knowledge and practices among surgeons regarding cross infection control procedures in general...

International Journal of World Research, Vol: I Issue VIII, August 2014, Print ISSN: 2347-937X

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KNOWLEDGE AND PRACTICES AMONG SURGEONS REGARDING CROSS INFECTION

CONTROL PROCEDURES IN GENERAL HOSPITALS

Dr. Vibha Haripriya, Assistant Professor, Obs & Gynaecology, CIMS, Bilaspur

Dr. Anil Haripriya, Assistant Professor, General surgery, CIMS, Bilaspur

ABSTRACT

Background: Cross infection control is an essential aspect of medical profession, so the purpose of the

study was to assess knowledge and practice towards infection control.

Method: A structured self–administered pretested questionnaire was administered to 142 surgeons in

order to assess their knowledge and practice regarding cross infection control methods. Data were

analyzed using SPSS vers. 15., at p < 0.05.

Result: Half of the participants (53%) knew about immunization schedule for hepatitis B vaccination. 77%

were properly aware about universal precaution guidelines. 72% of the surgeons wash their hands after

gloves removal and 68% participants have the habit of separating needle from the syringe prior to disposal

but still they are having needle prick injuries. Females had higher level of knowledge and practices than

males.

Conclusion: Our finding showed adequate knowledge regarding infection control but their practices were

limited.

Key words: Cross infection, sterilization, surgeons, hospitals

INTRODUCTION

Hospitals are places where sick people go with the expectations that they will get better. Ironically,

hospitalized patients may at times become infected in the environment of the hospital, and such infections

are referred to as nosocomial infections.(1) It is the imbalance between classical triad of epidemiology i.e.

agent, host and environment which leads to the initiation of disease process and to which even hospital

acquired infections are not an exception. By controlling and adequately sanitising the environment of the


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host, the hospital authorities can markedly reduce the incidence of these infections.(2) Also, the physical

design of hospital is an essential component of a hospital’s infection control strategy, incorporating

infection control issues to minimise the risk of infection transmission.(3)

Effective infection control in a surgery clinic is a priority as number of diseases can also be transmitted in

the surgical environs, including streptococcal and staphylococcal infections, tuberculosis, the common

cold, influenza, mumps, herpes simplex, hepatitis B virus (HBV), syphilis, and human immunodeficiency

virus (HIV).(4)

Since the discovery of HIV, cross infection control has occupied the attention of health care workers

(HCW). Consequently, certain health care authorities, including the British Dental Association, the British

Medical Association and the World Health Organization, have recommended stringent guidelines for the

management of HIV infected and AIDS patients.(5)

In 1987, the Centers for Disease Control and Prevention (CDC) developed universal precautions to help

protect both health care workers (HCWs) and patients from infection with blood-borne pathogens in health

care settings. Their recommendations stress that blood is the most important source of HIV, HBV and other

blood-borne pathogens, and that infection control efforts should be focused on the prevention of exposures

to blood as well as the receipt of HBV immunizations.(6)

Previous seroepidemiological studies have confirmed these occupational hazards, showing higher

concentrations of serum antigen and antibodies for hepatitis B, hepatitis C and Legionella spp. (7) in

surgeons than in the lay population and an increased prevalence of respiratory infections and symptoms

possibly related to aerosols. The use of procedures to control infection and universal precautions in

surgeries is effective in preventing microbial pollution and cross-contamination, and is strongly supported

by organizations such as the Centers for Disease Control and Prevention, the American Dental Association,

schools of dentistry, and many other health agencies and professional associations.(8)

Even before the sudden awareness of the potential infectivity of HIV and hepatitis B virus (HBV),

practitioners followed a practice of washing their hands before and after examining patients, as an aspect of

infection control. However, a U.K. study (9) showed that this practice was no longer strictly observed.

Furthermore, an observation of compliance with hand washing by physicians and nurses in a medical

intensive care unit was disappointing as only 28% of physicians and 43% of nurses washed their hands

following contact with patients.(10) Hence, the objective of the present study was to assess the knowledge

and practices of infection control procedures among surgeons in Chhattisgarh.

MATERIALS AND METHODS

The present cross-sectional study was conducted in January – February 2014 among surgeons to access the

knowledge and practices regarding cross infection procedures in Chhattisgarh.

Study population

Before starting the study, information about total number of surgeons in the state was obtained. All

surgeons available during the study period were included in the study. So a total of 160 surgeons were

available at the time of the survey, of whom only 142 agreed to participate consisting o (92 males and 50

females).


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Official permission was received from the Institute and a written informed consent was obtained from all

those who were willing to participate in the survey. Before data collection, a pilot survey was conducted

among surgeons to assess the appropriateness of the questionnaire, and it was found that the questions were

unambiguous and easy to respond. A self-administered, structured questionnaire written in English and

validated through a pilot survey including questions on demographic information and other were on

knowledge and practices regarding infection control.

These questions were like asking about medical history, knowledge about the universal precaution, have

you ever had a needle stick, vaccination for hepatitis, wearing gloves & face mask, changing instruments,

sterilization of instruments, needle recapping, use of disinfectant, hand washing.

Methodology

Surgeons were visited by a single investigator, and all available and willing participants were given the

questionnaire on the day of the visit. Participants were asked to respond to each item according to the

response format provided with the questionnaire.

Data analysis

For data analysis, each correct answer was given a score of ‘1’ and each wrong answer was given a score of

‘0’. Individual scores were summed up to yield a total score. Data were analyzed using SPSS vers. 15

(SPSS, Chicago, IL, USA). Frequency and percentage distributions were calculated. Student’t test and

ANOVA test were used to access knowledge and practices. Statistical significance for all tests was

accepted at P < 0.05.

RESULTS

The distribution of the study subjects according to their gender and experience is demonstrated in Tables.

Regarding knowledge of the participants, mostly (84%) know about cross infection control measures and

67% were aware of the precautions taken during accidental needle exposure from a HIV positive patient.

Half of the participants (53%) knew about immunization schedule for hepatitis B vaccination. 77% were

properly aware about universal precaution guidelines and 69% knew about biomedical waste procedures

(Table 1).

Table 2 shows different practices by the study subjects regarding infection control as 85% of surgeons took

past medical history of their patients. More than half of the participants change face mask and gloves

before the start of new patient and almost all of them (98%) change instruments on each patient. 72% of the

surgeons wash their hands after gloves removal and 68% participants have the habit of separating needle

from the syringe prior to disposal as mentioned in Table 2.

In the present study, Females had higher level of knowledge and practices regarding cross infection

procedures and sterilization techniques as mentioned in Table 3. However, regarding experience a

statistically significant difference was observed among all the three groups (P<0.001), as shown in Table 4.

Graph 1 showed different procedures of sterilization by the study subjects and the most common was

autoclave and boiling water (34.7%) followed by just autoclave (30%). Very few participants follows

different methods of cold sterilization as 18.4% cold sterilization and autoclave, 8.1% cold sterilization and

boiling water and 3.6% only cold sterilization. A positive correlation between knowledge and practices

regarding infection control procedures was seen which was found to be (r=0.67, p<0.001).


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DISCUSSION

Infection is most often used in relation to healthcare, in particular with reference to preventing patients

acquiring those infections most often associated with healthcare (such as wound infection) and preventing

the transmission of micro-organisms from one patient to another (sometimes referred to as cross-infection).

Hand washing commonly seen in our study but according to the results of the compliance study in

Germany and Austria (2002), 44% of doctors did not know any regulations concerning hand

disinfection.(11)

As regard the variation in compliance to hand washing hygiene among different health care workers.

Doctors showed the highest compliance (37.5%) in comparison to nurses (36.4%) and housekeepers

(22.6%) and this disagree with Lipsett and Swoboda (2001) who had found that nurses showed higher

compliance (50%) than doctors (15%) and nursing supporting personnel (37%).(12) However in other

study, it was found that only 26% of physicians and 43% of nurses washed their hands after patients’

examination.(13)

Most of the participants use gloves while treating the patients in this data. It has been traditional teaching

that gloves should be changed promptly if punctured.(14) Some surgeons use double gloves for more

protection, mentioned by Patterson et al who demonstrated that double gloving may be uncomfortable,

reduce manual dexterity and tactile sensitivity but it provides increased protection from penetration of

needle stick injuries.(15) Also randomized studies within various surgical specialties have shown that

wearing two pairs of gloves decreases leaks by 3-9 fold in water permeability tests, when compared with

wearing one pair of gloves.(16)

It was found in this study that 38% of surgeons had needle prick injuries where as it was 60% in nurses and

50% in resident doctors in a study done by Haudhari et al. Nurses had high prevalence as they are more

involved in giving injections.(17)

Around half of the participants had knowledge regarding HBV transmission which is essential health care

and the results were similar in Daud et al study among MBBS students. They must take proper protection

as HBV is 50 times easier to transmit than HIV.(18)

Despite the fact that surgeons undertook procedures which generated aerosol and some of which caused

blood splashes on the face, it was disturbing to find that, about 45% of them did not regularly wear face

masks when carrying out invasive procedures on patients. Studies have demonstrated that cutaneous,

percutaneous and mucous membrane exposures to patients blood are common even during general surgical

practice. However, the efficacy of facemasks in reducing cross infection in practice is questionable.(19)

The present data showed positive correlation between knowledge and practices regarding infection control

and sterilization which was similar to results found in the literature.(11,20)

There is good level of knowledge regarding awareness of biomedical waste management. A separate study

reported a varied compliance rate regarding universal precautions among hospital physicians in United

States: glove use as 94%; disposal of sharpsas 92%; not recapping needles as 56%.(21)


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CONCLUSION

The study revealed good knowledge of infection control procedures but there were problems in practices of

sterilization. Most of them did not separate the needle from the syringe prior to disposal therefore needle

prick injuries were common. So more intensive and regular training programs to surgeons must be included

in the plans of quality control in all hospital and regular inspection from the ministry of health guarantees

good infection control practices.

TABLES

Table 1: Showing knowledge regarding standard cross infection precautions

Sr no Question Yes (%)

1 Do you know cross infection control measures? 84%

2 First step to be done after accidental needle exposure from a HIV positive

patient?

67%

3 Disinfectant effective in removing dried blood on a surface? 58%

4 Does hand washing minimize infection risk secondary to leakage? 88%

5 Immunization schedule for hepatitis B vaccination? 53%

6 How often is biological monitoring of autoclave sterilization done? 61%

7 Do you know about the universal precaution guidelines? 77%

8 Can hepatitis B be transmitted by needle stick? 65%

9 Aware of biomedical waste procedures 69%

Table 2: Showing practices regarding standard cross infection precautions

Sr no Question Yes (%)

1 Asking about medical history of patients? 85%

2 Do you have vaccination for hepatitis B? 56%

3 Do you wear gloves? 62%

4 Do you wear face masks? 55%

5 Changing instruments on each patient? 96%

6 Storage of sterilized instruments packed in plastic bag? 47%

7 Sterilization of instruments in an autoclave? 79%

8 Do you wash hands after gloves removal? 72%

9 Do you separate the needle from the syringe prior to disposal? 68%

10 Do you had needle prick injuries 38%

Table 3: Mean scores of Knowledge & practices regarding standard cross infection precautions

according to gender

Gender No Mean SD p-value

Male 92 11.6 3.566

0.001 Female 50 13.4 4.654


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Table 4: Mean scores of Knowledge & practices regarding standard cross infection precautions

according to experience

Experience No Mean SD p-value

0-5 years 70 12.5 3.876

0.001 5-10 years 49 11.2 3.265

10-15 years 25 13.6 3.156

Graph 1: Showing different methods of sterilization among surgeons

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