Practices of Healthcare Workers regarding Infection Prevention in Bale Zone Hospitals, Southeast Ethiopia

Zenbaba, Demisu; Sahiledengle, Biniyam; Bogale, Daniel

doi:https://doi.org/10.1155/2020/4198081

Advances in Public Health

On this page

Abstract Introduction Materials and Methods Results Discussion Conclusions Data Availability Conflicts of Interest Acknowledgments References Copyright Related Articles

Research Article | Open Access

Volume 2020 | Article ID 4198081 | https://doi.org/10.1155/2020/4198081

Practices of Healthcare Workers regarding Infection Prevention in Bale Zone Hospitals, Southeast Ethiopia

Demisu Zenbaba,¹Biniyam Sahiledengle,²and Daniel Bogale²

Academic Editor: Carol J. Burns

Received17 Apr 2019

Revised02 Jan 2020

Accepted14 Jan 2020

Published01 Feb 2020

Abstract

Introduction. In Ethiopia, infection prevention to protect patients, healthcare workers, and visitors from healthcare-acquired infections is one of a number of nationwide transformational initiatives to ensure the provision of quality healthcare services. The aim of this research was to assess the practice of healthcare workers regarding infection prevention and its associated factors in Bale zone Hospitals. Methods. A cross-sectional study targeted 402 healthcare workers using simple random sampling to learn about their practices related to infection prevention. Data were collected in interviews using pretested, structured questionnaires. Returned questionnaires were checked for completeness and then data were entered into a database and analyzed using SPSS Version 20. Adjusted odd ratio (AOR) with a 95% confidence interval was calculated to determine the strength of association, and variables with a p value <0.05 in the final model were considered as statistically significant. Results. Three hundred ninety-four healthcare workers participated in the study. Of these; 145 (36.8%, 95% CI 32, 42%) of them were found to have self-reported good infection prevention practice. Good knowledge towards infection prevention (AOR = 1.84, 95% CI 1.02, 3.31), availability of personal protective equipment (AOR = 1.96, 95% CI 1.16, 3.32), and water (AOR = 4.42, 95% 2.66, 7.34) at workplace were found to have a statistically significant association with healthcare workers self-reported good infection prevention practices. Conclusions. In this study, slightly more than one-third of the healthcare workers reported to have good infection prevention practice. Good knowledge towards infection prevention, working in departments, availability of personal protective equipment, and water at work place were found to have statistically significant association with self-reported good infection prevention practices.

1. Introduction

Infection prevention refers to all policies, procedures, and activities which aim to prevent or minimize the risk of transmission of infectious diseases at healthcare facilities. An effective hospital infection prevention and control program improves patient safety and the quality of patient care and reduces adverse socioeconomic and psychological impact of infectious diseases to patients and health systems [1, 2]. In Ethiopia, infection prevention in healthcare settings is a nationwide initiative that involves the implementation of recommended infection prevention practices in every aspect of patient care. Such practices include hand hygiene, injection safety, and healthcare waste management among infection prevention components [3, 4].

Healthcare-associated infections (HCAIs) are a major challenge for low- and middle-income countries which have limited healthcare resources. HCAIs pose a real and serious threat to both the patients and healthcare workers. Common pathogens may easily be transmitted through healthcare workers’ hands, equipment, supplies, and unhygienic practices [5, 6]. An estimated 10% of hospitalized patients in developed countries and 25% in developing countries develop HCAIs and subsequently result in adverse healthcare outcomes as increased hospital stay, economic burden, significant morbidity, and mortality. It is unevenly distributed in developing countries where more than 90% of these infections occurred [7–9]. The high burden of HCAIs is due to the lack of standardized infection prevention programs, which was neglected due to limited resources, poor sanitary conditions, and hygiene practices [10–12].

The World Health Organization (WHO) estimates that 3 million percutaneous exposures occur annually among 35 million HCWs globally, over 90% occurring in resource constrained countries. Healthcare workers in Africa suffer two to four needlestick injuries per year on average [13, 14], with Nigeria, Tanzania, and South Africa reporting 2.10 injuries per healthcare workers on average. Worldwide occupational exposure accounts for 2.5% of HIV cases and 40% of hepatitis B and C cases among HCWs [15]. Each year as a consequence of occupational exposure, an estimated 66,000 hepatitis B, 16,000 hepatitis C, and up to 1,000 HIV infections occur among healthcare workers. These infections are preventable through infection prevention measures which significantly reduce the risk of HIV and hepatitis transmission among healthcare workers [16].

The Centers for Disease Control and Prevention estimates that 2 million patients suffer from hospital-acquired infections and nearly 100,000 of them die every year. Hepatitis B virus, hepatitis C virus, and HIV infection are mostly transmitted by healthcare workers who fail to practice infection prevention measures. Hence, healthcare workers are front line of protecting themselves and clients from infection [17–19].

A study conducted in Jimma Zone, Ethiopia, also showed that the majority of injections were completed by recapping the syringe and needle. Many healthcare workers reported frequent needlestick injuries in one year, associated with sudden movement of patients, disposal of sharp materials, recapping during surgical procedures, and recapping of needles immediately after use [20, 21].

A study conducted in the west Arsis zone, southeast Ethiopia, indicated that healthcare workers had poor hand-hygiene practice after patient care during their regular activities. About 39% of healthcare workers had a history of contact with blood and body fluids; if such event occurred, 40% of workers believed that cleaning the wound with alcohol was the best measure to be taken to prevent infection while 60% wash/rinse with water [22]. To better understanding of healthcare worker's compliance with infection prevention measures and to minimize the risk of occupational exposure to healthcare associated infections, the assessment of the current infection prevention practice is vital in Bale zone hospitals. To the best of our knowledge in southeast part of Ethiopia, particularly in Bale zone, there is no study that describes healthcare workers infection prevention status. The current study is the first attempt to describe practice of healthcare workers regarding infection prevention.

2. Materials and Methods

2.1. Study Area and Period

A cross-sectional study of healthcare workers practices regarding infection prevention was conducted in Bale zone hospitals, southeast Ethiopia. In Bale zone, there are 84 health centers and five hospitals (One Primary and Referral Hospital, three General Hospitals). All hospitals found in the Bale zone were included in the study. The sampling frames of healthcare workers were prepared for each hospital, and the simple random sampling method was used to selected study participants by the lottery method. The study period was from February 01/2018 to 28/2018.

2.2. Source and Study Population

The source and study populations were all healthcare workers (HCWs) except pharmacists, druggists, and environmental health officers who provide healthcare services in Bale zone hospitals.

2.2.1. Inclusion Criteria

Healthcare workers who had at least one of four possible contacts (patient, medical equipment, linens, and high-risk waste).

2.2.2. Exclusion Criteria

The healthcare workers who were on annual leave, on maternity leave, and ill and who had night duty were excluded from the study.

2.3. Sample Size Determination

The sample size was determined using the single-population proportion formula with a 5% margin of error (d) and a confidence level of 95% (Z). The sample size calculated for practice of healthcare workers regarding infection prevention was 382, and a 5% nonresponse rate was considered giving a final sample size of 402.

2.4. Data Collection Tool and Technique

Data were collected by interview using pretested, structured questionnaires containing health care workers’ sociodemographic characteristics, practices, and knowledge regarding infection prevention.

2.5. Data Quality Control

The questionnaire was developed first in English and translated to local languages by an expert of both languages “Amharic” and “Afaan Oromoo” and then back to English to check for consistency of the translation. To assure the data quality, data collection instruments were pretested, and in order to minimize over-reporting of infection prevention practices, the questionnaire was also set in PK (Practice and Knowledge) order. For each component, the reliability test was done and the reliability coefficient for practice and knowledge items had a Cronbach’s alpha of 0.750, and 0.732 was found to be the acceptable level. A pretest was conducted using 5% of the intended total sample size (20 individuals). By doing so, the tool was checked for its clarity, understandability, and completeness.

2.6. Data Processing and Analysis

The returned questionnaires were checked for completeness, and then, data were coded, entered, cleaned, and stored using SPSS Version 20 statistical software for analysis. Descriptive statistics (mean (SD), median, mode, and frequency tables) were computed to check normal distribution of data and describe practice of healthcare workers regarding infection prevention. Bivariate logistic regression analysis was used to identify the candidate variables for multivariable logistic regression by using a value less than 0.2. Adjusted odds ratio with 95% confidence interval was calculated to determine the strength of association, and variables having a value <0.05 in the final model were considered as statistical significance.

2.7. Operational Definition

Practices of healthcare workers regarding infection prevention were assessed for main domains of infection prevention measures like hand hygiene, utilization of personal protective equipment (PPE), and postexposure prophylaxes (PEP), healthcare waste management, and safe injection. Infection prevention knowledge and practice of healthcare workers were assessed by using 20 items/questions (10 for each of them).

2.7.1. Good Infection Prevention Practice

Respondents who correctly answer questions regarding infection prevention practice scored above (≥70%). In the same manner, the knowledge of healthcare workers regarding infection prevention was assessed.

3. Results

3.1. Sociodemographic and Work-Related Characteristics of Study Participants

Among 402 healthcare workers selected, 394 healthcare workers were interviewed with a response rate of 98%. From total study participants, 202 (51.3%) males and 192 (48.7%) females were participated in study with age ranging from 18 to 43 years and mean age of 28.8 years (SD ± 5.2) (Table 1).

3.2. Practices of Healthcare Workers regarding Infection Prevention

A summary score was developed from continuous data of practice of healthcare workers regarding infection prevention. The mean was 5.5 (SD ± 2.22), and the median and mode were 6. Using this cutoff point, the practices of healthcare workers were categorized as good (code = 1 above mean value or ≥70%) and poor (code = 0 score less than 70%). Accordingly, 145 (36.8%) (95% CI 32), 42%, of HCWs had good self-reported infection prevention practice with while 249 (63.2%) of HCWs had poor practice (Table 2).

3.3. Factors Associated with Practices of HCWs regarding Infection Prevention

Healthcare workers working in pediatric wards had 66% lower odds of self-reported good infection prevention practices than HCWs working in medical and surgical wards (AOR = 0.34, 95% CI (0.15, 0.76)). In this study, waste handlers had 75% lower odds of self-reported good practice regarding infection prevention than healthcare workers who had the profession of medical laboratory technician or technologist and other professions (AOR = 0.25, 95% CI (0.08, 0.78). The study participants who had all necessary personal protective equipment (AOR = 1.96, 95% CI 1.16, 3.32) and water (AOR = 4.42, 95% 2.66, 7.34) at their work place nearly two and four times more likely reported to have good infection prevention practice than their counterpart, respectively (Table 3).

4. Discussion

Hospital-acquired infection is a common problem all over the world. Without adequate infection prevention practice, healthcare workers are at a higher risk of acquiring infectious diseases. Therefore, up-to-date healthcare workers knowledge and practice can play important roles in infection prevention and control [23, 24].

Based on the responses provided, in this study, slightly more than one-third (36.8%) of healthcare workers had good self-reported infection prevention practice, which is lower than study findings in an Egyptian hospital, 57.3% [25], in Bihar Dar city, Ethiopia, 54.2% [26], in governmental healthcare facilities, Addis Ababa, 66.1% [27], and in Shenen Gibe hospital, 68.08% [28]. The possible reason for the current low practice might be due to 1) variation in cut of point which is used to determine the outcome variable 2) variation in type and number of healthcare facilities included in these studies, 3) difference in healthcare worker infection prevention training (e.g., only 13.2% of healthcare works reported that they received infection prevention training in the past 12 months), and 4) sample size discrepancy. Healthcare workers who had good knowledge appeared to have nearly two times the likelihood of reporting good practice scores than those who had poor knowledge. In addition, the healthcare workers who had all the necessary personal protective equipment (PPE) and water supply at their work place were nearly two and four times more likely to report good practice than their counterparts (who had none of these supplies). This finding was consistent with the study finding in a governmental healthcare facility in Addis Ababa where healthcare workers who had PPE and continuous water supply were 1.37 and 1.68 times more likely reported to have good infection prevention practice, respectively [27]. In this study, 62.3% and 37.7% of healthcare workers had a history of sharp material injuries within the lifetime and the last one year, respectively. This appears to be higher than of study findings in two administrative regions of Ethiopia, where the lifetime and last one year exposure were 30.5% and 25.7%, respectively [29]. Similarly, this finding was higher than a previous study of the prevalence of needlestick injury in Bale zone hospitals, 37.1% lifetime and 19.1% last one year [30]. The possible explanation for this discrepancy might be the number of healthcare facilities included in the study, duration of the study, and characteristics of study participants. The percent of healthcare workers with two hand needle recapping practice was 27.6%. This finding was comparable with the study finding in Mizan Aman general hospital, 27.8% [31]. Waste segregation is a hospital strategy to dispose infectious wastes off safely. In this study, 45.3% of healthcare workers reported not segregating waste at their work place. Healthcare workers report that 59.9% practice hand washing practices at all critical times; of these, 71% of HCWs report washing their hands before and after procedures. This result was better than the finding of 29.8% reporting hand washing in Shenen Gibe Hospital, southwest Ethiopia [28], and higher than the result reported from a study conducted in Bihar Dar City administration, 61% [26]. Majority of the healthcare workers (72.1%) appear to have good knowledge regarding infection prevention. This finding was better than the study finding from three regional hospitals in Trinidad and Tobago in India, 20.3% [32], and lower than the study finding in Bihar Dar city administration, 84.2% [26], and in Wolaitta Sodo Otona Teaching and Referral Hospital, 99.3% [33]. These study findings were higher than an equivalent study finding of governmental healthcare facilities in Addis Ababa, 55.6% [27]. The possible justification for this difference might be due to difference level of hospitals (only general), level or types of healthcare facilities (governmental vs. private, hospital vs. health center), sample size, and study participant characteristics.

5. Limitations of the study

As participants were only chosen from hospital settings, generalization of this study is limited to hospitals of Bale Zone and not to smaller healthcare facilities found in the Bale zone.

6. Conclusions

Regardless of the above limitation, this study enables us to determine the status of healthcare workers’ self-reported practice regarding infection prevention revealing that slightly more than one-third of them have good self-reported practice. Good knowledge of healthcare workers regarding infection prevention, profession of healthcare workers, working place, availability of personal protective equipment, and water at the work place were found to have significant association with practice of healthcare workers infection prevention. Therefore, this required strong effort of all stakeholders, especially all levels of hospital administration, hospital infection prevention committee, and healthcare workers and updating healthcare workers infection prevention knowledge and practice through off-job and on-job training. Hospitals should improve infection prevention practices of healthcare workers by establishing or providing infection prevention facilities and supplies, continuous water supply at all working departments, hand washing sinks, and all necessary personal protective equipment. Besides, enforcement of existing laws on infection prevention at work places and continuous monitoring should be performed to increase adherence of healthcare workers to infection prevention practices.

Data Availability

The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.

Conflicts of Interest

The authors declare no conflicts of interest.

Acknowledgments

The authors would like to thank Dr. David Allison, all study participants, data collectors, supervisors, and Bale zone hospital administration for their helpful participation in this study.

References

World Health Organization, WHO Best Practices for Injections and Related Procedures Toolkit. No. WHO/EHT/10.02, World Health Organization, Geneva, Switzerland, 2010.
World Health organization, “Infection control,” 2015, http://www.Who.int/tropical/Infection_control.
View at: Google Scholar
Federal Ministry of Health, Infection Prevention and Patient Safety Training Resource Package Facilitator’s Guide, Federal Ministry of Health, Abuja, Nigeria, 2012.
E. Tesfahun, A. Kumie, W. Legesse, H. Kloos, and A. Beyene, “Assessment of composition and generation rate of healthcare wastes in selected public and private hospitals of Ethiopia,” Waste Management & Research, vol. 32, no. 3, pp. 215–220, 2014.
View at: Publisher Site | Google Scholar
S. A. Khan, “Nosocomial infection: general principles and the consequences, importance of its control and an outline of the control policy-a review article,” Bangladesh Medical Journal, vol. 38, no. 2, pp. 60–64, 1970.
View at: Publisher Site | Google Scholar
J. D. Stanaway, A. D. Flaxman, M. Naghavi et al., “The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013,” The Lancet, vol. 388, no. 10049, pp. 1081–1088, 2016.
View at: Publisher Site | Google Scholar
S. B. Nejad, B. Allegranzi, S. Syed, B. Ellis, and D. Pittet, “Health-care-associated infection in Africa: a systematic review,” Bulletin of the World Health Organization, vol. 89, no. 10, pp. 757–765, 2011.
View at: Publisher Site | Google Scholar
M. G. Menegueti, S. R. M. da Silva Canini, F. Bellissimo-Rodrigues, and A. M. Laus, “Evaluation of nosocomial infection control programs in health services,” Revista Latino-Americana de Enfermagem, vol. 23, no. 1, pp. 98–105, 2015.
View at: Publisher Site | Google Scholar
E. Nwankwo, “Isolation of pathogenic bacteria from fomites in the operating rooms of a specialist hospital in Kano, North-western Nigeria,” Pan African Medical Journal, vol. 12, p. 1, 2012.
View at: Google Scholar
W. W. Yallew, A. Kumie, and F. M. Yehuala, “Risk factors for hospital-acquired infections in teaching hospitals of Amhara regional state, Ethiopia: a matched-case control study,” PloS one, vol. 12, no. 7, Article ID e0181145, 2017.
View at: Publisher Site | Google Scholar
M. A. Borg, “Prevention and control of healthcare associated infections within developing countries,” International Journal of Infection Control, vol. 6, no. 1, pp. 1–6, 2010.
View at: Publisher Site | Google Scholar
V. A. Curtis, L. O. Danquah, and R. V. Aunger, “Planned, motivated and habitual hygiene behaviour: an eleven country review,” Health Education Research, vol. 24, no. 4, pp. 655–673, 2009.
View at: Publisher Site | Google Scholar
O. Rasslan, Z. S. Seliem, I. A. Ghazi et al., “Device-associated infection rates in adult and pediatric intensive care units of hospitals in Egypt. International Nosocomial Infection Control Consortium (INICC) findings,” Journal of Infection and Public Health, vol. 5, no. 6, pp. 394–402, 2012.
View at: Publisher Site | Google Scholar
E. Kamunge, T. Cahill, G. Zipp, and R. Parasher, “Knowledge, attitudes and practices of registered nurses regarding the spread of nosocomial infections and the impact of organizational support,” Antimicrobial Resistance and Infection Control, vol. 4, no. S1, pp. S1–60, 2015.
View at: Publisher Site | Google Scholar
A. Prüss-Üstün, E. Rapiti, and Y. Hutin, “Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers,” American Journal of Industrial Medicine, vol. 48, no. 6, pp. 482–490, 2005.
View at: Publisher Site | Google Scholar
E. Rapiti, A. Prüss-Üstün, and Y. J. F. Hutin, Sharps Injuries: Assessing the Burden of Disease from Sharps Injuries to Health-Care Workers at National and Local Levels, London, Germany, 2005.
World Health Organization, The World Health Report 2002: Reducing Risks, Promoting Healthy Life, World Health Organization, Geneva, Switzerland, 2002.
A. Gupta, S. Anand, J. Sastry et al., “High risk for occupational exposure to HIV and utilization of post-exposure prophylaxis in a teaching hospital in Pune, India,” BMC Infectious Diseases, vol. 8, no. 1, p. 142, 2008.
View at: Publisher Site | Google Scholar
Centers for Disease Control and Prevention, Healthcare Associated Infections, Centers for Disease Control and Prevention, Atlanta, GA, USA, 2013, http://www.cdc.gov/sttpublichealth/psr/hai/.
T. Bosena and H. Chernet, “Assessment of HIV exposure prophylaxis among health workers of governmental health institute in jimma zone, Oromia Region, south west Ethiopia,” Ethiopian Journal of Health Sciences, vol. 20, no. 1, pp. 55–64, 2010.
View at: Publisher Site | Google Scholar
A. Gessessew and A. Kahsu, “Occupational exposure of health workers to blood and body fluids in six hospitals of Tigray region (August 1–30, 2006): magnitude and management,” Ethiopian Medical Journal, vol. 47, no. 3, pp. 213–219, 2009.
View at: Google Scholar
B. S. Geberemariyam, G. M. Donka, and B. Wordofa, “Assessment of knowledge and practices of healthcare workers towards infection prevention and associated factors in healthcare facilities of West Arsi District, Southeast Ethiopia: a facility-based cross-sectional study,” Archives of Public Health, vol. 76, no. 1, p. 69, 2018.
View at: Publisher Site | Google Scholar
N. Z. Janjua, M. Razaq, S. Chandir, S. Rozi, and B. Mahmood, “Poor knowledge–predictor of nonadherence to universal precautions for blood borne pathogens at first level care facilities in Pakistan,” BMC Infectious Diseases, vol. 7, no. 1, p. 81, 2007.
View at: Publisher Site | Google Scholar
O. E. Johnson, M. C. Asuzu, and A. D. Adebiyi, “Knowledge and practice of universal precautions among professionals in public and private health facilities in Uyo, Southern Nigeria- a comparative study,” Ibom Medical Journal, vol. 6, no. 1, pp. 9–19, 2013.
View at: Google Scholar
El-Enein, N. Younis Abou, M. Hala, and El Mahdy, “Standard precautions: a KAP study among nurses in the dialysis unit in a University Hospital in Alexandria, Egypt,” The Journal of the Egyptian Public Health Association, vol. 86, no. 1-2, pp. 3–10, 2011.
View at: Publisher Site | Google Scholar
K. Gulilat and G. Tiruneh, “Assessment of knowledge, attitude and practice of health care workers on infection prevention in health institution Bahir Dar city administration,” Science Journal of Public Health, vol. 2, no. 5, pp. 384–393, 2014.
View at: Publisher Site | Google Scholar
B. Sahiledengle, A. Gebresilassie, T. Getahun, and D. Hiko, “Infection prevention practices and associated factors among healthcare workers in governmental healthcare facilities in Addis Ababa,” Ethiopian Journal of Health Sciences, vol. 28, no. 2, pp. 177–186, 2018.
View at: Publisher Site | Google Scholar
B. S. Alemu, A. D. Bezune, J. Joseph, A. A. Gebru, Y. Y. Ayene, and B. A. Tamene, “Knowledge and practices of hand washing and glove utilization among the health care providers of shenen gibe hospital, South West Ethiopia,” Science, vol. 3, no. 3, pp. 391–397, 2015.
View at: Google Scholar
A. A. Reda, “Shiferaw Fisseha, Bezatu Mengistie, and Jean-Michel Vandeweerd. “Standard precautions: occupational exposure and behavior of health care workers in Ethiopia,” PLoS One, vol. 5, Article ID e14420, 12 pages, 2010.
View at: Publisher Site | Google Scholar
T. Bekele, A. Gebremariam, M. Kaso, and K. Ahmed, “Attitude, reporting behavour and management practice of occupational needle stick and sharps injuries among hospital healthcare workers in Bale zone, Southeast Ethiopia: a cross-sectional study,” Journal of Occupational Medicine and Toxicology, vol. 10, no. 1, Article ID e0140382, 10 pages, 2015.
View at: Publisher Site | Google Scholar
E. Yakob, T. Lamaro, and A. Henok, “Knowledge, attitude and practice towards infection control measures among Mizan-Aman general hospital workers, South West Ethiopia,” Journal of Community Medicine & Health Education, vol. 5, no. 5, pp. 1–8, 2015.
View at: Publisher Site | Google Scholar
C. G. Unakal, A. Nathaniel, B. Keagan et al., “Assessment of knowledge, attitudes, and practices towards infection prevention among healthcare workers in Trinidad and Tobago,” International Journal of Community Medicine and Public Health, vol. 4, no. 7, pp. 2240–2247, 2017.
View at: Publisher Site | Google Scholar
S. Hussein, W. Estifanos, E. Melese, and F. Moga, “Knowledge, attitude and practice of infection prevention measures among health care workers in wolaitta sodo Otona teaching and referral hospital,” Journal of Nursing & Care, vol. 6, no. 416, pp. 2167–1168, 2017.
View at: Publisher Site | Google Scholar

Copyright

Copyright © 2020 Demisu Zenbaba et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

PDF Download Citation

Download other formats

Order printed copies

Views

10458

Downloads

2880

Citations