AWARENESS AND APPLICATION OF HOSPITAL INFECTION CONTROL MEASURES AMONG HEALTHCARE PROFESSIONALS IN THE HOSPITALS OF AN URBAN AREA IN EL- MINIA

Khaled Hussein M.I. El dessouki and Sanaa Mahmoud Ahmed Hassane. 1. Department of Public health and preventive medicine, Faculty of Medicine, Minia University, Egypt. 2. Department of Pediatrics nursing, Faculty of nursing, Minia University, Egypt. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

All body fluids, secretions, excretions and mucous membranes may cause infections. The standard precautions include hand hygiene, use of personal protective equipment (PPE), use of the aseptic technique to reduce patient exposure to infections and proper management of sharps, blood spills, linen, and hospital wastes to maintain a safe hospital environment [2].
Healthcare professionals including nursing and medical students with standard precautions are efficient to prevent and control hospital infections which caused by healthcare workers. These measures protect both the patient and the healthcare workers. Hand hygiene is considered the most important infection control precaution [3,4]. Adequate use of gloves, to protect the healthcare workers, as well as the patient is very important. Safe practices for handling needle sticks and other sharp objects are a preventive measure for parenteral infection like hepatitis B virus and hepatitis C virus infections [4].There is very low compliance with these standard precautions, in many hospitals [3].
Assessing the necessary knowledge, attitude and practice and the skills on infection control procedures in general hospitals can give way to manage the limited resources available in the Egyptian health sector for health providers and patients [4].
Antibiotic resistance, multi-drug resistant tuberculosis and increasing infectious diseases including HCV are creating major risks for health care system [5]. These conditions make the environment of the health professionals unsafe and risky which could interfere with the appropriate care of patient health [6].
World health organization reporting that unsafe injections and needle stick injuries cause every year at least 8-16 million HBV infections, 2.3-4.7 million HCV infections, and 160,000 HIV infection. WHO estimated that in developing countries 12 billion injections administered each year at least 50% of them are unsafe to recipients, health care professionals, health students and the public Injuries from sharp devices this also transmit more than 40 infectious agents including (HBV), (HCV) and HIV [4].
The practice of standard precautions in developed countries is done to protect healthcare professionals from exposure to blood and the risk of infection with blood-borne pathogens while in developing countries the standard precautions are improperly practiced [7].
In Egypt, there is increasing the prevalence of hepatitis B and hepatitis C virus infections and the unsafe injections and needle stick injuries cause the majority of infectious diseases. [4].
Health science students reported as they had sustained at least one form of accidental injury by needle or other sharps. Nurses and health assistants sustained the highest proportion of accidental injuries by needles or sharps [8]. So the purpose of this research was to assess the knowledge, attitude and practice of standard precautions among health care workers in the health care system to all levels of staff at the 4 Hospitals in Mallawy district EL-Minia governorate (Mallawy central hospital, Mallawy fever hospital, Mallawy chest hospital and Mallawy ophthalmology hospital). The study will help in identifying and improving the practice of infection control precautions at the hospital level in the study area and will provide information for both governmental and private health care workers regarding infection control precautions.
This will estimate the current basic knowledge and attitudes of the healthcare professionals to measure what is known and practiced so that educational and training programs better designed [18]. The professional relations between Physicians and nurses may have differences with respect to their attitudes towards patient-care [19]. The 518 present study aimed to clarify the knowledge, attitude, and practice of the physicians and nurses in relation to healthcare infection control precautions in an urban area in EL-Minia governorate.

The aim of the study:
To estimate the current basic knowledge and application of infection control measures by healthcare professionals in the hospitals of an urban area in EL-Minia governorate

Study design
A cross-sectional hospital based descriptive study design was conducted to assess knowledge, attitudes, and practice of health professionals towards infection preventions in 4 Hospitals in Mallawy district EL-Minia governorate Study area and period a study was done in July

Study ethical considerations
Data was collected with the consent of health care workers after they informed about the objective, procedures, potential risks, and benefits of the study. They were asked to provide accurate and honest responses. verbal consent obtained from each participant. The identification of the respondents was possible only through numerical codes which were secured so that there are anonymity and confidentiality in completing the questionnaire. Health care workers were reassured of the information they provided to this study.

Study Population
Among the 225distributed questionnaires, 210 were returned; out of which ten questionnaires were incompletely filled and were not included for analysis the remaining were 200 questionnaires (100 physicians & 100 nurses).

Data analysis
Analysis of data was done using the Statistical Package for Social Sciences (SPSS)version 17.

Results:-
A total of 225 questionnaires were distributed out of which 200 were retrieved, 25 did not respond giving a response rate of 88.8%. Of the 200 responders, 100 were nurses and 100 were doctors. The study population has a median age of 35 years (interquartile range [IQR] 31-39) and median years of experience of 7 years (IQR 4-12) [ Table 1]. The median overall percent knowledge and practice scores were 70% and 65%, respectively. On examining the knowledge of the respondents [ Table 2], nurses were more knowledgeable of the fact that hand hygiene is the most effective method to prevent healthcare-acquired infection (HCAI) (P = 0.001). When asked about standard precautions, the majority agreed that avoiding recapping needles, use of barrier precaution and hand hygiene effectively prevent HCAI [ Table 2]. Despite the nurses having better knowledge on hepatitis B virus (HBV) seroconversion compared to doctors, knowledge on percentage estimated risk of acquiring infection with the human immunodeficiency virus (HIV), HBV or hepatitis C virus (HCV) following exposure to blood and other body fluid 519 was generally poor [ Table 2].As regards to the practice of hand hygiene, 77% of doctors' versus 92% of nurses (P = 0.004) and 52% of doctors' versus 76% of nurses (P = 0.002) always practice hand hygiene before and after glove use and in between patient care, respectively. When asked about recapping needles, none of the respondents reported not recapping his/her needle after use, however, 32% versus 18% of doctors and nurses, respectively, said they recap needles most of the time.
Results of logistic regression analysis [ Table 3] indicated that knowledge of infection control was greater among respondents stationed in surgical wards (odds ratio = 3.414 [1.822-6.395]) compared to those in medical wards. There was no statistically significant difference in both knowledge and practice between male and female respondent, nurses and doctors or those with years of working experience of ≥10 years and ≤10 years. There was a weak negative correlation between overall percent knowledge score and overall percent practice score (r = −0.004, P< 0.001).

Discussion:-
This current study approves a gap in knowledge about hand hygiene, with about fifty percent of the doctors agreeing with the use of sterile glove as the most effective method of preventing Healthcare-acquired infections. The overall knowledge about the risk of transmission of blood-borne infections (HIV, HBV, and HCV) and post-exposure prophylaxis was poor. The practice of hand hygiene is generally good, but relatively fewer of the respondents of the healthcare professionals stated washing their hands in between patient care, with nurses reporting a better practice. There was a weak negative correlation between good knowledge and good practice among the respondents of the healthcare professionals.
The regular obligatory training by the hospital infection control committee would likely explain the overall good knowledge and practice shown in this study. A similar pattern has been previously reported in Nigeria. [24] Studies elsewhere also showed that training improves knowledge and compliance with standard precaution. [19,26,27] In another study among healthcare providers in family health settings in Shebin El-Kom district, Menoufia Governorate training on standard precautions was predictive of correct knowledge of standard precaution. [37] The identified gaps in knowledge and practice of hand hygiene in this study despite regular training alarming. Ogoina et al. [11] reported the poor practice of hand hygiene despite good knowledge among health care providers in two tertiary hospitals in Nigeria. In Uganda, Sethi et al. [28] reported that up to 75% of healthcare providers at Mulago general hospital disagreed with the fact that their hands, when unclean, can be a source of infections.
The poor knowledge on the risk of transmission of blood-borne infections (HIV, HBV, and HCV) suggests most of the respondents undervalue the risk of transmission and this may put healthcare providers at risk of being infected. This may explain the poor compliance with the use of simple personal protective equipment such as caps, gowns, goggles, and masks with invasive procedures. According to WHO, globally 40% of HBV infections among healthcare providers are due to occupational exposure. [29] The lower compliance to the observance of hand hygiene by medical doctors as shown in this study is in accordance with the observation in many other studies where doctors are shown to poorly comply with infection control precaution compared to nurses. [23,24,30,31,37] Bamigboye, Adesanya [32] and Abu Salam et al., [37] observed a higher level of knowledge among nursing staff 77%, compared to medical students, 61%, with only 18.9% of the students claiming that infection control precautions. Adinma et al., [24] in their study suggested years of experience as one of the factors responsible for poor compliance with infection control precautions among doctors compared to nurses who have more years of experience. This finding is in conflict with Gershon et al. [33] observation of the better practice of infection control precautions among younger health care providers. In a study among medical students, females were shown to comply more with infection control precaution than males. [34] In the present study, we did not find any significant association between years of experience or gender of health care workers and good knowledge and practice of infection control respectively.
The weak correlation between good knowledge and good practice suggests that good knowledge does not always produce good practice. This agrees with a previous study by Abu Salam which was done among healthcare providers in family health settings in Shebin El-Kom district, Menoufia Governorate. [37] Other confusing factors affecting the infection control practice may probably have a role. Excess workload and lack of resources were influencing the poor practice of infection control in healthcare workers in Nigeria, [11,24,35] and other countries of the world. [26,36] 520

Conclusion and recommendations:-
This study in the 4 hospitals in Mallawy district indicates that gaps have been identified in the knowledge and practice of infection control measures among doctors and nurses. This highlights the need for continued refresher training and measures to induce implementation of infection control in the hospital. According to the high rate of hospital-acquired infection, it becomes vital to adopt strict measures of infection control in hospitals. Regular training courses for infection control measures are recommended for medical staff.