ABSTRACT

Background: Infection prevention and control is an integral component of nursing care delivery in any setting to reduce risks for morbidity in patients and care givers at all levels. Nurses share responsibility with other health care personnel for infection risk reduction in patients across entire continuum of care and play vital role in reducing risks for infection through a variety of direct care activities.

Aim and Objective: To Determine knowledge, practice and challenges faced by nursing students on Clinical practice at the Buea Regional Hospital.

Materials and Method: Cross sectional study was conducted from 24th to the 30th of March 2023at Buea Regional Hospital. Simple Random sampling technique was used to select participants. Data was entered and analyzed by using SPSS.

Result: Most of the student Nurses 84(60%)were females within age group 25-30, majority were SRN students 84(60%).All of participants 140(100%) had good knowledge of PPE, 112(80%) had poor practice of PPE, Majority 70(50%) faced financial challenges, 40(28.57%)faced discomforts using PPE.

Conclusion: Students have good knowledge on PPE, poor utilization on PPE, faced challenges like finances, discomforts, Deficient practical skills.

Keywords: PPE, knowledge, practice, challenges, Student Nurses.

CHAPTER ONE

INTRODUCTION

1.1 Background of Study

Personal protective equipment is also called PPE. It is commonly worn by health care workers to prevent the transmission of infection. PPE include helmets or caps, face shields, face masks, goggles, gowns, respirators, shoe covers or boots and gloves. PPE provides a physical barrier between microorganisms and the wearer, thereby preventing the microorganisms from contaminating the hands, eyes, clothing’s, hair and shoes. When used properly it acts as a barrier between infectious materials such as  viral and bacterial contaminants and the skin, nose, mouth, and eyes mucous membranes(Cullen et al.,2006).Use of PPE includes proper removing and disposing of contaminated PPE to prevent exposing both the wearer and other people from infection. Since PPE is part of everyday health care, it is important that healthcare workers and students should be knowledgeable and confident in the proper utilization of PPE and should have access of evidence based training.

Use of personal protective devices and safety engineered medical devices is mandated by occupational safety and Health administration (OSHA, 2014) the purpose of which is to prevent infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) (NIOSH, 2010).safety climate is defined as employees shared perception regarding safety within their work organisation (Gershon et al., 2009). It has been associated with the use of personal protective equipment (Gershon et al., 1995)(Rivers et al.,2003). Exposure to blood and body fluids (BBF) can occur through a percutaneous injury (needle stick injury or NSI) or muco-cutaneous incident.Awareness regarding this occupational risk led to the issue of guidelines by CDC as universal precautions in 1987, later updated in 1996 (CDC,2008).Prospective studies of healthcare workers have estimated that the average risk  for transmission after a percutaneous exposure is approximately 0.3%, 6 to 30% and 1.8%for HIV, Hepatis B and Hepatitis C respectively. Over 90% of these infections are occuring in low income counteries and most are preventable (World Health Report, 2002).

In the developing countries, the health care workers are at greater risk due to sub-optimal infection control practices like lack of equipment (PPE)  training, compliance with universal precautions (Sagoe et al.,2001). A study amongst health care workers in rural health care facilities showed that proportion exposed to BBF and was 37.1% and 63.2% respectively. (Kermode et al., 2005).

In another study, health care workers cited various reasons for not using the personal protective equipment (PPE) and emergencies were the reason cited by most of them (91.3%) for not using the PPE. This was followed by nonuse of PPE by co-workers (67.14%), busy scheduled (37.14%), risk of offending the patient (27.14%), discomfort (24.29%) and difficulty in carrying out the job (18.57%) (Med et al., 2011)

In another study, 87.5% of respondents believed that use of the appropriate PPE would confer adequate protection for health workers. Half of respondents reported that PPE use was inconvenient, while 21.2% believed that PPE use would interfere with patient care, with no difference observed between physicians and nurses. With regards to the organization factors, 63.2% of respondents reported that appropriate PPE was readily available in their working place. As to behaviours of PPE use, about 21% of respondents reported that their colleague often forgot to use PPE during patient care, while a similar proportion reported themselves to forget to change PPE between patients (Xiaoyun et al.,2012).

 During COVID-19 pandemic in the United Kingdom, shows demographic and occupational characteristics of Health care workers included in primary analysis, stratified by PPE access and adjusted odds ratios for the association of these characteristics with reported PPE access. Just over a third (35.2%) of health care workers working during lockdown reported access and use of appropriate PPE at all times. Significantly c proportion reporting access and use of PPE were from Asian ethnic groups than those not reporting access and use of PPE (16.3%vs 21.9%, or 0.68%,95%CI 0.6 -0.76 [reference white].At the time of questionnaire response ( secondary analysis) 83.9% of health care workers reported to access and use of PPE at all times. Martin et al., 2014).

Another study by (Chika et al., 2019)on the Knowledge and use of personal protective equipment among Nurses in teaching hospital wards, Enugu, Nigeria. A descriptive design was used to study all 86 nurses working in the teaching hospital surgical and labour wards, data was collected using a questionnaire and observational checklist. Upon data analysis, using descriptive statistics with SPSS, version 16 was performed based on the 79 questionnaire returned. Of the 79 nurses, 41 (60%) knew about PPE and uses, 32(42%) knew that PPE are used to protect against splashes from blood and body fluids, while 6(8%) knew that PPE protects nurses from contact with infected body surface.

Descriptive study was conducted between Febuary and April 2022 on the Information and thoughts of nursing students on the use of personal protective equipment by (Behire et al., 2022). The study reached 87.8% of sample of students studying in the nursing department of Foundation University. Data was collected through a face to face interview using questionnaire based on literature. Data obtained was analysedusi32.5%) students made errors in protective equipment in nursing practice.

1.2 Problem Statement

It is known that personal protective equipment serves as a source of protection against infectious diseases, but the problem of diseases and disabilities that occurs to students on clinical practices increases rapidly, these students are exposed to various infections and diseases like Hepatis B and C, HIV and other infections so this study is aimed at ” Assessing the Knowledge and practice of PPE among students on clinical practice at Buea Regional Hospital.

1.3 Rationale

This research is aimed at creating awareness on the effects of not using PPE during clinical practice and also the various means by which they can prevent and control its effects and consequences. The study will also create awareness on the importance of using PPE during patient care.A qualitative research approach along with descriptive design was used. A total of 110 student nurses were selected through convenient sampling technique from DGNM 3rd year, B.sc. ( Hons) Nursing 4th year of  Rufaida college of Nursing , jamia Hamdard , New Delhi in the month of July -August 2020. 

Structured questionnaire was used via an online platform (Google forms) due to covid 19 lockdown to assess knowledge and practice on PPE. Out of 110 samples 66(60%) had good knowledge, followed by 44(40%) having average knowledge and none were having poor knowledge on PPE .Whereas 67(60.9%) had an average practice, followed by 41(37.3%) having good practice and only 2 (1.8%) had poor practice on PPE

1.4.1 General Objective

This study was carried out to determine personal protective equipment knowledge, attitude and practice of Student Nurses in Buea Regional Hospital.

1.4.2 Specific Objective

– Ascertain the knowledge of personal protective equipment amongst student nurses in Regional Hospital Buea.

– To determine the practices of personal protective equipment’s amongst student in Regional Hospital Buea.

– To determine the challenges faced by these students in using PPE on clinical practice at the Regional Hospital Buea.

1.5 Research questions

– What knowledge does these student nurses on clinical practice at buea regional hospital have on PPE?

– What are the practices of PPE during clinical practice?

– What are the challenges faced by these students using PPE during clinical practice?