www.udsspace.uds.edu.gh UNIVERSITY FOR DEVELOPMENT STUDIES INFECTIONS PREVENTION AND CONTROL PRACTICES AMONG HEALTHCARE PROVIDERS AT THE SURGICAL DEPARTMENT OF TAMALE TEACHING HOSPITAL BY ABDUL RAUF ALHASSAN 2020 www.udsspace.uds.edu.gh UNIVERSITY FOR DEVELOPMENT STUDIES INFECTIONS PREVENTION AND CONTROL PRACTICES AMONG HEALTHCARE PROVIDERS AT THE SURGICAL DEPARTMENT OF TAMALE TEACHING HOSPITAL ABDUL RAUF ALHASSAN UDS/MPH/0006/17 A THESIS SUBMITTED TO THE DEPARTMENT OF COMMUNITY HEALTH AND FAMILY MEDICINE OF SCHOOL OF MEDICINE AND HEALTH SCIENCES UNIVERSITY FOR DEVELOPMENT STUDIES IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF A MASTER OF PUBLIC HEALTH 2020 www.udsspace.uds.edu.gh DECLARATION Student I hereby declare that this thesis is the result of my own original work and that no part of it has been presented for another degree in this University or elsewhere: ABDUL RAUF ALHASSAN ………………. ………………. (UDS/MPH/0006/17) SIGNATURE DATE Supervisors We hereby declare that the preparation and presentation of the thesis was supervised in accordance with the guidelines on supervision of thesis laid down by the University for Development Studies. PROF. DER MUONIR EDMUND ………….......... ……………….. (MBChb, MGCPS, FWACP) (FIRST SUPERVISOR) SIGNATURE DATE DR. EUGENE DOGKOTENGE KUUGBEE. ………………… ………………… (SECOND SUPERVISOR) SIGNATURE DATE i www.udsspace.uds.edu.gh ABSTRACT Background: Efficient infection prevention and control (IPC) practices are basic requirements for all health facilities to reduce the morbidity and mortality associated with microbial agents and hence excellent patient outcome. Adherence to IPC is important to reduce the transmission of nosocomial infections. Objectives: The main objective of this study was to assess infection prevention and control (IPC) practices among healthcare workers at the surgical department of Tamale Teaching Hospital (TTH). Methodology: This study was conducted using descriptive cross-sectional survey of 156 participants plus observational study of forty healthcare providers and forty-five operation room cases. Stratified and simple random sampling was used in selecting the study participants. Data entry and analysis was done using Statistical Package for the Social Sciences (SPSS) version 20 and Graph Pad Prism version 6.05. The univariate analysis was done using pie chart and bar chart and arithmetic mean. Bivariate analysis such as chi-square analysis, Pearson correlation, analysis of variance (ANOVA) was used for the significance of associations and multiple logistic regressions to identify predictors of IPC compliance. Results: Out of the 156 participants who responded, 22 (14.1%) were Doctors, with 107 (68.6%) Nurses, 12 (7.7%) Anaesthetics and 15 (9.6%) Orderlies. Approximately, 50.6% of the respondents’ were knowledgeable with regards to IPC, 55.1% of the respondents’ had a good attitude towards IPC and 58.3% had good compliance towards IPC. Factors associated with knowledge level were: educational level (p = 0.0001), occupation (p = 0.0001), Marital status (p = 0.0300) and age (p = 0.0300). The occupation was the only factor associated with the attitude level (p = 0.0480). The factors associated with IPC compliance level were: occupation (p < 0.0010), educational level (p = 0.0010), age (p = 0.0090), IPC materials ii www.udsspace.uds.edu.gh availability level (p = 0.0010), IPC knowledge level (p =0.0010) and attitude level towards IPC (p =0.0010). IPC materials were 78.9% always not available, 14.7% sometimes available and 6.4% were always available. Conclusion: More than half the respondents’ reported having good knowledge, good attitude and good compliance towards IPC. And majority of the respondents’ reported that IPC materials were not always available. The major predictor of IPC compliance was IPC materials availability, followed by the occupation of respondents and age of the respondents’. iii www.udsspace.uds.edu.gh ACKNOWLEDGMENT I am grateful to the Almighty Allah for the strength and guidance on this work. My heartfelt thanks also go to the following persons for their invaluable support and encouragement Dr. Edmund Muonir Der and Dr. Eugene Kuugbee, my thesis supervisors, for all they taught me and the words of encouragement given me throughout the period of the thesis. The head and staff of the Department of Community Health and Family Medicine, University for Development Studies. My course mates with whom I shared ideas. All the people who responded to my questionnaire. Authors of the books and articles used for this study My family and all the friends who one way or the other contributed to the success of this work. To you all, I say ‘thank you’ and I wish you all the best in your endeavors; may others show you as much care and help as you showed me. iv www.udsspace.uds.edu.gh DEDICATION This work is dedicated to my late parents of blessed memory, and also my wife, children, brothers, sisters and friends for their prayers and support throughout this course. v www.udsspace.uds.edu.gh TABLE OF CONTENT CONTENTS DECLARATION ................................................................................................................... i ABSTRACT ......................................................................................................................... ii ACKNOWLEDGMENT ...................................................................................................... iv DEDICATION ...................................................................................................................... v TABLE OF CONTENT ....................................................................................................... vi LIST OF TABLES ............................................................................................................. xiii LIST OF FIGURES ............................................................................................................ xv ABBREVIATIONS/ACRONYMS ..................................................................................... xvi DEFINITION OF CONTEXTUAL TERMS ..................................................................... xvii CHAPTER ONE ................................................................................................................... 1 INTRODUCTION ................................................................................................................ 1 1.1 Background ..................................................................................................................... 1 1.2 Problem Statement .......................................................................................................... 3 1.3 Research Questions ......................................................................................................... 4 1.4.1 General Objective ......................................................................................................... 4 1.4.2 Specific Objectives ....................................................................................................... 5 1.5 Significance of the study ................................................................................................. 5 1.6 Conceptual Framework: Infection Prevention and Control Practices ................................ 6 1.7 Organization of the Study ................................................................................................ 7 vi www.udsspace.uds.edu.gh CHAPTER TWO .................................................................................................................. 9 LITERATURE REVIEW ...................................................................................................... 9 2.0 Introduction ..................................................................................................................... 9 2.1 Nosocomial infection ...................................................................................................... 9 2.2 Types of nosocomial infection ....................................................................................... 10 2.2.1 Catheter-Associated Urinary Tract Infections .......................................................... 10 2.2.2 Central Line-Associated Bloodstream Infection ...................................................... 11 2.2.3 Surgical Site Infection ............................................................................................. 11 2.2.4 Ventilator-Associated Pneumonia ........................................................................... 11 2.3 Causes of nosocomial infections .................................................................................... 11 2.4. Mode of transmission ................................................................................................... 12 2.5. Disease infection chain ................................................................................................. 13 2.6. Infection Prevention and Control .................................................................................. 15 2.6.1 Hand hygiene .......................................................................................................... 17 2.6.2 Personal Protective Equipment (PPE) ..................................................................... 21 2.6.3 Proper patient placement, staff allocation, visitors, and transportation ..................... 24 2.6.4 Environmental control, cleaning, and disinfection ................................................... 24 2.6.5 Handling and disposal