KNOWLEDGE, ATTITUDE AND PRACTICES OF NURSES ABOUT HIV/AIDS AT HAYATABAD MEDICAL COMPLEX, PESHAWAR

Principal investigator: Dr. Tauseef Aman (Masters in Public Health, Khyber Me ical !niversity" #ecturer, Department of $ommunity Me icine, Khyber %irls Me ical $ollege, Hayataba , Pesha&ar. $o author Dr. 'ai ul Abrar (Masters in Public Health, Khyber Me ical !niversity" Public Health officer, (orl Health )rgani*ation

ABSTRACT The H+,-A+D' pan emic has become a serious public health problem. As the prevalence of the infection rises, healthcare professionals &orl &i e can e.pect greater clinical e.posure to infecte patients. Aims: The care of people living &ith A+D' presents a significant challenge to the health care sector. This stu y see/s to estimate the /no&le ge, attitu es an infection control practices of nurses about H+,-A+D'. Me !"#s: 0urses from a tertiary care teaching hospital from a provincial capital in Pa/istan &ere intervie&e using a semi1structure 2uestionnaire. Res$% s: The sub3ects ha fragmente /no&le ge regar ing isease transmission, prevention an treatment, generally positive attitu es but poor practices about stan ar precautions an use of personal protective e2uipment (PP4". Most of the respon ents reporte course te.tboo/s follo&e by me ia as the source of /no&le ge about H+,-A+D'. C"&'%$si"&s: The stu y sho&e lacuna in /no&le ge &hich can be a resse by revising the nursing curriculum. 5urthermore the institutions-employers shoul feel their responsibility to provi e PP4 in a e2uate 2uantities to guarantee the safety of its employees. Ke()"*#s: H+,-A+D', Kno&le ge, Attitu es, Practices, 0urses.

INTRODUCTION +n Pa/istan, &here routine screenings of patients is not carrie out couple &ith limite or no use of isposable instruments in emergency settings, puts the healthcare personnel at ris/ of ac2uiring bloo borne infections from potentially infecte patients. The routine use of personal protective e2uipment (PP4" an stan ar precautions ('Ps" for infection control are also lac/ing. An estimate 678 of 9.: million annual bloo transfusions in Pa/istan are not screene for H+,. +n 9;;<, the A+D' surveillance centre in Karachi con ucte a stu y of professional bloo onors (very poor people, often rug users, &ho give bloo for money". The stu y foun that =78 &ere infecte &ith Hepatitis $, 978 &ith Hepatitis > an 98 &ith H+,. About =78 of the bloo transfuse comes from professional onors. Pa/istan?s per capita rate of me ical in3ections is aroun 6.:. ;68 of in3ections are a ministere &ith use e2uipment. !se of unsterili*e nee les at me ical facilities is also &i esprea . Accor ing to (H) estimates, unsafe in3ections account for @=8 of Hepatitis >, <68 of Hepatitis $ an A8 of ne& H+, cases. (9, =" A stu y con ucte on stu ent nurses in 0igeria sho&e an improvement in the /no&le ge an attitu e to&ar s the isease an care for H+,-A+D' patients, as &ell as their compliance &ith universal precautions after an e ucation program for the group.A A survey carrie out on :77 nurses in +n ia sho&e that the conversion of their theoretical /no&le ge into safe practices &as shoc/ingly poor. High inci ence of acci ental e.posures an complete ignorance of post1e.posure prophyla.is gui elines &as another highlight of this stu y. 6 A stu y con ucte on me ical stu ents in Pa/istan sho&e improvement in /no&le ge regar ing transmission of iseases &ith seniority in me ical college, although /no&le ge about preventive protocols &as not up to the mar/.: 0urses constitute a vulnerable group because of their 3ob nature. 0o stu y has so far been con ucte regar ing /no&le ge, attitu es, an practices of nurses about H+, in Pesha&ar. Proper /no&le ge an attitu e &ill lea to safe practices an thereby controlling the sprea of isease. This stu y can provi e baseline information about their a&areness level an possible policy recommen ations for improvements &here gaps e.ist. METHODOLOGY:
A hospital1base

$ross 'ectional 'tu y &as carrie out in Hayataba Me ical $omple., Pesha&ar, Khyber Pu/htoonKh&a, Pa/istan. The hospital &ith @6= be s has A=,777 a missions annually &hile the average aily )PD is 99<;. Bualifie nursing staff &ho gave informe consent an &ere &illing to participate &ere inclu e in the stu y. 'tu ent nurses, nurses &ho came for training as part of their post gra uate practical curriculum an &ere employees of other hospitals &ere e.clu e from the research. The total number of nurses in the sai hospital &as
2

+,-. Thirty &ere on leave an 9C< &ere on uty. A sample si*e of ;= nurses &as selecte ran omly. A 'emi1structure , pre1co e 2uestionnaire &as constructe to meet the re2uirements of the stu y, base on similar stu ies in ifferent countries. (6, @, 9=" Pilot testing &as one on a sample of 9= nurses ra&n from another teaching hospital. Data &ere analy*e using 'P'' version 9@.7. Mainly Descriptive statistics &ere use . RESULTS +n some cases, &ith not all the respon ents ans&ering all the 2uestions, there &as a variability occasionally observe in the enominators reporte in these results.

Table 1: Socio demographic characteristics of the study population (n = 92) '.0o 9 A n Bualification %ra uation Post1gra uation 4.perience !p to 97 years 991=7 years More than =7 years =< AC :; =9 9= 8 A7.6 67.= @6.9A ==.< 9A

K&")%e#.e "/ HIV/AIDS Analysis reveale that 9778 of the nurses ha hear about H+,-A+D'. $ourse te.tboo/ &as reporte by (C@.98" as the source of information, follo&e by television an ra io (C=8", octors (@=8", ne&spapers (:6.A8", frien s (6@.C8", pamphlets, leaflets an brochures etc (A=.@8", an the least chosen &as by performing their uty &ith an H+,-A+D' patient (==.<8". Table 2: Answers on !"#A!$S %nowledge &uestions as%ed from the respondents (n = 92) 'r. Des n (8" 0o n (8" Don?t /no& n (8"
3

= A

6 : @ C <

Healthy loo/ing person carrying H+,-A+D' Mo es of transmission 9. se.ual intercourse =. 'harp instruments-syringes A. +nsect bites 6. Kissing, touching, hugging :. 4ating E rin/ing &ith patients @. Mother to chil C. >loo transfusion <. 'taying filthy ;. Through animals Kno&le ge of ,$T E PPT$T centers in HM$ Thin/ you are at ris/ of getting H+, Hear of 0A$P +s there a successful F. of A+D'G Hospital policy for H+, screening

@6 (@;.@" <A(;7.=" <7 (<C" 6= (6:.C" 6< (:=.=" 9@ (9C.6" C9 (CC.=" <C (;6.@" =9(==.<" 6A (6@.C" 6A(6@.C" 6A (6@.C" @C (C=.<" == (=A.;" A@ (A;.9"

96 (9:.=" ; (;.<" 9= (9A" 6; (:A.A" 69 (66.@" C= (C<.A" =7(=9.C" : (:.6" @6 (@;.@" 6: (6<.;" 6C (:9.9" 69 (66.@" =: (=C.=" @9 (@@.A" AA (A:.;"

96 (9:.="

9 (9.9" A (A.A" 6 (6.A" 9 (9.9" C (C.@" 6 (6.A" = (=.=" < (<.C" ; (;.<" =A (=:"

'igure 1: (nowledge of pre)ention methods*

A i $#es %enerally the attitu es of nurses to&ar s people living &ith H+, an A+D' (P#(A" &ere foun to be accepting an positive. <;8 of the nursing staff sho&e their &illingness to provi e
4

nursing care for H+,-A+D' patients an <<8 (nH<9" respon e that people living &ith H+, an A+D' (P#(A" shoul be given the social rights to stu y an -or &or/. Fegar ing the 2uestion &hether they consi er treatment of A+D' patients a &aste of resources, ::.68 isagree &hile 67.=8 sai that it is a &aste of resources. )f those polle , <A.C8 (nHCC" sai &hen bringing bloo from the bloo ban/ they &oul ma/e sure that it is screene , especially for H+,.

P*0' i'es

Table +: ,esponses on -ractice &uestions (n = 92)

'r. 9 (ash han s before-after nursing proce ures 9. Des =. no (ear gloves &hen ta/ing patient?s bloo 0ever )ccasionall y Al&ays Feasons for never or occasional use +nterrupte or short supplies Don?t consi er important 5eel uncomfortable 0ee le recapping >imanual )ne1han e techni2ue 0ee le pric/s in past 9 year Des 0o 0o 8 Total n (8"

;= 7 =6 A; =;

977 ;= (977" =@.9 6=.6 A9.: ;= (977"

6= 9= ; 6< 6= 9; @7

6:.C 9A ;.< :=.= 6:.C =7.C @:.6

@A (@<.:"

;7 (;C.<" ;= (977"

Don?t remember @ +f yes, ho& many pric/s 9 time = times A1: times More than @ times 4ver been e.pose to H+,-A+D' pt in career Des no +f yes, ho& many pts 9 patient =1A patients 6 or more patients

9A 6 = 6 ;

96.9 =9 97.: =9 6C.6

9; (=7.C"

A< :6 9; 9A @

69.A :<.C :7 A6.= 9:.C<

;= (977"

<

A< (69.A"

To the 2uestion on the use of personal protective e2uipment, mas/s &ere reporte ;A.A8 of the times, protective goggles =A.@8, apron in )T or labor room <A.98 an rubber boots in )T :A.;8 of the times. The most fre2uently reporte reason for not using PP4 &as interrupte or short supplies (@C8", follo&e by ==.68 &ho i n?t consi er the use of PP4 important an ;.=8 felt uncomfortable &ith its use. To the multi response 2uestion about the isposal of use nee les an sharps, nee le cutter &as reporte <:.;8, thro&ing in puncture proof containers <.C8 &hile thro&ing in general ustbins 9:.=8 of the times. 'igure 2: -ie showing combination of different barrier methods used in nursing !"#A!$S patients

Table .:$etails of trainings recie)ed

Training receive on H+,-A+D' in hospital Des 0o +f yes, ho& many trainings 9 training = trainings A or more than A trainings Duration 9 ay = ays A ays @ ays 99 <9 97 9 7 6 = A = 9= << ;7.; ;.9 99 (9="

A@.6 9<.= =C.A 9<.=

DISCUSSION All respon ents /ne& about the e.istence of A+D' &hich is similar to a stu y one on health care professionals in +n ia.C $ourse te.tboo/, follo&e by television an ra io &ere the most common means of information reporte . Therefore, assuring affective messages through me ia an strengthening the course curriculum of nursing schools shoul be promote . This outcome is similar to a stu y one on me ical stu ents in Pa/istan an another stu y on health care professionals in 'outhern 0igeria. (:, <" >loo transfusion (;6.@8", unprotecte se. (;7.=8", infecte nee les an sharps (<C8" an mother to chil transmission (CC.=8" &ere comparable to a stu y one on 9st year me ical stu ents in +n ia &hereas insect bite an /issing or touching someone &ith A+D' &as incorrectly ans&ere as yes by 6:.C an :=.=8 respectively in our stu y &hereas C6.=@ an <9.=;8 in the abovementione stu y, sho&ing better un erstan ing of our respon ents. This may be because they &ere professional nurses &ith years of e.perience compare &ith stu ents 3ust entering the me ical college. ; $oncerning /no&le ge about the
7

isease, @;.@8 /ne& that a healthy loo/ing person may be carrying H+,. ; Fegar ing the availability of a successful treatment of A+D', @@.A8 &ere a&are that no such treatment e.ists. This is much better than a stu y one among nurses in +n ia, &hose response &as A=8.97 Kno&le ge of preventive metho s &as fragmente . $on om &as chosen by @C.68 of nurses. 97 'taying a&ay from patients as a preventive measure &as &rongly reporte by =:8 as oppose to :A8 in a stu y one on health professionals in +n ia. 99 'creening bloo for transfusion an using clean syringes &as correctly reporte by :C.@ an <=.@8 respectively &hereas in the stu y one on 9st year me ical stu ents in +n ia, the figures &ere <C.C= an C@.@8.; This sho&s lac/ of /no&le ge of our respon ents regar ing transmission of H+, through unscreene bloo transfusion. Despite the fact that ,oluntary counseling an testing (,$T" an prevention of parent to chil transmission (PPT$T" centers &ere locate in the sai hospital, only 6@.C8 /ne& about them. This coul a versely affect the nurses? role as a health e ucator an promoter. Attitu es &ere generally positive. Ma3ority (<;.98" sho&e &illingness for provi ing nursing care to A+D' patients, <<8 sai that P#(A shoul have the social rights to stu y or &or/ &hile 67.=8 consi ere the treatment of A+D' a &aste of resources. +n the stu y on nurses in $alcutta @@8 &oul avoi or eny loo/ing after H+, positive an A+D' patients.97 +n the practices section, all nurses sai they &oul &ash han s &ith &hatever available before-after nursing proce ures. Plain &ater &as reporte 9A8 of the times, soap-&ater @:.=8 an the use of antiseptic solution :@.:8. This is in contrast &ith a stu y one on health care &or/ers (H$(s" in $hile &hich sho&e neglect in han &ashing. 96 %loves &ere never use by =@8 &hereas occasionally use by 6=.68 &hile ta/ing patients? bloo . 'hort supplies &ere reporte by 6:.C8 &hich is comparable to a couple of stu ies one in ifferent eveloping countries &here resource shortage is al&ays a problem. (9A, 96, 9:" 0ee les shoul not be recappe , but in resource poor settings &here there is a nee for nee le recapping it shoul be one &ith the one1han e techni2ue. More than half (:=.=8" of the respon ents reporte bimanual recapping of nee les, &hich is a ris/y act an can result in acci ental e.posure to infecte bloo .96 0ineteen (=7.C8" nurses sai they &ere e.pose to nee le pric/s uring the past one year. Buite a big percentage (69.A" of our respon ents &as e.pose to H+,-A+D' patient-s in their professional career. The use of barrier metho s uring nursing care of H+, positive patients &as not al&ays practice . Feasons reporte &ere stoc/1outs an restrictive accessibility specifically in case of goggles an rubber boots. (6, 9A" )nly 99 (9=8" nurses ha receive some form of training about H+,-A+D' as oppose to the stu y one in $ameroon 9A in &hich CA.98 of the staff ha atten e lectures an instructions on safety &ithin the hospital. The fin ings &ere similar to a stu y one on Tai&anese nurses 9:, an the use of stan ar precautions in $hilean $ommunity $linincs.96

CONCLUSIONS The stu y sho&e gaps in /no&le ge, but li/e most eveloping countries, resources are scarce in Pa/istan. Hence espite ac2uisition of /no&le ge, some of the personnel practices an attitu es o not conform to available universal precautions. An integral part of their role is provi ing e ucation an information to patients. They can only fulfill this by having a strong /no&le ge base of their o&n. Health care planners nee to un erstan the importance of I'afe practicesJ an our teaching an training programs nee complete re1orientation to achieve this goal. RECOMMENDATIONS 9. 0ursing curriculum shoul be revise an revitali*e . =. Perio ic on 3ob trainings an refresher courses shoul be offere to all nurses. A. A option of safe practices an stan ar precautions shoul be ma e a &ay of life.

Re/e*e&'es: 9. Pa/istan sitting on a tic/ing A+D' bomb (5ri ay )ctober 7@, =77@" by Amir #atif http:--&&&.pa/tribune.com-ne&s-in e..shtmlG9:@A=C KAccesse 0ovember A7, =797L =. Preventing H+,-A+D' in Pa/istan (Mune =77:"

http:--&&&.&orl ban/.org.p/-(>'+T4-4NT4F0A#-$)!0TF+4'-')!THA'+A4NT -PAK+'TA04NT0-7,,contentMDK:=79:6A7AOpagePK:9699ACOpiPK:=9C<:6Othe'ite PK:=;A7:=,77.html KAccesse 0ovember =6, =797L

3. $harles >.!. Mournal of A vance 0ursing =777PA=(=":69@16=6. 'ystemati*e

H+,-A+D' precautions.

e ucation for stu ent nurses at the !niversity of +ba an, 0igeria: impact on /no&le ge, attitu es an compliance &ith universal http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2648.2000.014 2.!/ab"tract KAccesse 0ovember =6, =797L 6. Kumar F, Mohan 0, 'eenu , et al. Kno&le ge, attitu e an practices to&ar s H+, among nurses in a tertiary care teaching hospital: t&o eca es after the iscovery. M $ommun Dis. =77= DecP A6(6":=6:1:@. http:--&&&.ncbi.nlm.nih.gov-pubme -96C97<:: Kaccesse December ;, =797L

:. Taimur 'aleem, !mair Khali , 'i ra +sha2ue, Afia Qafar. Kno&le ge, attitu es an practices of me ical stu ents regar ing nee le stic/ in3uries KonlineL. Mournal of Pa/istan Me ical Association (MPMA". Available http:--&&&.3pma.org.p/-fullRarticleRte.t.phpGarticleRi H9;A: Kaccesse Manuary A, =799L @. ' ' Tib e&el, 'K (a hva. H+,-A+D' a&areness among hospital. +n ian Mournal of Me ical 'ciences. =779P ::(=":@;1C=. Available http:--&&&.in ian3me sci.org-article.aspGissnH779;1 :A:;PyearH=779PvolumeH::PissueH=PspageH@;PepageHC=PaulastHTib e&el Kaccesse December ;, =797L C. Menon ,, >harucha K.Ac2uire immuno eficiency syn rome an health care professionals. M Assoc Physicians +n ia. 9;;6P 6=(9":==1A. KonlineL http:--&&&.ncbi.nlm.nih.gov-pubme -C<A@=69 Kaccesse Manuary :, =799L
<. $hiama/a 0. !meh, 4. Mames 4ssien, 4mmaneul 0. 4*e inachi, Michael (. Foss. Kno&le ge,

>eliefs an Attitu es about H+,-A+D' relate issues, an the sources of Kno&le ge among Health $are Professionals in 'outhern 0igeria. M F 'oc Health. =77<P 9=<(:":=AA1=A;. http:--&&&.ncbi.nlm.nih.gov-pmc-articles-PM$=:@=;7=- Kaccesse December A, =797L
;. Maria Kuruvila, PP ,enugopalan, K' 'ri har, Kumar. KAP stu y on H+,-A+D' among first

year M>>' stu ents. +n ian Mournal of Dermatology, ,enereology an #eprology. 9;;CP @A(6":==:1 ==<. Kavailable onlineL http:--&&&.i3 vl.com-article.aspGissnH7AC<1 @A=APyearH9;;CPvolumeH@APissueH6PspageH==:PepageH==<PaulastHKuruvila Kaccesse Manuary :, =799L
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$alcutta. Manuary A, =799L 99. Ac2uire

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(or/ers of $ivil Hospital Karachi. Mournal of Pa/istan Me ical Association (MPMA". KAvailable onlineL http:--3pma.org.p/-fullRarticleRte.t.phpGarticleRi H=96= Kaccesse 0ovember =, =797L
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an /no&le ge of nurses in a Tai&anese hospital regar ing A+D' an H+,. +nternational

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