Abstract

Background: Nosocomial infections can be acquired by a patient or developed among hospital staff, as a serious problem among low- and middle-income hospital settings.

Assessing the perception of health workers regarding prevention and control of nosocomial infection in health facilities in Buea Health District has unquestionable importance of handling and management of these. Thus, in this study, we assess the perception of health workers regarding the prevention and control of Nosocomial Infections in health facilities in Buea Health District.

Method: a hospital-based cross-sectional study was conducted among health care workers towards the perception of health workers regarding prevention and control of Nosocomial infection, from May to June 2021. Each study participant was selected by simple random sampling. Data was collected using structured self-administered questionnaires.

Descriptive analysis was used to present the frequency and percentage of main findings. The association between dependent and independent variables was calculated using Pearson’s Chi-square and p-values less than 0.05 were considered as statistically significant.

Results: A total of 150 participants were included in this study with a 100% response rate. 60% of the participants had good perceptions toward prevention and control of Nosocomial infections.

Conclusion: even though the respondents have good knowledge with a sympathetic attitude about HAIs, there remain some gaps in fully acquiring a good perception regarding the prevention and control of nosocomial infections in Buea Health District

CHAPTER ONE

INTRODUCTION

1.1 Background

Nosocomial infection is a leading cause of prolonged hospital stay, long-term disability, increased antimicrobial resistance, increase in socio-economic disturbance, and increased mortality rate in developing countries, and the prevalence of Nosocomial infection is expected to increase in the next decades in these countries. The aim of this study is to determine the perception of healthcare workers regarding the prevention and control of Nosocomial infections in health facilities in the Buea health district.

Nosocomial infection (NI) or health care-acquired infection (HCAI) also called Hospital-acquired infection (HAI) is an infection that is acquired in the hospital or other health care facility [1]. The perception of health care workers regarding the prevention and control of nosocomial infections involves the attitudes, behaviors, measures taken to prevent and control hospital-acquired infections (HAIs).

HCAIs appear in a patient under medical care in the hospital or other health care facility which was absent at the time of admission. Additionally, they comprise occupational infections among the medical staff [1].

Invasive devices such as catheters and ventilators employed in modern health care are associated with these infections [2]. Of every one hundred hospitalized patients, seven in developed countries and ten in developing countries can acquire one of the HCAIs [3].

In 1841, Ignaz Semmelweis specifically identifies the manifestation of NIs as he was working at a Vienna maternity Hospital. He was shocked by the death rate of children who developed a puerperal fever. He documented that mortality was three-time higher in the ward where the medical students were delivering babies than in the next ward that was staffed by midwifery students [1].

The medical students were also routinely working with cadavers. He compared the rate of infection with a similar hospital in Dublin Ireland and hypothesized that it was the medical students who somehow were infecting the women after labour. He instituted mandatory hand washing in May 1847 and infection rates dropped dramatically [2,3].

As medical care becomes more complex and antibiotic resistance increases, the cases of HAIs will grow but the good news is that HAIs can be prevented in a lot of healthcare situations. The Population at stake are patients in intensive care units (ICUs), burn units, undergoing organ transplants,s, and neonates.

According to the extended prevalence of infection in intensive care study, the proportion of infected patients within the ICU are often as high as 51% [4]. Based on extensive studies in the USA and Europe shows that HCAI incidence density ranged from 13.0 to 20.3 episodes per thousand patient days [5].

NIs are the most frequent adverse event in healthcare delivery worldwide. Hundreds of millions of patients are affected by healthcare-associated infections worldwide each year, leading to significant mortality and financial losses for health systems.

At any given time the prevalence of NIs in developed countries varies between 3.5% and 12% [5]. The European center for disease prevention reports an average prevalence of 7.1% in European countries[5].

The center estimates that 4131000 patients are affected by approximately 4544 episodes of NIs every year in Europe. The estimated incidence rate in the United States of America (USA) was 4.5% in 2002, corresponding to 9.3 infections per 1000 patient-days and 1.7 million affected patients.

According to a recent European multicenter study, the proportion of infected patients in intensive care units can be as high as 51%, most of which are healthcare-associated. A recent analysis by WHO found that healthcare-associated infections are more frequent in developing countries than in the developed countries.

At any given time, the prevalence of NIs varies between 5.7% and 19.1% in developing countries. Among hospital-born babies in low-income countries, NIs are responsible for 4% to 56% of all causes of death in the neonatal period, and 75% in South East Asia and Sub-Saharian Africa.

Also, Surgical sites infection is the leading infection in the general patient population in countries with limited resources, affecting up to two-third of operated patients and with a frequency up to nine times higher than in developed countries.

NIs can be prevented from the baseline so that their spread can be controlled. An unhygienic environment serves as the best source for the pathogenic organism to prevail. Air, water, and food can get contaminated and transmitted to the patients under healthcare delivery.

There must be policies to ensure the cleaning and use of cleaning agents on walls, floors, windows, beds, baths, toilets and other medical devices. Proper ventilated and fresh filtered air can eliminate airborne bacterial contamination.

A regular check of filters and ventilation systems of general wards, operating theatres, and ICUs must be maintained and documented. Infections attributed to water are due to the failure of healthcare institutions to meet the standard criteria. Improper food handling may cause food-borne infections [4]. Infections can be transferred from healthcare staff. It is the duty of healthcare professionals to take a role in infection control. Personal hygiene is necessary for everyone so staff should maintain it [5].

In Buea health District there are no effective infection control programs due to lack of awareness of the problem, lack of personnel, poor water supply, erratic electricity supply, ineffective antibiotic policies with the emergence of multiple antibiotic-resistant microbes, poor laboratory backup, poor funding, and non-adherence to safe practices by health workers.

It is recommended that the cost of the hospital infection control program should be included in the health budget of the country and funds allocated for the infection control committee for routine control purposes and to bear the cost of outbreaks.

In the Buea health district, there is a need for adequate staffing and continuous education of staff on the principles of infection control, especially hand washing which is the single most important effective measure to reduce the risks of cross-infection.

There is the insufficient water supply for hand washing in Buea municipality meanwhile in the developed countries such as in Canada there is a good water supply and the rate of awareness is high.

1.2 Problem Statement

Nosocomial infections can negatively affect not just the health of the health care workers but also the academic achievements due to prolong disability and death, affects the future career plans of health Personnel due to an increase in socio-economic disturbance, and also it affects the total well-being of the health personnel due to emotional distress.

If left unchecked, the problem will expand and create a total avoidance pattern on the part of the health workers which can be expressed most visibly in the form of cutting Shifts/ work and Habitual absenteeism due to infection. As we can see this will negatively affect the performance of the health care workers at work.

In fact, the study conducted by Ignaz Semmelweis revealed that the outcome of nosocomial infection does not only negatively affect the nurse performance in health care-related situations but also their future career as professionals. Without a doubt therefore NI is a recurring problem for many health care workers which will negatively affect the performance and future career for the Personnel.

1.3 Justification of the study

Health care workers are an integral part of preventing and controlling nosocomial infections and complications. Awareness of health care workers and their patients about control methods such as putting on their face mask, hand washing, wearing gloves, social distancing, and lifestyle choices such as appropriate nutrition to boost the immune system enables health care workers to effectively take part in the prevention and control of nosocomial infection and complications.

This study will help to identify the various perceptions of health care workers regarding the prevention and control methods of nosocomial infections and also expose personnel to other strategies they are ignorant about in order to improve awareness.

1.4. Study Goal

This study seeks to strengthen, improve or promote the quality of perception healthcare workers should render regarding the prevention and control of Nosocomial infection health facilities in Buea Health District. It also seeks to provide suitable information for further research.

1.5 Research Objectives

1.5.1 General Objective

To assess the Perception of health workers regarding prevention and control of nosocomial infection in health facilities in Buea Health District.

1.5.2 Specific Objectives

1. To assess the perception of health workers on nosocomial infection.
2. To determine the preventive and control methods of nosocomial infection among health care workers in health facilities in Buea health district.
3. To assess the coping strategies used by health care providers in order to prevent and control Nosocomial infections in Buea Health District.

 1.5.3 Research Questions

1. How do health care workers perceive nosocomial infection?
2. What are the preventive and control methods of Nosocomial infections?
3. What coping strategies are used by health care workers to prevent and control nosocomial infections?