CHAPTER ONE
INTRODUCTION

• Background
  Infection-related diseases are still the main cause of death in Cameroon. according to the 2013 health profile acquired by the World Health Organization (WHO, 2013) statistics. The burden of disease in Cameroon, Includes HIV, TB, Malaria, other infectious diseases and respiratory infections. Expansion of the infection prevention and control movements occur due to the increase in infection occurrences in the country. This increase in infection-related disease’s impact the increase health financing in Cameroon with a government contribution to health care of 57.5% above the figures budgeted for (WHO, 2014).

Infectious patients are admitted into hospitals and therefore hospitals have become common settings for transmission of diseases. In hospitals, infected patients are a source of infection transmission to other patients, health care workers and visitors (Sydnor & Perl, 2011). Nosocomial infection, also known as hospital-acquired infections is one of the leading causes of death and has much economic cost due to increased hospitalization and prognosis (WHO, 2015). According to WHO (2010), Hospital acquired infection is defined as an infection occurring in a patient during the process of care within a health care facility which was not present or incubating at the time of admission. These infections are those occurring more than 48 to 72 hours after admission and within ten days after hospital discharge (Collins 2008:2). Due to the admission of patients with different organisms, the hospital environment has become saturated with highly virulent organisms, namely: Staphylococcus aureus, Streptococcus pyogenic, Escherichia coli, Pseudomonas aureginosa and Hepatitis viruses that survive in a hospital. These organisms cause diseases ranging from minor skin infections to life-threatening conditions such as sepsis (Sydnor, & Perl, 2011).

The Cameroon Ministry of Health has indicated that Ebola virus disease epidemic in the Democratic Republic of Congo is a public health risk as a neighboring country and therefore preparedness in infection prevention and control measures should be strengthened. Efficient knowledge, good attitude and best practices by nurses in infection prevention and control may contribute to decreasing in infection rate in the hospital. The Cameroon. Public Health Act, Cap 295, stipulates that the health care institution should provide a safe environment for the patients in their care. Hospital nurses form the backbone of infection prevention and control, therefore possibly, will either contribute to infection transmission or prevent and control infection.

According to Damani (2012), the environment in which a patient is nursed must be planned to reduce the risk of transmission of infection. Infection prevention and control measures aim to protect the vulnerable people from acquiring an infection while receiving health care (Damani, 2012). Lack of knowledge, bad attitudes and poor practices amongst nurses in the prevention and control of infections can lead to hospital-acquired infections. In clinical practice, the researcher has observed cases where nurses handle contaminated linen with bare hands, put needles in the patient’s mattress after giving injections, do not clean the stethoscope between patients and do not wash hands regularly in the clinical environment. Poor infection prevention and control practices among nurses increase the rates of hospital-acquired infections. Hand hygiene is the single most important intervention to prevent transmission of infection and should be a quality standard in all health institutions. An attitude of not washing hands among individuals involved in the provision of health care can increase the rate of hospital-acquired infections. In a study that was conducted in India, where Nair, Hanumantappa, Hinemath,Siraj and Raghunath (2013:3) assessed knowledge, attitude and practices of hand hygiene among medical and nursing students at a tertiary health care centre, the majority of students had poor knowledge with regard to hand hygiene.Lack of knowledge among nurses can increase the rate of hospital-acquired infections. This is supported by a study that was conducted in Zimbabwe by Tirivanhu, Ancia and Petronella (2014:73) who determined the barriers of infection prevention and control practices among nurses at the Bindura provincial hospital.

The study revealed that the majority of nurses’ lack knowledge on infection control principles as only n= 14 (28%) of n= 50 (100%) nurses had excellent knowledge on infection control principles, n= 21 (42%) of n= 50 nurses did not utilize the infection control manuals. Infection control workshops were poorly organised as 68% of thenurses did not attend any workshop on infection prevention and control practices (Tirivanhu et al., 2014).Hayeh and Esena (2013:47) assessed the infection prevention and control (IPC) practices among health workers at Ridge Regional Hospital in Accra (Ghana). The study showed that knowledge in IPC practices among health care workers was moderate 51% (n= 204), as availability and access to material for IPC practices at the facility was 58% (n= 118) and overall compliance with IPC guidelines was 54% (n= 110).The World Health Organisation (2016) has indicated that surgical site infections at this particular tertiary hospital in Zambia are a research priority as there was an increase in wound infections of those people who had surgery at this hospital and this coincides with the researcher’s experiences and proposal. Therefore, this study determined the knowledge, attitude and practices of nurses in infection prevention and control within a tertiary hospital in Cameroon
1.2 Problem Statement

A research problem is an area of concern in which there is a gap in the knowledge base needed for nursing practice (Burns & Grove 2011:146). The researcher has observed that nurses do not apply infection prevention and control measures in the hospital setting which is required to ensure patient safety. Lack of knowledge, attitude and practices in infection prevention and control contribute to high rates of hospital-acquired infections (Jain, Dogra, Mishra,Thaku and loomba, 2012 & Hayehand Esena, 2013).these infection occur worldwide both in developed and developing countries. Nosocomial infection accounts for 7 percent in developed world and 10 percent in the developing countries. Uncontrollable nosocomial infection contributes to prolonged stay, morbidity and mortality which put stress on health care economics of the country (Mishta, Banerjee & Gosain, 2014).Therefore this study sought to determine the knowledge, attitudes and practices of nurses regarding infection prevention and control within a tertiary hospital in Cameroon.

1.3 Research Question

What is the level of knowledge, attitudes and practices of nurses in infection prevention and control within a tertiary hospital in Cameroon?
1.3.1  General objectives
In order to address the research question, the aim of the study is to determine the knowledge, attitudes and practices of nurses regarding infection prevention and control within a tertiary hospital in Cameroon.
1.4 Research Objectives
Based on the purpose of the study, the following objectives have been set for the study to determine:
• The knowledge of nurses in infection prevention and control within a tertiary hospital within Cameroon.
• The attitude of nurses in infection prevention and control within a tertiary hospital in Cameroon.
• The practices of nurses in infection prevention and control within a tertiary hospital in Cameroon.
• To make recommendations to the risk programme and policies of the tertiary hospital.