Practices of nurses towards the control of nosocomial infection at Ospital ng Maynila Medical Center : an assessment / Asuncion D. Cobacha Balisado 6

Thesis (M.A.) -- Pamantasan ng Lungsod ng Maynila, Intramuros, Manila, 2000.;A thesis presented to the faculty of Graduate School of Arts, Sciences, Education, and Nursing, Pamantasan ng Lungsod ng Maynila in partial fulfillment of the requirements for the degree of Master of Arts in Nursing. 56

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ABSTRACT. Statement of the Problem: This study aimed to determine the practices of nurses in the control of nosocomial infection. Specifically, it sought to answer the following question: 1. To what extent do nurses practice the control of nosocomial infection as to: a. Wound Infection b. Nosocomial Pneumonia c. Intravascular Infection d. Catheter-Associated Urinary Tract Infection? 2. Is there a significant relationship between the practices of nurses and the prevalence of nosocomial infections as to: a. Wound Infection b. Nosocomial Pneumonia c. Intravascular Infection d. Catheter-Associated Urinary Tract Infection? 3. What administrative remedies can be proposed to improve the control of nosocomial infections? 3. What training programs can be proposed to improve the practices of nurses in the control of nosocomial infections? Sampling and Instrumentation: The study was conducted on January to August 2000 utilizing the descriptive research method with the use of checklist questionnaire as an instrument. The principles set by the core group of national nosocomial infection control program of the Department of Health was adopted as the instrument consisting of fifty(50) statements pertaining to the control of nosomial infection as to wound infection, nosocomial pneumonia, intravascular infection, catheter-associated urinary tract infection, and on administrative aspect which focused on physical set-up, supplies and equipment, manpower and policy. There were a total of one hundred forty five (145) nurse respondents in fourteen(14) clinical areas namely: Emergency Services, OPD, EENT, Ob-gyne, DR, Pediatrics and Hemodialysis of the Ospital ng Maynila Medical Center. Universal sampling technique was utilized in the study. Questionnaires were distributed to head nurses in the different clinical areas who in turn requested their respective staff nurses to respond to the said questionnaire. A four (4) points numerical scale was used with the qualitative interpretation of the items resulting from a formulated numerical scale to determine the strengths and weaknesses in the control of nosocomial infections. Spot checking was conducted to validate the responses made on the questionnaire through frequent rounds during their peak hours of activity in nursing care. The survey was conducted for a period of two months, from June to August 2000. There were one hundred forty five (145) questionnaire retrieved. The statistical analysis of the data used in the study were the summative rating score to determine the practices of nurses; the problems encountered by nurses in the control of nosocomial infections and to give proposal on administrative remedies to improve in the control of nosocomial infections. To determine the significant relationship between the practices of nurses and the prevalence of nosocomial infection, the Pearson's Correlation Coefficient Value was used and the level of significance at 0.05. Findings: 1. The nurses always practice the control of nosocomial infection as to wound infection, nosocomial pneumonia, intravascular infection and catheter-associated urinary tract infection based on summative rating score of 3.2385, 3.0681, 3.2336 and 3.3528 respectively. 2. The correlation between the practices of nurses in the control of nosocomial infection and its prevalence of 0.05 level of significance revealed: a. There is a significant correlation between the practices of nurses and prevalence of wound infection. b. There is no significant correlation between the practices of nurses and prevalence of nosocomial pneumonia, intravascular infection and catheter-associated urinary tract infection. 3. There was no problem encountered by nurses in the control of nosocomial infection. 4. The highly recommended proposed administrative remedies that will improve the control of nosocomial infections were as follows: a. There should be an improvement in the ventilation of patient's room in all clinical areas. b. There should be an adequate supply of surgical gloves, suction catheters, oxygen catheters, masks, endotracheal tubes, nebulizer kit, disposable needles, syringes, vacosets, foley cathethers and urobag. c. There should be an adequate utility workers in all clinical areas. d. There should be a proper segregation of waste materials with regards to color-coded plastic bags for biohazards materials (e.g soiled dressings, used gloves, cotton balls soaked with blood). 5. A training program on infection control will be proposed to improve the practices of nurses in the control of nosocomial infections. This program will enable the nurses to apply the acquired knowledge and skills on nursing procedures and techniques related to infection control principles for quality improvement in patient care management. The duration of the courses will be four (4) weeks (16 hours) and will focus on the following topics: First Session - Wound Infection a. Sources and Mode of Transmission b. Prevention and Control c. Hand washing Technique d. Proper Wound Dressing Second Session - Nosocomial Pneumonia a. Sources and Mode of Transmission b. Prevention and Control c. General Guidelines on the Principles of Suctioning and its Technique Intravascular a. Sources and Mode of Transmission b. Prevention and Control c. Care of Patient on Intravenous Administration Third Session - Catheter-Associated Urinary Tract Infection a. Sources and Mode of Transmission b. Procedural Guidelines on Urinary Catheterization c. Care of Patient with Indwelling Catheter Fourth Session - Cleaning, Disinfection and Sterilization Procedures a. General Procedures for Cleaning and Washing Articles and Equipment b. Guidelines for Care of Respiratory Equipment • Ventilators • Oxygen Gauges • Nebulizers • Suction Machines • Incubators • Ambu-Bags and Masks Conclusions: Based on the findings of the study, the following conclusions were made: There is a correlation between the practices of nurses in the control of nosocomial infection and the prevalence of wound infection at 0.05 level of significance. The null hypothesis is rejected. Therefore, there is a significant relationship between the practices of nurses and the prevalence of wound infection. However, there is no correlation between the practices of nurses in the control of nosocomial infection and the prevalence of nosocomial pneumonia, intravascular infection and catheter- associated urinary tract infection. The null hypothesis is accepted. Therefore, there is no significant relationship between the practices of nurses and the prevalence of nosocomial pneumonia, intravascular infection and catheter -associated urinary tract infection. The nurses always practice the control of nosocomial infections as to wound infection, nosocomial infection as to wound infection, nosocomial pneumonia, intravascular infection and catheter-associate urinary tract infection. The administrative remedies that were highly recommended should focus on physical set-up, supplies and equipment, manpower and policy. There is a need for training program on infection control to upgrade the knowledge and skills of the nurses in the control of nosocomial infections. Recommendations. Based on the findings of the study, the researcher recommends the following: 1. Encourage continuous surveillance of suspected cases with hospital acquired infections. Follow up study should be done on the practices of nurses in the control of nosocomial infections. 2. For the administration, strengthen the Infection Control committee and mandate to implement the Infection Control Program of the hospital. 3. Continuous education and training on infection control practices to all hospital personnel to update their knowledge and skills. 4. The hospital management should: a. Ensure the availability of supplies such as: surgical gloves, suction catheters, oxygen catheters, mask, endotracheal tubes, nebulizer kit, disposable needles, syringes, vacosets, foley catheters and urobag. b. Provide adequate supply of the color-coded plastic bags for biohazards materials for proper garbage disposal in order to minimize nosocomial infection. c. Improve the ventilation of patients' room in all clinical areas. d. Provide more utility workers to augment the personnel requirement in all clinical areas. 5.

The same study should be conducted to a group of medical personnel at Ospital ng Maynila Medical Center related to the practices in the control of nosocomial infections so as to identify their needs in the improvement of patient care.

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