INFECTION CONTROL AND USE OF STANDARD PRECAUTIONS

AMONG HEALTHCARE WORKERS IN PRIMARY HEALTH

CENTERS IN SAGAMU LOCAL GOVERNMENT, NIGERIA.

BY

A RESEARCH PROJECT SUBMITTED TO

THE DEPARTMENT OF COMMUNITY MEDICINE AND PRIMARY
CARE,
OBAFEMI AWOLOWO COLLEGE OF HEALTH SCIENCES,
OLABISI ONABANJO UNIVERSITY.

IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE

AWARD OF M.B.Ch.B DEGREE (OGUN), OLABISI ONABANJO
UNIVERSITY, AGO-IWOYE, OGUN STATE, NIGERIA.

2021
 CHAPTER ONE

INTRODUCTION
1.0 BACKGROUND

The healthcare setting is one with an innate risk of exposure to infectious agents. Such
diseases resulting from pathogens acquired from the healthcare environment are called
nosocomial or hospital-acquired infections. As such, protecting the patients and the health
care givers from these group of diseases requires a set of standardized principles and
guidelines which must be strictly adhered to and applicable in the most basic of health
facilities. Healthcare acquired infections (HCAIs) are associated with increased morbidity
and mortality among hospitalized patients and predisposes healthcare workers (HCWs) to an
increased risk of infections (Iliyasu et al., 2016).

Worldwide, the healthcare workforce represents 12% of the working population (Goniewicz
M et al., 2012). By virtue of the nature of their job and their place of work, healthcare
workers are vulnerable to work-related health hazards that could be detrimental to their health
and well-being. Healthcare workers who work at primary health centers are at risk of
exposure to nosocomial, blood-borne and air-borne diseases during the course of their daily
work activities. They could also become vehicles for transporting infectious agents to their
clients, and vice versa if precautions are not taken, endangering their lives and that of the
patients they care for.

The need for infection control in healthcare facilities is born out of the need to prevent
HCAIs. Infection Prevention and control (IPC) according to the World Health Organization
(WHO) is a practical, evidence-based approach which prevents patients and health workers
from being harmed by avoidable infection and as a result leads to antimicrobial resistance.
There are two tiers of recommended precautions to prevent the spread of infections in
healthcare settings which are Standard Precautions and Transmission- Based Precautions
(CDC).

Sequel to the HIV/AIDS pandemic, the Centers for Disease Control (CDC) in 1985,
introduced universal precautions which are a standard set of guidelines to prevent the
transmission of blood-borne pathogens from exposure to blood and other potentially
infectious materials (OPIM) (Yasin et al., 2019). The CDC also introduced another set of
guidelines termed ‘Body Substance Isolation’ which advocated avoiding direct physical
contact with “all moist and potentially infectious body substances,” even if blood is not
visible (Broussard & Kahwaji, 2021). Later, the major features and Universal Precaution and
Body Substance Isolation were combined to form what is now referred to as Standard
Precautions.

Standard precautions apply to the care of all patients, irrespective of their disease state
(Broussard & Kahwaji, 2021). It is defined by the CDC as ‘the minimum infection prevention
practices that apply to all patient care, regardless of suspected or confirmed infection status of
the patient, in any setting where health care is delivered’. These precautions apply when there
is a risk of potential exposure to blood; all body fluids, secretions, and excretions, except
sweat, regardless of whether or not they contain visible blood; non-intact skin, and mucous
membranes (Ndu & Arinze-Onyia, 2017).

Standard precautions is now replacing universal precautions, as it expands the coverage of

universal precautions by recognizing that any body fluids may contain contagious and
harmful microorganisms. Standard precautions includes hand hygiene and personal protective
equipment (PPE), with hand hygiene being the single most important means to prevent
transmission of disease. Other components include safe injection practices (i.e., aseptic
technique for parenteral medications), use of sterile instruments and devices, and cleaning
and disinfecting environmental surfaces (Banach et al., 2018).

The level of practice of infection control and universal precautions by HCWs may differ from
one healthcare worker to the other. The differences in knowledge of universal precautions by
HCWs may be influenced by their varying type of training. The primary health care is usually
the first level of contact of individuals and their communities to health care. This cadre of
health workers in primary health centres do not have the same level of training as the HCWs
in the higher centres.

In Nigeria, Primary Health Care Centers (PHCCs) constitute major sites for health service
delivery to the vast majority of the population. The absence of an enabling environment in the
most primary health centres in Nigeria, such as a lack of constant running water or a shortage
of personal protective equipment (PPE), would lead to poor compliance with standard
precautions and infection control (Amoran & Owunbe, 2013). It therefore, becomes
important to assess the level of compliance with standard infection control precautions by the
HCWs in primary healthcare settings.
1.1 STATEMENT OF THE PROBLEM

Healthcare associated infections contributes to significant morbidity and mortality, longer

duration of hospitalization, as well as increased cost of treatment in both developed and
resource-poor countries (Iliyasu et al., 2016). The prevalence in the developed world is
reported to be 15% among hospitalized patients while it is as high as 37% for patients

admitted into the Intensive Care Unit (WHO, 2009). The prevalence in developing countries
is somewhat higher with up to 19% prevalence of HCAI among hospitalized patients (WHO,
2009). Even with the paucity of data in sub-Saharan Africa, HCAI remain a major cause of
preventable morbidity and mortality in developing countries where infection rates are
relatively higher due to poor infection control practices and overcrowding of hospitals.

In 2005, WHO estimated that about 2.5% of HIV infections and 40% of hepatitis B virus
(HBV) and hepatitis C virus (HCV) infections among healthcare workers worldwide were as
a result of exposure, following a needle stick injury. In Africa, the incidence of sharps
injuries among health care workers was estimated to be about 2.1% per year (Osagiede et al.,
2020). The Nigerian National HIV sero-prevalence sentinel reports show that HIV and AIDS
epidemic in Nigeria remains a public health problem of enormous magnitude (FMoH, 2010).
Similar high rates have been reported on HBV and HCV, thus, exposing HCWs to risk of
occupational exposure to these infections (Opaleye et al., 2010).

Despite the obvious importance of the use of standard precautions by health care workers
generally, its practice amongst primary health care workers is disappointing which exposes
these HCWs to various occupational hazards including blood borne and air-borne infections.
Many studies have shown disparity in knowledge of infection control based on a cadre of
HCW and their years of experience (Ogoina et al., 2015).

The prevalence of hospital acquired infections due to the disuse or non-compliance of low-
cadre healthcare workers to practice of standard precautions is alarming and could be due to
number of reasons. These include lack of knowledge of healthcare workers concerning
standard precautions; the absence of enabling environment in the health institution, such as a
lack of constant running water or a shortage of personal protective equipment (PPE); non-
compliance of healthcare workers to simple instructions such as hand hygiene before and
after attending to a patient.
In a study conducted in Norther Nigeria, 77.9% of the respondents were able to correctly
describe universal precaution and infection control, and almost all of the HCWs were able to
recognize hand washing technique, sterilization process and various equipments used for
personal protection, appropriate handling of the patients care equipments and soiled linen,
environmental cleaning and spills management, and appropriate handling of waste as
essential technique of universal precautions for infection control (Amoran & Onwube, 2013).
However, a significant number of the HCWs in that study could not recognize vaccination
post-exposure prophylaxis, and surveillance for emerging diseases as standard precaution for
infection control.

In another study conducted in Kaduna, mean knowledge scores were low in the surveyed
primary health workers (Nmadu et al., 2006). This low level of awareness and knowledge of
infection control and standard precautions was attributed to lack of staff training. In a study
conducted in Enugu state, only 18% had adequate knowledge on universal precaution and
infection control, with their source of information varying from school/training (39%) as the
major source to mass media (2%) as the least (Agu et al., 2015). Most of the respondents in
that study concluded that wearing of only gloves while conducting risky procedures on
patients is the only way of preventing blood borne infection, and only a few would wear
other protective materials such as apron, and eye goggle.

1.2 JUSTIFICATION OF THE STUDY

The important role played by Primary Health Care Workers as health care providers make
their safety an important health concern. As such, the significance of infection control in
primary healthcare settings cannot be overemphasized as both the patients and HCWs are
capable of spreading microorganism if adequate infection control measures are not strictly
adhered to. In addition, primary healthcare workers are increasingly being involved in
providing healthcare outside the clinics, such as free community medical outreaches, in
patients' homes or during pre-referral centre emergency care and may acquire infections from
or transmit infections to patients, other personnel, household members, or other community
contacts

The importance of airborne transmission of microorganisms in the hospital setting and the
risk of cross infection between patients and HCWs especially in respect of blood-borne
pathogens are widely documented. While many studies have focused on infection control and
use of standard precautions among healthcare workers in secondary and tertiary health
facilities, there is a dearth of knowledge on the practice of infection control and standard
precautions amongst health workers in the primary health care settings.

There is need to assess the level of knowledge and extent of adherence of primary health care
workers to infection control and standard precaution practices among primary health workers
in Sagamu Local Government Area. It is also important to carry out this study so as to
understand the factors that influence compliance of primary health care workers to standard
precautions in Sagamu Local Government. It will also contribute the body of knowledge on
occupational health hazards among primary healthcare workers.

1.3 AIM

To determine the knowledge and practice of infection control and standard precautions
among health workers in primary health centres in Sagamu Local Government Area.

1.4 OBJECTIVES

The specific objectives of this study are as follows:

1. To determine the level of knowledge of primary health care workers about infection
control and standard precautions in Sagamu Local Government Area.
2. To assess the attitude of primary health care workers in Sagamu Local Government
Area towards infection control and standard precautions.
3. To assess the practice of infection control and standard precautions among health
workers in primary health centres in Sagamu Local Government Area.
4. To determine factors that affects the compliance of primary health care workers to
standard precautions in Sagamu Local Government Area.
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