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.
2. To assess knowledge of staff nurses regarding
the maintenance protocol for the instrument to be
used.
3. To assess knowledge of staff nurses regarding
the protocol to be followed before putting the
instruments/equipments for sterilization in the
devices.
4. To assess knowledge of staff nurses regarding
storage of instruments / equipments after
sterilization.
5. To assess knowledge of staff nurses regarding
usage and storage of various chemical
disinfectants.
6. To assess knowledge of staff nurses regarding
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
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”
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