KNOWLEDGE AND COMPLIANCE WITH SAFETY PRECAUTIONS AMONG HEALTH FACILITIES IN NIGERIA A CASE STUDY OF ORUK ANAM LGA, AKWA IBOM STATE
CHAPTER ONE
INTRODUCTION
BACKGROUND OF THE STUDY
Infection is one of the most important problems in health care services worldwide. It constitutes one of the most important causes of
morbidity and mortality associated with clinical, diagnostic and therapeutic procedures. 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 human immunodeficiency virus (HIV), hepatitis B and hepatitis C viruses, from sharp injuries and contacts with blood
and other body fluids. According to a World Health Organization (WHO) estimate, in year 2002, sharp injuries resulted in 16 000 hepatitis C
virus, 66 000 hepatitis B virus and 1000 HIV infections in health care workers worldwide. Recapping, disassembly, and inappropriate
disposal increase the risk of needle stick injury. The incidence rate of these causative factors is higher in developing countries for the higher
rate of injection with previously used syringes. Developing countries where the prevalence of HIV infected patients is very high, record the
highest needle stick injuries too. Needle stick injuries were also reported as the most common occupational health hazard in a Nigerian
teaching hospital. Interventional measures have been proposed to minimize exposure of health care workers and patients to infection with
the implementation of universal precautions as one of the strategies. In 1983, the US Centre for Disease Control and Prevention (CDC)
published a document that 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. This applies to blood and other body fluids containing visible blood and also to vaginal secretions and semen. In 1996, the CDC
included the universal precautions in a new prevention concept the so-called “safety precautions.” The “safety 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.” The fact that “safety precautions” are recommended for the care delivery to all patients, regardless of their
presumed infection state, is important when handling equipment and devices that are contaminated or suspected of contamination, and in
situations of contact risk with blood, body fluids, secretions and excretions except sweat, without considering the presence or absence of
visible blood and skin with solution of continuity and mucous tissues. Safety precautions include hand washing; use of barriers (e.g., gloves,
gown, cap, mask); care with devices, equipment and clothing used during care; environmental control (e.g., surface processing protocols,
health service waste handling); adequate discarding of sharp instruments including needles; and patient’s accommodation in accord to
requirement levels as an infection transmission source. Another important measure is adequate professional immunization, as this
guarantees anticipated protection against immune-preventable diseases. The level of practice of universal precautions by health care
workers may differ from one type of health care worker to another. The divergences in knowledge of universal precaution by health care
workers may be influenced by their different type of training. Various studies carried out among different categories of health care workers
found that exposure to blood or other body fluids was approximately 9.3%.A similar study conducted in Ibadan found a higher exposure
rate of 25.1%. Several factors ranging from personal to organizational causes were responsible for non-adherence to the basic principles of
universal precautions among health care providers. Universal precaution awareness education has not been pronounced among health
care workers, particularly in developing countries. According to the most recent guideline published by the Healthcare Infection Control
Practices Advisory Committee (HICPAC) in 2007, it has been recommended to apply safety precautions (SPs) for all people during healthcare
irrespective of their disease status. These SPs include but not limited to hand hygiene, use of personal protective equipment, and
instrument processing. In many studies, compliance with safety precautions among healthcare professionals was reported to be
inadequate with regard to eye protection, avoidance of needle recapping, glove use when required, and washing hands before and after
patient contact, use of face masks, and avoidance of a used needle that is disassembled from a syringe and in implementation of
precautions for all patients. According to the literature, major reported factors that affect compliance with safety precautions include but
not limited to lack of understanding and knowledge among healthcare workers on Safety Precautions, shortage of time to implement the
precautions (work overload), limited resources, lack of proper training, uncomfortable equipment, skin irritation, forgetfulness, distance
from the necessary facilities, and insufficient support from management in creating a facilitating work environment. Moreover, certain
socio-demographic variables such as age, sex, job category, marital status, working site in the hospital and work experience were found to
be associated with compliance with safety precautions. Interventions tried in other countries to increase the compliance of healthcare
workers with Safety Precautions include but not limited to in-service training on Safety Precautions beyond ordinary level, pre-service
training by inclusion of Safety Precautions in educational curricula, and availability of personal protective equipment. We, therefore,
conducted this study to assess the knowledge, and compliance with safety precautions among health facilities in Oruk Anam L.G.A, Akwa
Ibom State.
1.3 AIMS AND OBJECTIVES OF THE STUDY
The general objective is to assess the knowledge and compliance with safety precautions among health facilities in Nigeria. Other general
objectives of the study include the following;
To assess the level of knowledge of safety precautions among health facilities in Nigeria.
To ascertain the attitude of health care workers in health facilities towards safety precautions.
To determine the level of compliance with safety precautions among health facilities in Nigeria.
To examine the impact of knowledge and compliance on safety precaution among health care workers in health facilities in Nigeria.
To examine the relationship between compliance and compliance with safety precautions among workers in health facilities in
Nigeria.
To describe the action taken by the health care workers in health facilities when they are exposed to occupational hazards and injuries.
To determine some of the factors that affect knowledge, attitude and practice of safety precautions among the health care workers in
health facilities.
1.6. SIGNIFICANCE OF THE STUDY
On the whole, available data show that needle stick injuries and blood borne pathogens are serious threats to patients, health care workers
and to the host community. The rising prevalence of morbidity and mortality as a result of nosocomial and blood borne infections such as
HIV/AIDS, HBV and HCV among others is as a result of lack of awareness, wrong attitude towards and non-compliance with the definitions
and recommendations of safety precautions. Compliance with safety precautions has been shown to reduce risk of exposure to blood and
body fluids. Due to this, surveillance of health care workers compliance to safety precautions is an important element of occupational and
nosocomial infection control as it enables assessment of risks from occupation exposure to infection.
This study will expose the level of awareness, attitude and practice of safety precautions among the health care workers in health care
facilities in Nigeria and hence could be used as a baseline for intervention. It will also identify gaps which would be recommended for
correction through interventions. This study could be used to monitor trends of events concerning knowledge, attitude and practice of
safety precautions among health care workers in health care facilities in Nigeria, by reviewing from time to time, the incidence of needle
stick injuries and the morbidity and mortality pattern. It will also identify gaps in the standard precaution practices among these HCWs and
the results from the study will be used for the planning of health education intervention programme. It will also provide reference material
for the academic society as well as further research.
1.7. SCOPE OF THE STUDY
The study is restricted to the knowledge and compliance with safety precautions among health facilities in Nigeria using Oruk Anam LGA in
Akwa Ibom state as a case study.
LIMITATION OF THE STUDY
Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or
information and in the process of data collection (internet, questionnaire and interview).
Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on
the time devoted for the research work.
KNOWLEDGE AND COMPLIANCE WITH SAFETY PRECAUTIONS AMONG HEALTH FACILITIES IN NIGERIA A CASE STUDY OF ORUK ANAM LGA, AKWA IBOM STATE
