A Study to Assess the Knowledge of Staff Nurses

“A STUDY TO ASSESS THE KNOWLEDGE OF STAFF NURSES

ON THE PRACTICE OF ASEPTIC TECHNIQUEDURING

LABOUR IN SELECTED HOSPITALSOF RAICHUR,

WITH AVIEW TO DEVELOP SELF

INSTRUCTIONAL

MODULE”

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

RAJKUMARI LAKSHMI DEVI

NAVODAYA COLLEGE OF NURSING, RAICHUR

DECEMBER 2010

RAJIV GANDHI UNIVERSTITY OF HEALTH SCIENCES, BANGALORE,KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

Name of the candidate:Ms.RajkumariLakshmi Devi

And address: M.ScNursing (1st year)

Navodaya College of Nursing

Navodayanagar

Mantralayam Road, Raichur

Name of the institution:Navodaya College of Nursing
Course of the study and:MSc Nursing (1st year)

Subject : Obstetrics and Gynaecological

Nursing

Date of admission :15-07-2010
Title of the topic:

“A STUDY TO ASSESS THE KNOWLEDGE OF STAFF NURSES

ON THE PRACTICE OF ASEPTIC TECHNIQUE DURING

LABOUR IN SELECTED HOSPITALS OF RAICHUR,

WITH AVIEW TO DEVELOP SELF

INSTRUCTIONAL

MODULE”

6. BRIEF RESUME OF THE STUDY

6.1NEED FOR THE STUDY

Aseptic technique is a set of specific practices and procedure performed under carefully control condition with the goal of minimizing contamination by pathogen.

Aseptic technique is employed to maximize and maintain asepsis,the absence of pathogenic organisms, in the clinical setting.Aseptic technique can be applied in any clinical setting. Pathogens may introduce infection through contact with the environment,personal or equipment.All patient are potentially vulnerable to infection,although certain situation further increase vulnerability,such as extrinsic burns or immune disorders that disturb the body natural defences.Typical situation that call for aseptic measure include surgery,insertion of intravenous line,urinarycatheter,drains and labour room setting1.

According to WHO report (2008),In India it is reported that 50-60%of all neonatal death occur within the first month of life due to poor aseptic technique practising in the labour room.Of these more than half may die during the first week of life2.

The concept of asepsis can be applied in any clinical setting. A key element requiring careful attention is equipment or supplies Medical equipment can be sterilise by chemical treatment,radiation,gas or heat.Personal can take steps to ensure sterility by assessing that sterile packages are dry and intact and checking sterility indicators such as dates or coloured tape that changes colour when sterile3.

The universal precaution to control infection which applied by all medical and para-medical staffs include the basic elements such as hand washing thoroughly with soap and water before caring out the procedure,immediately.If gloves are torn and hand is contaminated with blood or other body fluids soon after the procedurewith gloves on again after removing the gloves. Strict asepsis during the delivery or operative procedure are practices “no touch technique” which is any instrument or part of instrument which is to be inserted in the cervical canal much not touch any non-sterile object or surface prior to insertion.Sterilization or high level disinfection of instrument with meticulous attention should followed in the labour room .In case autoclaving is not possible,the instrument must be fully immersed in water in a covered container and boiled for atleast20 minutes4.

The concept of aseptic technique is not new to India Bhore committee in 1946 high lighted about the septic and asepticdeliveries. It was recommended that separate delivery rooms be required inall hospitals. Reasons for this conference recommendation were not based on preventing the spread of infection,but rather for technical efficiency,convenience,availability,ease of staffing and maintaining harmonious staff relationship most conference agreed that since sterile aseptic technique is observed in surgical procedure and in deliveries,there is no series danger of spreading infection to either the maternity patient or surgical patient if the same room is used.It was felt that in hospitals were space could always be available for deliveries,some flexibility should be provided so that delivery room and operating room might be used for whatever procedure was necessary5.

Every day 1500 women die from pregnancy or child birth-related complication.In 2005 there was an estimated 5,36,000 maternal death worldwide.Most of the death occurs in developing countries due to home delivery and poor aseptic techniques.Data shows that less than two third (62%) of women in developing countries receive assistance from a skilled health worker when giving birth.This means that 45 million home deliveries each year are not assisted by skilled health personal6.

Recent newspaper report, May 2005 claimed that although there is a enough staff nurse in the labour room,she remains busy with her and may be following strict aseptic technique but the sweepers and other support staff do not followed the aseptic precaution which will transferred the infection to the patient.

Every year about 5000 patient die unnecessary in India from hospitals acquired infection(National audit office 2000).Many become infected during simple procedure such as IV drugs,owing to poor hand washing and aseptic technique in labour room7.

The health care professional in general and nurses in particular play a vital role to ensure that the newborn has best possible beginning of life and the nurse must be aware of the potential problems and alert to the infant’s changing condition and to intervene appropriatelywhen necessary.The nurse is the first health care provider who has direct contact with the neonate during birth .Hence nurses required the knowledge and skill to take care of the babies as well as in aseptic technique to prevent infection to both mother and baby,so that many complication can be prevented8 .

Hence keeping the above points in mind the researcher felt the need to assess the knowledge of labour room staffs on the practices of aseptic technique during labour.

6.2REVIEW OF LITERATURE

A literature review is an examination of the research that has been conducted in a particular field of study.It is to find out the method of study,it help us to determine what has been done in past and will give us pointers on how to develop or make some progress on its status.It provides basis to locate pertinent data and new ideas that need to be included in the present study9.

A survey was conducted to examine the aseptic precaution for insertion of an Epidural catheter in the labour ward at New Zealand College of anaesthetists. The study consist of 435 consultant anaesthetists and the sample were selected by simple random method.Of the 435 consultant anaesthetists survey,367 responded (84%), revealing a wide variation in practices.It was not thought to be essential practice to removed a watch before washing hand by 51 responded (14%),to wear a face mask by 105(29%) or to wear sterile gown by 45(12%).Three anaesthetists (1%) did not believed sterile gown were essential. However all respondent indicated that an aseptic skin preparation was essential. The result concluded that a minimal standard of essential precaution is needed for insertion of an epidural catheter10.

A Prospective case controlled study was conducted to assess the association between bacterial vaginosis and preterm labour and to compare it with those who delivered at term in MeeadKadumHassan,Hefa-Al-shaheenjehanmajeedAlmukh, Afghanistan. Data were collected and analyse on 179 women in spontaneous labour,72 with preterm labour and 107 at term this study was confirmed that gononerellavaginosis was the commonest bacterial pathogens isolated from women with preterm labour ,It was detected in 17 out of 72 women with preterm labour (23.6%)in comparison to 2 of 107(1.9%)women who delivered at term (p value0.001 ) follow by group B.Streptococus in 4(5.5%),E-coli in 2(2.8%),proteusin 1(1.4),streptococcus and Neisseriagonorrhoea in 1(1.4%),In addition to bacteria listed above,Trichomonasvaginalis was detected in 4(5.5%) of women preterm labour.Itwas found that 72.3% of women with preterm labour had preterm rupture of membrane in comparison to 39.2%of control (p:<0.001).From this result it is concluded strict precaution will reduce the bacterial infection11.

A cross sectional study was conducted to assess the quality of care provided by nursing personal to new born in the labour room at Koirala Institute of Health Science,Nepal.Care provided by nursing personal to 814 normal newborn and sample were chosen by non-probability purposive sample technique.Data was collected through observational method by trained nursing personal,using 46 item pre-tested,validated and self-develop observational check lists.Result concluded that care provided to newborn from birth to 2 hourand categorise as good and average due to strict aseptic techniquepractices during labour .Over all quality of care was good in 42.3%,average in 57.64% and non of them received poor care12.

A study was conducted to asses the professional attire at delivery part in Chicago to document current practices a questionnaire was mailed to obstetric nursing supervisor 30 metropolitan hospitals.Follow up letter and phone calls resulted in a response rate of 100% .As the annual number of birth per hospital increase ,the use of surgical attire (p=0.056)and surgical drapes (p=0.03) decrease. No significant difference was found between physician and certified nurse-midwife use of apparel (p>0.16) .However, less frequent use of the cap and gown by the certified nurse midwife did approach statistically significance (p=0.09).A significance difference (p<0.05) was found for the use of attire between delivery room and birthing room settings;more surgical attire was required for the more traditional delivery room births13.

A survey was conducted to assess the bacterial infection after intra-partum spinal anaesthesia inKolkata.Study consists of 200 sample consultant anaesthetist and samples were selected by lottery method.Theintrathecal space is entered during several diagnostic and therapeutic spinal procedures, including lumbar puncture (50%),myelography(10%) and spinal anaesthesia (40%) and can occur inadvertently during epidural anaesthesia.Cases of meningitis have been reported after all of these procedures,although most published case has involved spinal anaesthesia (89%). Post spinal procedure meningitis causes serious infection; in one cases series,one third of cases resulted in death14.

6.3 STATEMENT OF THE PROBLEM.

“A study to assess the knowledge of staff nurses on the practice of aseptic technique during labour in selected hospitals of Raichur, with a view to develop self instructional module”.

6.4OBJECTIVES OF THE STUDY

To assesstheknowledgeof staffnurses regardingthe

practice of aseptic technique during labour.

Toanalyse therelationship between knowledgeof staff

nursesregarding the practice of aseptic technique with

demographic variables.

3. To prepare a self-instructional module regardingthe practice

ofaseptic technique.

6.5. OPERATIONAL DEFINITION

Knowledge: Refers to the level of understanding of staffnurses regarding the practice of aseptic technique as measured by their correct responses to the correct item of questionnaire.

Staff nurses:The title and position accorded to a registered

nurse who is permanent member of a Hospital.

Labour: Labour is the process by which the foetus, placenta,

membrane and cord are expelled through the birth canal.

Aseptic technique: A set of specific practices and procedure

performed under carefully controlled condition with the goal

of minimising contamination by pathogens.

Self-instructional module: Systemic organization of

scientific information regarding the assessment on practice

ofaseptictechnique which serves as a hand guide for staff

nurses to practice the aseptic technique effectively.

6.6. HYPOTHESIS

H1-There will be significant relationship between knowledge of staff nurses regardingthe practice of aseptic techniqueand selected variables (Age, Educationalqualification, ExperienceandPrevious orientation).

SELECTED VARIABLES

Variable is an attribute of a person or object that varies, whichtakeson different values.

Two types of variables are identified in the study. They are:

Dependent Variable

Independent Variable

Dependent Variable: -The outcome of interest, the variable that is hypothesized to depend on or caused by another variable i.e. independent variable.In this study the knowledge of Staff Nurses on the practice of aseptic technique is the dependent variable.
Independent variable: -Independent variables are the stimulus or activities that are manipulated or varied by the researcher to create an effect on the dependent.

Selected variables:-

Age: Refers to the chronological age of the staff nurses. For the present study it is categorized as

20 – 25 years
26 – 30 years
36 years – above

Educational qualification: Refers to the professional education of the staffnurses. For the present study it categories as:

G.N.M
BScNursing

Experience:It refers to years of working period .The following ranges of experience are considered for the study.

<2years
2-3years
3years

Previous orientation training: Refers to any training on the practice of aseptic technique,previously expose or not.

MATERIALS AND METHODS
SOURCES OF DATA:

Design: The research design adopted for this study is descriptive design.
Setting of the study: Thepresent study was conducted in selected hospitals of Raichur.Raichurdistrict is one of the backward districts;it has an area of 6,839 sq.mtand located in the North region of Karnataka.Navodaya Medical College,Hospital and Research Centre,Sanjeevani Maternity Hospital, NandiniHospital is selected for the study.
Population: - The population for present study are staff nurses.
Sample:-Consists of 100 staff nurses from the selected Hospitals.
Sample Technique:-Purposive sampling technique will be used to select the Hospitaland Convenient sampling method to be used to select the samples.
Inclusion criteria :-

The study includes the staffnurseswho are –

in the age group of 20 years and above
working in selected Hospitals
available at the time of data collection
willing to participate in the study

Exclusion criteria

The study excludes the staff nurseswho are not–

in the age group of 20 years
working in selected Hospitals
available at the time data collection
willing to participate in the study

7.2DATA COLLECTION INSTRUMENT

Structured self administered questionnaire will be used for data collection and information will be gathered regarding knowledge of staff nurses on practice of aseptic technique during labour.

7.3 DATA COLLECTION METHOD

After obtaining prior permission for data collection from the selected Hospitals and concerns from the subjects,the investigator will assess the knowledge of staff nurses regarding on the practice of aseptic technique, by using structured self- administered questionnaire.

It consists of two parts:-

Part1- Deals with socio-demographic data.

Part2-Represent knowledge regarding on the practice of aseptic technique among staff nurses during labour.

7.4 PLAN FOR DATA ANALYSIS:

The word analysis means categorizing and summarizingthe data statistically to obtained answers to research question.The following methods were planned to analyze the data:

Frequency and percentage distribution would be used to

Summarizing the sample characteristics.

Mean and standard deviation were used to determine the

knowledge score.

Chi – square value will be computed to find the association

between knowledge with selected variables.

7.5 PROJECTED OUTCOME

The present study gives an insight regarding the knowledge level of staffnurses regarding aseptic technique during labour by which the researcher can implement educational programme to improve the awareness regarding practices of aseptic technique during labour and also help the future researcher to inculcate newer method of assessment and educational programmes.

7.6DOES THE STUDY REQUIRE ANY INVESTIGATION OF INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR HUMANS OR ANIMALS? IF SO, DESCRIBE BRIEFLY?

Since it is a descriptive study, the study does not require any investigation or intervention to be conducted.

7.7HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?

Permission will be obtained from the Institutional Ethical

Committee, Navodaya College of Nursing, Raichur.

Permission will be obtained from Hospital authorities.

Consent will be obtained from all the participants.

BIBLIOGRAPHY

Bjerke,Nancy,Hand Hygiene in Health care: Playing by the new rules, Infection Control Today February 2003[cited February 2003].

Dix Kathy, Observing Standard Precaution in the OR, Infection Control Today October 2002[cited February 2003]

OsmanCathy.Asepsis and Aseptic Practices in the Operating room. Infection Control Today July 2000[cited February 2003].

Myles Textbook for Midwife 13 Edition. Churchill Livingstone Publishes: 414-425.

Katherine Hauswirth APRN ,Gale Encyclopedia of Nursing and Allied Health,2002 ,76(2):277-287.

WinnyHandwith,PregmaLaproscopes-Manufacture of high Quality Laproscopic instruments-

http/

P.Padmanabam;ParvathySankaraRaman,Innovation and challenges in Reducing maternal mortality,J health population Nutr.2010 june;27(2):202-209.

PolitF.Denis and Bernadatta,Hungler B.P. Nursing Reserch Principles methods London;JBLipincott company:1987

J.Morisslemons ,NewZealand state journal of medicine infection. November 2008:222-226.

Medical journal of Basrah University 2005 June.

Kathmandu University Medical journal (2009),vol 7.No 3, Issue 27,231- 237.

Journal of Nurse-Midwifery, volume 36, Issue 4 July,August 2005:240-244.

Bacterial infection after intrapartum spinal Anesthesia,Kolkata 2008-2009,Weekly January 29,2010/59(03);65-69.

10. Remark of the Guide:

11.Name and Designation of:

11.1 Guide: Mrs. Sreelekha.C

Associate Professor & HOD

Obstetrics Gynaecological Nursing

Navodaya College of Nursing

Raichur.

11.2 Signature :

11.3 Co-Guide:

11.4 Signature :

11.5 Head of the Department:Mrs. Sreelekha.C

Associate Professor & HOD

Obstetrics& Gynaecological Nursing

Navodaya College of Nursing

Raichur.

11.6 Signature:

12. Remarks of the

Chairman&Principal:

12.1 Signature :