Knowledge, Attitude and Practice On Nosocomial Infections Among Medical Students at Kampala International University Teaching Hospital Western Campus In June 2018

ABSTRACT Introduction: Nosocomial or those infections acquired in a hospital setting are a great cause of morbidity in our patients due to their easy transmissibility from a patient to another at times through the health care provider who does not practice appropriate infection control. Of more importance is the fact that, other than their prevalence going up, resistance to antibiotics has developed within the causative agents of these infections. Medical students, like other health staff, are in constant encounter with patients in the wards and thus may be at risk of getting infected themselves, or acting as a vehicle of spread of these infections throughout the ward. For this reason, this study is about the Knowledge Attitudes and Practice among medical students at KIU on nosocomial infections. Background of the study: Hospital-associated infections or nosocomial infections are those infections acquired during the patient's stay in hospital. They form a major worldwide public health problem despite advances in our understanding and control of these infections. The best clinical care in the world can be worthless if patients pick up other infections while they are in the hospital. Hospital-associated infections also include occupational infections which occur in health care workers due to occupational hazard (Biberaj, Gega, & Bimi, 2014). An infection is considered nosocomial if it becomes evident 48 hours or more after hospital admission or within 30 days of discharge following inpatient care (Bello et al., 2011). Nosocomial infections increase patients’ morbidity, mortality, length of hospital stays and treatment cost (Kaye et al., 2014). Standard precautions are designed to reduce the risk of acquiring occupational infection from both known and unexpected sources in the healthcare setting. Strict adherence by healthcare workers to standard infection control precautions may prevent a percentage of these risks. For that reason, healthcare workers should have adequate knowledge and practice about standard infection control precautions (Ogoina et al., 2015). Objective: To assess knowledge Attitude and practice of medical students of KIUTH towards nosocomial infections. Method: A questionnaire based cross sectional study design with a quantitative component was and that involved 292 medical students in their 3rd, 4th, and 5th years was utilized. A convenient random sampling technique was employed in recruiting the respondents. Results: A total of 292 medical students took part in the study. The knowledge and attitudes of the respondents were found to be satisfactory but practice was not. HBV vaccination uptake the students was also very low. Conclusion: Medical students of KIU, despite having excellent knowledge and good attitude towards nosocomial infections, the translation of this knowledge into practice leaves quite a lot to be desired. Their uptake of the HBV vaccine is very low the key factor being cost implications. More needs to be done in terms of educating the incoming and continuing clinical students on proper protocols pertaining prevention of nosocomial, and infections at large.

TABLE OF CONTENTS

DECLARATION ............................................................................................................................. i

APPROVAL ................................................................................................................................... ii

DEDICATION……………………………………………………………………………………iii

AKNOWLEDGEMENT………………………………………………………………………….iv

TABLE OF CONTENTS................................................................................................................ v

LIST OF FIGURES ....................................................................................................................... ix

LIST OF TABLES.......................................................................................................................... x

LIST OF ABBREVIATIONS AND ACRONYMS ...................................................................... xi

OPERATIONAL DEFINITIONS................................................................................................. xii

ABSTRACT................................................................................................................................. xiii

CHAPTER ONE: INTRODUCTION............................................................................................. 1

1.1. BACKGROUND ................................................................................................................. 1

1.2. PROBLEM STATEMENT.................................................................................................. 2

1.3. STUDY OBJECTIVES........................................................................................................ 3

1.3.1. BROAD OBJECTIVE.................................................................................................. 3

1.3.2. SPECIFIC OBJECTIVES............................................................................................. 3

1.4. RESEARCH QUESTIONS ................................................................................................. 3

1.5. JUSTIFICATION OF THE STUDY ................................................................................... 3

1.6. STUDY SCOPE................................................................................................................... 4

GEOGRAPHICAL SCOPE........................................................................................................ 4

CONTENT SCOPE .................................................................................................................... 4

TIME SCOPE ............................................................................................................................. 4

1.7. CONCEPTUAL FRAMEWORK........................................................................................ 5

CHAPTER TWO: LITERATURE REVIEW................................................................................. 6

2.0. INTRODUCTION ................................................................................................................... 6

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2.1. KNOWLEDGE TOWARDS NOSOCOMIAL INFECTIONS ............................................... 6

2.2. ATTITUDE TOWARDS NOSOCOMIAL INFECTIONS..................................................... 7

2.3. PRACTICE OF HAND HYGIENE......................................................................................... 8

CHAPTER THREE: METHODOLOGY ....................................................................................... 9

3.0. INTRODUCTION ............................................................................................................... 9

3.1. STUDY DESIGN..................................................................................................................... 9

3.2. STUDY POPULATION.......................................................................................................... 9

3.2.1. INCLUSION CRITERIA.................................................................................................. 9

3.2.2. EXCLUSION CRITERIA ................................................................................................ 9

3.3. SAMPLE SIZE DETERMINATION ...................................................................................... 9

3.4. SAMPLING TECHNIQUE ..................................................................................................... 9

3.5. DATA COLLECTION METHOD ........................................................................................ 10

3.5. Measures and Study variables:....................................................................................... 10

3.5.1. Dependent/ Outcome Knowledge of standard precaution ...................................... 10

3.5.2. Independent/Exposure variables/socio-demographic characteristics ..................... 10

3.6. DATA COLLECTION TOOLS AND PROCEDURE.......................................................... 10

3.7. QUALITY CONTROL.......................................................................................................... 11

3.8. DATA ANALYSIS................................................................................................................ 11

3.9. ETHICAL CONSIDERATIONS........................................................................................... 12

CHAPTER FOUR: STUDY FINDINGS...................................................................................... 13

4.0. INTRODUCTION ............................................................................................................. 13

4.1. DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS ..................................... 13

4.1.1. AGE............................................................................................................................ 13

4.1.2. SEX............................................................................................................................. 14

4.1.3. NATIONALITY......................................................................................................... 14

4.1.4. RELIGION OF RESPONDENTS.............................................................................. 15

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4.1.5. YEAR OF STUDY OF RESPONDENTS.................................................................. 15

4.1.6. FULL CLINICAL ROTATIONS ALREADY DONE............................................... 16

4.1.7. AVERAGE NUMBER OF PATIENTS HANDLED IN A 30 DAY PERIOD ......... 16

4.2. RESPONDENTS’ KNOWLEDGE & ATTITUDES CONCERNING NOSOCOMIAL

INFECTIONS ............................................................................................................................... 17

4.2.1. DISEASES TRANSMISSIBLE THROUGH CONTAMINATED NEEDLES AND

SHARPS ................................................................................................................................... 17

4.2.2. SCENARIOS AND ITEMS THAT INCREASED HANDS COLONIZATION BY

GERMS17

4.3. RESPONDENTS’ PRACTICE TOWARDS NOSOCOMIAL INFECTIONS................. 17

4.3.1. HAND WASHING IN VARIOUS CLINICAL SCENARIOS.................................. 18

4.3.2. ITEMS THEY DISPOSED IN THE SAFETY BOX................................................. 19

4.3.3. AVAILABILITY OF CONSTANT SUPPLY OF WATER AND ALCOHOL

SWABS19

4.3.4. BLOOD AND/OR BODY FLUIDS AND NEEDLE-PRICK ACCIDENTS............ 19

4.3.5. USE OF PERSONAL PROTECTIVE EQUIPMENT ............................................... 19

CHAPTER FIVE .......................................................................................................................... 20

DISCUSSION, CONCLUSION AND RECOMMENDATIONS................................................ 20

5.0. INTRODUCTION ................................................................................................................. 20

5.1. DISCUSSION........................................................................................................................ 20

5.2. CONCLUSION...................................................................................................................... 22

5.3. RECOMMENDATIONS....................................................................................................... 22

5.3.1. To the Students ............................................................................................................... 22

5.3.2. To KIU Hospital Administration .................................................................................... 22

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REFERENCES ............................................................................................................................. 23

APPENDIX ONE: CONSENT FORM..................................................................................... 26

APPENDIX TWO: STUDY QUESTIONNAIRE ON KNOWLEDGE ATTITUDE AND

PRACTICE ABOUT NOSOCOMIAL INFECTION AMONG MEDICAL STUDENTS AT

KAMPALA INTERNATIONAL UNIVERSITY TEACHING HOSPITAL BUSHENYI

DISTRICT, UGANDA ............................................................................................................. 27

APPENDIX THREE: WORK PLAN ....................................................................................... 33

APPENDIX FOUR: BUDGET................................................................................................. 34

APPENDIX FIVE: MAP OF UGANDA SHOWING THE VARIOUS DISTRICTS............. 35

APPENDIX SIX (a): POLITICAL MAP OF BUSHENYI DISTRICT ................................... 36

APPENDIX SIX (b): TOPOGRAPHICAL MAP OF BUSHENYI (RED STAR) WITH ITS

NEIGHBOURS......................................................................................................................... 37

APPENDIX SEVEN: MAP OF ISHAKA IN BUSHENYI DISTRICT .................................. 37