ADDIS ABABA UNIVERSITY

COLLEGE OF HEALTH SCIENCES

DEPARTMENT OF NURSING AND MIDWIFERY
TITLE: KNOWLEDGE ,ATTITUDE AND PRACTICE OF
NURSES TOWARDS INFECTION PREVENTION IN
SAINT PAUL HOSPITAL, ADDIS ABABA,
ETHIOPIA,2016

BY:- 1 YIKEBER
BISHAW…………………………….HSR/1037/04
2 YOHANNES
AREGA………………………….HSR/5768/04
3 OLIYAD
ESHETU…………………………………HSR/6278/04
4 ZEMENU
TSEGAYE……………………………..HSR/3938/04

ADVISOR: - Mr. ENGIDA YISMA

1
A RESEARCH PROPOSAL TO BE SUMITTED TO ADDIS
ABABA UNIVERSITY COLLEGE OF HEALTH SCIENCES
DEPARTMENT OF NURSING AND MIDWIFERY IN
PARTIAL FULFILMENT OF THE REQUIREMET FOR
BACHELOR OF SCIENCE DEGREE IN NURSING

SUMMARY

Background: Infection prevention means taking precautions while caring for every
if precautions taken up by everyone health care workers do not have to make
assumptions about peoples life styles and risk of infections whenever we are
applying knowledge of infection prevention we are applying idea of body
substances isolation together with universal precautions which savage the life of
both service givers and receivers.

Objective፡ To assess knowledge, attitude and practice of nurses to wards

infection prevention in Saint Paul hospital, Addis Ababa, Ethiopia 2016.

Methodology: Faculty based cross- sectional study will be conducted to assess the
KAP of nurses to wards infection prevention in saint Paul hospital from march 12
to 16. Data will be collected using persisted self- administered questionnaire and
analyzed using scientific calculator and computer. Finally, the result will be
presented by using tables, figures and statements. The questionnaire will be
administered to all nurses who have direct contact with patients working in saint
Paul hospital.

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 I

ACKNOWLEDGMENTS

We are very glad to express out deep gratitude to our Audis or [Link]
Yisma for giving us suggestions during the development of proposal.

We would like to acknowledgment our family relatives and friends for their moral
and material support and encouragement throughout our study period.

Finally, we would like to thanks a secretary that wrote the proposal on time.

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 II

LIST OF ACRONOMYS AND ABREVIATIONS

BSI = body substance isolation

CDC = center for diseases control

HVC = hepatitis c virus

HBV = hepatitis b virus

HCWS = health care workers

HIV = human immune virus

HLD = high level disinfectant

PPE = personal protective equipments

SP = standard precaution

UP = universal precaution

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 III

CONTENTS

summary ………………………………………………………………………. I

Acknowledgement …………………………………………………………… II

List of Acronyms and abbreviations ………………………………………… III

Chapter one: Introduction……………………………………………….1

1.1 Background …...…………………………………………………1-3

1.2 Statement of the problem………………………………………… 4-6

1.3 Significance of the study……………………………………………7

Chapter two: Literature review ………………………………………… 8-10

2.1. Knowledge of nurses towards infection prevention…………………….10-11

2.2 practice of nurses towards infection prevention …………………………11

2.3 Attitude of nurses towards infection prevention…………………………11

Chapter three: Objectives

3.1 General objectives…………………………………………………………. 12

3.2 Specific objectives…………………………………………………………. 12

Chapter four: Methodology

4.1 Study area and study period ……………………………………………….. 13

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4.2 Study design ………………………………………………………………...13

4.3 Source population…………………………………………………………...13

4.4 Study population……………………………………………………………..13

4.5 Eligibility Criteria……………………………………………………………13

4.5.1 Inclusion criteria …………………………………………………………..13

4.5.2. Exclusion Criteria ………………………………………………………...13

4.6. Simplify technique and sample safe ……………………………………….13

4.7. Study variable……………………………………………………………….13

4.7.1. Dependant variable ……………………………………………………13-14

4.7.2. Independent variable ……………………………………………………. 14

4.8. Definition of terms and operational world...……………………………14-15

4.9. Data collection tools and procedures……………………………………..15

4.10 Data collectors…………………………………………………………...15

4.11. Data processing and analysis……………………………………………15

4.12 .Data quality assurance………………………………………..…………15

4.13. Ethical consideration……………………………………………............15

4.1.4. Limitation of the study………………………………………….……..15

Chapter Five

Project work plan……………………………………………………………16

Chapter six; budget proposal

6.1 Budget Breakdown……………………………………………………...17

6.2 Budget summary………………………………………………………..18

6.3. References…………………………………………………………....19-22

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7

Chapter one: Introduction

1.1. Background

Infection prevention is a gridline for protecting of both health care personal and
patients from Nosocomial (health care associated) infection (1).
In 1985 largely because of the emergence of HIV/AIDS and other blood bone
infection such as HCV, HBV, A gridline for protection health care workers and
patients from becoming infected with these disease wake quickly developed and
become known as universal precautions (UP), This is a new strategy that
protecting patient to patient, patient to health care personal and health care
personnel to patient transmission of infectious agents (1).
Because of many people with blood borne infections such as HIV/AIDS do not
have symptoms not can they be visibly recognized as being infected up have to
be modified to include all persons, patients ox land clients attending health care
facilities regardless of whether or not they are infected (1).
At nearly the same time the universal precaution were introduced a new system
called body Substance Isolation(BSI) as an alternative that focused on

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 protecting patients and health as an alternative that focused on protecting
patients and health care workers from all moist and potentially infected body
substance, not just blood(4) that was primarily on the use of gloves, just before
touching mucous membranes or non intact of gloves , just before touching
mucous membranes or non intact skin and before anticipated contact with moist

Body fluids such as blood, semen , vaginal secretions, wound drainage sputum
saliva, a meiotic fluids, etc (2).

People receiving health and medical care wealth in hospital or clinic are at risk
of becoming infected unless pre cautions are taken to prevent infection
Nosocomial infections are a significant problem throughout the world and are
increasing, and the range of it is ranges from as low as 1% in a few countries in
Europe and American to more than 40% in parts of Asia, Latin America and
Sub-Saharan Africa. Where implantation of infection prevention is very
low(2,4).
Most of these infection (Nosocomial infection) can be prevented with readily
available, relatively cheap strategies, by adhering infection prevention.
Practiced, especially hand hygiene before and after procedure between different
patient contact, use PPE , improving safety in operating room and other high
risk areas where the most serious and frequent injuries and exposures to
infectious agents occurs (5).
New Guide Lines issued by CDC in 1996 involve a two level approach standard
precautions which apply to all clients and patients attending health care
facilities and transmission based precaution which apply only to hospitalized
patients (6).
8
This new system retains features of both universal precautions and body substance
isolation in infection prevention by hand hygiene (using an antiseptic or hand sub)
after touching blood, body fluid, secretions, excretions and contaminated items,
immediately after removing gloves, patient precautions were not applied may
result in potential of infection (7).

Health care workers including support staff who work in health care setting also
are at risk of exposure to serious, potentially life treatmenting infections. For
example In US more than 800,000 need stick injuries occur each year despite
continuing education and vigorous efforts aimed at preventing such accidents
including reducing unnecessary and unsafe injections. Training all staff to
immediately dispose of needles and syringes in sharp containers. Without
recapping. Therefore health care workers should know and use recommended
infection prevention practices to minimize their risk of accidental exposure or
injury(8,9).

The following universal infection prevention precaution are advised by WHO to

help protect health care workers and clients room blood born infection
including HIV
These are:-
- hand washing with soap and water before and after procedure
- Using protecting barriers such as, gloves, gowns, aprons masks, goggles for
direct contact with blood and other body fluids.
- Disinfecting instrument and other contaminated equipments
- Handling properly soiled liner, gloves and leak proof bags should be used if
necessary
- Cleaning should be occur outside of patient areas using detergent and hot
water (10).

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 WHO estimated that about 2.5 % of HIV case among health care workers
and 405 of Hepatizes B and C cases among health h care worker in the world
is as the result of these exposure , since there is no immunizations for HIV
and HCV, it is better to prevent become infected by preventing
exposure(10).

1.2. Statement of Problem

In the world the infection prevention gridline for protecting of both health care
workers and patients from nosocomial (health care associated) infection but still
now the spread of infection related to healthcare activity is increasing specially
after the emergency of HIV/AIDS and blood borne infections such as HIV and
HCV.

The world health organization (WHD) estimated that at least 50% of the
12billion infections administered each year in the developing world are unsafe
posing serious health risk to recipients health workers and the public(13,14) injury
from sharp devices have been associated with the transmission of more than
40pathogens including hepatitis B virus (HIV), hepatitis C virus (HCV) and HIV
The center for disease control and prevention (COD) in us estimated that each year
385,ooo needle sticks and other sharps related injuries are sustained by hospital
based health care personnel (15,16). Globally, WHO estimates that every year
unsafe infection and need stick injuries cause at least 8-16 million HBV infection
2,3-4,7 million HVC infection and 160,000 HIV/AIDS infection which are
chronic infections and leads to a high Burden on morbidity and mortality (14,16)
From national surveillance system for health care workers nurses sustain the
10
highest number of pre caution infers however health care worker including the
supportive taffy housekeeping, maintenance and laboratory personnel, who work
in the settings also are at risk or expels are to serious potentially life threatening
infection (17) .

People receiving health and medical care whether in a hospital or clinic, are at risk
of becoming infected unless pre cautions are taken to prevent infection no so
comical infections are a significant problem throughout the world and are
increasing for example no so comical infection rates range from as low as1% in
anew countries in Europe and the Americas to more than 40% in parts of Asia
Latin America and sub Saharan Africa (2,4)

Another study done in the United States (US) showed than more than 800,000
needle stick injury occur each year despite continuing education and rigorous
efforts aimed at preventing such accidents studies have shown the risk of diseases
often exposure to HBV from single needle stick injury lunges from 27-37% while
the risk following single needle stick injury exposure to HIV is much lower, 0.2-
0.4% and 3-10% for HCV (18).

The study done in Africa on softy of infection showed waste disposal was
problematic in Chad come-on cote de voile guinea Bissau and Uganda. In these
countries there were no health center that had a facility for safe disposal of used
materials but in Ethiopia, Rwanda, Kenya and Zambia incineration of used
syringes was reported to be the common practice. (19).

Study done in Ethiopia at southern nation, nationalities and peoples

region{SNNPR} showed that 32.4% of health care workers (HCD) reported as
they had sustained at least one form of accidental injury with needle or other
sharps among these injures both deep and penetration injuries constitute 63,8%
nurses and health assistants substance the highest proportion of accidental injuries
with needles or sharps and mole HCW had less chance of sustaining injury either
with needs or with sharps than the female(21).

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Other study done by negate project and engender health in Ethiopia showed that
health care workers don’t usually wash their hands on arrival to work place and
before putting on glove, even though it is well practiced between client and before
leaving work place(23).

So, we want to study this subject matter, to assess the knowledge, attitude and
practice of nurses to ward infection prevention, because of the problem mentioned
above. Globally, in Africa and in Ethiopia. The problems mentioned above are:

The severity of blood born infection, related to health care activities e.g.
HIV/AIDS, HBV and HCV which are chronic infections and with high rate of
mortality and morbidity.

1. From national surveillance systems for health care workers nurses are
sustained the highest number of precautions injury and why this?
2. From the study done in Ethiopia at SNNPR, reported the of the accident
injury with need and sharps 63.8% are nurses and these problem make us to
study the knowledge, attitude and practice of nurses in infection prevention.

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 1.3. Significance of the study

In countries with limited resource it is important to develop the health care

stuff knowledge, attitude and practice on standard practice to minimize their
risk of recommended infection prevention and provide safe service to clients
should be a standard practice. In Ethiopia, were the health professionals,
assessing the necessary knowledge, attitude and practice or the skill on
standard peculation will improves the quality and safety of health service for
health care providers, clients, researchers & government policies. Thus, this
survey will be conducted to asses knowledge Attitude determinant factor for
practice in health care facility, so that, the health planet health care
providers, managers and evaluators can use the fin dips this to study.
Yet very view studies were conducted in sent Paul hospital to assess
knowledge a attitude and practice of loath care workers and factors affection
them in heath faculty there for Therese study will design to investigate the
level of standard precut this proposal study will have a significant in
identifying and improving the pattern of infection prevention study area.

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Chapter two: Literature Review

It is important to prepare injections in a cleanly designed area, were the risk of

contamination by blood or body fluids low.

Hepatitis B persists up to seven days on surfaces which can lead to potentially

environmental contamination. The preparation of injection in contaminated area
also can read to bacterial infection. Cleaning heavily contaminated hands with
antiseptic before patient contact can reduce nosocomial transmission of contagious
diseases. This evidence was provided for 160 years ago in review article. Sem
Melwis is observed that mortality rate from puerperal fever was high (16%) may
1847 in a clinic were Doctors and student doctors provided care to women in
labor despite washing hand with soap and water before the entering the obstetric
clinic (26,28).

Sem Melwis (1847) postulate that the high rates of puerperal fever was caused by
cadaverous particles transmitted from the autopsy room to the obstetric ward via
the hands of student doctors. (12).

In may 1847, Sem Melwis insisted that doctors and students scarab there hands by
a chlorinated lim solution before every physical examination. Consequently the
mortality rate in that clinic dropped from 16% to3.06% in the remaining menthes
of 1847, (29).

14
practices :

The WHO estimate that at least 50% of the 12 billion injections administered in the
developing world each year are un safe posing serious health risk to recipients,
health workers and public (2,3).

Use of new, single use siring and needle provides high level of safety to the
recipients. However, unreliable and insufficient supplies might lead to the
equipment being re used. A stem sterilization procedure including decontamination
cleaning, is conduction to the WHO recommendation, and is control educing (time,
stem, temperature/TST) spot indicators. Injuries from sharp devices have been
associated with the transmission of more than 40 pathogens including HBS, HCV
and HIV (52,13).

Globally, WHO estimated that every yearn un safe injections and needle stick
injury cause at least 8-16 million people were infected by hepatitis ,B,2.3-4.7
million hepatics C infections and 160,000 HIV/ADIS infections. In many
countries for many years Health care workers have become infected with HIV as a
result of their pre face(27).

The main cause of infection in occupation settings is exposure to HIV infected

blood via a precutanous injury. protective barriers now commonly referred to as
personal protective equipment/ PPE/, have been used for many years to protected
patient from microorganisms present on staff working in the health care setting
more recently, wise the emergence of HIV/ADIS and HCV as well as resurgence
of tuberculosis in many countries use of PPE now has become important for
protecting staff as well(18.30).

The type of protective clothing well depend on the extent of the risk associated
with the health care waste, so that the following should be made available to all
personnel who collect or handle health care waste head covers caps, glove or heavy
duty gloves. It is important to collect and properly contain siring and leak proof
and that is sealed before it is completely full. Unsafe sharp waste collection causes
between 5% and 28% of needle stick injuries interventions like risk
communication managing sharp waste inefficient , safe and friendly way can
reduced needle stick injury to health care workers, clients and the community at
large. after closing and sailing , sharp containers must not be opened, emptied,
reused or soled. Four commonly used methods to destroy filled safety bodes or to
15
keep them away people are incineration (usually this is the best option), burning in
a metal drum (next best option) ,open burning (if Incineration or burning in a drum
or health is not possible) and burring without burning list safe option unless the
burning pit is extremely secure(32).

Yet recent study and reports indicate that lack of or improper hand washing
still contributes significantly to diseases transmission

While we are potentially at risk of contracting hand transmitted illness, onto third
of out population is especially un learnable, including pregnant women, children,
old people and thus weak immune system it seems reasonable to assume that
Hospitals have come closest to responding to this problem. Modern surgery, after
all, has long science solved many of the early problems of infection.

However fundamental problems of hygiene still exist still. In 1992 the New
England Journal of medicine reported on a hand washing study in an intensive care
unit despite special education and monitored observation, hand washing rates were
as low as 30% and never went about 48% (23).

Instrument processing Decontamination is the first step in processing soiled

(Contaminated) surgical instruments, gloves and other items, especially if they will
be cleaned by hand. for example briefly soaking contaminated items in 0.5%
chlorine solution or locally available disinfectants, rapidly kill HBV and HIV,
thereby making the instruments and other items safer to be handled during cleaning
larger surfaces such as examination and operating tables laboratory bench tops and
other equipments that may have come in contact with blood or other fluids also
should be decontaminated wiping with a suitable disinfectant (e.g. 0.5% chorine
solution or 1.2% phenol) is a practical in expensive way to decontaminated them
after instruments and other items have been decontaminated , they need to be
cleaned and finally either sterilized or high level disinfected (2,11).

During the 19th century women in child birth were dying at alarming rates in group
and United States. up to 25% of women who their babies in hospital died as a
result of child birth fever (puerperal), which later was found to cause by
streptococcus progeny bacteria. As early as 1843 Dr. Oliver Wendell Holmes
advocated hand washing to prevent child birth fever (Puerperal Sepsis) Holmes
believed that an infectious diseases could to be passed to pregnant women by the
hands of doctors (34).
16
He recommended that a physician finding two cases of the diseases in his practice
within a short time should remove himself from obstetrical duty for a month.
Holmes ideas were greeted with disdain by many physicians of his time (34)

2.1 Knowledge of nurses towards infection prevention

Among 235 health professionals 189 (74.2%) of them had ever participated in an
of training program about infection prevention all of the respondents know that
dirty needle and sharp materials could transmit diseases causes agents. some of the
common known by respondents were HIV (98.5%) hepatatotis (HBV)
(84.4%),hepatitis /HCV), tetanus (clostridium tetani) (57.8%) and tuberculosis
(2.2%) (27).

Another descriptive cross sectional study conducted towards infection preventions

among 135 respondents 103(76.3%) of health care workers known place,
104/77.4%) of health care workers know that is not safe to use syringes if needle is
changed, on contrary 31(22.6%) of respondents said that is safe to use syringe
between patients if needle is changed but all respondents (135) (100%) know that
gloves and gowns were required for any patient contacts (13, 18).

2.2. attitudes of nurses to ward infection prevention

Among 235 HCWs who participated in the study 23 (12.3%) strongly agree and
27(14.1%) agree that admitted patiently in the hospital with HIV and 34/15.1%)
were disagree and strongly disagree that admitted patients with HIV and TB should
be put in rooms with other patients (6, 23).

From 135 HCWs who participated in the study 38/28.8%/ strongly agree and
48(35.6%) agree that using PPEs were protect from any nosocomial infections but
the rest 12(8.2%) strongly disagree and 37(27.6%) agree that PPE were not prevent
from any infection (s).

2.3. Practice of nurses to words infection prevention

Among 135 respondents almost all 134 (99.2%) of the respondents had ever were
at least one type of PPE . many respondents who ever were PPE 98(57.8%) user
17
apron, 135 (100%) used utilize glove, 74(54.8) used head cover 74(54.8) used
boots, 59(43.7) used eye protectors (goggle), 87(64.4%) used mask, 133 (98.5 %)
were 64(47.4%) believe PPE were not always necessary, 42(31.1%) replied that
PPE were not comfortable and 18(13.3%) stock out and desired PPE. (32%)

From the above respondents 103(76.5%). HCW wears glove while they took blood
sample and the rest 32(23.5%) did not were gloves when they took blood sample.
92(68.7%) of HCWs wash their hand before examining the patients and 84(62.5%)
HCWs keep needles immediately after using them (34, 35).

Chapter three : Objectives

2.1. General objective

To assess knowledge, attitude and practice of nurses towards infection prevention

in Saint Paul hospital in Addis ababa,Ethiopia from march26 to April 10 .

2.2. Specific objectives

o To asses knowledge of nurses towards infection prevention
o To asses attitude of nurses towards infection prevention
o To asses practice of nurses towards infection prevention

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 Chapter – Four: Methodology

4.1. Study area and period

This study will be conducted at saint Paul hospital which is located in western
Addis Ababa in central Ethiopia 2km far away from sefere selam campus.
According to BPR the hospital has the following categories of Jobs admission case
team, OPD case team and prevention case team. The Hospital has a total of 82
nurses who are directly involved in patient care and the study will be conducted
from march 26 to April 10,2016

4.2 . Study design

Facility based cross sectional study design will be employed

4.3. Source population

All nurses who actively involved providing health care services at Saint Paul
hospital will be employed.

4.4. Study population

All nurses at saint Paul hospital available during study period will be included in
the study

4.5. Eligibility criteria

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4.5.1. Inclusion criteria

All nurses on duty during data collection at Saint Paul hospital

4.5.2. Exclusion criteria

Those who are mentally or acutely sick nurses will be excluded.

4.6 Variables

4.6.1. dependant variables

 Knowledge towards infection prevention

 Attitude towards infection prevention
 Practice towards infection prevention

4.6.2. Independent variables

 Socio demographic variables

 Age
 Sex
 Religion
 Marital status
 Working place(wards)
 Income
 Service year

 4.7 Operational and term definitions

 Knowledge = defined in this study from related questions if, the nurses
correctly respond less than 60% categorized as having poor knowledge
 60 -75% categorized as having fair knowledge and greater than 75% as
having good knowledge

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  Practice= experience or way of doing the study subject regarding to prevent
any sort of infection
 Antimicrobial soap = soap(detergent) containing an antiseptic agent
 antiseptic agent=are antimicrobial substances that are applied to the skin to
reduce the number of microbial flora
 colonization= pathogenic (disease causing) organism that are present in
person
 hand hygiene care =a general term that applies to hand washing , Antiseptic
hand rub or antiseptic hand wash
 Multi – drug resistance pathogens = Bacteria that cause serious infections
that are very difficult to treat due to pathogens resistance to commonly
prescribed drugs.
 Safe injection= an injection that does not cause harm to the recipient , does
no expose the providers to any risk and does not result in waste that is
dangerous to other people.

4.8. Data collection tools and procedures

Self administered semi-structured questionnaire that are prepared in English will

be used to collect the data.

4.9. Data collectors

Our group members modify the questionnaire if there is ambiguity and vagueness
of words in terms of difficulty to understand for nurses

4.10. Data processing and analysis

After data collection, it will be compiled , cleansed and frequencies will be

calculated by using scientific calculator finally the result will be presented using
tables ,graphics and charts

4.11. Data quality assurance

Quality control measure will be employed during data collection and analysis. The
principal will make follow up during data collection process and check for missing
information and inconsistencies all materials used for data collection will be
arranged sequentially and data will be stored in safe and secure places.
21
 4.12. Ethical consideration.

Permission will be gained from Saint Paul hospital moreover, the objective of the
study will be explained and the cultures and norms of the hospital and health care
providers will be respected. Verbal consent from the respondents will be asked
before intervening.

4.13. Limitation of the study

Respondents may not give accurate information

Chapter Five

No Activity Nov Des Jan Feb Mar Apr May Jun

1 Topic Selection ▬
2 Proposal ▬
Development
3 Submission of 1st ▬
draft proposal
4 Submission of 2nd ▬
draft proposal
5 Final proposal
submission
6 Data collection ▬
7 Data processing and
Analysis
8 Report writing
9 1st draft research ▬
submission
10 2nd draft research
submission
11 Final report ▬
submission
Project Work Plan

22
 CHAPTER SIX: BUDGET PROPOSAL
6.1 BUDGET BREAKDOWN
The overall budgets break down to assess KAP of nurses towards infection prevention in saint
paul hospital weastern AA, cnteral Ethiopia 2016.
No Budget catégories Unit cost Multiplying Total cost
factor
1 Personal

Data collectors 25 25x2 50

Secretarial work 200 200x1 200
Data entry creak 250 250x1 250
Sub total 500
2 Material Cost per item
CD-Rw 25 25x1 25
Paper 70 70x3 210

Pen 4 4x5 20

Eraser 1 1x5 5

Print and binding 30 5x30 150

Qustionaire duplicaton 1birr/quest 500 500
Pencil 2 5x2 10
Sharpener 2 2×5 10

23
 Subtotal 1025

3 Transport Costper k/m No of k/m× No

of day
Car 0.5 birr 2×0.5×45×3 135

Sub total
4 Total 1560

6.2 Budget Summary

 Persona l cost=500 birr
 Material cost=1025 birr
 Transport cost=135 birr
Total cost (subtotal 1 + subtotal 2+subtotal3)=1560 birr
Contingency 5% (total×5%)=78
Grand total+ Contingency=1648

24
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22. Karen Pallarito. Doctors Skimp on Hand Hygiene. Health on network
foundation. 09-JUL-2004. Available online at
[Link]

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23. Nigat project and Engender health. Stigma or discrimination and infection prevention
practices in health care settings. 2003 (Unpublished). Ministry of Health. Infection prevention
guidelines for health facilities in Ethiopia. (2005 (Unpublished

24. Mark B., Cassandra C., Stephanie G., Pamela B., Anna KK., MargareteS., and Joanne T.
Infection prevention: A reference booklet for healthcare providers 2001. Available online
at:[Link]
25. Ministry of Health. Infection prevention guidelines for health carefacilities in Ethiopia. 2005:
1-79,
26. CDC. Recommendations for preventing transmission of infection among chronic
hemodialysis patients. Morbidity and Mortality weeklyreport 2001;50(RRO5): 1-43
27. HU,dkane MA heymann DL Transmission of HIV ,HBV,and other blood borne pathogens in
health care setting,bulletinof WHO 1991
28. Simon PA, Chen RT, Elliton JA, Schwartz B. Out Break of pyogenicabscesses after
diphtheria and tetanus toxoids and pertussis vaccination. Pediatric Infection Disease 1993; 12:
368-71
[Link], P. and Boyce, J. M. 2001. “Hand Hygiene and Patient Care: Pursuing the
Semmelweis Legacy”. Lancent Infectious Diseases: April 9-20
30. Pruss A., Giroult E., & Rushbrook P. Safe Management of Wastes from Health-Care
[Link],Geneva:[Link]
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31. Haiduven DJ, DeMaio TM, Stevens DA. A five year study of needlestick injuries: significant
reduction associated with communication, education, and convenient placement of sharps
containers. Infection control and Hospital Epidemiology 1992; 3:265-71
32. Children Vaccine program at path. Proper handling and disposal of
Auto-disable syringe and safety Boxes. May 2002: 5-7
33. Melkamu, Y. and Kumbi, S. Quality of post abortion care in selected
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public facilities, Amhara and Oromiya regional states, 2003/ Unpublished/
34 . Christine L. Case, Ed.D. Microbiology Professor at Skyline College. Biography, In: Access
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Desk. Annual plan of the year 2006. 2005;12-1568

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QUESTIONERS AND INFORMATION SHEET
Addis Ababa University
College of Health sciences

Department of Nursing and Midwifery.

Questionnaire on assessment KAP of nurses towards infection prevention at [Link] Hospital,
Addis Ababa central Ethiopia 2016

INFORMATION TO THE CLIENT

Interview code No______

Greeting and self-introduction

Our names are yikeber Bishaw,Oliad Eshetu,Yohannes Arega and Zemenu Tsegaye. we are
undergraduate nurse students in Addis Ababa University. we are conducting a research on
assessment of KAP of nurses towards infection prevention at [Link] Hospital,Addis Ababa
centeral Ethiopia. we are happy to inform you that you are one of the potential participants in
this study. The information gathered will be used for writing a research paper for partial
fulfillment of bachelor science degree in nurse and your genuine answer is of paramount
importance to the outcome of the research and the findings of the study will be used for better
understanding of the KAP of nurses towards infection prevention. So that it can be helpful for
planning and intervention on the problem under the study. Your participation is determined by
you, if you feel you will not participate in this study, your decision is respected from outset, it is
only if you are willing we will proceed to give a questionnaire. Here, we want to assure you that
any information obtained from you will remain confidential and even there is no need of writing
your name or any identifiable personal inform

Addis Ababa University

29
 College of health sciences
Department of Nursing and Midwifery
Self administered questioner to assess the knowledge, attitude and practice of nurses towards
infection prevention in St ,Paul hospital, Addis Ababa Central Ethiopia 2016

A. Socio-demographic questioner
1. Age -------------------
2. Sex 1. Male 2. Female
3. Name of health institution----------------------

4. Profession
1. Clinical nurse 2. Health assistant/junior nurse 3. Midwife nurse

5,What is your service year -------------------?

6,Which disease comes to your mind when issue of prevention raised?-----------------------
B. Knowledge questioner about infection prevention
1. Have you ever participated in any training programme about infection prevention?
1. Yes 2. No
2. Is hand washing is necessary?
1 between every patient encounter
2 affect clinical outcome
3 Even when gloves are worn.
4 take too much time
5 other specify _________________
3. Hepatitis virus can persist for up to seven days on host surface
1. yes 2. no
4. Can disease be transmitted through contaminated needles and sharps?
1. Yes [Link]
5. If yes, which of the following diseases can be transmitted through contaminated needles and
sharps? Circle which you know(more than one choices are possible)
1. Hepatitis B virus (HBV).
2 Hepatitis C virus (HCV)

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 3 HIV AIDS
4. Tetanus (clostridium titanic)
5. Malaria (plasmodium SPP)
6. Tuberculosis (mycobacterium tuberculosis)
7 Of above disease which one is highly infectious following body fluid splash or needle stick
Injury?-------------------------------------------------------------------------------------------------------
6. What do you think are the main reason for reuse of syringe and needles? (more than one
choices are possible)
1 No reuse of syringe need to
2 Shortage of supply
3. Knowledge deficient
4 Careless
5 to reduce the cost of treatment
6 other (specify)-----------------------------------------
7 .Is there any prophylaxis to have after exposed to injury by needle/sharp
1. yes
2,no
3,donot know
8. The ratio of chlorine and water you use to prepare HLD or decontamination solution is
1) 1:00
2) 1:1
3) 1:6
4) 1:9
5) other (specify)____________
9. who could be at risk of infection from your health facility cost?(more than one choice are
possible)
1 Health care providers/workers
2 supportive staff
3 The patient (child)
4 the community
5 children
C. Attitude Questioner (circle which you know)

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1. glove use for all patient care contacts is a useful strategy for reducing risk of transmission of
organisms (only for health professionals)
1,.strongly agree 2, Agree 3, Disagree 4, strongly disagree
2. Do you think you can have acquired HIV though your profession?
1, yes 2, No
3. In the absence of infection prevention, health care facilities can be the source of infection
and epidemic disease?
1 Strongly agree 2, Agree 3, In different 4, Disagree 5, Strongly disagree
4. Do you think your clients have acquired HIV through the service they get in your health care
facility
1, yes 2, No
5. Health care associated organism are commonly resistant to alcohol
1, strongly agree 2, Agree 3, Disagree 4, Strongly disagree
D. Practice questionnaires infection prevention
1. Do you clean your hands before touching patient or his/her surroundings
1, yes 2,. No
2. Do you clean your hands after touching patient his/her surroundings?
1 yes 2. No
3. which method do you use to clean your hands at work?
1. Plain water and soap 2. Antimicrobial 3. Alcohol based hard rub
4. plain water only 5. Other (specify) ………………….
4. When do you clean your hands (technical staff)
1. Always 2. When needed 3. Sometimes 4. Never

5. Estimate how often you clean your hands before touching a patient or contaminated
surface in the health facility.
1. 25% 2. 50% 3. 75% 4. 90% 5. 100%
6. Do you wear personal protective equipment
1 yes 2. No
7. If you wear which one ?(more than one choices are possible)
1 a prone
2 utility glove/double gloves

32
 3 head cover (cape)
4 boots (shoes)
5 eye protective (goggles0
6 mask
7 examination glove
8 gowns
9 other (specify)--------------------------------
8. if your answer is no for Q. no 7, why?
1 difficult to work with
2 not always necessary
3 Un comfortable
4 out of stock
5 other (specify)
9. When do you use glove
1 For all people
2 For only HIV suspected cases
3 For only HIV positive cases
4 For procedures which needs gloves
5 Other specify ………………………
10. How do wash sorted timer in your health facility
1 Using laundry machine
2 Hand washing
11. How frequently wash you gown ?
1,once a week 2, twice a week 3,other(specify)
12. What are the reasons for over prescription of injection
1 client demand
2 inject able are more effective than other drugs
3 unavailability other drugs
4 knowledge deficient on risk of injection
5 other specify _______________________
13. have you ever had needle stick/sharp injury ?
1 yes 2. No

33
14. have you ever had blood or body fluid splash to your eye, mouth and/or nose?
1 yes 2. No
15. After exposure to blood or body fluid what measure did you take?(more than one choices are
possible)
1 washing with soap and water
2 washing with alcohol iodine chlorine
3 applying pressure to stop weeding
4 press the wound
5 squeezing to extract more blood
6 take TAT
7 visiting VCT
8 seek PEP
9 report to the had health personnel
10 other specify ______________
16. What type of the medical instrument do you sterilize in your health care facility?
1. Dressing set 2. Syringe and needles 3. Delivery set
4. MVA set 5, do not know
17, What is the chemical you use to decontaminate or HLD(more than one choices are possible)
1 Chlorine
2 Savlon
3 Formaldehyde
4 Iodine
5 Alcohol
6 Other specify _________________
18. In your health facility the instrument processing procedure you follow include.(more than
one choices are possible)
1 Decontaminate with chlorine solution (0.5%)
2 Cleaning with brush and detergents
3 High level disinfection (HLD)
4 Sterilization
5 Storing in appropriate place
6 Use immediately

34
 7 Other specify _________________
19, Are needles, syringes and other sharps immediately discarded after use in sharp container in
your health institution
1. Yes 2. No
20. What goes in the safety(more than one choices are possible)
1 Disposable syringe
2 Needles
3 Needles of Iv set and bags
4 Lancets
5 Empty vials
6 Cotton pads
7 Pressing materials
8 Latex glove
9 Other plastic materials or waste products
21. Where do you dispose sharp materials or used needles?
1 Open dial
2 Mixed with other wastes
3 Other specify

35