A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING ASEPTIC TECHNIQUES AMONG STAFF NURSES IN A SELECTED HOSPITAL, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
SUBMITTED BY
KANCHANA.M
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / KANCHANA. MI YEAR M.Sc.( NURSING )
HARSHA COLLEGE OF NURSING,
193/4, SONDEKOPPA CIRCLE, NH4, NELAMANGALA, BANGALORE.
2. / NAME OF THE INSTITUTION / HARSHA COLLEGE OF NURSING
No. 193/4 SONDAKOPPA CIRCLE,
NH4 NELAMANGALA,
BANGALORE-562 123.
3. / COURSE OF STUDY AND SUBJECT / MASTER DEGREE IN NURSING,
MEDICAL SURGICAL NURSING.
4. / DATE OF ADMISSION TO COURSE / 06-07-2009
5. / TITLE OF THE TOPIC / A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING ASEPTIC TECHNIQUES AMONG STAFF NURSES IN A SELECTED HOSPITAL, BANGALORE.
6.1.NEED FOR THE STUDY
Nosocomial infections related to the development of catheter-related infections are a leading cause of morbidity and mortality among critically ill hospitalized patients. Despite important preventive efforts, these infections remain a daily concern for most clinicians. Significant improvements in the knowledge of their pathophysiology and diagnosis allow us to treat them more efficiently.1
A Study estimated that over 27 million surgical procedures are performed in the all over world every year. Surgical site infections are the third most common nosocomial (hospital-acquired) infection and are responsible for longer hospital stays and increased costs to the patient and hospital. Aseptic technique is vital in reducing the morbidity and mortality associated with surgical infection.2
A study wasdone on to analyse the pattern of nosocomial infection in geriatric patients admitted in Intensive Care Unit. incidence of nosocomial infections in geriatric patients was 19.7% (80/405 patients).urinary tract infections (45%) were the most frequent, followed by pneumonias (30%) and blood stream infections (16%). A direct correlation existed between the use of intensive devices in ICU and the occurrence of nosocomial infections.3
The incidence of nosocomial infections in children varies by age and hospital unit, ranging from 0.2% to 23.5% in prospective cohort studies. A recent multicenter European study demonstrated an overall hospital nosocomial infection rate of 2.5% , with the highest rates in pediatric ICUs (23.5%), hematology units (8.2%), and neonatal units(7%), and the lowest rate in general pediatric units(1%). A second prospective cohort study of 4684 pediatric patients found the highest nosocomial infection rates in children aged 23 months or younger (11.5%). 4
A prospective study was conducted on Intravascular Catheter Related infection. The results showed that 58 (86.6%) patients had their catheter related local infection and 9 (13.4%) patients had Catheter Related Local and Blood Stream Infections. The most common indicates was for administering parental antibiotics (88.1%). Infections were more common in triple lumen (55.2%) and in subclavian catheters (43.3%).5
A study was conducted on nosocomial infection in elderly trauma patients. The results showed that nosocomial infections were acquired by 147 patients (39%), with a total of 297 infections. Respiratory and genitourinary tract infections were the most common nosocomial infection.6
A prospective, single blinded observational study was done on hand hygiene and simple aseptic measures before invasive procedures are effective in reducing rates of health care associated infection. The results showed that hand hygiene between patient consultations was very low at 14% in the UK and 12 % in Newzeland.7
A comparative study was conducted on the detection of Methicillin-Resistant Staphylococcus aureus directly from Clinical Specimens by Multiplex Polymerase Chain Reaction and Conventional Culture Method. Out of 270 samples, Polymerase in Reaction could detect 29 (10.74%) Methicillin Resistant Staphylococcus Aureus isolates and conventional method 26(9.62%). Multiplex Polymerase Chain Reaction is a good alternative for rapid and accurate deduction of Methicillin Resistant Staphylococcus Aureus directly from clinical specimens.8
A study was done on selective decontamination for the prevention of nosocomial respiratory infection in Intensive Care Unit Patients. The study concluded that mortality was reduced by approximately 3.5% with selective digestive tract decontamination and by 2.9% with selective digestive tract decontamination.9
Issues in aseptic technique challenge every peri- operative practitioner equally challenging to creatively, present information to large groups of staff members in a way that facilitates learning. The process used to address practice issues in aseptic technique and to present educational in service programs to a large number of staff members and health care workers. 10
Nurses specializing in infection control as responsible for agency-wide policy development and program direction. Staff nurses play an important role in risk deduction by careful attention to hand washing and by following guidelines to reduce technical risks associated with patient care.11
The practice of aseptic techniques among staff nurses is not up to the mark.In order to improve the knowledge of staff nurse regarding aseptic techniques, the investigator has chosen this study to find out the effectiveness of structured teaching programme on aseptic techniques among staff nurses.
6.2.REVIEW OF LITERATURE
A review of literature is an essential aspect of scientific research. It involves the systematic identification, scrutiny and summary of written material that contains information on the research problems.
Review of literature is discussed under the following headings.
1. Studies related to aseptic techniques
2.Studies related to nurses knowledge on aseptic techniques
1. Studies related to aseptic techniques
A study was done on improving standards of aseptic practice through an Aseptic Non Touch Technique(ANTT). The study revealed that the aneffective tool for standardizing aseptic practice across largeclinical workforces.12
A retrospective survey study was done on evaluation of aseptic measures in the performance of epidural catheterization and perception of its risk of infection. The results showed that good aseptic practice in epidural catheterization should be clarified by a consensus conference. There is an obvious lack of knowledge concerning features of epidural abscess.13
A study was sought to determine if the use of only daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream infection because of methicillin resistant staphylococcus aureus and vancomycin-resistant enterococcus among ICU patients. A study concluded and daily chlorhexidine bathing among intencive care unit patients may reduce the acquisition of methicillin resistant staphylococcus aureus and vancomycin-resistant enterococcus.14
A study was done on outcomes in drug resistant acinetobacter infection. The results showed that multidrug resistant are associated with significant mortality and greater duration of hospital stay.15
2. Studies related to nurses knowledge on aseptic techniques
A study was done on prevalence of hospital- acquired infection(HAI) and research factors associated with its occurrence. The results showed that the hospital acquired infection is linked to the medical category, the use of intravascular devices and antibiotic prophylaxis.16
A study investigated the epidemiology of nosocomial bloodstream infection in elderly intensive care unit patients. The study conclude that over the past 15 years, an increasing number of elderly patients were admitted to intensive care unit. The incidence of nosocomial bloodstream infection is lower among very old intensive care unit patients when compared to middle –aged and old patients.17
A study was conducted on the incidence of nosocomial pneumonia in a medical intensive care unit and journal medical ward patients in a public hospital in Bombay, India. The results showed that crude mortality in general ward patients was 88.9% vs 14.6% in patients without pneumonia. The corresponding figures for Intensive Care Unit patients were 67.4 vs 37.1%;40% of the crude mortality in Intensive care unit patients with pneumonia was attributed to the infection. Infected patients stayed an additional 5.8 days in the intensive care unit and 6.7 days in general ward.18
A study was conducted on pediatric infectious disease on intensive care unit of sepsis. Among infants in the retrospective cohort group, 88(77%) of 115 had clinical sepsis, and 59 (51%) died. In the case series group, we septic <24 hours after birth. Extrinsically contaminated iv fluids resulted in sepsis and deaths. The result of the study concluded that standard infection control precautions significantly improve mortality and sepsis rates and are prerequisites for safe Neonatal Intensive Care Unit .19
A study was done on the influencing post operative wound infections, such as the patient’s age, sex, type and duration of surgical procedure, length of hospital stay and the type of anti- biotic prophylaxis used. The results will provide hospital administrators with strategic goals and actions that might have a significant impact on reducing infection control procedures, and new information on anti-microbial resistance is recommended to increase detection and identification of surgical wound infections.20
A study was done on aseptic hand washing practices of nurses working in pediatric neonatal intensive care unit. The result of the study showed that the need for standardization of practice in line with the current centers for disease control and prevention guidelines, including the introduction of alcohol handrub.21
A study was conducted on sterile versus non-sterile gloves use and aseptic technique.The result of the study showed that the improvement of aseptic technique and therefore clean or sterile gloves, using a risk assessment protocol.22
The study was conducted on the prevalence of Methicillin Resistant Staphylococcus aureus in surgical wound infections at AIIMS in 2001-02 was determined. The result of the study showed that high incidence of MRSA in this hospital warrants the use of antibiotics and application of control measures to prevent the spread of such resistant strains.23
6.3. STATEMENT OF THE PROBLEM
A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING ASEPTIC TECHNIQUES AMONG STAFF NURSES IN A SELECTED HOSPITAL, BANGALORE.
6.4.OBJECTIVES OF THE STUDY
To assess the existing knowledge on aseptic techniques among staff nurses.
To determine the post test knowledge level regarding aseptic techniques among the staff nurses following structure teaching programme.
To compare the pre and post teaching knowledge scores on aseptic techniques among staff nurses.
To associate the post teaching knowledge scores on aseptic techniques with demographic variables.
6.5.HYPOTHESIS
H1- The mean post-test knowledge score of staff nurses who received structured teaching programme on aseptic technique will be significantly higher than the mean pre- test knowledge score.
H2- There is a significant association between post-test knowledge and selected demographic variables.
6.6.OPERATIONAL DEFINITIONS
Effectiveness
Theimpact in terms of increased knowledge after the structured teaching on aseptic techniques among staff nurses.
Structured teaching programme
It is an organized individual teaching to provide a well defined area of knowledge on aseptic techniques for staff nurses by lecture cum discussion and by using of handouts, charts, flash box and maps.
Aseptic Technique
Aseptic technique refers to those activities or efforts used to keep the patient free from micro-organisms.
Staff Nurse
Refers to those who have completed General Nursing Midwifery & Bachelor of Nursing who are engaged in direct patient care.
6.7. ASSUMPTIONS
Knowledge influence behavior
Infection leads to complication
Some of the nursing procedures requires aseptic precaution
Nurses are aware of infection control practices and care expected to practice it.
Practice of aseptic techniques is related to the work environment and hence may be influenced by it.
6.8.DELIMITATIONS
Data collection period is delimited to 4 weeks.
Only aseptic techniques will be chosen for the study.
Staff nurses age between 20 and 50 years are selected for study.
6.9.PROJECTED OUTCOME
The study will improve the knowledge of staff nurses regarding aseptic techniques before and after Structure Teaching Programme. The results of the study will help to follow correct aseptic techniques.
7.MATERIALS AND METHODS
7.1.SOURCE OF DATA
Staff nurses working in a selected Hospital, Bangalore.
7.1.1.Research design
Free Experimental design with one group pre test and post test method will be adopted for study.
7.1.2. Setting of the study
Study will be conducted in a selected hospital, Bangalore.
7.1.3. Population
Staff nurses who are all working in a selected hospital.
7.2.METHODS OF COLLECTION OF DATA
7.2.1. Sampling procedure
Non probability convenient sampling will be used for the study.
7.2.2 Sample size
The sample size will be 60.
7.2.3.Inclusion criteria for sampling
Staff nurses who had complete General Nursing Midwifery and Bachelor of Nursing.
Staff nurses of both sexes.
Staff nurses between 20 and 50 years of age.
Staff nurses who were interested to participate in the research study.
7.2.4 .Exclusion criteria for sampling
Staff nurses who are engaged in administrative work like ward sister and ward manager.
Staff nurses working in the operation theatre.
7.2.5. Tool for Data collection
Section A.
Demographic variable which include age, sex, education, income, religion.
Section B.
A structured questionnaire which used to assess the knowledge of staff nurses regarding aseptic techniques. It consists of 30 questions.
Structured questionnaire scoring and grading procedure.
Scoring: The correct answer of each question carries 1 mark; the wrong answer is marked 0. The maximum scores obtained by the sample is converted to percentage and grading as follows.
GRADINGScore (%) / Level of Knowledge
Below 50% / Poor Knowledge
50-75% / Average Knowledge
Above 75% / Adequate Knowledge
7.2.6 Data collection method
A formal permission from concerned authorities will be obtained for conducting the study. The investigator will take concerned from their staff nurses who are willing to participate in the study. Confidentiality will be maintained during the data collection.
Main study will be done on 10th September to 10th October 2010. The pretest will be done by administering the questionnaire the samples on 10-09-2010, 17-09-2010 & 24- 09-2010. Structured teaching programme will be conducted after each pretest. After an interval of 7 days of each pretest, a post test will be done by using their same questionnaire to evaluate the effectiveness of structured teaching programme.
7.2.7.Method of Data analysis and interpretation
The researcher will use descriptive and inferential statistical technique for data analyzing by using mean, standard deviation & Chi square test.
7.2.8.Variables
Independent variable: Structured Teaching Programme regarding aseptic techniques of staff nurses.
Dependent variable: Knowledge of the staff nurses on aseptic techniques.
7.3.DOES THE STUDY REQUIRE ANY INVESTIGATION OR INVENTIONTO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS?
Yes. Structured Teaching Programme will be administered to the staff nurses.
7.4. HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?
Yes. Permission will be obtained from the research committee of the Harsha college of Nursing,Bangalore.
LIST OF REFERENCES
- Jean-Luc Pagani, Phillippe Eggiman, ‘’ Management of Catheter- Related infection’’, 2008.
- Amam EL Kholy, Hospital acquired infection, “The Centre of disease control and prevention”, 2007.
- Mary Lou Morritt, Anne Senner, et.al, ‘’ Nursing practice development unit’’, Journal of geriatric critical care, vol-19, 2006, page-220.
- Gita Srinivasan, Medha Y. Rao, ‘’ Centre for nosocomial disease control and prevention’’, 2005.
- Ramanathan P, et.al, ‘’ Intravascular Catheter Related infection’’.
- Grant V. Bochicchio, et.al, ‘’Nosocomial infections in elderly trauma patients’’, 2002.
- Elsevier B.V. “ Hand hygiene and simple aseptic techniques”, 2009
- Chawla K. Shetty Anoop, ‘’ A journal of Deduction of Methillicin Resistant Staphylococcus Aureus’’, vol 5.
- Greg E. Martin MD, ‘’ Selective decontamination for the prevention of nosocomial respiratory infection in ICU patients’’, 2009.
- Evaluation of aseptic techniques, ‘’ Journal of infection control’’.
- Grace, A, Rotter, et.al, ‘’ Medical Surging Nursing’’, Infection control, 3rd edition, Mosby publication, 1993, page-341.
- Stephen Rowley and Simon Clare, ‘’ Aseptic practices’’, 2009.
- Ann and Sleth JC, ‘’ Epidural Catheterization of aseptic measures’’, 2008.
- Michael W, Climo, et.al, ‘’Results of quasi experimental multicenter trail’’, 2009.
- Muralidhar Varma, ‘’Acinetobacter infections’’.
- ‘’A creative process for reinforcing aseptic practices’’, 2001.
- Stijn Blot, et.al, ‘’Assess clinically focused nosocomial bloodstream infection’’.
- M. Merchant, D.R. Karnad, ‘’ Incidence of nosocomial pneumonia in a medical intencive care’’, 2004.
- Journal of Paediatric infection disease control, 2006
- Michlopoulous A, Sporos L, ‘’Post operative wound infection’’, 2003.
- Golway, etal., “ Aseptic technique and hand washing practices”, 2006
- Flores A, “Sterile vs Non-Sterile gloves use in aseptic techniques”. 2008
- Anti Kapil, ‘’Department of medical sciences’’, AIIMS, 2002.
8. / SIGNATURE OF THE CANDIDATE
9. / REMARKS OF THE GUIDE
10. / NAME AND DESIGNATION OF
10.1. GUIDE
10.2 SIGNATURE
10.3 CO-GUIDE (IF ANY)
10.4 SIGNATURE
11. / 11.1 HEAD OF THE DEPARTMENT
11.2 SIGNATURE
12. / 12.1 REMARKS OF THE CHAIRMAN /PRINCIPAL
12.2 SIGNATURE