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A STUDY TO EVALUATE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME ON PREVENTION OF NOSOCOMIAL INFECTION AMONG
THE STUDENT NURSES IN A SELECTED SCHOOL OF NURSING
GULBARGA.
PERFORMA FOR REGISTRATION OF
SUBJECT FOR DISSERTATION
Mr. Abdul Samad
M.Sc. Nursing – I year.
AL – KAREEM COLLEGE OF NURSING,
GULBARGA, KARNATAKA
RAJIV GANDHI UNIVERSITY OF HEALTH
SCIENCES,
BANGALORE, KARNATAKA.
ANNEXURE – II
PERFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1
1. NAME OF THE CANDIDATE AND
ADDRESS
(IN BLOCK LETTERS)
MR.ABDUL SAMAD
H.NO.-5-23/2,JALAWADI,BEHIND KHAJA
HIGH SCHOOL, ROZA(B) GULBARGA – 585105
KARNATAKA
2. NAME OF THE INSTITUTION AL-KAREEM COLLEGE OF
NURSING,
3. COURSE OF ADMISSION OF THE
COURSE
1st YEAR M.Sc. NURSING,
MEDICAL AND SURGICAL NURSING
4. DATE OF ADMISSION TO THE
COURSE
24-05-10
5. TITLE OF THE STUDY A STUDY TO EVALUATE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME ON
PREVENTION OF NOSOCOMIAL INFELTION
AMONG THE STUDENT NURSES IN A
SELECTED SCHOOL OF NURSING
GULBARGA.
6. INTRODUCTION2
“While there is life there is hope”
- R. Macaulay
The term infection refers to a state in which parasitic organisms attach themselves to the body, or to the
inside of the body, of another organism, causing contamination and disease in the host organism. Infections fall
into two general categories:
endogenous, which occur when the body's resistance is lowered and exogenous, or those that originate
outside the body. Nosocomial infection is an exogenous type of infection1.
Nosocomial Infection is an infection originating in a patient in hospital. It is a serious hospital health hazard
world wide. In spite of advances in the prevention and control propgramme of nosocomial Infection; they
continue to be a major side effect of hospital and contribute significantly to the rate of morbidity, mortality and
cost of care2.
Florence nightingale more than 100 years ago, said “No stronger condemnation of any hospital or ward
could b e pronounced than the single fact that zymotic (infectious) disease has originated in it,” or that such a
disease has attacked other patients than those brought in with them. The history of Hospital Acquired Infection
goes back to the period since the sick were housed together for the treatment. The enormity of the problem of
Hospital acquired infection during pre Lister era can be best stated by quoting, John Bell who in 1801 wrote :
“There is no hospital, however small or well regulated, where this epidemic ulcer is not to be found at times; and
then no operation dare be performed, every care, stands still, every wound becomes a sore, every sore is apt to
run into gangrene.
The Nosocomial Infection is a problem, world over in all the hospitals, However, due to emergence of
H.I.V. Infection the need to prevent and control nosocomial infection is being emphasized. The aim is to reduce
nosocomial infection and ensure that no one acquires HIV infection from the hospital by strictly observing the
precautions recommended for handling blood and body fluids, precautions in relation to injections, skin piercing
and invasive procedures, effective use of sterilization, disinfection and disposal of infective waste3.
No Hospital can continue to perpetuate such condemnation, however hospital acquired infection remains a
problem world over. In a recent survey conducted by WHO on 28,861 patients in 47 hospitals of 14 countries
located in 4 continents, the prevalence rate of nosocomial infection of different hospitals, varied from 3% - 21%
3
with mean of 8.4%. The results of the survey reported in 1988 indicated that the nosocomial infection is a
considerable problem, even in hospital with means and interest in control of nosocomial infection. Further it is
possible to reduce in incidence of infection. The authors concluded that there is a need and opportunity for
international co-operation in finding and applying effective means of prevention and control4.
Infections occurs within 48 hours after admission are considered as nosocomial infection. Nosocomial infection
cannot be cradicated entirely but many of them can be prevented by proper aseptic measures5.
7. BRIEF RESUME OF THE INTENDED WORK.
7.1 Need for the study
Nosocomial infection is an infection originating in a patient, while in hospital. Nosocomial infection is a
serious health hazard worldwide. Despite advances in the control and prevention of nosocomial infection, they
constitute to remain as the major side effect of hospital treatment and contribute significantly to the rate of
morbidity and mortality and cost of care6.
The Nosocomial infection is responsible for about 29,000 deaths in U.S. per year. 10% American hospital
patient acquired clinically signified nosocomial infection. The infections transmit from patient to patient due to
high prevalence of pathogens. Nosocomial infection is potential hazard for all person having contact with the
hospital because of the high concentration of pathogenic micro organisms exists in hospital. It is estimated that
out of 16 million patients undergoing surgical procedure each year, 24% suffer with nosocomial infection4.
The incidence rate of Nosocomial infection in U.S.A was 2,159,230 amnong the estimated population
29,36,55,405 and in India it was 78,31,401among the population 106,50,70,607 7.
A study on effectiveness of self instructional module on knowledge of health worker care providers
regarding protection against hospital acquired infection at Ramaiah College. 50 samples were selected by using
purposive sampling technique. The tool used was structured questionnaire. The mean pre test was 46.2 +- 25.0
whereas the post test score was 74.4 +- 24.2.8
A quasi experimental study was conducted to evaluate the effect of an educational training programme
for 100 randomly selected hospital nurses on universal precautions in Chang Hospital in China. Questionnaire
4
were administered to the 100 nurses prior to and four months after the training. The result showed that
educational training significantly improved Chinese nurses knowledge, practice and behaviors related to
universal precautions. There was remain room for improvement in glove use and needle stick injury reporting. 9
According to above studies and incidence, as a researcher myself according my experience, felt there is a
need for in depth knowledge regarding prevention of Nosocomial infection among nursing students to reduce
mortality and morbidity related to Nosocomial infection
7.2 REVEIW OF LITERATURE
The review of literature is traditionally considered a systematic critical review of the most important
published, scholarly literature on particular topic. A thorough literature review on prior research provides a
foundation on which to base knowledge.
1. Review literature related to general studies of Nosocomial Infection.
2. Review literature related preventive measures of Nosocomial Infection.
3. Review literature related to Structured Teaching on prevention of Nosocomial Infection. On G.N.M.Students.
4. 1. Review literature related to general studies of Nosocomial Infection.
A study on an outbreak of severe acute respiratory syndrome was detected in Singapore at the beginning
of March 2003. The outbreak initiated by a traveler to Hongkong in February 2003 lead to spread of SARS to
three major acute care hospitals in Singapore. The critical factor, of this outbreak was early, detection and
complete assessment of movement and follow up of patients, healthcare workers and visitors who had contacts. In the
3 hospital outbreaks, 3 different containment strategies were used to contain spread of infection, closing an entire
hospital, removing all potentially infected persons to a dedicated SARS hospital and managing exposed persons in
place on the basis of his experience. If a nosocomial outbreak is detected late, a hospital may need to be closed in
order to contain spread of disease, outbreaks detected early can be managed by either removing all exposed persons
to a designated location or isolating and managing them in place10.
5
A study on neurosurgical patients operated upon over a period of one year from January to December.
Samples of surgical patients about 2441 were taken. A total of 2558 operations were performed, 1824 on elective and
734 as emergency. They observed nosocomial infection was (7.03 %) 186 patients. Prolonged catheterization (more
than 7days) caused bacterial infection accounting about 79 %( 132)11.
A survey on identifying knowledge and performance of the nursing personals and medical students in Korea was
conducted. The questionnaire was administered to a total of 714 nursing and Medical students for the period
between Nov 2, 1998 and April 30, 2000. The results showed that the knowledge level of the nursing students
(270.4+-19.4) was higher than that of the medical students (261.0+-24.4). The average performance level was
52.7 +- 60.2 (scores ranged from 14 to 75).The student of the nursing college showed a higher performance level
in universal precautions (53.2 +- 5.9,p=0.002). The correlations showed :a weak and positive
correlation(r=0.317).12
2. Review literature related preventive measures of Nosocomial Infection
An evaluation study with one group pretest post test design in the medical, surgical and orthopedic wards
of Guru Tej Bahudur hospital, Delhi. The surgical knowledge and practice of staff nurses on biomedical waste
management were accessed through structured knowledge questionnaire and observations check list and book let
was administrated to 32 nursing personnel. It was observed that less than half of staff nurses were aware of
various risks and methods of treatment and disposal of biomedical waste. The post test knowledge score were
significantly higher than pre test knowledge scores.13
A study on effective hand washing with lotion or soap to remove nosocomial bacteria pathogenesis
persisting on fingertip it is called intra hospital spread. 30 seconds hand wash with a nonseptic lotion or soap to
remove nosocomial pathogens applied to fingertips was studied. Species dropped after the first hand wash,
persistent maintained thereafter wiping hands with an antiseptic (70% isopropanol or 10% parodine iodine)
sponge
A study about comparison of effect of detergent Hypochlorite solution cleaning on environmental
contamination and incidence of Clostridia deflicile infection. He studied about two medical wards cleaned with
hypochlorite disinfectant and after one with neutral detergent. The samples were collected for 1,128 two years.
6
There was a significant decrease of the infection, incidence of ward which was washed by the hypochlorite
solution. Another ward which was washed with neutral detergent showed culture positive.14
William & Water man (2001) conducted a study in liver pool to examine the nurses' practice when
performing aseptic technique. The data was collected through observations and formal interview from 21 trained
nurses selected conveniently. The result showed reduced frequency of hand washing, the transfer technique and
maintaining the principles of the glove technique required for procedures.15
3. Review literature related to structured teaching on prevention of Nosocomial Infection. On
G.N.M.Students.
A comparative study to assess the knowledge of nosocomial infection in student nurses at Mangalore.
100 samples were selected by using purposive sampling technique. The tool used was structured questionnaire.
The mean pre test was 2.3! +- 1.25 by students whereas staff nurses mean score was 9.43 +- 2.18 .16
A Study evaluated the effectiveness of PTP on knowledge of breast cancer and breast self examination
among college girls in Kerala. The data were collected from 49 samples using questionnaire and observation
check list, the finding has shown the effectiveness of planned teaching programme through a significant increase
in the post test scores.17
Omisakin (2001) conducted a study on 4721 registered nurses to assess the knowledge and skills about
caring patients with HIV/ AIDS in osum state. A self administrated questionnaire was used. The result showed
that majority(80.3%) of nurses specially in that teaching hospitals were knowledgeable about HIV/AIDS and
were skill full in caring for patients with HIV/AIDS. However knowledge deficit was recovered on the
organisms targeted HIV/AIDS viruses available, diagnostic tests and drug used for treating patients with
HIV/AIDS. The majority (60%) felt that there was a need to update their knowledge and skills in the care of
patients with HIV/AIDS. 18
7.3 STATEMENT OF PROBLEM
“A study to evaluate effectiveness of structured teaching programme on prevention of nosocomial
infection among the student nurses in selected school of nursing Gulbarga”.
7
7.4 OBJECTIVES OF THE STUDY :-
1) To assess the effectiveness of structured teaching programme on prevention of Nosocomial Infection by
pre-test score.
2) To administer structured teaching programme among student nurses on prevention of Nosocomial
infection in selected nursing school.
3) To assess the effectiveness of pre-test and post-test knowledge scores.
4) To find the association between pre-test knowledge scores with selected demographic variables.
7.5 OPERATIONAL DEFINITIONS :
1. Assess: It is an activity to estimate the outcomes of structured teaching programme on knowledge
regarding prevention of Nosocomial Infection.
2. Effectiveness: It refers to the ability of an intervention to procedure desired beneficial effects in actual
stage.
3. Knowledge: It is the ability to know the things; self awareness.
4. Student Nurse: It refers to the students who are studying in II and III GNM nursing.
7.6 Assumption :-
1) Student Nurse may have some knowledge regarding prevention of Nosocomial infection.
2) Structural teaching programme will improve the knowledge of student nurses regarding prevention of
Nosocomial Infection.
3) Students may have interest to gain knowledge regarding prevention of Nosocomial Infection.
7.7 Hypothesis :-
Ho1 :- There will be significant difference between mean pre and post test knowledge scores students
nurses regarding practice & prevention of Nosocomial Infection.
Ho2 :- There will be significant association between pre and post test knowledge scores of students nurses with
selected demographic variables.
8
8. MATERIAL AND METHOD :-
8.1 Source of Data :- The date will be collected from student nurses of selected school of Nursing in
Gulbarga.
8.2 Research Design :-
01 X 02
Our group pre-test and post-test with pre experimental design is adopted for the study.
8.3 Setting of the study :- The study will be conducted in selected nursing school of Gulbarga.
8.4 Population :- Student Nurses who are studying in II and III GNM nursing.
9. METHOD OF DATA COLLECTION :-
9.1 Data Collection Instrument :- Structural knowledge questionnaire will be used for data collection.
9.2 Sampling Techniques :- In this study Non Probability sampling technique is used for the study.
9.3 Sample Size : Sample consist of 50 students nurses.
10. CRITERIA FOR RESEARCH STUDY :-
10.1 Inclusion Criteria :- Study includes the student nurses who are
Willing to participate in the study.
Studying in II and III GNM.
Present during the period of data collection.
10.2 EXCLUSION CRITERIA : Study includes the student nurses who are
Not willing to participate in the study.
Studying in I year, Internship.
Not present during the period of data collection.
10.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE
CONDUCTED ON PATIENTS OR BRIEFLY? OTHER HUMAN OR ANIMALS? IF SO, PLEASE
DESCRIBE.
Yes as the investigator is giving structured teaching programme for the student nurses.
9
10.4 Ethical clearance has been obtained from your institution in case of 10.3?
Ethical clearance has been obtained from
- Al- Kareem college of nursing.
- Consent will be obtained by the subjects.
- The head of selected nursing school.
10
11. LIST OF REFERENCES.
1. http://www.answers.com/topic/infection
2. Monica P. Infection controls a Policy and Procedure Manual. Philadelphia WB Sounders Company,
1990.
3. Mukerjee AK. Hospital Acquired Infection Guidelines for Control. Government of India, New Delhi,
1992.
4. Park K. Text book of Social and Preventive Medicine. Jabalpur, Bharat Publishers, 2000. PP. 82, 137-
138.
5. Potter and Perry. Text book of Fundamental Nursing. 5th edn. Mosby Publishers 2000.
6. Vijaya De Silva. Health Care Management. India’s first News paper for the Health care business feb
2004.
7. http://www.wrongdiagnosis.com/n/nosocomial infections/stats-country.htm
8. Gowda M N. A study on effectiveness of self instructional module on knowledge of Health worker care
provider regarding hospital acquired infection and self protection. RGUHS, 2001.
9. Hung Jang, Wang, Lin, Ferrie Burgers. A survey to determine knowledge of nurses in a clinical setting
about universal precautions. 2002.
11
10. Gopal K. Cluster of severe acute respiratory syndrome protected health care worker. Indian medcial
journal, 2004.
11. Meena A. Prevalence of post operative nosocomial infection in neuro surgical patients and associated risk
factors. A prospective study of 2441 patients. 2003.
12. Kim KM, Chung MA. Knowledge and performance of the universal precautions by nursing and medical
students in Korea. American journal of infection control. 2001: 29(8); 295-300.
13. Singh, Kishore R, Mathur J., Mandal RG, Puri K. The roles of an information booklet on biomedical
waste management for nurses. The nursing Journal of India, 2002.
14. Wilclox, Maziolla A. Nurses and hospital infections control Knowledge, attitude and behaviour of
station, operating theatre staff. Journal of hospital infection. 1999; 42(2); 105-112.
15. Williams and Watermen. A study on aseptic technique at Liverpool. American journal of infection
control. August 1-7, 2001.
16. Alexie A. A comparative study to assess the knowledge of nosocomial infection between student nurses
and staff nurses. RGUHS, 2004.
17. Rubina. A study to determine the effective of PTP on knowledge of breast cancer. RGUHS, 2001.
18. Omisaken FD. Nurses knowledge and study about caring for patients with HIV/SAIDS in Orissa state.
Niger journal of medicine. 2001; 10(1);30-3.
12
12. Signature of Candidate
13 Remarks of the Guide
14 Name & Designation of the (In Block Letters)
11.1 Guide
11.2 Signature
11.3 Co Guide (if any)
15 11.4 Signature
11.5 Head of the Department
11.6 Signature
16 12.1 Remarks of the Chairman and Principal
12.2 Signature
13