Nursing Research Group1

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COMPLIANCE OF INFECTION CONTROL PRACTICES AMONG BSN LEVEL 3

NURSING STUDENTS OF BULACAN STATE UNIVERSITY: AN EVALUATION

Presented to Faculty of College of Nursing

Bulacan State University

In Partial Fulfilment of requirements forThe degree of BSN in subject Nursing Research

By:

Aguilar, Florence Diane T.

Bernardo, Krista Euca Ira L.

Castro, Pierre Marie N.Centeno, Janelle C.

Centeno, Jean Marie N.

Chua, Jessica Emmanuelle R.Cruz, Mark Dennis S.

Lopez, Jorge Albert O.

Vargas, Rodalyn M.Villanueva, Klaribelle Marie C.

BSN-3F Group 1


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CHAPTER 1

The Problem and Its Background

Introduction

Infection control has been a primary concern of health care workers for a long time.

Many of them may be exposed to certain infections in the course of their work. Protecting their

selves and preventing the spread of infection within the health care setting is an essential part of

the infrastructure of care.

Hospitals have been in existence to care for the sick and dying since 500 BC. Modern Era

of infection control began in the early 1950s, the recognition and awareness that the provision of

medical and nursing care in an institutional setting could result in an increased risk for the

acquisition of infection occured more than 100 years ago (Khinehast and McGoldrick, 2006).

As time passes, many kinds of diseases spread worldwide. Infections are among the

leading causes of death and significant morbidity among patients who receive health care. Most

micro organisms are harmless and some are beneficial, many can cause infection in susceptible

person. Preventing infection in healthy or ill persons and preventing the transmission of micro

organisms from infected clients to others are functions of nurses (www.wikipedia.com).

Giving enough care to ones health is needed in order for us to continue our daily

activities. It is important to give attention to our health especially to college students taking up

nursing who are prone to infections every time they are exposed in the hospital. They consider

the use of protective measures such as hand washing, cleaning, disinfection, sterilization,

vaccination, use of gloves and gowns to prevent the incidence of acquiring an infection and

protect the patients from risk of exposure to micro organisms. It is an ethical obligation to ensure
http://www.wikipedia.com/http://www.wikipedia.com/


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that appropriate aseptic measures are taken to protect clients, support people and health

personnel including themselves.

Statement of the Problem

The principal concern of this study is to evaluate the basic preventive measures done the

BSN 3rd level student of Bulacan State University infection control practices.

Specifically, the study wanted to seek to answer the fallowing questions:

1. What was the profile of the respondents in terms of:

- Age

- Gender

2. How does the given factors affect the compliance of BSN 3rd Level students to infection

control procedures:

- Gender

- Environment

- Personal hygiene regimen

- Availability of Disinfectants and Antiseptic

- Time allotted for the infection control practice

- Knowledge of students with regards to the importance of infection control

3. How do the response of 2 groups of respondents compare as to infection control

practices?

- Male

- Female

Hypothesis of the Study

1. There is no difference between the responses of the two groups of respondents.


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The results of the study were confined to the answers given by the 3rd year students who

were grouped according to their gender the data were gathered by means of the questionnaire as

the principal research tool.

Operational Definition of Terms

In line of this study, some terms used are defined in order to provide a better

understanding and view of the said research study, these are the following:

Aseptic Technique infection control used to prevent the transmission of micro

organisms.

Infection Control effective intervention to reduce the incidence of nosocomial

infection.

Nosocomial Infection acquired 3 days after hospitalization.

Asepsis absence of micro organism.

Medical Asepsis process of reducing the number of micro organisms growth and its

spread.

Surgical Asepsis process that totally eliminate micro organism from an object area.

Hand washing basic and most effective infection control.

Surgical Scrub/Handwashing used to reduce number of transient and colonizing

micro organism from nails, hands and fore arms.

Sterilization process of reducing all micro organism including spores.

Hygiene a practice which promotes a good health.

Sanitation a practice means of preventing human contact from the hazard of wastes.

Compliance willingness to follow.

Infection invading and multiplying in the body tissue with cellular injury.


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Disinfection reducing of micro organism with the exception of spores from in animate

objects.

Standard it is used to promote guidance in the field of health care setting.

Clinical area area where the students are being exposed to different experience inside

the health settings.

Pathogenic from a Greek word pathos which means bringing into being.

bringing a disease into being productive, its capable of causing disease.


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Notes on Chapter 1

Khinehast, McGoldrick (Friedman). Infection control in home care & hospice. 2000.

http://www.wikipedia.com

Bailey, N. T. J. The Mathematical Theory of Epidemics. London: Griffin. 1957.

Fine, P. E. M. Herd Immunity; History, Theory, Practice Epidemiologic Reviews 15:256-302. 2003.

Greenwood, M. Epidemics and Crowd Diseases; an introduction to the study ofEpidemiology. London: Williams and Norgate. 1935.

Hamer, W. Epidemiology Old and New. London: Kegan Paul. 1928.

Kozier, .Fundamentals of Nursing

Comley, Mike. Basic Infection: A practical Exercise. 2001.

West; et al. Public Health and Preventive Medicine. 2003.

Blesilda, M. Compliance to Infectious control measures by O.R personnel at the Bicol

Regional Training & Teaching Hospital. 2001.
http://www.wikipedia.com/http://www.wikipedia.com/


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CHAPTER 2

Related Literature and Study

Review of Related Studies (Foreign and Local)

The review provides information on related studies regarding infection control practices

and to gather current knowledge about the use of effective infection control programs to ensure

to prevent the spread of nosocomial infection in a health care setting.

The modern era of infection control began in the early 1950s, the recognition and

awareness that the provision of medical and nursing care in an institutional setting could result in

an increased risk for the acquisition of infection occurred more than 100 years ago. In the 1840s,

Dr. Ignaz Phillip Semmelweis was caring for postpartum women in a lying-in hospital in Vienna.

He was concerned about the incidence of puerperal fever and its related mortality eighteen

percent of the women who acquired the infection died. As the first hospital epidemiologist,

Semmenlweis observed and studied postpartum infection and proved that it was related to care

provided by the medical students.

The idea behind the position of the ICP may have arisen when, during the Crimean war,

Florence nightingale said that the first requirement of hospitals is that they do no harm to the

sick. In 1959, Torbay hospital in England named the first Infection Control Sister as a liaison

among all personnel and disciplines in the hospital with respect to asepsis.

A substantial but overlooked component of the health revolution was a sociocultural

transformation in personal hygiene and cleanliness. The quarter-century 1890 to 1915, in

particular, was the beginning of a mass change in bathing, laundering, and domestic hygiene

practice.


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Patients are protected against infection in hospital by a system of methods, including

surgical asepsis and hospital hygiene, the purpose of which can be summarized under three

headings: to remove the source of infection; this includes treatment of infected patients as well as

sterilizing, disinfection and cleaning of contaminated materials and surfaces: to block the routes

of transfer of bacteria from these sources to uninfected patients, which include isolation of

infected and susceptible patients, barrier nursing, aseptic operation and no touch dressing

techniques; and to enhance the patients resistance to infection.

The Joint Commission continued its requirements for an organized infection control and

surveillance program in home care and hospice, updating its standards in January 2005. These

standards are very comprehensive, addressing organizational issues, surveillance, prevention of

infections in patients and staff, and education. A consideration has been added to require home

care organizations to plan for a sudden influx of patients resulting from an infectious disease

outbreak (JCAHO, 2004).

Today, the health revolution continues in the form of personal hygiene and household

cleanliness two important disease-prevention strategies. This supplement includes an

examination of the effectiveness of hand washing as well as household cleaning and disinfecting

practices today in removing and killing microbes. Surveillance for health care-acquired

infections is the cornerstone of an affective infection control program. Historically, a key case

finding methodology for surveillance activity has been manual review of computerized

microbiology reports performed by trained infection control professionals. But this process is

labor intensive and diverts a substantial amount of time from the ICPS consultative and

educational responsibilities.


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The ICP must understand nursing procedures related to infection control, including

isolation technique, proper use of all patient care equipment, such as Foley catheters, ventilators,

intravenous catheters, as well as other equipment in the hospital environment, and adequate

decontamination, disinfection, and sterilization techniques for the inanimate environment. The

ICP should also understand the structure of the nursing department and the responsibilities of the

levels of the nursing personnel. Nursing is the department in which the ICP will probably spend

the most time; therefore ICPs with nursing backgrounds have a great deal of the required

knowledge and expertise to deal with patient care situations.

The ICP must have a good understanding of microbiology in general and specifically as

it relates to patient and employee infections. In order to understand the agents that cause disease,

knowledge of normal human flora, natural pathogens, reservoirs, natural habitats, and

characteristics of micro organisms is necessary. Knowledge of laboratory methods that identify

microbes will be useful for the correct collection, handling, and interpretation of cultures from

patients and the environment. An understanding of antimicrobial sensitivity patterns is essential

in order to identify unusual organisms in the hospital.

Carrying out the practical aspects of infection control is largely a function of the nursing

service staff, which handles not only routine matters but special needs as well. Nurses must

know how to perform all the procedures necessary for the prevention or containment of

infection. They serve as sources of information for others and carry out special supervisory and

reporting duties. Many of their duties and responsibilities are both burdensome and exacting and

demand careful planning and programming. As nurses are the only persons in the hospital close

to the patient every hour of the day and night, only they can provide continuous professional

supervision with respect to infection control.


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Although nursing responsibilities rest primarily on the registered nurse, all other

members of the nursing service share these responsibilities to the extent of their training and the

nature of their assign duties. Included among these other nursing service personnel are licensed

practical nurses, nursing aides, operating room technicians and orderlies.

Soaps and other detergents aid in the cleansing process through the properties of wetting,

penetration, emulsification, deflocculating, and dispersion. For most purposes, plain soap is the

preferred cleansing agent. A thorough, sudsy, 30-second lavage and rinse can be depended upon

to rid the hands of most transient pathogens, such as S. aureus, lished resident flora are not

appreciably affected. The desire to effect sterilizations of the hands by ridding the hands of

resident micro organisms had led to incorporation of anti microbial agents into the hand-washing

procedure. Here the objective is to kill pathogen and maintain such an effect without harm to the

skin. Unfortunately, this goal is seldom achieved. Because the hand cannot be sterilized, they

should at least be made as bacteria free as possible. The use of antimicrobial agents is usually

reserved for:

The operative scrub

Before performance of procedures such as catheterization

Cleansing following heavy contamination

Cleansing during an outbreak of nosocomial infection

The most used and effective agents are:

70 percent ethyl alcohol or 10 percent isopropyl alcohol

To facilitate cleanliness, the fingernails should be kept closely trimmed. A manicure stick

should be used to remove visible dirt, as is done routinely in a complete surgical scrub. Hand

brushes and fingernail brushes facilitate the cleansing process by mechanical action, as in


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preoperative scrubbing. Brushes must be soft enough to avoid abrasion of the skin. They must be

sterilized after each used and kept free from bacterial contamination.

Facilities for hand-washing should be located as conveniently as possible, because

proximity is conducive to their greater use. Paper towels should be available even though single-

use or disposable towels cal also be provided. Soap dispensers, brushes, manicure sticks, nail

cleaners, towel racks, and germ free lotion should be conveniently placed.

The extent of hand-washing varies with conditions. For example, a prolonged wash using

a soft brush is desirable upon starting work or for marked soiling. The used of a manicure sick is

helpful in removing gross soil from the nail fold.

Hand washing presents certain inconveniences because of the time it requires and it

require and its effect on the skin. The techniques used should satisfy the criteria of effectiveness,

economy of time and effort economy of supplies and equipment, comfort, cosmetic appeal, and

simplicity. Jewelry should not be worn while the hands are being washed.

The 10-minute surgical scrub includes washing above the elbows, a germicidal rinse (70

percent alcohol), and the use of sterile towels. This type of scrub is indicated also for personnel

coming on duty in the newborn nursery, for any intensive care unit or isolation unit, and for

certain invasive procedures such as cardiac cauterization.

All hospitals personnel should be instructed in how to wash their hands. This can be done

by demonstration or videotape or film that depicts a standard 30-second simple wash. The

demonstration should show the following sequences.

Hand washing presents certain inconveniences because of the time it requires and its

effects on the skin. The techniques used should satisfy the criteria of effectiveness, economy of


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time and effort, economy of supplies and equipment, comfort, cosmetic appeal, and simplicity.

Jewelery should not be worn while the hands are being washed.

The 10-minute surgical scrub includes washing above the elbows, a germicidal rinse

(70% alcohol), and the use of sterile towels. This type of scrub is indicated also for personnel

coming on duty in the newborn nursery, for any intensive care unit or isolation unit, and for

certain invasive procedures such as cardiac catheterization.

Hand-washing facilities should be readily available in all areas of the hospital. For the

hand-washing lavatory in the patients room it is generally preferable to have the short lever type

of faucet handle. This type of handle is convenient to use; it also is cheaper to install maintain

than are the types design to avoid use by the hands. For the surgical or obstetrical patients room

and the intensive care unit, elbow-knee, or foot-operated controls can by used. There is some

question as to whether or not there should be a lavatory in the toilet room as well as in the

patients room, particularly in multipatient rooms, but this is not always economically feasible. A

paper towel dispenser should be located adjacent to every hand-washing facility.

Theoretical Framework

William Farr (1807-1883) was the first to discern mathematical principles governing the

behaviour of epidemics. He developed refined mathematical models in the early 20th century

factoring into their equations, the variables involved in determining the interactions of disease

agents, human hosts, and environmental conditions.

In William Farrs Epidemic theory, there are three variables he considered, the agent, the

host and the environment. Each of these has many components, however host-agent

interactions vary greatly, and variations in environmental conditions influence the interactions in

innumerable ways. Therefore, Epidemic theory has been verified by empirical observations, and


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by experimental epidemiology. Through this, epidemiologist enables to construct simple

mathematical rules about the behavior of agents and hosts, while observations in the filed

provide data on variations in environmental conditions.

The agent, which is one of the three variables are infectious pathogens which vary in size

and biological make up from protein particles (prions) and ultramicroscopic viruses. They are

spread by direct contact, person to person contact; and from the inanimate environment.

For the environment some agents can survive and/or transmit infection only within a

narrow temperature range. For any given pathogenic organism the range of tolerable

environmental conditions may be wide or narrow. Any epidemic model of a specific disease

must allow for these variations of the causative organism.

For the host it is said that when an infectious agent invades a host, defensive immune

responses are invoked to protect the host from harm.

The probability of an infectious agent encountering a susceptible host in which the agent

can survive, propagate the infection, and sustain an epidemic depends on the proportion of

susceptible hosts in the herd, or population. When an infectious agent is introduced into a

population that has never previously encountered it, all are susceptible. As the epidemic passes

through successive hosts, leaving them immune, progressively higher proportions of the

population become immune. When a sufficiently high proportion of the population becomes

immune to the infectious agent, the epidemic subsides and eventually ceases.

Conceptual Framework

Empirically, the habit of one person may influence the host reaction. The environment

affects the host by means of the disease causing micro organism that might be acquired by the

patient or by the health care provider.


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Effectiveness of this study shows that compliance to infection control will help reduce

the transmission of diseases, and is also necessary in implementing quality health care service.

Included in the input box are the profiles of student nurses in terms of age and gender.

All the inputs above will proceed on the process box which reflects the analysis of the

data gathered through a close-ended questionnaire. Included in the process box are the factors

affecting the compliance of BSN 3rd level students to infection control procedures.

The output box reflected the expected outcome of the study which is efficient and

effective compliance of 3rd level BSN students on different procedures involving infection

control, harmonious delivery of quality health care rendered by BSN 3

rd

level students involve in

the study and improved nursing service among BSN students.


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Paradigm of the Study

Factors affecting the compliance of 3rd level BSN students with regards to the

performance of infection control procedures in their clinical duties.

INPUT: PROCESS: OUTPUT:

Notes on Chapter 2

Students profile:

a. Age

b. Gender

c. Years of Clinical

Experience

Efficient and effective

compliance of 3rd levelBSN students on

different procedure

involving infectioncontrol.

Harmonious deliveryof quality health care

rendered by 3rd BSN

students involve in thestudy.

Improved nursing

service among BSNstudents.

Factors affecting the

students compliance toinfection control

procedure in their

clinical duties:

a. Gender

b. Environmentc. Personal hygiene

regimen

d. Availability ofDisinfectants and

Antiseptice. Time allotted for

the infection controlpractice

f. Knowledge of

students with regards tothe importance of

infection control


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Daniels, Rick R. T. 41 D228 (2004). Nursing Fundamentals Caring and Clinical Decision

Making.

Altman, Gaylene Bovska R. T. 71 A179 (2004). Second Edition Delmars Fundamental

and Advanced Nursing Skills.

Kowels, John (2001). Infection control in Hospital and Emergency Department.

Kenmamer, Mike (2000). Basic infection control for health care providers.

Mehtar, Shaheen (2002). Hospital Infection Control: Setting up w/ Minimal Resources.

Dawn, Mary (2006). Hospital Infection Control Practices.

Davis, Jonathan (2003). Emergency Incident risk management: Safety and Control.

Recierdo, M. J. Effects of Occupational Hazards among the Health Workers ofBicol Regional Training & Teaching Hospital (BRTTH). 2004.

Tapanian, G. Evaluation of the incidence of Nosocomial Infections & the Infection

Control Programs at the De La Salle University Center. 2005.

Practice and Protection TO Infection KDIC Issue 3, Supplement, Page S7-S10.2000.

CHAPTER 3


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Research Design, Methods and Principle

Research Design

Descriptive studies describes and interprets what is, and reveals conditions and

relationships that exist or do not exist, practices that prevail or do not prevail, beliefs or points of

view or attitudes that are held or not held, procedures that are developing.

Descriptive researches systematically, factually and accurately describe an area of

interest or situation. Description, analysis and interpretation of the conditions as they now exist

are involved. It may also deal with comparison and contrast; or the discovery of existing

relationships between events or groups.

Survey is the type of this study that were using in which the data are gathered from a

relatively large number of cases at a particular time. This method is applied to the analysis of

public opinion.

Research Locale

The purpose of this study conducted in Bulacan State University was to introduce a study

related to infection control. This study endeavor challenging circumstances where in, effective

ways to prevent and control the consequence of complications are established.

Defining the problems about infections in hospitals and home.

Identifying effective intervention programs that can help prevent nosocomial infections

that may lead to further complication.

Allowing supportive clinical instructors and professors to provide recommendation

/suggestion that will be helpful during our thesis study


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b.10 Discard gloves atappropriate container

C. Masking

c.1 Holding mask with colorlayer and ear fastener on theoutside of the mask

c.2 Positioning the mask belowthe face

c.3 Scaring the nose piececomfortably over the bridge ofthe nose

c.4 Pulling the mask downfanning/extending the maskunder the chin

c.5 Pulling the ear loops tight

around the ear

c.6 Confirming mask if it issecure around the ear and theface

D. Disinfectant

d.1 No soap or dtergent shouldbe added to a disinfectant andno disinfectants should bemixed unless specified

d.2 Knowing that plasticsdeactive disinfectants

d.3 Preparing the disinfectantas close as practicable to useddiscarded after 24hrs.

d.4 Always wear gloves whenapplying disinfectants ifnecessary

d.5 Not using brushes, bowls,bottles or other plastics

Validation of the Questionnaire

Extent of performance in the application of infection control practices.

Weight Qualitative Rating Equivalent

5 Always Complied 4.50-5.00


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4 Very often 3.50-4.49

3 Sometimes 2.50-3.49

2 Seldom 1.50-2.49

1 Never 1.00-1.49

Data Gathering Procedure

The researchers individually floated the questionnaires to the sample students involved in

the study and gathered data from collecting it personally. This action was done to accomplish a

data which is free from any errors that might be introduced by field interviewers and to ensure a

well understood questions which establishes the element of completeness comprehensibility,

consistency and reliability of data gathered.

Statistical Treatment of the Data

The data obtained through the sets of questionnaire will be tallied, tabulated and analyzed

statistically. To evolve a meaningful interpretation of data, the following statistical tools will be

employing.

1. Frequency Percentage Distribution

It will discuss or describe the facts or occurrence in a sample and determine likewise the

cluster of respondents which will stem from a specific category.

1.a Frequency Distribution

A systematic arrangement of numerical value from the highest to the lowest and the

number counts, value to be obtained.

1.b Percentage Distribution


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Is the division of each category or class frequency by the total no. of respondents and

then multiple by 100.

Formula:

100%

=

N

F

Where:

F = number of occurrence of the value / frequency

N = total number of respondents

2. Mean

The mean is a measure of central tendency where in it is the point on the score scale

which is equal to the sum of the scores divided by the number of samples.

Formula:

n

EfxX =

where:

X = mean

x = each individual category

n = number of samples

E = the sum of frequency within the class interval

f = frequency within the class interval

3. Standard Deviation

Standard deviation is a measure of variability and the degree to which the frequency

deviates from the mean.


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Fomula:

22

1

=

n

NxEfxSD

Where:

N = number of samples

E = the sum of mean

X = mean

f = frequency within the class interval

x = each individual category

4. t-Test

T-test is a hypothesis testing procedure to determine whether two group means differ

significantly. It is also used to determine if a single mean (X) differs significantly from a

stated value for or whether a correlation coefficient differs from zero.

Formula:

2

2

1

2

21

n

pS

n

pS

XXt

+

=

Where:

1X = mean of the first sample

2X = mean of the second sample

1n = the number of the second sample

2n = the number of the second sample


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pS2

= the pooled estimate of the population in variance

Notes on Chapter 3

Kozier, .Fundamentals of Nursing

Comley, Mike. Basic Infection: A practical Exercise. 2001.

West; et al. Public Health and Preventive Medicine. 2003.


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Blesilda, M. Compliance to Infectious control measures by O.R personnel at the Bicol

Regional Training & Teaching Hospital. 2001.

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