|Year : 2019 | Volume
| Issue : 2 | Page : 51-56
Infection prevention and control practices among health-care workers in tuberculosis clinics in Ondo State, Nigeria
Wasiu Olalekan Adebimpe1, Waheed Folayan2, Abdulwahab Adewale Shittu3, Maryam Abisola Adebimpe4, Demilade Ibirongbe1
1 Department of Community Medicine, University of Medical Sciences, Ondo, Nigeria
2 Malaria Division, Epidemiology Unit of the Ministry of Health, Ondo, Nigeria
3 Department of Laboratory, Al Noor Specialist Hospital, Makah, Kingdom of Saudi Arabia
4 Department of Medical Laboratory Sciences, Kwara State University, MaleteIlorin, Nigeria
|Date of Web Publication||24-Jun-2019|
Dr. Abdulwahab Adewale Shittu
Department of Laboratory, Al Noor Specialist Hospital, Makah
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: Healthcare-acquired infections are significant causes of morbidity and mortality among hospitalized patients worldwide, most especially in resource-limited settings. Similarly, the tuberculosis (TB) clinic is a high-risk area due to the nature of the clients being managed, and the infectivity of the implicated microorganism. TB infection control is an essential, but often-overlooked, component of a comprehensive infection control program in developing countries like Nigeria. The knowledge and attitude of the relevant health workers would be a determinant of their preventive practice toward preparedness and infection prevention and control (IPC) Objectives: The study assessed IPC practices among health-care workers in TB Clinic, in Ondo State, Nigeria. Methodology: A descriptive crosssectional study was carried out among 400 healthcare workers in selected TB clinics in Ondo State Nigeria, and these were selected using the multistage sampling method. Research instruments used were semi-structured self-administered pretested questionnaire. Data were analyzed using the SPSS software version 23.0. Mean scores were generated for the major outcome variables of knowledge, attitude, and practice of IPC. The P value was assumed significant at values ≤0.05 for all inferential statistics. Results: Mean age of respondents was 34 years ± 8.1 years, majority (83%) of the health-care workers had good knowledge of IPC, another majority (80%) of the health-care workers interviewed had good attitude toward IPC, 314 (78.5%) have read the guideline, while 68% of the health-care workers had good practice. Year of experience, type of facility, and facility settings were statistically significantly associated with respondents' knowledge, attitude, and practice of IPC (P < 0.05). On binary logistic regression, having working experience of >1 year, and working in a TB facility were significant predictors of good knowledge, attitude, and practice of IPC. Conclusion: There are huge gaps between knowledge and practice of IPC among respondents in this study. Since TB clinics are major sources of cross infection within the hospital setting, stakeholders have significant roles to play in IPC in the health-care setting.
Keywords: Health-care workers, infection control, infection prevention, Nigeria, tuberculosis
|How to cite this article:|
Adebimpe WO, Folayan W, Shittu AA, Adebimpe MA, Ibirongbe D. Infection prevention and control practices among health-care workers in tuberculosis clinics in Ondo State, Nigeria. Libyan J Med Sci 2019;3:51-6
|How to cite this URL:|
Adebimpe WO, Folayan W, Shittu AA, Adebimpe MA, Ibirongbe D. Infection prevention and control practices among health-care workers in tuberculosis clinics in Ondo State, Nigeria. Libyan J Med Sci [serial online] 2019 [cited 2022 Nov 28];3:51-6. Available from: https://www.ljmsonline.com/text.asp?2019/3/2/51/261133
| Introduction|| |
The health-care setting parades a diverse nature and cader of staff whose primary roles and responsibilities are inter-related. They face a number of diseases emanating from the environment work, the nature of the work they do, and even from the patients, they treat. Infection prevention and control (IPC) measures aim to protect the vulnerable people (including the health workforce) from acquiring an infection while receiving or providing health-care services, respectively. Healthcare-acquired infections are significant causes of morbidity and mortality among hospitalized patients worldwide. Recent literature suggests the burden and estimated that the prevalence of healthcare-associated infection in developed and developing countries is 7.6% and 10.1%, respectively. Healthcare-acquired infections may be disproportionally high in resource-limited settings with rates of Healthcare-acquired infections estimated to be two to twenty times that of developed countries.
One of the major reasons for the high rates of healthcare-acquired infections is the lack of infection control programs, which have been neglected due to limited resources, competing priorities, and other barriers. Whereas inadequate infection control favors the spread of microorganisms in health-care facilities, the resulting healthcare-associated infections can further put the health system workforce at risk. Tuberculosis (TB) clinic is a high-risk area due to the nature of the clients being managed, and the infectivity of the implicated microorganism. Yet, TB infection control is essential, but often-overlooked, component of a comprehensive infection control program in developing countries like Nigeria. Thus, standard guidelines on IPC contains evidence-based approach to ensure global standard among health-care workers for effective infection control, yet these guidelines may not be found in many TB clinics in Nigeria.
In many health-care facilities, the required infrastructure capacity to prevent and control suspected and active TB cases are lacking and minimal. These include poor ventilation, lack of individual rooms, and other mechanisms to separate patients with and without TB disease, poor availability of personal protective equipment (PPEs), and poor disease surveillance system for TB and other hospital-acquired infections. The knowledge and attitude of the relevant health workers would be a determinant of their preventive practice toward preparedness and IPC. Thus, identifying existing infection control knowledge, attitudes, and practices among high risk and vulnerable health-care workers is a key first step in developing a successful infection control program. The objective of this study was to assess IPC practices among health-care workers in TB Clinic, in Ondo State, Nigeria.
| Methodology|| |
The study was carried out in Ondo State with a population of about 484,798 going by a recent projection of the 2006 national census. Nigeria is among six countries responsible for 60% of the total TB burden in the world with an incidence rate of 322/100,000 population in 2015. The prevalence of TB in the State was not formally documented, although most TB control programs are under the National TB Control program. For ease of accessibility, a significant number of activities in TB and TB/HIV care has been decentralized to the primary health care level, most especially community TB care. There are a significant number of other secondary and tertiary health-care facilities offering TB care within the state.
This was health facility-based cross-sectional descriptive, survey.
Health-care workers in selected TB care health facilities in Ondo State, Nigeria. Eligible health care workers should have been working in the TB unit for at least 6 months.
Using the Leslie Fishers formula for the calculation of sample size for simple proportion among a population <10,000; and a 14% infection control practices compliance prevalence rate from the previous study on TB preventive practices among health-care worker, a sample size of 377 was calculated. This was rounded up to 400 to account for attrition and nonresponse.
A multistage sampling technique was employed in sample selection. In Stage 1, two out of three senatorial districts in the state were selected through simple random sampling employing simple balloting. In Stage 2, five local government areas (LGAs) were selected per se natorial district through simple random sampling employing simple balloting. In Stage 3, a list of TB (and TB/HIV clinics) per LGA was made, six were selected from the list through simple random sampling employing simple balloting. Questionnaires were equally allocated per se natorial district and LGA and proportionately allocated per health facility based on the number of eligible respondents. In Stage 4, all eligible health-care workers that meet up with the inclusion criteria and who gave consent to participating in the study were serially recruited into the study.
A semi-structured self-administered questionnaire with inputs from the WHO guidelines on IPC was used to collect data. The instrument was pretested among 20 TB care workers in a conveniently selected TB health facility in Oyo State. The instrument was also validated by the State epidemiologist and a nationally certified TB control medical officer based in Ondo state. Data collection was carried with the assistance of trained medical and nursing students. Selected health-care workers who were on leave or off duty were appropriately reached through a destination follow-up. Data collection took about 2 weeks to complete. The questionnaire consists of nine variables for sociodemographic data, 17 for knowledge, 15 variables for each of the attitudes, and practice of IPC.
to conduct the study was obtained from the Ethics Review Committee of the Ondo State Ministry of Health. Permission was obtained from the heads of selected health facilities, while individual respondents gave written informed consent toward participating in the study.
Data analysis was carried out using the Statistical Package for Social Sciences (SPSS) software version 23.0 (SPSS Inc, Chicago, IL, USA) after data cleaning, double entry, and checking for outlier values. Data were presented as charts and tables. Questions related to knowledge was scored accordingly with score 1 given to right knowledge for those with “Yes” or correct response; and score 0 given to wrong knowledge or those with “No” response. Total score on knowledge was computed and mean score determined. Respondents with scores equal to and above the mean were classified as having adequate knowledge, while those below the mean score were classified as having inadequate knowledge. The responses from attitude and practices were scored similarly. The bi-variate analysis was performed using the Chi-squared test, while binary logistic regression showcased association between the major outcome variables and some selected variables most especially sociodemographic. Level of significance was considered at P ≤ 0.05.
| Results|| |
[Table 1] shows the sociodemographic characteristics of respondents. Mean age was 34 ± 8.17 years, with the age group 28–37 years having the highest 138 (34.5%) of respondents; 141 (35.3%) were male, 254 (63.5%) were married, nurses and doctors constitutes 89 (22.3%) and 9 (4.5%), respectively, 247 (61.8%) were TB/HIV centers, while 334 (83.5%) offer basically primary health-care services. [Figure 1] shows that the majority (83%) of the health-care workers had good knowledge of IPC, another majority (80%) of the health-care workers interviewed had a good attitude toward IPC, while 68% of the health-care workers had a good practice of IPC. [Table 2] shows that 363 (90.8%) said that they were familiar with hospital-acquired infection guidelines, 314 (78.5%) have read the guideline on IPC, 351 (87.8%) said know how to prevent and control hospital-acquired infections, 378 (94.5%) said that they usually carry out proper disposal of used materials, while 359 (89.8%) said that they were using PPEs.
|Figure 1: Knowledge, attitude and practice scores of IPC among respondents|
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[Table 3] shows that there was a statistically significant association between knowledge scores of IPC and number of year of practice and types of facilities (P < 0.05). There was a statistically significant association between the practice of IPC and gender, a number of years put in practice, and type of health facility (P < 0.05). [Table 4] shows that respondents with working experience of >1 year are 1.8 times more likely to have a good knowledge of IPC compared to those who have scored less than a year, and this observation was found to be statistically significant (P < 0.05). Similarly, respondents in combined TB and HIV clinics were 1.7 times more likely to have a good knowledge of IPC compared to those in TB clinics alone (OR 1.767, 95% Cl 1.097 – 2.846, P0.019). Thus, predictors of good knowledge of IPC include the years of working experience (OR 1.866) and being in a TB/HIV center (OR 1.7371). The only predictor of good attitude to IPC was being in a TB/HIV health facility (OR 1.252). Predictors of good practice of IPC were essentially the years of working experience (OR 1.354) and being in a TB/HIV center (OR 1.531).
|Table 3: Bi-variate analysis of Socio demographic information of respondents and their knowledge and practice on Infection Prevention and Control.|
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|Table 4: Binary Logistics regression of social demographic information of respondents and their Knowledge, Attitude and Practice towards Infection Prevention and Control.|
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| Discussions|| |
This study assessed the knowledge, attitudes, and practices of IPC among health-care workers in TB Clinics, in Ondo State, Nigeria. The burden of TB in the State could be high, like many other States in Nigeria and other African countries, because of the endemic nature of the disease. Health-care workers are more at risk of healthcare-associated transmission of TB. Adequate understanding and active implementation of TB infection control measures will assist in reducing the risk., In this study, majority of the respondents had good knowledge of TB IPC. This is similar to what was reported in Iraq, 95.5% and Ethiopia, 74.4%. It is higher than what was obtained in Nepal, 54% and Lagos. The variation could be due to the different methodology of the different studies and the level of health education and training on IPC that the respondents have had.
Those with lower duration in the year of service had a better knowledge of TB IPC; this is similar to what was reported in the study done in Ethiopia. From another study done in Bahir Dar, Ethiopia, knowledge was poor in those with lower duration in the year of service. It is likely that some of the respondents in our study lack adequate information on TB IPC. This was evident as deficiency of information on universal precaution as well as in the methods of disinfection of hospital materials and equipment. It was noted that none of the sex; year of experience and occupation; but rather, the type of facility has a statistically significant association with knowledge of TB IPC in the respondents. The similar fact was obtained in the Ethiopian study “Assessment of knowledge, attitude, and practice of health-care workers on infection prevention in health institution Bahir Dar city administration.”
The attitude of the respondents towards TB IPC was favorably good among our respondents. The reports of Shrestha and Ekuma, from Nepal and Lagos, respectively,, also showed good attitudes. The poor attitude could probably be due to the lack of training, either formal institutional or on the job training related to IPC. Their perception to the risk of transmission was in both patient and health workers; and that guideline on IPC is very important, among others. Yet a great number of the respondents still have poor attitudes toward agreeing and complying with the hospital guideline on IPC. Furthermore, some of the respondents lack enlightenment on the importance of the use of PPEs as well as other precaution measures. There was no association between the respondents' attitude and any of sex, year of experience and occupation, or the type of facility. This is similar to the outcome of Gulilat and Tiruneh study in Ethiopia.
The practice of TB IPC by the respondents was equally good, as seen in two-thirds of the respondents. This is similar to the Ethiopian study that revealed good practice (63.3%) of TB IPC among health workers, and unlike the Nepal study, which recorded poor practice. The differences could be due to inadequate or lack of essential facilities and materials needed in these clinics to ensure good practice of IPC. In this study, the year of experience >10 years showed poor practice. This differs from the work of Gulilat and Tiruneh with good practice seen in those with year of experience >10 years. Some of the respondents have poor practice in toward environmental sanitation, the use of PPE, washing of hands after removal of gloves, sterilization of infectious waste before disposal, and other precaution measures. It was noted that years of experience, occupation, and facility are all in association with the practice of TB IPC.
| Conclusion|| |
There exist a significant gap between the knowledge and practice of TB IPC in this study, as it is in the report of Lagos. Exposure of the health workers to frequent and continuous enlightenment programs or courses will build their capacity and make them current. Continuous training and re-training is essential to improve their attitude, it will give them some confidence and make them develop good disposition toward TB IPC. In addition to the stated measures above, there should be the provision of materials needed to practice IPC. Finally, a committee to monitor the compliance of health workers to the IPC guideline will be necessary.
Largely, the practice of infection prevention program in our health facilities is inadequate due to poor hygiene, poor sanitary conditions, and limited resources. Such inadequacy could contribute to the burden of healthcare-acquired infections, even though the lack of infection control measures have not been associated with TB in healthcare workers.
The authors would like to thank the TB Control officer at the Ondo State Ministry of Health and the medical directors or heads of selected health-care facilities for creating an enabling environment that facilitated data collection. We thank the individual health-care workers for giving consent toward their voluntary participation and the smooth conduct of this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ojulong J, Mitonga KH, Iipinge SN. Knowledge and attitudes of infection prevention and control among health sciences students at University of Namibia. Afr Health Sci 2013;13:1071-8.
World Health Organization. Report on The Burden of Endemic Health Care-Associated Infection Worldwide. Switzerland: World Health Organization; 2011.
Barker AK, Brown K, Siraj D, Ahsan M, Sengupta S, Safdar N, et al.
Barriers and facilitators to infection control at a hospital in northern India: A qualitative study. Antimicrob Resist Infect Control 2017;6:35.
National Population Commission. The 2006 National Census Preliminary Results. Abuja, Nigeria: National Population Commission; 2006.
Araoye MO. Research Methodology with Statistics for Health and Social Sciences. Ilorin, Nigeria: Nathadex Publishers; 2004. p. 117-20.
Iliyasu G, Dayyab FM, Habib ZG, Tiamiyu AB, Abubakar S, Mijinyawa MS, et al.
Knowledge and practices of infection control among healthcare workers in a tertiary referral center in North-Western Nigeria. Ann Afr Med 2016;15:34-40.
] [Full text]
Claassens MM, van Schalkwyk C, du Toit E, Roest E, Lombard CJ, Enarson DA, et al.
Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa. PLoS One 2013;8:e76272.
Jo KW. Preventing the transmission of tuberculosis in health care settings: Administrative control. Tuberc Respir Dis (Seoul) 2017;80:21-6.
Schepisi MS, Sotgiu G, Contini S, Puro V, Ippolito G, Girardi E, et al.
Tuberculosis transmission from healthcare workers to patients and co-workers: A systematic literature review and meta-analysis. PLoS One 2015;10:e0121639.
Woith WM, Volchenkov G, Larson JL. Russian health care workers' knowledge of tuberculosis and infection control. Int J Tuberc Lung Dis 2010;14:1489-92.
Verkuijl S, Middelkoop K. Protecting our front-liners: Occupational tuberculosis prevention through infection control strategies. Clin Infect Dis 2016;62 Suppl 3:S231-7.
Temesgen C, Demissie M. Knowledge and practice of tuberculosis infection control among health professionals in Northwest Ethiopia; 2011. BMC Health Serv Res 2014;14:593.
Shrestha A, Bhattarai D, Thapa B, Basel P, Wagle RR. Health care workers' knowledge, attitudes and practices on tuberculosis infection control, Nepal. BMC Infect Dis 2017;17:724.
Ekuma AE, Oridota ES. Knowledge, attitude and tuberculosis infection control practice among healthcare workers in DOTS centres in Lagos, Nigeria. Int J Infect Control 2016;12:1-9.
Gulilat K, Tiruneh G. Assessment of knowledge, attitude and practice of health care workers on infection prevention in health Institution Bahir Dar city administration. Sci J Public Health 2014;2:384-93.
Yallew WW, Kumie A, Yehuala FM. Risk factors for hospital-acquired infections in teaching hospitals of Amhara regional state, Ethiopia: A matched-case control study. PLoS One 2017;12:e0181145.
[Table 1], [Table 2], [Table 3], [Table 4]