ABSTRACT
Standard precautions are guidelines recommended by the Centre for Disease Control for reducing the risk of transmission of blood borne pathogens in the clinical setting. Hospitals being one of the most hazardous places to work predispose health workers, especially medical laboratory scientists, to the risk of blood borne infections and sometimes death. This study aims to assess three major factors that determine adherence to standard precautions amongst medical laboratory scientists and the factors are information, motivation and behavioural skill in order to promote adherence which has been suboptimal even though the risk of non adherence is high.
The study utilized a cross sectional design and random sampling method to identify 425 medical laboratory scientists working in both public and private hospitals in Lagos State Nigeria and the information motivation and behavioural skill that predicts adherence to standard precautions were assessed using a validated questionnaire. Results were analyzed using SPSS 21.0. Regression analysis was used to measure the relationship between the three variables information, motivation, behavioural skill and adherence while their percentage was also measured.
Four hundred and twenty five participants were enrolled for this study following securing their consent to participate, Out of 425 participant recruited 41.6% of them were between the ages of 30-39 and 17 (4.0%) of them were between the ages of 50 and above. Also, 287 (67.5%) of them appeared to be civil servants. Moreso, 232 (54.6%) of them were married and 356 (83.8%) of them were Christians. It also appeared that 226 (53.2%) of them had years of practice of between 1-5 years. 232 (54.6%) of them were Yoruba.
The results showed that medical laboratory scientists were well informed on standard precaution and their behavioural skill was also high as well with a percentage of 91.5%. The motivation was slightly above average with a percentage of 55.5% and the overall adherence was 61.4% which was still sub optimal .The regression analysis showed that all the three variables had a significant effect on adherence with p value p<0.005 but behavioural skill and information had a more predictive effect on adherence (R2=0.072, 0.072) and motivation (R2=0.012)
In conclusion, the overall information and behavioural skill was good and the productive effect on adherence was significant but the motivation was low there is need to increase motivation amongst medical laboratory scientist as this would significantly improve overall adherence to standard precautions thereby preventing the spread of infection from patients to the medical laboratory scientist and from the medical laboratory scientist to the community. Adherence to standard precautions must be made compulsory in all laboratories at all times as this is the most effective way of reducing the risk of blood born infections.
Keywords: Standard precaution, Medical laboratory scientists, Adherence, Blood borne, Risk
Word Count: 443
TABLE OF CONTENTS
Content Page
Title page i
Certification ii
Dedication iii
Acknowledgements iv
Abstract v
Table of Contents vi
List of Tables ix
List of Figures x
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 1
1.3 Objective of the Study 2
1.4 Research Questions 2
1.5 Hypotheses 2
1.6 Justification for the Study 3
CHAPTER TWO: REVIEW OF LITERATURE
2.0 Introduction 5
2.1 Standard precautions for prevention of blood borne infections
(Wisconsin) 6
2.1.1 Hand Washing 6
2.1.2 Personal protective equipment 6
2.1.3 Needlestick and sharps injury prevention 7
2.1.4 Cleaning and Disinfection 8
2.1.5 Waste disposal 8
2.1.6 Safe injection practice 9
2.2 Adherence of laboratory workers to standard precautions 10
2.3 Factors that influence adherence of laboratory workers to
standard precautions 10
2.4 knowledge of laboratory workers on standard precautions 11
2.5 Attitude of laboratory workers with the use of standard precautions 12
2.6 Conceptual Model 13
Content Page
CHAPTER THREE: METHODOLOGY
3.1 Research Design 16
3.2 Population 16
3.2.1 Inclusion Criteria 16
3.2.2 Exclusion Criteria 16
3.3 Sample size and sampling Technique 17
3.4 Variables and Test of Significance 17
3.5 Instrument 18
3.6 Reliability and Validity of Instrument 18
3.7 Method of Data Collection 18
3.8 Method of Data Analysis 19
3.9 Ethical Consideration 19
3.9.1 Informed Consent 19
3.9.2 Confidentiality 19
3.9.3 Anonymity 19
3.9.4 Right to Withdraw 19
3.9.5 Post Research Benefit 19
3.10 Dissemination of Result 20
CHAPTER FOUR: DATA ANALYSIS RESULTS, AND
DISCUSSION OF FINDINGS
4.0 Introduction 21
4.1 Demographic Characteristics of Participants 21
4.2 Descriptive Statistics of Mean and Standard Deviation for Variables
in the Study As Measured From Participants 23
4.3 Information about Standard Precautions 25
4.4 Information Comprehension 27
4.5 Motivation 29
4.6 Willingness/Self-Efficacy to Adhere to Standard Precautions 31
4.7 Level of Self-Reported Adherence to Standard Precautions 33
4.8 Model Summaries of the Regression Coefficient 35
4.9 Model Summary of Regression Coefficient of Other Major Variables
Independently Against Adherence 37
Content Page
4.10 Hypotheses Testing 40
4.10.1 Hypothesis One 40
4.10.2 Hypothesis Two 40
4.10.3 Hypothesis Three 40
4.10.4 Hypothesis Four 41
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary 42
5.2 Conclusion 44
5.3 Recommendations 44
5.4 Limitation of the Study 45
REFERENCES 46
APPENDICES 51
LIST OF TABLES
Table Page
4.1: Demographic Characteristics of the participants in the study for each
arm of the intervention at baseline 22
4.2: Summaries of Descriptive Statistics of Mean and Standard Deviation for
Variables in the Study as Measured From participant 24
4.3: Information about Standard Precautions 26
4.4: Information Comprehension 28
4.5: Motivation 30
4.6: Willingness/Self-efficacy to adhere to Standard Precautions 32
4.7: Level of Self-Reported Adherence to Standard Precautions 34
4.8: Model Summaries of the Regression Coefficient 36
4.9 The result 37
4.10: Overall Information of Studied Participant 39
LIST OF FIGURES
Figure Page
1. Information Motivation Behavioural Skill Model 13
2. Conceptual Framework 15
3. Overall Motivation of Studied Participant 38
4. Overall Willingness of Studied Participant 38
5. Overall Adherence of Studied Participant 39
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Standard Precautions are guidelines recommended by the centre for disease control and prevention (CDC) 2015 for reducing the risk of transmission of blood borne and other pathogens in the clinical setting. Standard Precautions apply to blood and body fluids and it encompasses all the major features of universal precautions and designed to reduce the risk of transmission of microorganisms from both known and unknown sources. Standard Precautions refers to a standard method of infection control in which all human blood and body fluid specimen are treated as if known to be infectious for HBV, HCV, HIV, and other pathogens.
Hospitals are the most hazardous places to work. With the US recording 253,700 work-related injuries and illnesses which is 6.8 work related injuries to every 100 full time employee. Medical laboratory professionals are also a major part of the health workers who are at significant risk of exposure to blood borne pathogen from blood and body fluids emerging from occupational risk. Studies by Janjua et al., (2007) in Pakistan to predict reasons for non adherence to Standard Precautions showed low knowledge and poor practise of Standard Precautions. Another study by Aluko et al., (2012) on safety amongst health workers in Osun State, Nigeria revealed knowledge was at variance with practice. Therefore, there is a need to assess the information medical laboratory scientists have and how to promote adherence to Standard Precautions.
Outbreak of infection is a major problem in public health; therefore public health focuses on three major levels of controlling and ameliorating outbreak of infection, these levels includes prevention, treatment and rehabilitation. Adherence therefore falls under the first level of infection control which helps to prevent transfer of infection from patients to health care workers and from healthcare workers to the community.
1.2 Statement of the Problem
According to the American Society for Clinical Laboratory Science, Medical laboratory professionals are a group of healthcare scientists who provide laboratory information from analysing patients’ blood urine, tissue or other body specimen, the results derived from their analysis plays a very important role in the diagnosis and treatment of the patient as well as in disease monitoring and prevention. In the analysis of blood and body specimen medical laboratory professional face a lot of risk, and this could lead to infection and even death. There is therefore need for adherence to Standard Precautions in order to prevent infections and death.
1.3 Objective of the Study
The general objective is to explore the determinants of adherence to standard precautions for prevention of blood borne infections among medical laboratory scientists in Lagos State. The specific objectives are to:
- assess the level of information medical laboratory professionals have that can promote adherence to standard precautions;
- identify the nature and level of motivation that drive adherence of medical laboratory professionals to standard precautions to prevent blood borne infections during practice;
- identify behavioural skills that promote adherence to standard precautions by medical lab professionals;
- assess how Information, Motivation, and behavioural skill influence compliance and adherence to standard precautions, and
- assess self reported adherence to standard precautions.
1.4 Research Questions
The following research questions emerged from the background of the study that the study requires to address and include;h
- What is the level of knowledge medical laboratory scientists have regarding Standard Precautions to promote adherence
- What motivates their adherence to Standard Precautions?
- What behavioural skills does medical laboratory scientists have that promotes adherence to Standard Precautions?
- How does information motivation and their behavioural skill influence adherence to Standard Precautions?
1.5 Hypotheses
H1: There will be a significant relationship between Information and adherence to standard precautions.
H2: There will be a significant relationship between motivation and adherence to standard precautions.
H3: There will be a significant relationship between behavioural skill and adherence to standard precautions.
H4: There will be a significant relationship between information, motivation, behavioural skill and adherence to standard precautions.
1.6 Justification for the Study
Health Care personnel, particularly Medical Laboratory Scientists, constitute a subgroup of health care providers who constantly are exposed to occupational-risk of many blood borne infections because of direct contact with blood and body fluids during the conduct of their professional clinical practice. The occupational-risk faced by them is of serious concern given their inadequate implementation of standard precautions for prevention of blood borne infections skills. Although, the subject of this study has been given wide attention in the literature, however the problem persists, particularly among this category of health care providers in Nigeria. Accidental exposure to blood borne pathogens is primary source of infections from most common ones such as Hepatitis B, Hepatitis C and HIV.
Hepatitis B and other blood borne diseases are important occupational hazard for health care workers (HCW) [WHO]. In some studies, HCWs have been shown to have an up to four-fold increased risk of acquiring HBV infection (Jha et al., 2012 and Ziraba et al., 2010). The main risk factor to contract HBV infection for HCWs is direct contact with infectious material, especially HBV-infected blood or via a needle stick injury with HBV-contaminated body fluids (Pellissier et al., 2012). Based on UNAIDS factsheet, as at November 2016 2.1 million people became newly infected with HIV in 2015 and there are approximately 36.7millon people living with HIV. This data shows HIV is still a major public health problem. .
According to WHO factsheet (2016), between 130 and 150 million in the world have been infected with HCV, with 4 million infection each year and there is currently no vaccine for Hepatitis C. Despite the increase of incidence of these blood borne disease adherence to Standard Precautions among health care workers is still of major concern. Zaveri et al, (2012), in their research observed that the knowledge, attitude, perception and compliance among laboratory technicians in Ahmedabad were poor, also Izegbu et al, (2015) in Nigeria also showed poor attitude perception and practise of Standard Precautions among workers in the laboratories in Lagos. This study carried out wasn’t based on any behavioural theory. This study would use the information motivation behavioural skill model which has never been used before in the determinants of adherence to standard precautions amongst medical laboratory scientists.
Many studies have been conducted but most of which were not based on a conceptually logically grounded behavioural theory. This study is therefore guided by a model that would reveal the salient factors that determines adherence to Standard Precautions among medical laboratory professionals. This study has a number of distinguishing features that characterise it as innovative and unique. The findings from this study would provide adequate information about the information medical laboratory professionals have about Standard Precautions. The study would uncover what motivates them to adhere and the behavioural skills they need to adhere with Standard Precautions. This will go a long way in revealing the determinants of adherence and in promoting adherence to Standard Precautions and preventing hospital acquired infections and death amongst medical laboratory professionals.
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