each group and as a whole. The averages were converted into percentages. Any average score >75% was considered very knowledgeable with respect to that particular division, somewhat knowledgeable if between 50% and 75% and least knowledgeable if <50%.
In doctors' group, Knowledge levels were highest in hand washing with an average score of 97%, somewhat knowledgeable in PPE and bio medical waste disposal and least in bio-medical waste disposal with an average score of 64%. In none of the divisions, the average score of the doctors is <50%.
In doctors' group, Knowledge levels were highest in hand washing with an average score of 97%, somewhat knowledgeable in PPE and bio medical waste disposal and least in bio-medical waste disposal with an average score of 64%. In none of the divisions the average score of the doctors is <50%.
Nurses were found very knowledgeable in general information, Hand washing, sharps disposal, PEP and blood borne pathogens. Knowledge levels were highest in hand washing with an average score of 90%. They were reportedly somewhat knowledgeable in general information about standard precautions, PPE and sharps disposal. Knowledge levels were least in PPE with an average score of 62%.
Technicians were found very knowledgeable in all the seven divisions with the highest score in hand washing (87%). The knowledge levels were relatively least in general information and PPE with an average score of 75% in each.
As a whole, the participants were very knowledgeable in general information, Hand washing, PEP and blood borne pathogens. Knowledge levels were highest in hand washing with an average score of 89%. Participants were somewhat knowledgeable in PPE, sharps disposal and bio-medical waste disposal and least in PPE with an average score of 69% [Table 3] and [Table 4].
|Table 3: Awareness of standard precautions stratified by particular variable|
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|Table 4: Response analysis of the participant groups with respect to seven divisions of the questionnaire|
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| Discussion|| |
This study showed that the levels of knowledge and awareness of standard precautions varied considerably among the three categories of healthcare workers at this hospital. Though standard precautions are included in training/teaching curriculum, only 63.3% doctors, 56.6% technicians and 40% nurses were found to be very knowledgeable. In a similar study, 88% doctors, 70% technicians and 90% nurses were found to be very knowledgeable.  This disparity reflects the fact that doctors and nurses at the study hospital are not being subjected to regular training programs and/or workshops to keep their knowledge updated. Apart from inadequate training, other factors which may have contributed to their suboptimal knowledge levels are lack of proper laid down policies and protocols to make sure that the regular training programs are conducted and strict adherence of healthcare workers to standard precautions during their patient care activity. There is no proper monitoring to assess the practice of standard precautions. Knowledgeable Health care workers who practice standard precautions tend to remain knowledgeable for longer periods. Health care workers who do not have sufficient knowledge on standard precautions have fewer tendencies to practice them. A study conducted in western Algeria observed that lack of adherence to standard precautions was primarily due to lack of knowledge.  This study did not show any co-relation between the length of service and knowledge levels in contrast to the study done at university Hospital of the West Indies,  which showed most of the respondents (92.9%) employed in the health care sector for 16 years and over-reported higher levels of awareness of standard precautions than those who served for a shorter period. In this study only 51.3% health care workers who served for >10 years were very knowledgeable. The study presumed that health care workers of <5 years of length of service who were made regular employees after completing their basic training would be more knowledgeable compared with other two categories of length of service. However, their knowledge level is 53.8% (n = 21), which is lesser compared with other two age categories. Most of the doctors reported that their poor knowledge in biomedical waste disposal is because of their minimal participation in it. Nurses reported that their better knowledge in hand washing is because of the continuous insistence on hand hygiene by the doctors during patient rounds. Most of the nurses reported that their knowledge levels would be improved with regular training programs and workshops which will enable them in direct participation for better understanding. Though, technicians exhibited lesser knowledge levels compared to doctors, their knowledge levels are better than the medical nurses. They exhibited relatively better knowledge levels in five divisions compared to doctors. They reported that this better knowledge levels are due to their continuous high exposure to the blood and body fluids, which is compelling them to know and practice of standard precautions in addition to the training sessions, which are held intermittently for the technical staff by senior faculty and flow charts and posters highlighting several elements of universal precautions displayed in the laboratories of the respective departments.
| Conclusions|| |
This study showed the different levels of knowledge of standard precautions among various health care workers. It also showed the strengths and weakness of each category of healthcare workers that will be helpful in conducting focused training programs to address the weak areas. Thus, this study has attempted to highlight the issues that are to be addressed with regard to standard precautions. This will also be helpful in better utilization of resources in organizing training programs and workshops.
| References|| |
Beltrami EM, Williams IT, Shapiro CN, Chamberland ME. Risk and management of blood-borne infections in health care workers. Clin Microbiol Rev 2000;13:385-407.
Gerberding JL. Incidence and prevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and cytomegalovirus among health care personnel at risk for blood exposure: Final report from a longitudinal study. J Infect Dis 1994;170:1410-7.
Ruben FL, Norden CW, Rockwell K, Hruska E. Epidemiology of accidental needle-puncture wounds in hospital workers. Am J Med Sci 1983;286:26-30.
Prüss-Ustün A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Am J Ind Med 2005;48:482-90.
Pruss-Ustun A, Rapiti E, Hutin Y. Sharp Injuries: Global Burden of Disease from Sharp Injuries to Health Care Workers. Geneva, Switzerland: World Health Organization; 2003.
Centers for Disease Control (CDC). Recommendations for protection against viral hepatitis. MMWR Morb Mortal Wkly Rep 1985;34: 313-24, 29.
Centers for Disease Control (CDC). Recommendations for preventing transmission of infection with human T-lymphotropic virus type III/lymphadenopathy-associated virus in the workplace. MMWR Morb Mortal Wkly Rep 1985;34:681-6, 91.
McCarthy GM. Universal precautions. J Can Dent Assoc 2000;66: 556-7.
Centers for Disease Control (CDC). Update: Human immunodeficiency virus infections in health-care workers exposed to blood of infected patients. MMWR Morb Mortal Wkly Rep 1987;36:285-9.
Garner JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:53-80.
Spire B, Barré-Sinoussi F, Montagnier L, Chermann JC. Inactivation of lymphadenopathy associated virus by chemical disinfectants. Lancet 1984;2:899-901.
Martin LS, McDougal JS, Loskoski SL. Disinfection and inactivation of the human T lymphotropic virus type III/Lymphadenopathy-associated virus. J Infect Dis 1985;152:400-3.
McDougal JS, Martin LS, Cort SP, Mozen M, Heldebrant CM, Evatt BL. Thermal inactivation of the acquired immunodeficiency syndrome virus, human T lymphotropic virus-III/lymphadenopathy-associated virus, with special reference to antihemophilic factor. J Clin Invest 1985;76:875-7.
Vaz K, Mudedla S, Tej WL, Reddy KT, Sowribala M. Knowledge, awareness and compliance with universal precautions among health care workers at the university hospital of the west Indies, Jamaica. Int J Occup Environ Med 2010; 1:171-8. [PMID: 23022806]
Beghdadli B, Belhadj Z, Chabane W, Ghomari O, Kandouci AB, Fanello S. "Standard precautions" practices among nurses in a university hospital in Western Algeria. Sante Publique 2008;20:445-53.
[Table 1], [Table 2], [Table 3], [Table 4]