RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
MR. S. ELANGOVAN,
M.Sc., (NURSING) I YEAR,
MEDICAL SURGICAL NURSING,
(2010 – 2012).
VARALAKSHMI COLLEGE OF NURSING,
No:19, KIADB ROAD,
CHOKKASANDRA,
T.DASARAHALLI,
BANGALORE – 560 057.
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME CANDIDATE AND ADDRESS / Mr. S. Elangovan,I year M.sc., (Nursing),
Varalakshmi College of Nursing,
No:19, Kiadb road,
Chokka Sandra, T.Dasarahalli,
Bangalore – 560 057
2. / NAME OF THE INSTITUTION / Varalakshmi College of Nursing No:19, Kiadb road,
Chokka Sandra, T.Dasarahalli,
Bangalore – 560 057
3. / COURSE OF THE STUDY AND SUBJECTS / M.Sc., (Nursing),
Medical Surgical Nursing
4. / DATE OF ADMISSION OF THE COURSES / 21:05:2010
5. / TITLE OF THE STUDY / knowledge regarding common infection in the ICU, its control and preventive strategies among the newly appointed staff nurses.
6.0 BRIEF REUSME OF THE INTENTED WORK
INTORDUCTION
Infection is defined as a host interaction with an organism, Infection is actually a collection of organism in (or) around the human. As infection is the detrimental colonization of a host organism, infecting parasites seek to uitlise the host resourses to reproduce, often resulting in death.
Hospital acquired infections are preventable the nurses can play a major role in preventing the hospital acquired infection by following the preventive measures to spread disease through knowledge regarding modes of spreading and control measures are neede to reduce the rate of hospital acquired infection.
Infections at three major sites represented 68% of all reported infections are nosocomial pneumonia, 31% urinary tract infections, 23% and primary blood stream infections, 14% : 83% of episodes of ICU acquired pneumonia were associated with mechanical ventilation, 97% of UTIs occurred in catheterized patients, and 87% of primary blood stream infection in patience with a central line.1
In India nearly 10 - 25% of persons are affected by nosocomial infection in every year, In Mumbai nearly 16 – 20% of hospitalized person had nosocomail infection per day, In Delhi nearly 32% of persons are affected by nosocomial infection, invasive procedures and altered immune defense are main factors contributing infection.2
The mode of transmission most often is either cross-infection (e.g., indirect spread of pathogens from one patient to another on the inadequately cleaned hands of hospital personnel) or autoinoculation (e.g., aspiration of oropharyngeal flora into the lung along an endo tracheal tube). Occasionally, pathogens (e.g., group A streptococci and many respiratory viruses) are spread indirectly from person to person via infectious droplets released by coughing or sneezing. Factors that increase host susceptibility include underlying conditions and the many medical surgical interventions and procedures that bypass or compromise normal host defences.
Hospital acquired infections are preventable. The nurses can play a major role in preventing the hospital acquired infection by following the preventive measures to spread the disease. Thorough knowledge regarding modes of spreading and control measures are needed to reduce the rate of hospital acquired infection.
6.1 NEED FOR STUDY
ICU infection is defined as the infection which is passed on to a person being related in an ICU. ICU acquired infection is critical problem in developing countries were resources, facilities and staff are always in short supply. Primarily the patience are going to the hospital to get treatment for their suffering but during treatment phase they are more prone to get nosocomial infection. Commonly occurring ICU infections are urinary tract infection, lower respiratory tract infection, blood stream infection and pneumonia.
Vincent J.Lconducted a study to provide an upto data patterns of infection in ICU it stated that 51% patients were considered infected, 71% were receiving antibiotics, the infection was of respiratory origin 64%, 19% were fungi, patience who had longer ICU stays prior to the study day had higher rates of infection, infection due to resistant staphylococci, pseudomonas species, the ICU mortality rate of infected patience was more than twice that of non infected patients (25% vs 11%), respectively.3
Liberati conducted a study on preventing nosocomial pneumonia, nosocomial pneumonia is a lower respiratory tract infection that was not present or incubating on admission to hospital. Nosocomial pneumonia comprises 15% - 23% of all hospital acquired infection in a report of Auckland New Zealand hospitals, nosocomial pneumonia accounted for 19% of patients with nosocomial infection (n=110). Among all nosocomail pneumonia has the highest mortality rate ranging from 13% - over 50%.4
The staff nurse is responsible for providing safe environment to the client. The effectiveness of infection control practice depend on the nurses consciousness in using aseptic technique. Every nurse should have up to date knowledge regarding proper hand wasing, proper disposal of waste, follow aseptic technique, arrangement of isolation rooms and improvement of ventilation. Hence the researcher has interested to conduct this study to assess the knowledge newly appointed staff nurses on common ICU infections, its control and preventive strategies.
6.2 REVIEW OF LITERATURE
Review of literature divided into two areas
i)Studies related to common ICU infection.
ii)Studies related to knowledge of staff nurses regarding prevention of common ICU infection
iii)Studies related to structured teaching program.
i)Studies related to common ICU infection
Rahim R.H conducted a study on nosocomial infection is a common cause of morbidity and mortality for hospitalized neonates this study describes measures taken to reduce the prevalence of nosocomial infection with in a 34-bed neonatal intensive care unit in Malaysia intervention included a one to one education program for nursing staff’s (N=30) The education program for nurses focuses on the application of standard precautions to three common clinical procedures, Hand washing, Nasogastric tube feeding, Tracheobronchial suctioning, these was evaluated using competency check list’s. This study highlights the importants of education in contributing to the control of nosocomial infection in the neonatal intensive care unit.5
Quinn M.M conducted a study on sharp injury. Data on the prevalence of sharp injury were collected and analyzed from the major hospitals at New Delhi, The prevalence approximately 35% of nurses and 6.4% of aides had experienced at least one sharp injury during their carrier, Corresponding figures for other blood and body fluid exposures were 15.1% and 6.7% respectively, sharp with safety futures frequently were not used under reporting of sharp injuries to the work place based surveillance system was estimated to be about 50%.6
ii)Studies related to knowledge of staff nurses regarding prevention of common ICU infection
Manso V F et al did a cross-sectional study to determine the compliance with HBV vaccination, and the risk of occupational exposure to blood or other body fluids in intensive care unit (ICU) personnel (n=458) in Brazil. Vast majority (95.5%) of ICU nurses reported HBV vaccination. Among those who did not, nurses were statistically associated with nonvaccination (P<.05). They had a 19.1-fold (95%confidence interval: 2.07) greater risk of nonvaccination compared with physicians. A total of 220 participants reported an incident with biologic fluids. Nursing staff had a higher risk for occupational exposure to blood, other body fluids. This study showed a high frequency of HBV vaccination in ICU nurses in Brazil. Nevertheless, more efforts are necessary to increase compliance with vaccination in nurses. Nursing staffs showed high risk of occupational exposure to blood, other body fluids, or both, ratifying the importance of continuous education programs concerning prevention of bloodborne pathogen transmission for all ICU.7
Marin kollef conducted a series of studiesat our 1,200-bed facility beginning in Pennsylvania . Specific risk-reduction tactics focused on hand hygiene and aseptic technique, detecting signs and symptoms of infection, replacing administration sets and fluids, caring for injection ports and dead-end caps, handling parenteral fluids and multidose vials, and drawing blood cultures. This educational intervention was directed at ICU nurses and decreased the rate of infections by 66% (p < 0.0001). Random bedside audits revealed multiple adherence deficiencies, the most common being failure to date the dressing (nonadherence rate, 89%) and improper hand hygiene (83%). Adherence may have been improved by involving staff members in program design and requiring training for new nurses, and residents.8
iii)Studies related to structured teaching program
Soek Gek Tan conducted a study to assess the knowledge on common ICU infections awareness, evaluate the effectiveness of structural teaching program and to associate the knowledge of staff nurses with that of demographic variables. Data were collected from 80 randomly selected samples by using the structured interview scheduled, 40 samples were allocated for experimental group and remaining 40 samples for the control group, after the structured teaching program the paired‘t’ value was 17.69 with the p < 0.001 which is highly significant so there is a improvement knowledge on infections among staff nurses.9
Hall C.B conducted a study on effectiveness of structures teaching program among staffs on infant ward with signs of respiratory infection, the aim of the study was to asses the knowledge of prevention of nosocomial infection, who had worked in neonatal ward a total of 10 staffs were included a structured teaching program was administered to them regarding prevention of nosocomial infection, in post test, it was found that knowledge was improved then pre test.10
El Ayyat AA conducted a study to assess knowledge among the staff nurses in theodor bilharz research institute hospital at Egypt. Towards simple protective measures such as hand washing practices, re capping syringe needles after use, a questionnaire is designed and distributed to all staff nurses working in the hospital (39 nurses out of 50) with a total of 39 out of 50, scoring system is used for data analysis. The over all scoring of 2 items studied are below 39%, which means that they really need education about these items thus it is very important to create a awareness in the hospital among nurses about the concept of infection control.11
STATEMENT OF PROBLEM
The effectiveness of structured teaching program on knowledge regarding common infection in the ICU, its control and preventive strategies among the newly appointed staff nurses in selected hospitals at Bangalore.
6.3 OBJECTIVES
6.3.1To assess the pre test level of knowledge on prevention of common ICU infections amongnewly appointed staff nurses
6.3.2To assess the post test level of knowledge on prevention of common ICU infections among newly appointed staff nurses.
6.3.3To develop the structural teaching programme on prevention of common ICU infections
6.3.4To determine the association between the selected demographic variables such as prevention of common infection in the ICU.
6.3.5To compare the pre test and post test level knowledge on prevention of common infection in the ICU.
6.4 HYPOTHESIS
H1:The mean post test knowledge score of newly appointed staff nurses will be significantly higher then the pre-test knowledge scores, paired ‘t’ test at 0.01 level.
H2 :The mean post test knowledge score of newly appointed staff nurses will be significantly higher then the pre-test knowledge scores of (χ²) at 0.05 level.
6.5OPERATIONAL DEFINATION
- Assess
It refers to the organized systemic variables, a process of collecting information about pre test and post test knowledge form newly appointed staff nurses regarding prevention of infection.
- Effectiveness
A significant gain in knowledge as determined by significant difference in pre and post test knowledge scores.
- Structured teaching program
It refers to the systematically developed institutional method and teaching method designed for staff nurses to provide information on prevention of infections in ICU.
- Newly Oppointed Staff nurse
A person who has successfully completed any one of the nursing programs like diploma (or) B.Sc Nursing (or) Pc.B.Scoppointed as within 3 months as a staff nurse in selected hospitals, Bangalore.
Infection
A host interaction with an organism.
- ICU
It is ward where critically ill patience are kept, specialized treatment and nursing care are made a available in this area.
6.6ASSUMPTIONS
- The newly appointed staff nurses may or may not have adequate knowledge on prevention of infections in ICU.
- Staff nurses will have interest to know more about knowledge on prevention of infections in ICU.
6.7DELIMITATIONS
- The study is limited to staff nurses of both sexes who were newly appointed in the ICU.
- The study is limited to newly appointed staff nurses who will be available during the data collection
- VARIABLES
INDEPANTANT VARIABLES
Structured teaching program on prevention of infections in ICU.
DEPANTANT VARIABLES
Knowledge level of newly appointed staff nurses on prevention of infections in ICU
EXTRANEOUS VARIABLES
Age, sex, education, experience in months, income, socio-economic status, type of family, source of information.
7.0 MATERIALS AND METHODS
7.1 SOURCE OF DATA
Data will be collected from ICU staff nurse who oppointed within 3 months from selected hospitals at Bangalore.
7.2 METHODS OF COLLECTION OF DATA
Structured questionnaire
7.2.1RESEARCH DESIGN
Quasi experimental research design.
7.2.2RESEARCH APPROACH
An evaluative research approach.
7.2.3SETTING OF THE STUDY
The study will be conducted in ICU’S in selected hospitals at Bangalore.
7.2.4 POPULATION
Population of present study consists of newly appointed staff nurses in selected hospitals at Bangalore.
7.2.5 SAMPLE SIZE
The sample size will be 60 newly appointed staff nurses working in selected hospitals at Bangalore.
7.2.6SAMPLING TECHNIQUE
Non probability purposive sampling technique.
7.2.7SAMPLING CRITERIA
Inclusion criteria:
Newly appointed staff nurses in ICU within 3 months
- Who are willing to participate
- Who can follow Kannada and English
- Who are successfully completed either Diploma or Degree in nursing.
Exclusion criteria
Newly appointed staff nurses in ICU within 3 months
- Who are not willing to participate
- Who cannot follow Kannada and English
- Who are not available during the study.
- DATA COLLECTION TOOL
Structural knowledge questionnaire it, consists of two parts
- Part 1
- Part 2
Part 1
Demographic variables such as age, sex, education, experience in months, income, socio-economic status, type of family, source of information.
Part 2
Knowledge on prevention of common infections in ICU
7.2.9 DATA ANALYSIS METHOD
The data analysis through descriptive and inferential statistics.
DESCRIPTIVE STUDY
Frequency, mean, mean percentage and standard deviation of described demographic variables.
INFERENTIAL STATISTICS
Paired “t” test to compare pre and post test knowledge scores.
Non parametric chi square (χ²) test will be used to find out the association between selected variables with knowledge scores.
7.3DOES THE STUDY REQUIRE ANY INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMAL
-Yes –
7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION
Permission will be obtained from:
- The research committee of varalakshmi college of Nursing
- Authorities of selected hospitals at Bangalore.
8.0LIST OF REFERENCES
1, Tinsley R, Harrison, Prevention and Control of Infections, Nursing Clinics of North Amercia, 2005; 9(12): 34 – 37.
2, Malacarne P, et;al. Epidemiology of nosocomial infection in India, Indian Nursing Journal, 2008; 13(5): 12 – 18.
3, Vincent J.L, international study of the prevalence and outcomes of infections in ICU, journal of the American association, 2009; 22nd edition: 34 – 36.
4, Liberati, critical care nurses knowledge in preventing infection, Australian journal of advanced nursing, 2004; 7 – 14
5, Rahim R.H, Reducing nosocomial infection in neonatal intensive care, international journal of nursing practice, 2008; 15 (6): 580 – 584.
6, Quinn M.M, sharp injuries among home health care nurses and aides, American journal of public health, 2009; 28 (3): 710 – 717.
7, Manso V F, et al, Am J Infect Control, 2003; 31(7): 431 – 434.
8, Marin Kollef, Prevention of infections in hospitals, Nursing journal of Pennsylvania, 1997; 21(5): 65 – 69.
9, Soek Gek Tan, Mortality rates in a neonatal nursing, international journal of nursing practice, 2007; 52 – 58.
10, Hall C.B, structural teaching program among staff nurses with common ICU infections, 2007; 512 – 515.
11, El Ayyat AA, Effectiveness of structural teaching program among simple productive measures, American journal of nursing, 2000; 3 (11): 30 – 34.
9.SIGNATURE OF THE CANDIDATE:
10.REMARKS OF THE GUIDE:The study will help the newly
appointed staff nurses to
learn the prevention of
common infections in the
ICU.
11.NAME AND DESIGNATION
11.1GUIDE:Mrs. A. Therasa
Asst. Proffessor
Varlakshmi College of Nursing, Bangalore
11.2SIGNATURE:
11.3HEAD OF THE DEPARTMENT:Mrs. A. Therasa, HOD
Department of Medical Surgical Nursing, Varlakshmi College of Nursing, Bangalore.
11.4SIGNATURE:
12.1REMARKS OF THE PRINCIPAL:The topic selected by the
researcher will help the
newly appointed staff nurses to understand the way of working in the ICU.
12.2SIGNATURE: