Knowledge of sterilisation among staff nurses

KNOWLEDGE OF STERILIZATION ANDINFECTION CONTROL AMONGST THESTAFF NURSES OF K. M. SHAHDENTAL COLLEGE AND HOSPITAL,PIPARIA, VADODARA.

By:

BHATIA YASHPREETSINGH A.

III B.D.S. STUDENT(2009-2010),

K.M.SHAH DENTAL COLLEGE & HOSPITAL.

Under The Guidance Of

Dr. Shilpa Gunjal

Senior Lecturer,

Department Of Public Health Dentistry

K.M.Shah Dental College & Hospital.

NEED FOR THE STUDY

Hospital Acquired Infection (HAI) is a major health

problem today. In spite of progress in medical cares,

hospital infections among patients are not uncommon.

Although it is difficult to assess the exact incidence of

hospital acquired infections in our hospitals, ample

evidence exists to indicate the related problems. Most

often it is observed that the patient comes to the

hospital for treatment of a particular ailment but has

acquires other infection sometimes leading to

septicaemia, multi system organ failure and death.

Dental healthcare professionals (DHPs) are at risk

of infections caused by various microorganisms such as

Mycobacterium tuberculosis, hepatitis B and hepatitis C

viruses, staphylococci, streptococci, herpes simplex

virus types 1, human immunodeficiency virus (HIV), mumps,

influenza, and rubella. In the dental setting, there are

special circumstances and opportunities able to lead to

transmission of such organisms to DHPs.

Proper sterilization of various instruments,

equipments, dressing materials and field of operation is

very important for prevention of spread of infective

organisms from and to the patients. The success of

surgical treatment depends upon the aseptic precautions

taken by the operating surgeons and his auxiliary

assisting staff.

With the advancement and increase in the knowledge

of microbiology, the behaviour of different micro

organisms is well understood and there has been invention

of various instruments, equipments and chemicals for

making such pathogenic organisms ineffective. While using

such aids, it is important that proper protocol is

maintained for the effective results. At the same time,

one must have proper knowledge of handling and

maintaining them in proper condition.

In dentistry, commonly used sterilizing equipments

are simple sterilizers (water bath), autoclaves (front

and top loading), dry heat sterilizers, hot air oven,

glass bead sterilizers, etc. Each device is to be used in

specific manner for specific purpose and is to be

maintained properly. Similarly certain chemicals are used

for cold sterilization for the instruments, equipments

and materials which cannot withstand high temperature.

Such materials require proper care while storage and

handling and are to be used in proper concentration.

Moreover proper care is to be exercised for proper

disposal of surgical waste to prevent spread of

infection.

Normally, the auxiliary staffs such as staff nurses

are assigned duties to take proper care of sterilization

and disinfection in the dental clinics. It is important

that proper training is given to them to carry out this

important responsibility and they should have adequate

knowledge regarding the same for effective treatment

result and self-protection and prevention of spread of

infection.

AIMS AND OBJECTIVES

AIMS:

1. The present study is carried out to assess the

level of awareness and knowledge regarding the

sterilization and infection control measures and

its practice amongst the staff nurses of K. M.

Shah Dental College and Hospital, Piparia,

Waghodia, Vadodara.

OBJECTIVES:

1. To assess knowledge of staff nurses regarding

the working and manner in which the instrument is

to be used.


the maintenance protocol for the instrument to be

used.


the protocol to be followed before putting the

instruments/equipments for sterilization in the

devices.


storage of instruments / equipments after

sterilization.


usage and storage of various chemical

disinfectants.


prevention of spread of infection in dental

clinics.

REVIEW OF LITERATURE

Askarian M. et al1 (2009) assessed the level of

knowledge, attitude, and practice among Iranian dental

healthcare professionals towards standard isolation

precautions in Shiraz, Iran. The survey was completed by

152 (51.5%) of 295 potential respondents amongst the

Iranian dental professionals (faculty and students) from

School of Dentistry, Shiraz University of Medical

Sciences, Shiraz, Iran. A self-administered questionnaire

containing three parts (knowledge, attitude, and

practice) was distributed to the participants. After

validation of the survey, data were collected and

analyzed. According to their findings, the mean±SD scores

of knowledge, attitude, and practice towards standard

isolation precautions were 6.71±0.99, 34.99±4.47, and

4.97±2.17 from the maximum scores of 9, 45, and 9,

respectively. In addition, a positive linear correlation

was found between the two items of the survey including

knowledge-attitude (r= 0.394, P< 0.001), and attitude and

practice (r= 0.317, P<0.001). They concluded that the

practice of standard isolation precautions is poor among

dental professionals in Shiraz University of Medical

Sciences. This study showed that knowledge of infection

control measures and a positive attitude towards them

alone does not have an impact on adherence to

recommendations.

Sadeghi N. et al2 (2009) conducted a cross-sectional

study in Isfahan hospitals wards. 65 nurses answered to

the questionnaire. In general, findings showed that

averagely 63.9% of nurses correctly answered questions.

These results supported the need for more interventions

to prevent hospital infections.

Delahanty K. et al3(2009) in Nursing2009 developed a

survey designed to explore specifically, how well nurses

know and apply evidence-based guidelines for preventing

infections associated with peripheral and central venous

access devices. More than 560 nurses responded. This

survey included several questions that were asked in a

similar infection control survey conducted by Nursing in

2006, providing an opportunity to evaluate trends in

nursing knowledge and practice over the past few years.

Overall, responses to the current survey showed that more

experienced and older nurses generally did significantly

better than younger nurses, and master’s-prepared nurses

did significantly better than their colleagues without a

master’s degree. Nurses working in infection control did

better than those who don’t, but students did poorly.

Mukwato K.et al4 carried a study to determine the

level of health-care workers’ compliance with Infection

Prevention Guidelines and identify factors that influence

compliance at Ronald Ross General Hospital, Mufulira

District. Data was obtained using a self administered

interview schedule and an observation checklist. A total

of 77 health care workers who included Doctors,

Registered Midwives and Nurses, Enrolled Midwives and

Nurses, clinical Officers, Laboratory Technicians and

physiotherapists took part in the study. Additionally, 40

out of the 77 interviewed health workers were observed

carrying out at least one procedure requiring compliance

with the Infection Prevention (IP) guidelines. The study

revealed that, high compliance was associated with

inclusion of Guidelines in the Curricular, high knowledge

of infection prevention/ hospital acquired infections,

positive attitude towards infection prevention and

availability of materials for infection prevention. The

study further reviewed revealed varied levels of

compliance on different components of infection

prevention. The highest level of compliance (100%) was

with single use of needles and syringes while the lowest

(35.1) was with decontamination of needles and syringes

with 0.5% chlorine solution prior to disposal. Compliance

with hand hygiene was moderate (61%).The study findings

suggested a need for inclusion of Infection Prevention

Guidelines in the health workers’ curricular, provision

of in-service training in infection prevention protocols

and improvements in the supply of materials for infection

prevention.

Vij A.et al5(2001) carried out a descriptive study of

exploratory nature at Main Hospital, AIIMS. Subjects for

study were 50 registered staff nurses working in the

institute selected by systematic random sampling. A

questionnaire comprising of 35 questions was developed in

which knowledge and practice regarding infection control

measures was tested. It was found that mean knowledge

about Hospital acquired infections of staff nurses

working at the hospital was 73.1% and the mean practice

of staff nurses regarding infection control measures was

62.7%.

MATERIALS AND METHODS

METHODS OF COLLECTION OF DATA:This is a descriptive cross-sectional study. The

data for the study will be collected from the staff

nurses working in the various clinical departments and

laboratories of K. M. Shah Dental College and hospital.

A questionnaire will be prepared and staff nurses

will be requested to fill up the questionnaire comprising

of personal information, as well as their knowledge

regarding the infection control procedures.

Prior permission will be sought from Dean, K. M.

Shah Dental College and Hospital. Study will be conducted

in the month of September 2010.

The written or verbal information consent will be

taken from the participant.

Questionnaire Proforma

Sr. No. __________ Date: / /

Personal Information:

Name:

Age: Qualification:

Experience (Department wise):

Total experience:

PLEASE MARK APPROPRIATE ANSWER IN THE FOLLOWING QUESTIONS -

Sr.No

YES NO1. Hospital acquired infections (HAI)

are the result of cross infection.2. HAI's are transmitted through body

fluids, staff hands and reusable equipment

3. Hand washing should be practiced with soap and water above the elbow with friction

4. After hand washing tissue paper drying is preferable

5. Patients receiving immunosuppressivetherapy are more susceptible to HAI.It is essential to isolate the patients

6. Immunization is not a universal precaution

7. Sterilisation is a process ofkilling of microorganism includingspores

8. Boiling is a method of sterilisation9. Chemical disinfection is the best

method of sterilising surgicalinstruments

10. 2% activated glueraldehyde is to be changed every 28 days

11. Alcohol is an effective disinfectantwhen rubbed on skin.

12. A new pair of gloves should be used while handling the sterile instruments.

13. Disposable needles should bediscarded in the needle destroyers

14. A more efficient method of pre-sterilization cleaning is by using washer/disinfectors.

15. Should the instruments be alwayscarried in a covered container?

16. Unused sterile articles must be re-autoclaved

17. Vacuum Autoclaves are suitable for sterilizing Wrapped solid instruments, Hollow instruments and utensils (wrapped or unwrapped)

18. All dental autoclaves should beregularly serviced and maintained

19. Sterilisation of handpieces afteruse in each patient by autoclavingis mandatory.

20. Glass bead sterilisers are useful for certain dental instruments.

21. X-ray tube head and surfaces are to be regularly disinfected

22. Bite blocks and holders used inradiographic procedures are to besterilised

23. Impressions and appliances are to becleaned and disinfected prior tosending to the laboratory

24. Wearing gloves is a must for I/Vinjection

25. After removing gloves, hand washingis not necessary

26. Use of respiratory masks and eye protection help to prevent spread ofTB, influenza, varicella meningococcal infections and whooping cough

27. Are you vaccinated for hepatitis B?28. All sterilised instruments should be

stored in dry, covered conditions soas to minimise re-contamination.

29. Waste should be carefully labelled,secured and stored safely usingdisposable appropriate coloured bags

30. Black bags are used for Health CareNon Risk waste

31. Yellow bags are used for Health CareRisk Waste,

32. Is there any arrangements for the disposal of Health Care Risk materials.

33. Periodic fumigation of OT, Operatoryand wards is necessary.

DATA TABULATION AND STATISTICS

The data collected from the questionnaire answered by the

staff nurses is subjected to the statistical analyses to

derive the conclusions.

Table - 1

QUESTION NO. Knowledge Regarding…………

CORRECTRESPONS

E

% OFCORRECTRESPONS

E

1 Hospital acquired infections (HAI) are the result of cross infection. 17 100

2HAI's are transmitted through body fluids, staff hands and reusable equipment

17 100

3Hand washing should be practiced with soap and water above the elbowwith friction

17 100

4 After hand washing tissue paper drying is preferable 16 94.1

5

Patients receiving immunosuppressive therapy are more susceptible to HAI. It is essentialto isolate the patients

17 100

6 Immunization is not a universal precaution 9 52.9

7Sterilisation is a process ofkilling of microorganism includingspores

15 88.2

8 Boiling is a method ofsterilisation 17 100

9Chemical disinfection is the bestmethod of sterilising surgicalinstruments

7 41.2

10 2% activated glueraldehyde is to bechanged every 28 days 1 5.9

11 Alcohol is an effective 10 58.8

disinfectant when rubbed on skin.

12A new pair of gloves should be usedwhile handling the sterile instruments.

17 100

13 Disposable needles should bediscarded in the needle destroyers 17 100

14A more efficient method of pre-sterilization cleaning is by using washer/disinfectors.

17 100

15 Should the instruments be alwayscarried in a covered container? 17 100

16 Unused sterile articles must be re-autoclaved 15 88.2

17

Vacuum Autoclaves are suitable for sterilizing Wrapped solid instruments, Hollow instruments andutensils (wrapped or unwrapped)

13 76.5

QUESTION NO. Knowledge Regarding…………

CORRECTRESPONS

E

% OFCORRECTRESPONS

E

18 All dental autoclaves should beregularly serviced and maintained 17 100

19Sterilisation of handpieces afteruse in each patient by autoclavingis mandatory.

15 88.2

20Glass bead sterilisers are

useful for certain dental instruments.

11 64.7

21 X-ray tube head and surfaces are to be regularly disinfected 12 70.6

22Bite blocks and holders used inradiographic procedures are to besterilised

10 58.8

23Impressions and appliances are tobe cleaned and disinfected prior tosending to the laboratory

15 88.2

24 Wearing gloves is a must for I/Vinjection 9 52.9

25 After removing gloves, hand washingis not necessary 10 58.8

26 Use of respiratory masks and eye 13 76.5

protection help to prevent spread of TB, influenza, varicella meningococcal infections and whooping cough

27 Are you vaccinated for hepatitis B? 4 23.5

28

All sterilised instruments shouldbe stored in dry, coveredconditions so as to minimise re-contamination.

17 100

29

Waste should be carefully labelled,secured and stored safely usingdisposable appropriate colouredbags

17 100

30 Black bags are used for Health CareNon Risk waste 17 100

31 Yellow bags are used for HealthCare Risk Waste, 17 100

32Is there any arrangements for the disposal of Health Care Risk materials.

13 76.5

33 Periodic fumigation of OT, Operatory and wards is necessary. 11 64.7

Average knowledge 79.68

Mean knowledge regarding sterilization and infection control amongst the staff nurses of K. M. Shah Dental College and Hospital, Piparia, Vadodara is 79.68%.

CHART-1

0102030405060708090

100

PERCENTAGES OF CORRECT RESPONCE TO EACH QUESTION

Questions

% of correct Response

CHART-2

79.68%20.32%

Average knowledgeCorrect response Incorrect response

DISCUSSION AND CONCLUSION

In the present study an attempt is made to understand the

knowledge and awareness of modes of infection control amongst

the 17 staff nurses of K.M.S.D.C.H. A closed ended

questionnaire of 33 subject related questions was prepared and

the staff nurses were asked to answer either Yes or No. From

their assessment, percentage of correct response was estimated

for all the questions.

It was observed that the overall knowledge regarding

sterilization and infection control amongst the staff nurses

of K. M. Shah Dental College and Hospital, Piparia, Vadodara

is 79.68%.Out of all the questions, 14 were answered correctly

by all participants. Remaining questions were answered with

different levels of accuracy. Only 4 of 33 participants were

found to be vaccinated for Hepatitis B.

Refresher courses and training programmes on infection

control measures should be systematically planned and

regularly conducted for staff nurses so as to help them

increase and maintain their knowledge. This in turn will help

to check the problem of Hospital acquired infections and

decrease their incidence.

REFERENCES

1. Mehrdad Askarian MD MPH, Ojan Assadian MD DTMH. Infection

control practices among dental professionals in Shiraz

Dentistry School, Iran: Arch Iranian Med 2009; 12 (1): 48

– 51

2. Narges Sadeghi, Zahra Abdeyazdan, Adeleh Eslami. Nurses'

knowledge of hospital infections and sterilization

methods of hands, equipments and surfaces in neonatal

wards of Isfahan: IJNMR 2009; 14(4): 201-204

3. Kim M. Delahanty, RN, CIC, BSN, PHN, MBA, and Frank

Edward Myers, III, CIC, MA: I.V. infection control.

December Nursing2009; 24-30.

4. Katowa P. Mukwato, C.M. Ngoma, M. Maimbolwa. Compliance

with Infection prevention guidelines by health care

workers at Ronald Ross general hospital Mufulira

District: Medical Journal of Zambia, Volume 35 Number 3.

5. Aarti Vij*, Swapna.N. Williamson**, Shakti Gupta***

“Knowledge and Practice of Nursing Staff Towards

Infection Control Measures in a Tertiary Care Hospital”

Journal of the Academy of Hospital Administration Vol.

13, No. 2 (2001-07 - 2001-12)

Knowledge of sterilisation among staff nurses

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