1

Chapter one

Introduction

Background of the study

According To World Health Organization (2019) infection control is the process by which health

care facilities develop and implement specific Policies and procedure to prevent the spread of

infection among health care workers and patients. Infection Control Practices are directed at

controlling or eliminating source of infection in the healthcare agency, home or communities to

reduce the occurrence and transmission of infected diseases (Osuala and Oluwatosin, 2017).

Health-care associated infection (HALS) have been reported to be a severe problem in the

healthcare services as they are common causes of illness and mortality among hospitalized

patients including healthcare providers (Amoran and Onwbe, 2018). Infection can be contracted

through various means such as inhalation or contact with contaminated surfaces.

Noscosomial infections are a major problem in healthcare facilities resulting in extended duration

of care, substantial morbidity, mortality and excess costs (Hilbum, Hammond, Fendler and

Groziak, 2019). Standard precautions are recommended to prevent transmission of infection in the

hospital. However, their implementation is dependent on the knowledge and attitude of Health

care providers (Dimie, Kemebradikumo and Babatunde, 2019).

Hospital – acquired infections otherwise known as noscosomial infection are infections acquires

in the hospital or other health care facilities that were not present or incubating at the time of the

client’s admission. It includes those infections that become symptomatic after the client is

discharged as well as infections among medical personal. Most noscosomial infection are

transmitted by health-care personal who fail to practice standard infection prevention measures

such as hand-washing procedures or change of gloves between client contact, compliance on the
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part of the health-care provider including nursing and medical students with standard procedures

has been recognized as being an efficient means to prevent and control health-care associated

infections ( Amoran and Onwube, 2018).

According to McQuoid – Mason (2019). Hospital acquired infections may develop from surgical

operations, urinary catheter, central lines and endotracheal tubes in intubated patients. Health

care associated infection can develop either as a result of health care associated infection ( such as

medical or surgical treatment) or from being in contact with a health care setting. They can

worsen current or primary conditions, increase the length of hospital stay and increase mortality

rates. Effective infection prevention and control reduces health care associated infection by at

least 30% (WHO, 2019). Infection prevention and control; including hand washing hygiene) is

critical to achieving universal health coverage. This is a practical and evidenced based approach

with demonstrated impact in quality care and patient safely across all levels of the health system.

No country nor health-care facility (even within the most advanced and sophisticated health-care

systems can) claim to be free of the problem of health care associated infections. The need for

having infection prevention and control ( IPC) programmes nationally and at the facility levels is

clearly reinforced within the world Health Organization health indicator list (WHO,2019).

The Nigeria Policy on health had stipulated that health care institutions should provide a safe

environment for the patients in their care. Health care workers form the backbone of infection

prevention and control. They can therefore either contribute to infection transmission and or

prevent and control infection. Infection prevention and control aims to protect the vulnerable

people from acquiring infection while receiving health care services. Lack of Knowledge, bad

attitudes and poor practices amongst health care workers in the prevention and control of infection

can lead to hospital-acquired infections.

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In clinical practices, the researcher has observed cases where health care workers handle

contaminated linen with bare-hands, put needles in the patients mattress after giving injections, do

not wash hands regularly before and after every procedure, before and after attending to each

patients and also relapse of infections and prolong wound healing. Poor infection prevention and

control practices among health care workers increase the rate of hospital acquired infections.

Hand hygiene is the single most important intervention to prevent transmission of infection and

should be a quality standard in all health profession.

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Statement of Problem

Health –care associated infections have continued to be one of the most important public health
problems in most countries of the world including Nigeria. (Osoba, 2020).

Infection-related diseases are still the main cause of death in Nigeria, According to the 2018

health profile acquired by the world Health Organization statistics health care associated infection

is a major cause of morbidity and mortality. It remains a costly burden to health care services, a

source of concern to patient and public and at present, it is receiving priority from policy makers

as it contributes to the global threat of antimicrobial resistance (Welsh, 2019). Lack of

knowledge, attitude and practices of infection prevention and control contributes to high rates of

hospital-acquired infection (Jain, Dogra, Mishra, and Thaku 2018). Uncontrollable noscosomial

infection contributes to prolonged stay, morbidity and mortality which put stress on health care

economic of the country.

The researcher has observed that most health care workers do not apply infection prevention and

control measures in the hospital setting which is required to ensure patient safety. The researcher

therefore decided to embark on the study of knowledge, and practice of infection prevention and

control among health care workers in general hospital, Iquita, Oron, Akwa Ibom State.

Specific Objective:

 To assess the knowledge of health care workers in infection prevention and control

measures in general hospital Iquita, oron, Akwa Ibom State, Nigeria.

 To ascertain the attitude of health care workers towards infection prevention and control

in general hospital Iquita, Oron, akwa Ibom State, Nigeria.

 To assess the practice of infection prevention and control measures among health care

workers in general hospital Iquita, Oron, Akwa Ibom State.

Research Questions
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1. Do health care workers have knowledge about infection prevention and control in general

hospital, Iquita, Oron, Akwa Ibom State?

2. What is the attitude of health care workers towards infection prevention and control in general

hospital Iquita, Oron, Akwa Ibom State, Nigeria?

3. Do health care workers practice infection prevention and control in general hospital in Iquita,

Oron, Akwa Ibom State, Nigeria?

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Significance of the study

This study will enlighten the profession on the need to organize retraining of health care workers

in order to update their knowledge and skills on the standard precautions for infection prevention

and control in the hospital. This study will enlighten the health care workers on the need to

practice standard precaution on infection prevention and control in order to minimize the spread

of infection in the hospital. This study will enlighten the society as a whole on the methods,

techniques and the need to practice standard precautions on infection prevention and control and

will also help to create awareness even to the people in the interior areas in order to minimize the

spread of infection in the society.

Scope of the Study

This study will cover all the health care workers in general hospital in Iquita, Oron, Akwa Ibom

State, Nigeria. The variables studied include Knowledge, attitude and practice of infection,

prevention and control.

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Operational Definition of Terms

Knowledge: Being aware and having a better understanding regarding infection prevention and

control by health care workers.

Practice: Performing the actual standard precaution or infection and control by health care

workers.

Attitude: Behaviour of health care workers in general hospital Iquita, Oron towards infection

prevention and control

Infection: Sickness or illness acquired from general hospital Iquita, Oron.

Prevention: Stop the transfer of sickness and infection to patient by health care workers in

general hospital Iquita, Oron.

Control: Prevent the spread of infection from one patient to another in general hospital, Iquita,

Oron.

Midwives: These are group of persons who are trained and certified to practice and assist women

child birth.

Health Care Workers: Group of health professionals who prevent and control infection in

general hospital Iquita Oron .

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Chapter Two

Literature Review

This chapter deals with the review of related literature. It is reviewed based on conceptual review,

theoretical framework and empirical studies.

Conceptual Review

Knowledge of health care workers in infection prevention and control.

Knowledge is the information, understanding and skills that are gained through education and

experience. The surveillance of hospital acquired infections are regarded as an essential part of

infection control and prevention. Lack of knowledge among health care workers can increase the

rate of hospital acquired infection.

Knowledge on the three (3) areas of infection prevention are explained below to include primary,

secondary and tertiary.

Primary Prevention and Control

Primary prevention is a way of preventing diseases as well as in injury before it occurs.

Preventing hazards leading to injury and diseases are example of primary prevention, it also

includes education about healthy and safe habits (Hand hygiene) and Immunization against

infectious diseases. In this regard World Health Organization (2018) considers Universal

immunization to be the most effective preventive measures against disease induced by hepatitis B

infection.
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Unsafe injection practices can result in transmission of a wide variety of pathogens including

viruses, bacteria, fungi and parasites while safe injection practice is a primary intervention for

prevention of transmission of infection (WHO 2018).

Therefore, According to WHO (2018) a safe injection does not harm the recipient and provider

and does not harm both when properly disposed. In order to make decision about actions needed

to control the risk and prevent the spread of infection, risk assessment is performed (Fogie, 2019).

This includes implementation, training, practical infection control measures, information

provision, training and health surveillance. Hand hygiene is another measure that promotes

primary infection prevention.

Secondary Prevention and Controls

Secondary prevention aims to lessen the burden of illness or injury that has already happened. By

detecting and treating disease or injury as soon as possible as well as encouraging personal

strategies to prevent re-injury, the impact of the disease is reduce through use of personal

protective equipment and appropriate ventilation are good examples of secondary infection

prevention as well as isolation of patients with tuberculosis, rapid diagnostic evaluation and rapid

initiation of treatment. Patient with Tuberculosis are encouraged to stop smoking and minimized

intake of alcohol so as to reduce the impact of the disease. Paryford (2019) indicated that patients

should be instructed to follow the recommendations for respiratory hygiene and cough etiquette

by:

 Using a disposable, single use tissue to cover mouth and nose when coughing, sneezing,

wiping or blowing nose.

 Dispose off tissue promptly in a bin

 Practice hand hygiene by washing hard with soap under running water and drying them

thoroughly after coughing, sneezing or using tissue.

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Tertiary prevention and control

Tertiary prevention aims to reduce the influence of an ongoing disease or injury that has extensive

effect. This is done by helping people cope with long-term often difficult conditions and injury

(example chronic diseases, permanent impairments) in order to extend as much as possible their

life expectancy.

The nurse is a member of health care team who lead the rest of the group in performing

prevention approaches to keep the patient from infection. Health care associated infection is a

prominent problem among patient in paediatric intensive unit as it could result in significant

morbidity, prolonged hospitalization and an increase in medical costs (Yasmine, John and Walaa,

2019) All health care workers can show leadership in infection prevention and control by using

their knowledge expertise and immediately apply decision to start appropriate intervention. Health

care workers play a key role in infection prevention, the health and well-being of their patient and

the financial health of their employers.

Attitude toward infection prevention and control

Attitude is the way you think, feel and behave about something. Despite the knowledge that dirty

hands play a a significant role in spread of health care related pathogens and that hand hygiene

decrease the spread of these organisms, health care providers adherence with hand hygiene is poor

( Dixit, Hagtvedt, and Mark, 2019). Despite both national and international recommendations for

good practice in infection prevention and control (IPC), compliance is still low.

The attitude of washing hands among individuals involved in the provision of heath care can

increase the rate of hospital acquired infection. Standard precaution are a set of practices that

should be used in the care and treatment of all patients, regardless of whether they are known or
 11

suspected to be infected with a transmissible organisms. The purpose of standard precaution is to

break the chain of infection. (Digit, Hagtvedt and Mark, 2019)

Hands of patient can also carry microbes to other body sites, equipment and staff. Hand Hygiene

is one of the most effective means of preventing noscosomial infection ( lemass, Mcdonnell,

O’connor and Rochford, 2018). Health care workers should have positive attitude toward

infection prevention and control and the possible consequences if not adherent to infection

prevention and control, staff needs to work towards identifying barriers to good infection practice

and way to overcome these. (Ward, Furber, Tierney and Swallow, 2020).

Surgical operation provide opportunities for the transmission of infection between patient and

health care workers and between one patient and another the risk may increase in under developed

and developing countries due to compliance with infection control policies and precaution. The

positive attitude toward infection prevention and control can reduce the rate of hospital-acquired

infection (Mcgaw, Tennat, Harding, and Cawish, 2021).

Work load is another means of preventing health care workers from applying infection prevention

and control measures in the health facility Resulting in poor attitude of the health workers (Dimie,

Kemerbradikumo Babatunde, and Christain, 2019)

Practice by Health Care Workers in infection prevention and control

To practice is to do something regularly as part of your normal behaviour which in this case is

infection prevention and control practice. It is therefore, important that all health providers strictly

adhere to the practice of infection control guidelines, especially nurse because they spend more

time with the patients.

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Good hand hygiene is the most important practice in reducing transmission of infectious agents as

well as health-care associated infections. Respiratory hygiene or cough etiquette has been added

to standard infection control precautions due to a recent global influenza pandemic. Furthermore,

general good practices include ensuring that all staff must dispose of clinical waste according to

local policy with sharps in assembled sharp container. Personal protective equipment (PPE) refers

to a range of barriers and respirators used alone or in combination to protect Mucous membranes,

airways, skin and clothing from contact with infectious agents (Lenass, Mcdonneli, O’connour

and Rochford, 2018). Good practices by health care workers towards infection prevention and

control reduces the potential for noscosomial infection thereby promoting patient safety.

However, patient safety can be jeopardized if nurses intentionally fail to comply with

implementation of infection control measures.

Knowledge on the five moments of hand hygiene according to WHO (2019) is important to
heath care workers these are highlighted below.

Before Clean/ aseptic Technique

Before touching a patient After body fluid exposure

risk

After touching patient After touching a patient

surroundings
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Table 1: Guideline on hand hygiene in health care facility

1 Perform hand hygiene before a

Before touching patient
clean/sterile procedure
2 Perform hand hygiene before a
Before clean/aseptic procedure
clean/sterile procedure
Wash your hands with soap
3 After body fluid exposure and water immediately after
exposure risk to body fluids
Perform hand hygiene after
After touching a patient surroundings
4 touching a patient
Perform hygiene after
touching any object or
After touching a Patient Surroundings
furniture in the patient’s
5 immediate surroundings

Theoretical Framework

Florence Nightingale’s environment theory was adopted for the study

Florence Nightingale (1820 – 1910), considered the founder of educated and scientific nursing

and widely known as the lady with the lamp” wrote the first nursing note that became the basis of

nursing practice and research. Nightingale is considered the first nursing theorist. One of her

theories was the environment theory which incorporated the restoration of the usual health care.

She stated in her nursing note that nursing “is an act of utilizing the environment of the patient to

assists him/her in his/her recovery.

There are ten key aspects of the theory:

1. Patient should have fresh air and a temperature controlled environment.

2. Patient should have access to direct sunlight and not subjected to unnecessary noise

especially when sleeping.

3. Rooms should be kept clean.

4. Hospital facilities should be well-constructed

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5. Bedding should be change and aired frequently

6. Patients should be kept clean and nurses should wash hands frequently.

7. Patient should be offered a variety of scenery such as new books or flowers to prevent

boredom.

8. nurses should be positive but not offer false hope to patient or make light of their illness

9. offer a variety of small needs instead of large ones and not attend to patient while patient

is eating

10. consider not only the individual patient but the context of where he or she lives

Application of the theory to the study

Infection prevention is an essential part of today’s health care. Florence Nightingale can be

credited for this importance practice. It is integrated in a way that are may not realize how his/her

everyday routine aid in preventing infection .One major impact she has had in shaping today’s

health care is her philosophy of cleanliness and sanitation in order to prevent infection in hospital

patient. Her lasting effects are evident through today’s techniques used to inhibit the development

of unnecessary hospital acquired infections.

In applying Florence Nightingale’s Environmental theory to the study on knowledge and practice

of infection prevention and control, the following major variables were identified:

 Hand hygiene: This is the single most effective means of preventing the horizontal

transmission of infection among hospitalized patients and health care personnel. This habit

is one of the most important practices that prevent infection. Hands are the most common

vehicle for transmission of micro-organisms. Florence Nightingale knew this and this was

a significant factor to her success in infection control. Therefore if health care workers

adhere to proper and frequent hand hygiene practices in the health care facilities, the

spread of hospital related infection will be minimized.

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 Clean Environment: In addition to keeping hands clean, it is also important to maintain a

clean patient environment. This includes keeping hospital Equipment sanitized after

patient care and in between patient use. Most of the hospital equipment used today are

made disposable in order to decrease risk for hospital acquired infection (HAI). Florence

nightingale persistently emphasized on keeping a clean environment, not just sanitation

but high avidity of cleaning patient equipment such as bedrails and door knobs which is an

essential part of infection prevention. Florence Nightingale also passionately educated for

equipment sterilization and isolation of patient with infection and if these are

appropriately performed by health care workers the rate of nosocsoomial infection will

greatly reduce in the hospital.

 Nutrition: Nightingale’s holistic approach of care also emphasized nutrition as a means of

improving or preventing infection. It provide the body physiologically to aid in a version

of infections and also offer general sensory satisfaction

 Nightingale’s holistic approach: “Florence and her nurses scrubbed the hospital clean,

washed the sheets, blankets and towels, clean the hospital kitchens and prepared better,

wholesome food for patients”. Today evidence based practice has proved Nightingale’s

theories of nutrition in healing. Therefore health care workers should provide and

encourage their patient on better and wholesome meal that will boost their immunity and

prevent them from contacting hospital related infections.

 Cleanliness: Based on Nightingale’s theories of cleanliness, standards have been adopted

to standardize sanitation and prevent hospital acquired infections. Preventions today

include standard precaution, contact, droplet and airborne which are explained below;
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In standard precautions: It is applicable to all patient and that gloves should be worn

when in contact with any type of blood and bodily fluids and that gloves and eye wear

should be worn in situations with possible splash.

Contact precautions: Are used with organisms that are spread through direct or indirect

contact with infected persons, Surfaces, Patient environment or patient items.

Droplets and Airborne preparation: Reveres the use of mask but a negative pressure

room is required for airborne precautions. In airborne precaution, patients also need to be

in a single room. Therefore health care workers should ensure standardized sanitation and

precautions to prevent hospital acquired infection.

Empirical Studies

Various studies identified an average gap with regards to the knowledge and practice of infection

prevention and control by health care workers.

A study carried out by Yakob, Lamaro and Henok (2015) on knowledge, attitude and practice

towards infection control measures among Thigan – Aman. General Hospital workers south West

Ethiopia, reveal that out of 135 respondents 57 (42.%) of health care workers think that they

apply standard precaution always. About two-third (65.6%) of them had never participated in

training program. All the respondent know that recapping needle and sharp materials could

transmit diseases causing agent. More than three quarter (76.3%) of health works think that they

were at risk of acquiring HIV in their work place. Among health care workers, 59(43.7%) of them

disposed sharp materials in open pail, 91 (67.9%) in sharp and liquid proof container without

removing syringe, 95 (70.4%) of health workers know that gloves and gowns were required for

any contact with patients. Among respondent, 63 (46.8%) of health care workers were gloves the
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last time the took blood sample, 92 (68.7%) of Health workers washed their hands before

examining the patient and 84(62.5%) of health care workers recap needle immediately after using

them. Majority of health care workers knowledge, attitude and practice towards standard

precautions were not sufficient, favourable and safe enough to the expected standard.

A cross-sectional study with a self-administered structured questionnaire was distributed to the

study group (of doctors and nurses). A total of 200 responses were analyzed, 152 were nurses

while 48 were doctors. A total of 87.9% of the respondent correctly identified hand washing as

the most effective method to prevent and control infection. Majority agreed that avoiding injuries

with sharp (86%), use of barrier precaution (90%) and hand hygiene (92%) effectively prevent

infection. Only 44% and 42.4% of the respondents were of the risk of infection following

exposure to human immune deficiency virus, hepatitis B virus and hepatitis (Virus- infected by

blood, respectively about 52% of doctors and 76% of nurses always practice hand hygiene in

between patient care (Stien, Makarawo, Ahmed 2021).A hospital –based cross sectional study

was conducted in a structured pre-tested questionnaire among 150 participants. The health care

workers were selected through systematic random sampling technique more than two thirds

(84.7%) of health care workers were fund to be knowledgeable but only (52.3%) of respondents

demonstrated a good practice on infection prevention older age, lengthy work experience and

higher educational status were significantly associated with both knowledge and practice of

infection prevention. The finding of this study revealed a good knowledge of infection prevention

on the majority of participants with relatively minimal practice rate. Socio demographic factors

and health facility factors were associated knowledge and practice of infection Hospital and other

concerned stakes holder should ensure constant availability of guidelines and the provision of

training to health providers.

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However, developing professional educational level, introducing infection prevention standard of

practice and continuous mentorship was recommended (Askarian, Mclaws, Meylan, 2019).

Attitudes of health care workers in infection prevention and control. A cross sectional study

undertaken in two territory Hospitals located in South-South and North central Nigeria. A study

population of 381 Health Workers were used which include all doctors, nurses and laboratory

scientist of both hospitals. Data was collected from study participant using a standardize self

administered questionnaire was pre tested on a random sample of five doctors, eight nurses and

four laboratory staff to ensure practicability and validity in questions and interpretation of

responses. most (95%) of the study participant believed that standard precautions will prevent

them from acquiring infection from the seven percent were of the view that there were no need to

wash or decontaminate hands after touching patient surrounding while 98.9% agreed that the

gloves should always be worn before vein puncture 39% did not agree that sharps should never be

recapped while 13.4% felt that sharp needles can never be bent or broken after use (Izegbu,

Amole and Ajayi 2020).

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Chapter Three

Methodology

This chapter explains the design used for the study, research setting, target population, sample

size, sampling technique, Instrument for data collection, validity of instrument, reliability of

instrument, method of data collection, method of data analysis and ethical consideration.

Research Design

The researcher used a descriptive survey design which is a non-experimental approach conducted

to determine the level of knowledge, attitude and practice of health care workers regarding

infection prevention and control within general hospital Iquita, Oron, Akwa Ibom State, Nigeria.

Research setting

This study was carried out in general Hospital, Iquita, Oron, a government owned hospital. It is

situated in Iquita village, bounded on the North by Uya Oro, on the south by Idua Assang, on the

East by Local Government Council, on the west by Eyetong. The hospital is located on the right

side of the road before entering the main oron town and serves Okobo, Oron, Urue Offong/Oruko,

Udung Uko and Nsit Atai Local Government Area. The hospital commenced in 1942 as a small

secondary health care facility with few staff and equipment. It has now developed to serve as a

training centre for medical, nursing and paramedical personnel and it is also a research centre. It

has a total member of one hundred and fifty (150) staff with three hundred and ninety eight (398)

beds. The hospital has the following department: Medical department, pharmaceutical

department, Nursing department.

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It has the chief Medical superintendent as the in charge of the hospital, the chief nursing officer as

in-charge of nursing services and the chief pharmacist as in-charge of the pharmaceutical

department. It has the following units/wards. Nursing unit, HIV/AIDs Counseling and Testing

unit, X-ray, Main Theatre, Pharmacy, Laboratory, Outpatient Department, Accident and

Emergency unit, Medical Ward (male and female), Children and Child-Welfare Clinic. The

hospital also has centers such as Eye Clinic Centre, Family Planning Centre, Antenatal Unit,

Labour ward, Post- natal ward, Gynaecological ward.

Target Population

The target population for the study was all health care workers in general hospital in Iquita, Oron

Irrespective of gender or rank and they numbered 150.

Sampling size

A sample size of 109 was used using Taro Yamane formula which state thus;

Formula n=N
1+ N(e)2

Where; n = Sample Size

N = Population Size

e = Margin of error = 0.05

Sampling Technique

A continence random sampling technique was used to select the 109 respondents this implies

orderly and careful selection of health care workers.

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Instrument for Data Collection

A self structured questionnaire was used for data collection. The questionnaire consists of two

sections (section A and B). Section A deals with the demographic data of the respondent while

section B will be concerned with question related to the study.

Validity: The question was given to the supervisor who read and made necessary corrections thus

ascertaining the content and face validity of the instrument.

Reliability: The questionnaire was pretested on eleven (11) respondents outside the research

population using test re-test method (General Hospital, Ituk Mbang Uraun Akwa Ibom State).

This helps measure the consistency of the instrument what it is supposed to measure. Pearson

product moment correlation co-efficient was used for the calculation using split half test method.

Method of data collection

Data was collected using a self constructed questionnaire. It was administered face to face by the

researcher to the health care workers in general hospital, Iquita, Oron. The questionnaire was

completed within a stipulated time and same was retrieved by the researcher on the spot.

Method of data analysis

The Analysis of data was based on information obtained from the questionnaire using simple

descriptive statistical method of frequency and percentage (%). The data was presented in table,

multiple bar chart and histogram. Two Liket scale was used for the analysis.
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Ethical consideration

The following measure were taken to ensure that the respondent interest are protected

A letter of introduction was obtained from the Principal of School of Midwifery, General Hospital

Iquita, Oron to the chief medical officer of General hospital, Iquita, Oron for permission to carry

out study in the hospital.

Participation was voluntary the respondent was not forced to participate in the study. Principle of

confidentially was maintained by not indicating a place to fill in their names.

The respondent was not subjected to any harm or bias.

The right of the respondent was respected to gain cooperation.

The respondents’ right to anonymity and privacy was observed.

Plagiarism was avoided as any idea or fact taken from other people’s work was properly

acknowledged.
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Chapter Four

Analysis of Data

This chapter presents the data analysis and the interpretations of the results. The data

collected were arranged into tables, frequency, simple percentages, bar chart, the data

were analyzed based on the information obtained from health care workers in general

hospital Iquita, Oron, Akwa Ibom State.

Table 2: Demographic Data of respondents

(n = 109)
VARIABLES FREQUENCY PERCENTAGE
Age
20-30 years 42 38.5%
31-40 years 40 36.7%
41-50 years 15 13.8%
51 years and above 12 11.0%
Total 109 100%

Sex
Male 29 26.6%
Female 80 73.4%
Years of Service
1-5 37 34.0%
6-10 35 32.1%
10-20 17 15.6%
21-30 20 18.3%
Total 109 100%
Units
Maternity 40 36.7%
Family planning 4 3.7%
Laboratory 30 27.5%
Pediatric 18 16.5%
HIV/AIDS 17 15.6%
Counseling and Testing
Total 109 100%
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Christianity Religion 100%

Muslim 109 0%
Traditional 0 0%
Total 0 100%
109
Source: Field Survey 2023
 25

Table 2: Socio - Demographic Data of Health Workers in General Hospital Iquita, Oron.

The demographic data as represented in table 2 shows that 42 (38.5%) were in the age

group of 20 -30 years while 40(36.7%) were in the age group of 31-40 years, 15(13.8%)

were in the age group of 41-50 years and 12 (11.0%) were in the age group of 51 and

above. The data shows that 29(26.6%) were male and 80(73.4%) were female. The data

shows that the years of service varies per individual which shows thus 37(34.0%) had a

working experience of 1-5 years, 35(32.1%) worked for 6-10 years, 17(15.6%) worked for

10-20 years and 20 (18.3%) worked for 21-30 years.

The result also shows that 40(36.7%) were in maternity units, 4(3.7%) were in family

planning units, 30(27.5%) were in laboratory units, 18(16.5%) were in pediatric units and

17(15.6%) were in HIV/AIDS counseling and testing units. The table also indicated that

109(100%) were Christians 0(0) % were Muslims and 0(0 %) were traditionalists.
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Section B:

Research Question 2: Do health care workers have knowledge, about infection

prevention and control in general Hospital Iquita, Oron.

Table 3: Knowledge of Health care workers in infection prevention and control

(n = 109)
S/N ITEMS RESPONSES FREQUENCY PERCENTAGE (%)
6. Do you have any Yes 80 73.4%
idea about infection No 29 26.6%
prevention and
control?
Total 109 100%

7. Can hospital Yes 85 78.0%

acquired infection No 24 22.0%
be transmitted by
medical equipment
such as needle,
syringes, Catheters,
stethoscope,
thermometer?
Total 109 100%

8. Do you know the Yes 64 58.7%

world health
organization 5 rules No 45 41.3%
of hand hygiene?
109 100%
Total
9. Can you handle Yes 26 23.9%
body fluids with
bare hands if gloves No 83 76.1%
are not available?
109 100%
Total
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10 Can standard 36 33.0%

precautions be 73 67.0%
applied to all
patients regardless
of their diagnosis? 109 100%
Total
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FREQUENCY OF PERCENTAGES

FREQUENCY OF RESPONSES

Figure1: Bar chart showing knowledge of Health care workers in infection prevention and
control.

Table 3: result of findings for research question 1

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Knowledge of health care workers in infection prevention and control shows that

80(73.4%) of the respondent knew about infection prevention and control while 29

(26.6%) does not have an idea, 77(70.6%) agree that infection can be transmitted by

medical equipment such as needle, syringes, catheters, stethoscope and thermometer,

while 32(29.4%) do not understand, 64(58.7%) know the World Health Organization 5

rules of hand hygiene while 45(41.3%) do not know, 26(23.9%) said they can handle body

fluids with bare hands if gloves are not available while 83(76.1%) cannot, 36(33.0%) said

standard precaution can be applied to all patients regardless of their diagnosis while

73(67.0%) said they cannot.

SECTION C:
 30

Research question 2: what is the attitude of health care workers towards infection

prevention and control in General Hospital, Iquita, Oron, Akwa Ibom State.

Table 4: Attitude of Health Care workers in infection Prevention and Control.

S/N Items Responses Frequency Percentage

11 Should policies and procedures on Yes 61 56.0%

infection control be adhered to at all No 48 44.0%
times?

Total 109 100%

12 Can workload affect your ability to Yes 66 60.6%

apply infection prevention? No 43 39.4%

Total 109 100%

13 Must you attend in service Yes 45 41.3%

training/workshop related to No 64 58.7%
infection prevention and control
regularly in order to prevent and
control infection?
Total 109 100%

14 Do you still need to wash your hand Yes 43 39.5%

after using gloves? No 66 60.5%
Total 109 100%

15 Can following the prevention Yes 51 46.8%

guidelines reduce the rate of hospital No 58 53.2%
acquired infection?
Total 109 100%
 31
FREQUENCY OF PERCENTAGES

FREQUENCY OF RESPONSES

Figure 2: Multiple Bar Charts Showing Attitude of Health Care Workers in infection prevention
and control.

Table 4: Result of findings for research question 2

 32

The result in table 4 shows that 61(56.0%) agreed that policies and procedures on

infection control should be adhered to at all times while 48(44.0%) do not agree,

66(60.3%) agreed that workload can your affect ability to apply infection Prevention while

43(39.4%) do not agree, 45(41.3%) agree that in service training/workshop is compulsory

for infection prevention and control 64(58.7%) do not agree, 51(46.8%) agree that

following prevention guidelines reduce the rate of hospital acquired infection while

58(53.2%) do not agree, 43(39.5%) agree that they need to wash their hands after using

the gloves while 66(60.5%) do not agree.

Section D:
 33

Research Question 3: Do health care workers practice infection prevention and control in

general hospital Iquita, Oron?

Table 5: Practice of infection prevention and control among health care workers.

S/N Items variables frequency Percentage

16 Do you practice Yes 81 74.3%
hand washing No 28 25.7%
after attending to
patients/client?
Total 109 100%
17 Do you carbolize Yes 86 78.9%
patient bed and No 23 21.1%
disinfect your
instructment?
Total 109 100%
18 Do you use Yes 59 54.1%
gloves, facemask No 50 45.9%
and apron when
caring for a
patient? 109 100%
Total
19 Do you isolate Yes 65 59.6%
patient who have No 44 40.4%
communicable
disease from
other patients?
total 109 100%
20 Do you use Yes 86 78.9%
asepetic No 23 21.1%
technique when
carrying out
wound dressing? 109 100%
Total

Table 5: Result for findings in research question 3

 34

Table shows that 81(74.3%)agree that they practice hand hygiene after attending to their

patient while 28 (25.7%) do not, 86 (78.9%) carbolize patients bed and disinfect the

instrument while 23 (21.1%) do not, 59 (54.1%) use gloves, facemask and Apron while

caring for the patients while 50(45.9%) do not, 65(59.6%) isolate patients who have

communicable disease from other patients while 44(40.4%) do not, 86(78.9%) use

asepetic technique when carrying out wound dressing while 23(21.1%) do not.

Answering Research Questions

 35

Research Question 1: Do health care workers have knowledge about infection prevention

and control in general hospital Iquita, Oron. From the result of the findings in the study on

table 3, figure 1: majority of the respondent (73.4%) have an idea about infection

prevention and control, (70.6%) agree that hospital acquired infection can be transmitted

by medical equipment such as needle, syringes, catheters, stethoscope and thermometer,

(58.7%) know the world health organization 5 rules of hand hygiene, (23.9%) cannot

handle body fluids with bare hands if gloves is not available and (33.0%) disagreed that

standard precautions should not be applied to all patients regardless of their diagnosis.

Research Question 2: What is the attitude of health care workers towards infection

prevention and control in General Hospital, Iquita, Oron? From the result of the findings

in the study on table 4, figure 2: the result indicated that (56.0%) 0f the respondent agreed

that policies and procedures on infection control should be adhered to at all times, (60.6%)

agreed that workload can affect ability to apply infection prevention, (41.3%) said in

service training/ workshop related to infection prevention and control is compulsory,

(39.5%) agreed that hand washing is necessary after using gloves and (46.8%) agreed that

following the prevention guidelines reduce the rate of hospital acquired infection.
 36

Research Question 3: Do health care workers practice infection prevention and control in

General Hospital Iquita, Oron. From the result of the findings in the study on table 5:

result revealed that (74.3%) practice hand washing after attending to their patients/clients,

(78.9%) carbolize their patient bed and disinfect instrument, (54.1%) isolate patient who

have communicate disease from other patients and (78.9%) use asepetic technique when

carrying out wound dressing.

 37

Chapter Five

Discussion of Findings

This chapter deals with discussion of findings, identification of key findings, implication

of the study with literature support, alignment of the findings with findings of previous

studies cited, implication of findings to midwifery, limitation of the study, summary,

conclusion, recommendations and suggestion for further studies.

Do health care workers have knowledge about infection prevention and control in

General Hospital Iquita, Oron?

Analysis revealed in table 3 showed that majority of the respondent had knowledge about

infection prevention and control; this relates with study by onyemobo, Anekson and Pirs

(2014) which state that the majority of health care workers had good knowledge about

infection prevention and control.

These findings also contradict study by Tirivanchu, Ancia and Petronella (2015) on

barriers of infection prevention and control practices among nurses at the Bindura hospital

that majority of the nurses lack knowledge on infection control.

 38

What is the attitude of health care workers towards infection prevention and control

in General Hospital Iquita Oron?

Analysis revealed in table 4 showed that the attitude of health care workers in infection.

Prevention and control is sufficient and favorable. This relates with study by Yakob,

Lamaro and Henok (2015) on knowledge, attitude and practice towards control of

infection among health care workers in Aman general hospital south west Ethiopia that

health care workers had sufficient and favorable attitude in infection prevention and

control.

Do health care workers practice infection prevention and control in General

Hospital, Iquita, Oron?

Analysis in table 5 reveals that majority of health care workers practice infection

prevention and control this finding relates with Yakob, Lamaro and Henok (2015) study

on knowledge, attitude and practice of infection that majority of health care workers

practice safe standard precautions towards infection preventions and control.

This findings contradicts with the study conducted by Onyemobo, Anekson and Pirs

(2014) to assess the level of knowledge and practice of infection control that majority of

the health workers had fair practice of infection control and prevention. It was concluded

that regular and in service training job training programs should be done.
 39

Implication to Nursing and Midwifery Practice

Nurses and midwives should have adequate knowledge on standard precautionary

measures, nurses and midwives should be able to utilize the available personal protective

equipments in caring for their patient. Nurses and midwives should be involved in

continuing education in order to acquire more knowledge on the new technological aspect

of nursing practice.

Limitation of the study

The limitation encountered by the researcher during the course of the study were, nature of

health care workers work (shift-duty) which was overcome by re-visit to administer and

collect questionnaires. Hoarding of information which was overcome by telling the

respondent that all the information gotten will be treated with confidentiality and their

name will not be needed in the questionnaire.

 40

Summary of the study

The study investigated the knowledge, attitude and practice of infection prevention and

control measures among health care workers in general hospital Iquita, Oron, Akwa Ibom

State. Three (3) objectives were used to form 3 research questions and a comprehensive

review of literature and empirical studies were made according to the variable of the

study. The study population consisted of all the health care workers working in general

hospital, Iquita Oron. A descriptive design method was used for the study, after testing for

reliability, the researcher made questionnaire that was scrutinized by the research

supervisor, which was used in gathering data for the study. The questionnaire had 4

sections, A, B, C, and D containing 20 items. Section A had 5 items on socio-demographic

data of respondents.

Section B, C and D had 5 items on variable of the study. All data generated were

presented in bar charts, analyzed using simple frequency. Findings from the study

revealed that health care workers in General hospital, Iquita Oron had good knowledge on

the attitude and practice of infection prevention and control.

 41

Conclusion

Based on findings from the study on knowledge, attitude and practice of infection control

measure among health care workers in general hospital Iquita Oron majority of health

workers had knowledge about infection control measures, majority also had good practice

of infection control measures.

Recommendations

Based on the findings and conclusion of the study. The following recommendations were

made:

 Government should make adequate provisions of personal protective equipment to

all health care workers.

 Government should ensure adequate continuing education for health care workers

on proper implementation of infection prevention and control; measure.

 Barriers affecting compliance to infection prevention and control measure among

health care workers should be prevented.

Suggestions for Further Study

 Influence of knowledge of health care workers in infection prevention and control

in PHC Oron.

 The attitude of health care workers towards infection prevention and control in

M.C.H Okobo.
 42

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among health care workers northen, Nigeria: journal of global infections disease, 5(4),

156- 163

Askarian, M., Mclaws, M., Melyan, L. (2019), Infection control and hospital

epidemiology, 26(1), 105-108, accessed 16 January, [Link] /10.1086/502495.

Dimie, O., Kernebradikumo, P., Babatunde, A., and Christian, G. (2019). Knowledge,

attitude and practice of standard precaution and infection control by hospital workers

in territory hospital, Nigeria: Journal of infection prevention, 16(1), 16-22

Dixit, D., Hagtvedt, Ray, R., and Bakerman, O. (2019). Attitudes and beliefs about hand

hygiene pediatric residents, Zinvle, Benin West Africa: International journal of

infection 3(2).

Forgie, S. (2019). Advisory committee on dangerous pathogens: Management of hazard

Group 4 Viral Haemorrhagic Fevers and Similar Infection Disease of high

consequences, Mangalore, India, accessed 11 november 2022, [Link].

Gebermariyam, B., Donka, G., Wordofoa, B. (2018), accessed 13 January 2023,

[Link] 13690-018-0314-0.
 43

Hilburn, J., Hammond, B., Fendler, E., and Groziak, P. (2019). Use of alcohol hand

sanitizer as an infection control strategy in an acute care facility. American journal of

infection control, 31(2), 109-116, accessed 11 november 2022,

[Link] 2019, 15

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[Link]

practice-of-workers-as-regards-universal-precaution-measures.

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doctors and nurses in tertiary care hospital: Annals of tropical Medicine and public

Health 5(1), 29, accessed 11 november 2022,

htpps://[Link]/ps/[Link]?p=AONE&id=GALE/A280689330&v=2.1.

Lemass, H., Mcdonell, N., O’Connor, N., and Rochford, S. (2018). Infection prevention

and control for primary care, Ireland : A guide for general practice patient safety first,

1-98. Accessed 16 december 2022, [Link]

prevention-and-control-lemass/69i57j33i160.

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liable? South African medical Journal, 102 (6).

 44

Mishra, P., Banerjee, P., and Gosian, H. (2018). Study of Health care associated infection

(HALS), Paut Hospital, New Dehli, India: Merit research Journal of biochemistry and

bioinformations, 2 (2): 38 -48

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Nalunkuma, R., Nkalubo, J., Abila, D. (2021). Accessed 12 January

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infection: International journal of medical science and public health, 16 (4), 6

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 45

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summary. First global patient safety challenge clean clear is safer care, accessed 10

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Nurses Knowledge and Attitude in pediatric Intensive Care Units, Cairo University

Hospital Egypt: Journal of Use Egyptian Public Health Association 98(1)

: 22-28.
 46

APPENDIX I

QUESTIONAIRE

School of Midwifery,
General Hospital,
Iquita, Oron,
Akwa Ibom State.

Dear Respondent,

I am a final student midwife of the above named institution carrying out a research on the topic;

knowledge and practice of infection control measure among health care workers in general

hospital Iquita Oron, Akwa Ibom State.

The purpose of the questionnaire is to gather information for the above stated research, this is

purely for academic purpose and your confidentiality is highly guaranteed.

Thanks for your co-operation.

Yours faithfully,

Ben, Patience Elijah

Researcher
 47

Section A:

Demographic Data

Instruction: Please tick the boxes provided with appropriate information

1. Age: 20 – 30 years 31 – 40 years 51 and above

2. Sex: Male Female

3. Years in service 1 – 5 6 -10 10 -20 21 -30

4. Units: Maternity Family planning Laboratory pediatric

HIV/aids Counseling and testing

5. Religion: Christianity Muslim Traditional

SECTION B

Instruction: In this section you have two (2) to scale rating option you are tick ()
yes or No knowledge of Health care workers infection prevention and control

S/N ITEM YES NO

6 Do you have any idea about infection prevention and control

Can Hospital acquire infection be transmitted by medical

7 equipment such as needle, syringes, catheter, stethoscope,

thermometer?

Do you know the world health organization 5 rules of hand

8
hygiene?
 48

Can you handle body fluids with bare hands if gloves are not
9
available?

Can standard precautions be applied to all patients regardless of

10
their diagnosis?

Attitude of Health care workers in infection prevention and control

S/N ITEMS YES NO

11 Should policies and procedures on infection and control be adhere to at

all times?

12 Can workload affect your ability to apply infection prevention?

13 Must you attend in service training workshop related to infection

prevention and control regularly in order to prevent and control

infection?

14 Do you still need to wash your hands after using gloves?

15 Can following the prevention guidelines reduce the rate of Hospital

Acquire Infection?
 49

Practice of infection prevention and control among health care workers

S/N ITEM YES NO

16 How often do you practice hand washing after attending to your

patient/client?

17 How often do you carbolize patient bed and disinfect your

instruction?

18 How often do you use glove face mask and apron when caring for

a patient?

19 How often do you isolated patient who have communicable

disease from other patients?

20 How often do you use aspetic technique when carrying out wound

dressing?
 50

APPENDIX II

Formula n=N
1 + N(e)2

Where; n = sample size

N = Population size

e = Margin of error = 0. 05

n= 150
1+150 (0.05)2

n= 150
1+150x 0.0025

n= 150
1+ 0.375

n= 150
1.375

n= 109
 51

APPENDIX III

CALCULATION OF RELIABILITY

This is done by using Pearson Product Moment Correlation Coefficient.

Using 10% of the sample size.

10 109
100 X 1 = 11

S/N X Y X-X Y-Y (X-Ẋ)2 (Y-Ῡ)2 (X-Ẋ)(Y-Ῡ)

1. 12 14 1.3 2.4 1.69 5.76 3.12
2. 10 12 -0.7 0.4 0.49 0.16 -0.28
3. 9 10 -1.7 -1.6 2.89 2.56 2.72
4. 10 10 -0.7 -1.6 0.49 2.56 1.12
5. 13 13 -2.4 1.4 5.79 1.96 3.36
6. 13 13 2.4 1.4 5.79 1.96 3.36
7. 10 12 -0.7 0.4 0.49 0.16 -0.28
8. 10 10 -0.7 -1.6 0.49 2.56 1.12
9. 9 10 -1.7 -1.6 2.89 2.56 2.72
10. 13 13 2.4 -1.4 5.29 1.96 3.36
11. 9 11 -1.7 -0.6 2.89 0.36 1.9
TOTAL 11 128 0.6 0.4 29.13 22.56 21.34

Where;

X = Dependent Variable

Y = Independent Variable

Σx= Sum of Scores for dependent Variable

Σy = Sum of Scores for independent Variable

Σx2 = Sum of Squares of scores for dependent variable

Σy2 = Sum of Squares of scores for independent variable

Σxy = Sum of the product of scores for dependent and independent variable.
 52

Substituting:

r = Σ (X-Ẋ) (Y-Ῡ)
Σ(X-Ẋ)2(Y-Ῡ)2

Mean X = Σx = 118 = 10.7

11
Mean Y = Σy = 128 = 11.6
11

r = Σ (X-Ẋ) (Y-Ῡ)
Σ(X-Ẋ)2(Y-Ῡ)2

= 21.34
√ (2.9.13) (22.56)

= 21.34
√ 657.1728

r= 21.34
25.6

r= 0.83