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WEST VISAYAS STATE UNIVERSITY

COLLEGE OF NURSING
Iloilo City
1

Chapter 1

Introduction to the Study

Chapter One is divided into six (6) parts: (1)

Background of the Study, (2) Statement of the Problem and

the Hypotheses, (3)Theoretical and Conceptual Framework,

(4) Significance of the Study, (5),Scope and Limitation of

the Study ,and (6) Definition of Terms.

Background of the Study

Infectious diseases (IDs) continue to be the leading

cause of morbidity and mortality in the Philippines.

Seventy-five Filipinos die of tuberculosis (TB) every day.

The Philippines has the highest tuberculosis burden in the

Western Pacific region, with an estimated 30 million people

(32% of the entire Philippine population) infected with TB

bacilli. Sixty-six of the seventy-nine provinces in the

Philippines are considered endemic for malaria, with

malaria infection rates of 40%-60% widespread in rural

areas. Widespread dengue epidemic outbreaks occur every 2-3


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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years in the urban areas. Because of the dismal health

situation, prevention and control of major infectious

diseases have become key goals for the Philippines

Department of Health (DOH). In 1999, the Government of the

Philippines (GOP) and USAID, working closely with the U.S.

Centers for Disease Control and Prevention (US-CDC),

developed an activity to respond to the emergence of

resistant varieties of tuberculosis and malaria in epidemic

proportions and to periodic occurrences of dengue epidemics.

Over the last decades, the continued increase of

antibiotic-resistant organisms and the threat of hospital-

acquired infections has become a major concern for all

healthcare workers. The associated morbidity, mortality,

and related costs imposed by hospital-acquired infections

burdens our society and urge for action [3-6]. In this way,

infection prevention and control has become one of the key

issues within the broader perspective of healthcare.

Compliance with infection control measures is reported to

be worse for less experienced members of hospital staff.

Motivation to comply with the proposed recommendations


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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appears to be a complex, habitual matter which seems

difficult to influence. Potential reasons for poor

adherence to evidence-based recommendations include time-

consuming matters, negative influence of colleagues,

requirement of a high staff-patient ratio (e.g. in case of

source or protective isolation), the inability of hospitals

to provide in expensive equipment or place (e.g. isolation

facilities, separate units for admitting colonized/infected

patients), poor knowledge regarding the clinical

effectiveness of infection control measures or techniques

in reducing the emerging spread of infections. However, the

most important reason for this poor compliance might be due

to a failure to adapt the favourable behaviour during

nursing training at school. Consequently, the challenge is

to ensure implementation of, and compliance with evidence-

based guidelines in daily nursing practice. The simplest

way to do this is by taking full advantage of low-tech

interventions such as education and providing feedback and

this from the start of undergraduate courses.


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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As undergraduate nursing students have already direct

patient contact from an early stage in their instructive

training, basic principles of infection prevention and

control should be known by this particular group of care

givers. Successful teaching in infection control has been

shown to substantially change attitude and perception among

medical students, as well as their way of performing

clinical practice. Yet, such data are not available for

what concerns nursing students.

Statement of the Problem

This study aims to determine the knowledge and

preventive practices of nursing students in infection

control.

Moreover, this study aims to:

1. To determine the effects of year level, sex, and

family income of nursing students on infection control.

2. To determine the extent of practice of preventive

practices practice by the nursing students as grouped

according to level, sex, and family income.


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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3. To determine the difference between the knowledge

level of nursing students when they are grouped according

to year level, sex, and family income.

4. To determine the relationship between the level of

knowledge of infection control and the extent of preventive

practices among nursing students.

Hypotheses

1. Year level, sex and family income has a

significant effect on the practice of preventive

measures regarding infection control among

nursing students.

2. There is a significant difference on the extent

of practice of preventive practices practice by

the nursing students as grouped according to

level, sex, and family income.

3. There is a significant difference between the

knowledge level of nursing students when they are


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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grouped according to year level, sex, and family

income.

4. There is a significant relationship between the

level of knowledge of infection control and the

extent of preventive practices among nursing

students.

Theoretical Framework

This study is anchored in the theory of Health

Promotion by Nola Pender .This theory integrates nursing

and behavioral science on perspective on factor that

influence health behavior, biological, physical,

psychosocial, factors that influence individual to engage

in behaviors directed towards health promotion.

The health promotion model describes the multi

dimensional nature of persons as they interact within their

environment to pursue health. The model focuses on

following three areas: Individual characteristics and

experiences, Behavior-specific cognitions and affect and;


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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Behavioral outcomes. The health promotion model notes that

each person has unique personal characteristics and

experiences that affect subsequent actions. The set of

variables for behavioral specific knowledge and affect have

important motivational significance. These variables can be

modified through nursing actions. Health promoting behavior

is the desired behavioral outcome and is the end point in

the HPM. Health promoting behaviors should result in

improved health, enhanced functional ability and better

quality of life at all stages of development. The final

behavioral demand is also influenced by the immediate

competing demand and preferences, which can derail an

intended health promoting actions.

This study was anchored on the Social Learning Theory

of Bandura. This theory focuses on the learning that occurs

within a social context. It considers that people learn

from one another, including such concepts as observational

learning, imitation and modeling. The general principles of

the Social Learning Theory state that people can learn by

observing the behaviors of others and the outcomes of those


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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behaviors. Learning can occur without a change in behavior

because people can learn through observation alone and

cognition plays a role in learning.

Tollman’s Cognitive Theory (Walker, 1999) also lent

support to this study. According to this theory, man’s view

learning primarily as a cognitive process, a matter of

acquiring beliefs and knowledge about the environment and

then demonstrating that knowledge about the environment and

by acting purposeful, goal directed ways.

Conceptual Framework

Year Level Knowledge


Monthly and Infection
family Preventive Control
income Practices
Sex Practices

Antecedent Variable Independent Variable Dependent Variable

Significance of the Study


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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The results of this study would benefit the patients

assigned to nursing students and the nursing students

themselves in the following ways:

The nursing students, will be aware of their level of

knowledge and preventive measures and will anticipate the

need to improve their present status. This in turn will

benefit the patients because the caregivers (the nursing

students) will improve their infection control measures

thus alleviating, if not eradicating the cases of

nosocomial infections.

This study will benefit the nursing students in such a

way that they will be more conscious of protecting

themselves from contracting diseases through proper

infection prevention.

The patients who are under the care of nursing

students will be able to benefit in a way that the

students nurse that are handling them will practice an

effective way of preventing infection and further

complications. They will also be provided with health


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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teachings that are beneficial to them and their family

members.

This study will benefit the college in evaluating the

student’s awareness and practice in terms of infection

control. In addition, the factors that affect the knowledge

and practice of nursing students will also be determined

and how these factors contribute to the student’s health

practices in school, and in the clinical area. The

informations obtained in this study also will also help the

college determine if there is a need for emphasis in terms

on infection control practices of the students.

This study will benefit the Department of Health in a

way that it can help the agency evaluate the public

awareness and practice especially that of the student’s

about standard precautionary measures to prevent infection.

The information obtained from this study can serve as a

basis for health programs and enhanced information

dissemination in regards to infection control especially in

schools.
WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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Scope and Limitation of the Study

This descriptive-correlational research aimed in

determining the knowledge and preventive practices on

infection control among nursing students of West Visayas

State University.

The independent variables were the knowledge level and

practice of preventive measures while the dependent

variable would be infection control. On the other hand, the

antecedent variables are year level, family income and sex.

The data will be collected using the researcher-made

20-item questionnaire for the determination of the

knowledge level of infection control and researcher-made

20-item rating scale will be used to determine the

preventive practices against infection of randomly selected

levels 2,3,and 4 nursing students of West Visayas State

University in the clinical setting. The questionnaire will

be subjected to face and content validation. The

researchers will personally distribute and administer the

research instrument on June 2011.


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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The study will be limited to 50 students per year

level from the total student population of 400 nursing

students for the school year 2011-2012 of West Visayas

State University. This study will use a stratified random

sampling technique to select the participants.

The statistical tools employed were means, standard

deviations, frequency and percentages,t-test, One-Way

Analysis of Variance (ANOVA) and the Pearson’s Product

Moment Coefficient of Correlation (Pearson’s r). The level

of significance was set at 0.05 alpha. All statistical

computations were processed through the Statistical Package

for the Social Sciences (SPSS) software.

Definition of Terms

Infection- invasion of the body by pathologic

microorganisms that reproduce and multiply causing the

disease by local cell injury, secretion of a toxin, or

antigen-antibody reaction in the host. (Mosby’s Pocket

Dictionary, 2006, p.705)


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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In this study, it refers to acquisition of physiologic

symptoms (e.g. redness, swelling, tenderness, fever,

bleeding, increased mucus production and discharges) of an

individual as a result of exposure to pathologic

microorganisms.

Infection Control- the policies and procedures of a

hospital or other health facility to minimize risk of

spreading of nosocomial or community-acquired infections to

patients or member of the staff. (Mosby’s Pocket

Dictionary, 2006, p.705)

In this study, it refers to the actual practice of

hand washing, waste disposal, use of gloves, masks and

disinfectants by student nurses in the clinical area.

Prevention- any action directed to prevent illness and

promoting health to eliminate the need for secondary or

tertiary health care. (Mosby’s Pocket Dictionary, 2006, p.

1107)

In this study, prevention refers to the actual

practice of asepsis (e.g. hand washing, use of gloves,


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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masks and disinfectants, etc.) by student nurses in the

clinical area.

Knowledge- In this study, it refers to the facts the

students have regarding infection control. It will be

measured using a 20-item test about infection control and

categorized information. The scoring will be based on three

categories:

Below Average- 0-6

Average- 7-13

Above Average- 14-20

Sex-In this study, it refers to the biological orientation

of an individual, either male or female.

Income- In this study, it refers to the total earnings of

all working members of the student’s family for a span of

time who reside under one roof with the student.

Year Level- In this study, it refers to the current level

of education that the student is taking at the time of the

study.
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COLLEGE OF NURSING
Iloilo City
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Students- In this study, it refers to the randomly selected

students who are enrolled for the semester in West Visayas

State University-College of Nursing Students.

Visayas State university. They will be randomly selected

and with informed consent, asked to answer the 20-item

questionnaire prepared by the researchers.


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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Chapter II

Review Of Related Literature

Infection

An infection is the colonization of a host organism by

parasite species. Infecting parasites seek to use the host's

resources to reproduce, often resulting in disease.

Colloquially, infections are usually considered to be

caused by microscopic organisms or microparasites like

viruses, prions, bacteria, and viroids, though larger

organisms like macroparasites and fungi can also infect.

Hosts normally fight infections themselves via their

immune system. Mammalian hosts react to infections with an

innate response, often involving inflammation, followed by

an adaptive response. Pharmaceuticals can also help fight

infections.

The branch of medicine that focuses on infections and

pathogens is infectious disease medicine.


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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Infection indicates a host interaction with an

organism. A patient colonized with S. aureus may have

staphylococci on the skin without any skin interruption or

irritation. If the patient had an incision, S. aureus could

enter the wound, with an immune system reaction of local

inflammation and routing of white cells to the site.

Clinical evidence of redness, heat, and pain and laboratory

evidence of white cells on the wound specimen smear suggest

infection. In this example, the host identifies the

staphylococci as foreign. Infection is recognized by the

host reaction and by organism identification. (Brunner and

Suddarth's Textbook of Medical-Surgical Nursing. Tenth

Edition (Lippincott, 2003)

Infection Control

Every year, many lives are lost because of the spread

of infections in hospitals. Health care workers can take

steps to prevent the spread of infectious diseases. These

steps are part of infection control.


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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Proper hand washing is the most effective way to

prevent the spread of infections in hospitals. If you are a

patient, don't be afraid to remind friends, family and

health care providers to wash their hands before getting

close to you.

Other steps health care workers can take include

covering coughs and sneezes, staying up-to-date with

immunizations, using gloves, masks and protective clothing,

making tissues and hand cleaners available, following

hospital guidelines when dealing with blood or contaminated

items.

Nurses specializing in infection control are

responsible for agency wide policy development and program

direction. Infection risk is significantly increased as

patient care equipment becomes more complex and as more

devices that disrupt naturally protective anatomic barriers

are used. Staff nurses play an important role in risk

reduction by paying careful attention to hand hygiene, by

ensuring careful administration of prescribed antibiotics,

and by following procedures to reduce the risks associated


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COLLEGE OF NURSING
Iloilo City
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with patient care devices. (Brunner and Suddarth's Textbook

of Medical-Surgical Nursing. Tenth Edition (Lippincott,

2003)

Transmission of Organisms

Understanding the mode of transmission of infection is

necessary for practicing and designing infection control

strategies. Four main routes spread organisms: contact

(direct, indirect or droplet); airborne; vehicle; and

vectorborne transmission. Although vector-related spread is

not likely to be of relevance in an office setting, the

other mechanisms are all potentially important modes of

transmission in a doctor’s office.

Standard Precautions

The tenets of Standard Precautions are that all

patients are colonized or infected with microorganisms,

whether or not there are signs or symptoms, and that a

uniform level of caution should be used in the care of all

patients. The elements of Standard Precautions include hand


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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hygiene, use of gloves and other barriers (eg, mask, eye

protection, face shield, gown), handling of patient care

equipment and linen, environmental control, prevention of

injury from sharps devices, and patient placement. (Brunner

and Suddarth's Textbook of Medical-Surgical Nursing. Tenth

Edition (Lippincott, 2003)

Routine Practices

“Routine practices” refers to the standards of

practice that should be followed for the care of ALL

patients at ALL times. They are based on the premise that

all patients are potentially infectious, even when

asymptomatic, and that the same safe standards of practice

should be taken routinely when handling blood, body fluids,

secretions and excretions, mucous membranes, non-intact

skin, and undiagnosed rashes of all patients.

Adherence to routine practices protects not only the

health care worker but also other patients who may

subsequently be in contact with that health care worker.


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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There are three principles that are inherent in

routine practices and these are hand hygiene, personal

protective equipment (PPE), safe handling and disposal of

sharps

Hand Hygiene

The term “hand hygiene” has replaced hand washing and

includes the use of plain or antimicrobial soap with

running water, as well as the use of an alcohol-based hand

sanitizer. When caring for a patient with diarrhea,

including suspected or confirmed Clostridium difficile

infection. Wash with plain or antimicrobial soap and water,

or a waterless/alcohol-based product when performing

routine care and non-invasive procedures such as following

personal hygiene (e.g., use of toilet, blowing nose);before

eating, drinking or serving food; before and after direct

contact with individual patients; before preparing or

handling sterile products or medications; between “clean”

and “dirty” procedures on the same patient; after removing

gloves; after contact with the environment or equipment in


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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the treatment room;and after contact with laboratory

specimens.

Hand Decontamination with Alcohol-Based Product can be

done:After contact with body fluids, excretions, mucous

membranes,nonintact skin, or wound dressings as long as

hands are not visibly soiled, After contact with a

patient’s intact skin (as after taking pulse or blood

pressure or lifting a patient),In patient care, when moving

from a contaminated body site to a clean body site, After

contact with inanimate objects in the patient’s immediate

vicinity, Before caring for patients with severe

neutropenia or other forms of severe immune suppression,

Before donning sterile gloves when inserting central

catheters, Before inserting urinary catheters or other

devices that do not require a surgical procedure,or After

removing gloves. (Brunner and Suddarth's Textbook of

Medical-Surgical Nursing. Tenth Edition (Lippincott, 2003)

Hand Washing is done when hands are visibly dirty or

contaminated with biologic material from patient care or


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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when healthcare workers do not tolerate waterless alcohol

product. (Brunner and Suddarth's Textbook of Medical-

Surgical Nursing. Tenth Edition (Lippincott, 2003)

According to the study “Impact of age and gender on

adherence to infection control guidelines and medical

regimens in cystic fibrosis” (MASTERSON TL, WILDMAN

BG, NEWBERRY BH, OMLOR GJ., there is age-related

differences in adherence behaviors across both infection

control and medical regimens and support the use of

developmentally sensitive approaches to assessment and

interventions addressing adherence.

According to the study “The effect of an enhanced

infection-control policy on the incidence of Clostridium

difficile infection and methicillin-resistant

Staphyloccocus aureus colonization in acute elderly medical

patients” (SHELDON P. STONE, VIRKA BERIC, ANNE

QUICK1, ANITA A. BALESTRINI, CHRISTOPHER C. KIBBLER),

introduction of the policy was associated with significant


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
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reductions in CD infection and unoccupied bed-days and

helped maintain a lower incidence of MRSA.

According to the study, ”Healthcare workers' attitudes

to working during pandemic influenza: a qualitative study”,

(IVES J, GREENFIELD S, PARRY JM, DRAPER H, GRATUS C, PETTS

JI, SORELL T, WILSON S), Health Care Workers across a range

of roles and grades tended to feel motivated by a sense of

obligation to work through an influenza pandemic. A number

of significant barriers that may prevent them from doing so

were also identified. Perceived barriers to the ability to

work included being ill oneself, transport difficulties,

and childcare responsibilities. Perceived barriers to the

willingness to work included: prioritising the wellbeing of

family members; a lack of trust in, and goodwill towards,

the NHS; a lack of information about the risks and what is

expected of them during the crisis; fear of litigation; and

the feeling that employers do not take the needs of staff

seriously. Barriers to ability and barriers to willingness,

however, are difficult to separate out.


WEST VISAYAS STATE UNIVERSITY
COLLEGE OF NURSING
Iloilo City
25

In this study, “A KAP study among staff and student

nurses about infection control in Theodor Bilharz

Hospital”, it is very important to create public awareness

in the hospital community, and among nurses about the

concept of infection control. This will be done through

formal and informal instructions, by organizing regular

courses and posters. It is very essential to provide safe

disposal of syringe needles in special containers, have

facilities for hand washing during work and apply HB

vaccine for nurses working in the hospital. Meanwhile, a

highly motivated behavior should be enabled and reinforced

through realization of the regulatory and organizational

factors for better implementation arrangement, which all

supplement the educational intervention directed to change

rather than just planning. (AYYAT AA, SAYED HA, ABOU HAD

AM,Department of Community Medicine, Theodor Bilharz

Research Institute, Imbaba, Giza, Egypt.)

In the study, “Standard precautions: knowledge and

practice among nursing and medical students in a teaching

hospital in Brazil”, knowledge and practice of hand


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COLLEGE OF NURSING
Iloilo City
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washing, use of gloves and the handling and disposal of

needlesticks and other sharp objects was evaluated among

nursing and medical students. Performance of both groups in

terms of knowledge of hand hygiene showed a dichotomy

between the teaching and the practice of these standard

precautions. Results have shown a deficiency in the

teaching-learning process for the other measures evaluated.

(MARY ROCHA-CARNEIRO GARCIA-ZAPATA, ADENÍCIA CUSTÓDIA SILVA

E SOUZA, JANAÍNA VALADARES GUIMARÃES, ANACLARA FERREIRA

VEIGA TIPPLE, MARINÉSIA APARECIDA PRADO, MARCO TULIO

ANTONIO GARCÍA-ZAPATA