|Year : 2020 | Volume
| Issue : 2 | Page : 110-115
Perceived changes in knowledge and skills of nursing personnel after the completion of training in safe injection practices: A study from the tertiary care hospital of Haryana, India
Vikas Gupta1, Suraj Chawla2, Neeraj Gour2, Pawan Kumar Goel2
1 Department of Community Medicine, Government Medical College, Shahdol, Madhya Pradesh, India
2 Department of Community Medicine, SHKM Government Medical College, Nuh, Haryana, India
|Date of Submission||04-May-2020|
|Date of Acceptance||12-Jun-2020|
|Date of Web Publication||11-Sep-2020|
Dr. Suraj Chawla
Department of Community Medicine, SHKM Government Medical College, Nalhar, Nuh - 122 107, Haryana
Source of Support: None, Conflict of Interest: None
Background: Unsafe injection is an important cause of transmitting blood-borne infections such as hepatitis B virus, human immunodeficiency virus, and hepatitis C virus. In a country-like India, health system usually suffers from the paucity of workforce and nursing personnel are the most susceptible to unsafe injection and needle stick injury. Aim: The present study was carried out with the aim to assess the knowledge and skills among nursing personnel regarding safe injection practices and to measure the change following training session. Materials and Methods: This was a hospital-based cross-sectional study, included all 230 nursing personnel those who were currently working in the hospital. A pretested, predesigned, standardized questionnaire was used. Everyday activity of the study was divided into three parts. First part of activity included pretest second part of activity consisted of 3–4 h training session and third part was posttest. The collected data were tabulated and analyzed using the SPSS Statistics for Windows, version 22.0. Results: Nearly 52.9% of the participants were aware of diseases transmitted through unsafe injection and 45.5% of participants were aware about appropriate sharp waste disposal. Only 20.6% of participants wore gloves before injection administration, and 56.1% used needle destroyer for disposing off the needles. Conclusion: Periodic reinforcement of the nursing personnel with hands on training sessions is the need of the hour to protect them from needle stick injuries and prevent the spread of blood borne pathogens in public at large.
Keywords: Blood-borne infections, needle stick injury, standard precautions
|How to cite this article:|
Gupta V, Chawla S, Gour N, Goel PK. Perceived changes in knowledge and skills of nursing personnel after the completion of training in safe injection practices: A study from the tertiary care hospital of Haryana, India. J Sci Soc 2020;47:110-5
|How to cite this URL:|
Gupta V, Chawla S, Gour N, Goel PK. Perceived changes in knowledge and skills of nursing personnel after the completion of training in safe injection practices: A study from the tertiary care hospital of Haryana, India. J Sci Soc [serial online] 2020 [cited 2020 Sep 26];47:110-5. Available from: http://www.jscisociety.com/text.asp?2020/47/2/110/294794
| Introduction|| |
Injections are among the most frequently used medical procedures, with an estimated 20 billion injections administered each year worldwide. The World Health Organization (WHO) define safe injection as the one which does not harm the recipient, does not expose the provider to avoidable risk, and does not result in waste that is dangerous for the community. This is achieved by administering an injection using a sterile device, adopting sterile technique by a qualified and well-trained person, and discarding the used devices in a puncture proof container, especially designed for appropriate disposal. Any breach in the process makes the injection unsafe.
Unsafe injection is an important cause of transmitting blood-borne infections such as hepatitis B virus (HBV), human immunodeficiency virus (HIV), and hepatitis C virus (HCV). Complications such as injection abscesses and nerve damage may also occur following unsafe injections. It is estimated that every year around 1.3 million deaths (0.3 million in India) are caused by unsafe injection practices. These deaths could have been prevented by safe injection practices and proper disposal of sharps and other health-care wastes.
In a country like India which has a rapidly ticking population clock, the health system usually suffers from the paucity of workforce. The health-care providers are almost always overburdened. Nursing personnel are the most susceptible to unsafe injection and needle stick injury. There is dearth of intervention-based studies on knowledge and practices of nursing personnel on injection safety in India. Hence, the present study was carried out with the objectives to assess the knowledge and skills among nursing personnel regarding safe injection practices and to measure the change following training session in a tertiary care teaching hospital of Haryana, India.
| Materials and Methods|| |
Study setting and design
This hospital-based, cross-sectional study was conducted at the SHKM Government Medical College, Nalhar situated in district Nuh, Haryana, India, during November–December 2018. It is a tertiary care hospital with daily outpatient of around 1190/day and an average inpatient of 75/day.
Study population and sample size
The study participants included all 230 nursing personnel those who were currently working in hospital for the past 6 or more months. The purpose of the study was explained, and informed written consent was obtained from all the study participants, and anonymity and confidentiality of the participants were maintained.
A pretested, predesigned, standardized questionnaire containing objective and multiple-choice questions in the English language was used for the study. The questions regarding the safe injection practices were compiled from the existing literature including WHO Tool C.,,, The collected questions were subjected to content validation by a panel of 15 medical experts. The purpose was to identify the items with a high degree of agreement among experts. Aiken's V was used to quantify the concordance between the experts for each item. Questions that had an Aiken's V >0.7 were selected for the study.
The questionnaire was divided into two parts: the first part consisted of ten questions to assess the knowledge and second part consisted of seven questions to assess the skills. Scoring was done on the basis of response to each of the question. Score obtained below 30%, 31%–60%, and above 60% was labeled as poor, average, and satisfactory knowledge, respectively.
Everyday activity of the study was divided into three parts:First part of the activity included pretest where knowledge component of questionnaire was self-administered by participants and skills component was filled by investigator himself by direct observation and interview, second part of activity consisted of 3–4 h training session of participants by investigator and third part was posttest. The training session on safe injection practices was consisting of a power point presentation, video-film, charts and posters, and hands-on experience in safe injection practices. The participants took part in the batches of 12–15 counts per training session to avoid any undue delay in day-to-day activities of hospital.
The collected data were tabulated and analyzed using the SPSS Statistics for Windows, version 22.0 (IBM Corp. Armonk, NY, USA). All the tests were performed at significance level of 5%. Categorical variables were presented as percentage (%). The variables with quantitative data were presented as mean (standard deviation) and paired t-test was used to compare the scores of pretest and posttest. Bivariate analysis using McNemar's Chi-square was used to examine the association between each dependent variable at pretest and posttest.
| Results|| |
Out of the total 230 pretest and posttest questionnaires, 223 were complete and were analyzed with a response rate of 96.9%. The demographic characteristics of the study are shown in [Table 1]. Out of total 223 participants, majority (55.2%) were females, 61.9% of participants were in the age of 26-35 years, most (41.3%) of the participants were working on contractual basis, and nearly all (97.7%) participants had nursing diploma as their education qualification.
|Table 1: Sociodemographic characteristics of the study participants (n=223)|
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Response of participants regarding their knowledge toward injection safety and biomedical waste management is tabulated in [Table 2]. In the present study, around half (52.9%) of the participants were aware that HIV, hepatitis B and C are transmitted through unsafe injection, and 45.5% of participants were aware that sharp waste should be discarded in white/blue container; however, only 2.7% of participants were aware of standard precautions. Only 4.5% of participants correctly told about immunizations a health-care worker must undergo, 10% of participants were aware of specific three major components of unsafe injection. Management of accidental needle stick injury was not correctly answered by 34.1% of the participants. Only 23.8% participants were aware about of various components of personal-protective equipment, and 21.1% of participants were aware about the optimal concentration of chlorine solution that is required for disinfection of floor after body fluid spill. About 35.4% of participants had correctly mentioned about the equipment of choice for administering vaccines and 43.0% of participants had knowledge about the level of mark beyond which a puncture proof container should not be filled.
|Table 2: Knowledge and skills regarding injection safety and related biomedical waste management among study population (n=223)|
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Observation of participants regarding their skills toward injection safety is tabulated in [Table 2]. Only 20.6% of participants were wearing gloves before injection administration, and 56.1% used needle destroyer or a hub cutter for disposing off the used needles, while only 48.0% of participants were following color coding for biomedical waste management, 42.6% of participants obtained the consent while giving injection, and swabbing of vial top or ampoule done before injection procedure was observed among 35.9% of participants, while 57.8% did not recapped the needle after injection administration. Only 43.9% of participants were able to correctly perform the steps of effective hand wash/rub.
Tables 2 depicts the comparison of the pre- and post-intervention assessment of knowledge and skills regarding injection safety and related biomedical waste management, respectively. A highly significant (p < 0.001) improvement in the knowledge of participants was observed after intervention with respect to the standard precautions, equipment for administering vaccines during immunization, concentration of chlorine solution for decontamination, managing body fluid spills, puncture proof container for sharp waste disposal, management of needle stick injury, and different types of vaccination a health-care worker must undergo. However, there was no significant improvement in knowledge regarding unsafe injection practices, common diseases transmitted by unsafe injection practices, and personal protective equipment.
Similarly, there was statistically significant (p< 0.001) improvement in skills of participants after training session, and it included the wearing of gloves before administering injection, correctly performing steps of effective hand wash/rub, swabbing of vial top or ampoule prior to injection procedure, not doing recapping of needle after injection administration, use of needle destroyer or a hub cutter for disposing the used needles, and correct biomedical waste management. However, there was no significant improvement in skill regarding obtaining consent before the administration of injection.
The improved score can be clearly visualized from the bar diagram [Figure 1] as poor score in pretest got transformed into good score posttest after training session. The total mean score of participants for pre- and post-intervention was 5.81 ± 2.721 and 10.19 ± 2.392, respectively, [Table 3] and this difference in mean was highly statistically significant (P < 0.001). Similarly, a statistically significant difference (P < 0.001) was observed between pretest and posttest scores when scores were calculated separately for knowledge (2.76 ± 1.525 and 5.07 ± 1.598) and skills (3.05 ± 1.696 and 5.12 ± 1.287).
|Figure 1: Distribution of score (pretest and posttest) of knowledge and skills regarding injection safety and related biomedical waste management among study population (n = 223)|
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|Table 3: Mean score for knowledge and skills regarding injection safety and related biomedical waste management among study population (n=223)|
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| Discussion|| |
The present study was conducted among 223 nursing personnel who were working in the tertiary care hospital for the past 6 or more months. Despite this, level of knowledge and skills that is potentially unsafe and associated with risk were observed. Safe injection practices include standard precautions and should be observed from injection preparation to its final disposal after its use.
In the present study, only 2.7% of nursing personnel were aware of standard precautions for infection prevention and only 10.8% nursing personnel knew the correct definition of safe injection similar findings were observed by Omorogbe et al., whereas in the study done by Onyemocho et al., 65.2% of participants knew about the correct definition of safe injection., The knowledge was significantly improved after training, but it was not up to expected level.
Auto disposable (AD) syringes are recommended for all types of immunization because they can only be used once. In the present study, 35.4% of nurses were aware of AD syringe, similarly a study done by Ernest showed that only 8.6% knew about auto destruct syringes are also available. In the present study posttraining, the level of knowledge about syringe of choice was improved, but it was statistically not significant.
The knowledge about diseases transmitted by the unsafe practices, i.e., HIV, HBV, and HCV were 52.9% in the current study. Similar results were observed in study studies done by Ernest, Bolarinwa et al., and Vong et al.,, It was observed in the studies by Onyemocho et al., Paul et al., and Kotwal et al., that 65.9%, 81.3%, and 77.5% respondents knew about diseases transmitted through unsafe infections, respectively.,, In the present study posttraining, the level of knowledge about diseases transmitted by unsafe practices was improved, but it was statistically not significant.
Our study finds that 43.9% of participants performed proper hand washing technique before injection administration. Similar lower prevalence of hand washing was observed in studies done by Chowdhury et al., (33.5%), Onyemocho et al., (20.3%) and Paul et al., (12.5%), whereas Alkandari et al. and Omorogbe et al. reported that 93% and 78.7% of the respondents washed their hands before administering injection, respectively.,,,, The effective hand wash skill was enhanced posttest and was highly statistically significant.
In the present study, 20.6% of participants wore gloves before injection administration. The study done by Omorogbe et al. and Onyemocho et al. showed that only 3.3% and 7.2% respondents wear single use glove before administering injection, respectively, similarly none of the primary health-care workers wore gloves during immunization session in Bolarinwa et al., study.,, In a study by Naik et al., 35% nurses were actually wearing gloves during the injection procedure. The proportion of wearing gloves during injection process was significant improved posttest.
In the present study, practice after injection administration like recapping of needle after use was seen in 42.2% participants. Similar findings were seen in studies done in studies of Paul et al., (42.5%), Fitzner J et al., (28%), Al Awaidy S et al., (28%), Daly AD et al.(31%), Onyemocho et al., (30.1%), and Naik et al., (50%).,,,,, In a study done by Oladimeji et al., 86.7% of respondent were doing recapping of needle after use. This practice of recapping and detaching of needles increase the risk of needle stick injuries among the nurses.
Management of needle stick injury include, immediately wash the wound with soap and water, let the wound bleed freely for a few seconds, do not squeeze the puncture site or suck blood, and following National AIDS Control Organization postexposure guidelines. In the present study, 34.1% of nursing personnel were aware of the management of needle stick injury, whereas Mitra et al. and Avachat et al. reported that more than 50% of respondents were aware about postexposure prophylaxis.,
In the present study, 56.1% of participants used needle destroyer or a hub cutter for disposing the used needles. Immediate disposal of used needles and syringes in a puncture proof container was not observed in more than two third (81.5%) of the health facilities in Chowdhury et al. study. Timilshina et al. reported that 55% of participants did immediate disposal.
In this study, there was a statistically significant difference in the scores of pretest and posttest related to knowledge and skills, and it was in concordance with the other studies conducted by Razaee et al., Hong et al., Sharma et al., and Temesgen et al.,,,
| Conclusion|| |
Hence, it was concluded from the study that there was change in the level of baseline knowledge and skills of nursing personnel regarding injection safety and biomedical waste management after training session. As significant improvement was not observed in the certain components of knowledge and skills, periodic reinforcement of the nursing personnel with hands on training sessions is need of the hour to protect them from needle stick injuries and prevent the spread of blood borne pathogens in the public at large. There was limitation in the study as the nursing personnel were under direct observation, whereas skills were being assessed pretest and posttest and improvement was measured, but the present study did not assess the use of these skills in the actual practice during patient care. Further, the participants might be in a socially acceptable direction which is usually seen in researches with direct observation (social desirability bias).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]