RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 NAME OF THE
CANDIDATE
AND ADDRESS
MS. JEENA PAPPACHAN
1
ST
YEAR MSC NURSING
RATHNA COLLEGE OF NURSING
K.R PURAM, HASSAN, KARNATAKA
2 NAME OF THE
INSTITUTION
RATHNA COLLEGE OF NURSING
K.R PURAM, HASSAN, KARNATAKA
3 COURSE OF STUDY AND
SUBJECT
MASTER OF SCIENCE IN NURSING
[OBSTETRICS AND GYNECOLOGY
! DATE OF ADMISSION TO
COURSE
31"#$"1#
$ TITLE OF THE TOPIC STRUCTURED TEACHING
PROGRAMME ON KNO%LEDGE OF
INTERNSHIP NURSING STUDENTS
REGARDING NOSOCOMIAL INFECTIONS
AND ITS PREVENTION IN NE%BORNS.
$.1 STATEMENT OF THE
PROBLEM
A STUDY TO ASSESS THE
EFFECTIVENESS OF STRUCTURED
TEACHING PROGRAMME ON KNO%LEDGE
REGARDING NOSOCOMIAL INFECTIONS
AND ITS PREVENTION IN NE%BORNS
AMONG INTERNSHIP STUDENTS AT
SELECTED SCHOOLS OF NURSING,HASSAN.
&.BRIEF RESUME OF THE INTENDED %ORK
1
INTRODUCTION
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The vast majority of newborns enter the world healthy, but sometimes,
newborns are particularly susceptible to certain diseases, much more than older children
and adults. Their new immune systems are not adequately developed to fight the bacteria,
viruses,and parasites. That cause many infections .
1
Among that nosocomial infections are
one of the major type.
A nosocomial infection also called hospital acquired infection. Nosocomial
infections are infections that are a result of treatment in a hospital or a healthcare service
unit. nfections are considered nosocomial if they first appear !" hours or more after
hospital admission or within #$ days after discharge. Nosocomial infections are
commonly transmitted when hospital officials become complacent and personnel do not
practice correct hygiene regularly
%
.
Nosocomial infections affect more than 1.! million patients in a year and the
rates have been rising steadily in the world.
#
n ndia, nosocomial infection rate is at over
%& per cent and it is responsible for more mortality than any other form of accidental
death
!
only &' of hospitali(ed patients in the )*A suffer nosocomial diseases
#
+ealthcare,associated infections occur in both adult and pediatric patients.
-loodstream infections, followed by pneumonia and urinary tract infections are the
most common healthcare,associated infections in children. Among pediatric patients,
children younger than 1 year, babies with e.tremely low birth weight /0 1$$$ g1 and
children in either the 23) or N3) have higher rates of healthcare,associated
infections. 4is5 factors for the development of catheter,associated bloodstream infections
in neonates include catheter hub coloni(ation, e.it site coloni(ation, catheter insertion
after the first wee5 of life, duration of parenteral nutrition, and e.tremely low birth
weight /61$$$ g1 at the time of catheter insertion
&
2
nfection is facilitated by the multiple invasive procedures 78-9 infants undergo
/eg, long,term arterial and venous catheteri(ation, endotracheal intubation, continuous
positive airway pressure, N:Ts or nasojejunal feeding tubes1. The longer the stay in
special care nurseries and the more procedures done, the higher is the li5elihood of
infection
;
N3) is one of the most important but infection prone area of the hospital. t is
not the treatment but the prevention which is the goal of infection control for the
newborn. This goal is affected through good prenatal screening, immuni(ation and early
therapy of the mother prior to or during her pregnancy. 3autious care of neonate with its
well 5nown immature host defences require scrupulous hand washing, adequate staffing,
ample space, isolation facilities monitoring equipment and active employee health
programme along with a conscious effort to minimi(e invasive support
<
.
2revention of coloni(ation and infection in special care nurseries requires
provision of sufficient space and personnel. n intensive care, 1&$ sq ft /about 1! sq
m1=infant and " ft /about %.! m1 between incubators or warmers, edge,to,edge in each
direction, and a nurse>patient ratio of 1>1 to 1>% are required. n intermediate care, 1%$ sq
ft /about 11.% sq m1=infant and ! ft /about 1.% m1 between incubators or warmers, edge,
to,edge in each direction, and a nurse>patient ratio of 1># to 1>! are required. 2roper
techniques are required, including placement and care of invasive devices and meticulous
cleaning and disinfection or sterili(ation of equipment. Active surveillance for infection
/not coloni(ation1 and monitoring of techniques are essential
;
.
?ther preventive measures include frequent hand washing and wearing gowns and
gloves. 9ashing with alcohol preparations is more effective than soap and water in
decreasing bacterial colony counts on hands but does not eliminate 3lostridium difficile
spores. ncubators provide limited protective isolation@ the e.teriors and interiors of the
units rapidly become heavily contaminated, and personnel are li5ely to contaminate their
hands and forearms. )niversal blood and body fluid precautions add further protection
;
.
3
*urveillance for nosocomial infections in N3) permits early detection of
infection trends and clusters and identifies new ris5s. +owever routine surveillance
cultures are generally not recommended as coloni(ation is not a good predictor of
infection. Auring outbrea5s only surveillance should be carried out e.tensively for
purposes of isolating the organisms. ?ne needs to review the infection control practices at
the time of outbrea5
<
&.1 NEED FOR THE STUDY
Nosocomial infection is a major public health problem throughout the world.
9+? has described it one of the major infectious diseases having huge economic impact.
t is estimated that at any point of time more than 1.! million people are suffering from
nosocomial infections in the world.
"
The world over, appro.imately "",$$$ people will
die with these infections.
#
n ndia, nosocomial infection rate is at over %& per cent and it
is responsible for more mortality than any other form of accidental death.
!
3onservative 9+? estimates put the figure for ndia at 1$ per centBone in every
1$ patients will boomerang bac5 to his hospital bed and endure additional medical costs
and hospital stay..C This is a common enough occurrence in understaffed or badly,funded
healthcare facilities across ndia
#
Newborn infections claim an estimated 1.! million lives each year and remain
responsible for appro.imately one,third of the worldDs !.$ million neonatal deaths
E
. The
overall nosocomial infection /N1 incidence has been reported to be # to %&' /1E' in
Furope1 in neonatal special and intensive care units
1$
.
Nosocomial sepsis is a serious problem for neonates who are admitted for
intensive care. As it is associated with increases in mortality, morbidity, and prolonged
length of hospital stay, both the human and fiscal costs of these infections are high.
Although the rate of nosocomial sepsis increases with the degree of both prematurity and
low birth weight, no specific lab test has been shown to be very useful in improving our
ability to predict who has a CrealC blood,stream infection and, therefore, who needs to be
treated with a full course of antibiotics. As a result, antibiotic use is double the rate of
CprovenC sepsis and we are facilitating the growth of resistant organisms in the neonatal
4
intensive care unit. The purpose of this article is to review the topic of nosocomial
infections in neonates
11
.
A study conducted to determine the incidence and ris5 factors for neonatal
nosocomial infections. 4is5 factors for nosocomial infection were analy(ed by both
univariate and multiple logistic regression methods..?ne hundred and thirty,four
neonates were enrolled in the cohort. The overall nosocomial infection rate was
1;."=1$$$ patient days. Aevice associated infection rate was 11.E=1$$$ device days.
Gultidrug resistant Hlebsiella species was the commonest organism causing nosocomial
septicemia and pneumonia followed by 2seudomonas aeruginosa. The ris5 factors
detected to be significantly associated with infection on multiple logistic regression
analyses were a birth weight 6 1&$$ g /?4 #.#1 and assisted ventilation I <% h /?4
1!.%1.7ery low birth weight /78-91 neonates, especially those undergoing interventions
such as mechanical ventilation are at the greatest ris5 for infection and death. Therefore,
strict protocol for asepsis must be adhered to when handling these high ris5 infants.
1%
A retrospective cohort study conducted to determine the epidemiology and ris5
factors for nosocomial infections. 3hi,square test and logistic regression model were
performed for statistical analyses. A total of E!" medical records were reviewed. ?verall
N incidence rate was #!'. The main neonatal N was bloodstream infection /;".1'1,
with clinical sepsis accounting for !<.%', and pneumonia was the second most common
N /".;'1. Gultivariate analysis identified seven independent ris5 factors for Ns> birth
weight, e.posure to parenteral nutrition, percutaneous catheter, central venous catheter or
mechanical ventilation, abruptio placentae and motherDs se.ually transmitted disease
/*TA1. Neonates from mothers with *TA or abruptio placentae, those weighing less than
1,&$$ g at birth or those who used invasive devices were at increased ris5 for acquiring
N
1#
.
Neonatal mortality in ndia accounts for &$' of infant mortality, which has
declined to "!=1$$$ live births. There is no prenatal care for over &$' of pregnant
women, and over "$' deliver at home in unsafe and unsanitary conditions . The
establishment of neonatal intensive care units /N3)s1 in ndia and developing countries
5
would require space and location, finances, equipment, staff, protocols of care, and
infection control measures. The largest e.penses would be in equipment purchase,
maintenance, and repair.. The nurse,patient ratio should be 1>1 and 1>% for other infants.
Training mothers to wor5 in the N3)s would help ease the problems of trained nursing
staff shortages. 2rotocols need not be highly technical@ they could include the substitution
of radiant warmers and room heaters for e.pensive incubators, the provision of breast
mil5, and the reduction of invasive procedures such as venipuncture and intubation.
Nocosomial infections should be reduced by vacuum cleaning and wet mopping with a
disinfectant twice a day, changing disinfectants periodically, maintaining mops to avoid
infection, decontamination of linen, daily changing of tubing, and cleaning and sterili(ing
o.ygen hoods and resuscitation equipment, and maintaining an iatrogenic infection
record boo5, which could be used to study the infection patterns and to apply the
appropriate antibiotics
1!
.
A study conducted to determine the neonates are at high ris5 of nosocomial
infections and surveillance has been shown to be valuable for the reduction of
nosocomial infections in N3) .They decided not to adopt merely all 3enters for
Aisease 3ontrol and 2revention definitions and NN* methods, but also to develop their
own surveillance methods for this patient group. Jor this process four steps became
necessary>/11development of modified definitions for nosocomial infections and their
evaluation@/%1testing the NN* method in three N3)s with infection control nurses@/#1a
pilot project for a surveillance component within the national surveillance system in
:ermany@ and/!1establishment of a surveillance component within our national
surveillance system.The system is now established in ## hospital departments and ;;
N3)s participate in the surveillance system. 9e have an overview of ##&< neonates in
three birthweight groups. This article e.plains the reasons for the various steps, and the
advantages and disadvantages of modification of the original NN* methods and
definitions
1&
.
Nosocomial infections are one of the major causes of morbidity in the Newborn
ntensive 3are )nit /N3)1. Hnown ris5 factors include birth weight, gestational age,
severity of illness and its related length of stay, and instrumentation. nfections result in
6
prolonged hospital stays and, consequently, increased hospital costs. As advances in
medical technology improve mortality in the tiniest of infants, it is imperative that health
care providers identify effective interventions to minimi(e the ris5s of nosocomial
infections in the N3). This article e.amines the effects of common procedures on the
incidence of nosocomial infections. )nit,based procedures discussed include visitation,
hand washing and nail care, s5in and cord care, maintenance of hubs in peripheral and
central lines, gowning and isolation procedures, use and misuse of antibiotics, and unit
design and staffing. nvestigation of these procedures in individual units may reveal areas
to improve patient outcomes
1;
.
n the light of above and investigatorKs e.perience wor5ing in the Newborn
ntensive 3are )nit /N3) unit1. To minimi(e the ris5 of infection, nursing personnel
should have adequate 5nowledge regarding nosocomial infections following admission
and appropriate practice to control these infections .investigator found that the nursing
5nowledge and practice in this area have remained inadequate. Therefore the investigator
felt the need to educate internship nursing students before they are e.posed into the
clinical conditions to create awareness among them related to incidence, ris5 factors,
prevention and control of nosocomial infections.
&.2 REVIE% OF LITERATURE
8iterature review is a standard requisition of scientific research it means reading
and writing the pertinent information of the attempt in the research topic, it also supports
and e.plains why the proposed topic is ta5en for research and avoids unnecessary
duplication and e.plores the feasibility and illuminates the way of new researcher.
I( 2, 34*,,292-; 6/;-. 3 7-*;2/0,.
ncidence and prevalence of nosocomial infections in newborns.
4is5 factors of nosocomial infections in newborns.
Hnowledge and prevention of hospital acquired infections in
newborns among health care wor5ers.
7
STUDIES RELATED TO INCIDENCE AND PREVALENCE OF NOSOCOMIAL
INFECTIONS IN NE%BORNS.
A study conducted on 1!# neonates were diagnosed to have acquired systemic
candidiasis out of a total !&#$ admissions /#.% per cent1 to the neonatal intensive care
unit .Gean age at onset was 1$.! days, mean birth weight 1!&! g, and mean gestation
was #1.< wee5s. Ninety,four per cent were premature, E& per cent low birth weight
/8-91, and all had undergone peripheral vein catheteri(ation and had received broad
spectrum antibiotics, e.cept one, prior to the diagnosis. Jifty,eight per cent were
ventilated and 1& per cent received parenteral nutrition. 2ersistent=recurrent pneumonia,
apnoea, lethargy, high gastric aspirates, and abdominal distension were the common
clinical manifestations. 3andida tropicalis, 3. albicans, and 3. guillermondii were the
most common isolates. -lood and urine were the predominant sites for isolation of
3andida. Jlucona(ole was the most used antifungal agent, with %! per cent resistance
against it. Jifty per cent of babies died due to all causes. ?f all the deaths, two,thirds
were 3andida related. 3andida,attributable deaths occurred in %! cases
1<

A perspective study conducted to describe the epidemiologic profile of
nosocomial infection in the newborn who were admitted in the N3). The result was a
total of 1 1&E neonates were recruited. A total of 1;E nosocomial infections occurred,
with a cumulative rate for nosocomial infection of 1!.&"'. The incidence of nosocomial
infection was 1E.&% per 1 $$$ patient,days. Ninety,two cases of pneumonia, including #"
cases of ventilator,associated pneumonia /7A21, were reported, with a nosocomial
infection rate of <.E!', which was the most common nosocomial infection in the N3).
Among these infants the rate of 7A2 was !"." per 1 $$$ ventilator days. The major
microorganisms isolated from the infected patients were Acinetobacter baumannii,
Hlebsiella pneumoniae, 3oagulase negative staphylococcus, and aeruginosus -acillus.
-irth weight , mechanical ventilation , chest tube drainage and ibuprofen therapy were
the ris5 factors for the development of nosocomial infection. The conclution was
2ulmonary infection is the most common nosocomial infection in the N3), and the
:ram,negative bacillus is the main pathogen. 8ow birth weight, mechanical ventilation,
8
chest tube drainage and ibuprofen therapy are independent ris5 factors for nosocomial
infection in the N3)
1"
.
A retrospective cohort study conducted on the occurrence of nosocomial
infections /Ns1, including infection rates, main infection sites, and common
microorganisms .3umulative incidence rate for Ns was #$.# neonates out of 1$$
admissions, with a total of !!.; infections. The incidence density was average 1$.%
neonates and 1&.1 infections per 1$$$ patient days. The most common infections were
pneumonia /%"'1, bloodstream infection /%;'1, and conjunctivitis /%%'1. Gajor
pathogens were :ram,positives such as *taphylococcus aureus and coagulase,negative
staphylococci. The factors associated with N was less than 1&$$ g of birth weight, less
than #% wee5s of gestational age, and less than " of apgar score. ThereDs no statistical
difference in discharge status between two groups, but hospital stay was longer in
subjects with nosocomial infection than those without infection. Although the distribution
of pathogens was similar to previous reports, a high rate of nosocomial infection and in
particular conjunctivitis was observed in this study that merits further evaluation
1E
.
A prospective surveillance programme for nosocomial infection in Neonates
who are admitted to N3)s .A total of 1%#; neonates /&"' male1 were admitted during
the surveillance period, involving 1E,!%$ days in the N3). The average birth weight
was 1E!<.; L=, 1$$E.& g and average gestational age was #%.E L=, &.! wee5s. The most
frequent associated pathology was respiratory distress /%#.$;'1. A total of #1;
nosocomial infections were diagnosed in %%; neonates, <;.<' affecting premature
neonates /6 1&$$ g1. The most frequent location was bacteremia /&;.#'1, and there was a
predominance of coagulase,negative staphylococci /!;.$&'1. :ram,negative
microorganisms were isolated in #%.1' of the cases /Fscherichia coli and 2seudomonas
aeruginosa were the most frequent pathogens1. ?verall incidence of nosocomial infection
was %&.;'. ?verall mortality was ;.;', with higher mortality in the group with
nosocomial infections /".<'1.The conclusion was Nosocomial infection rates are
acceptable, with a typical epidemiological pattern for these units. 2resence of a central
catheter increased the ris5. A program to promote proper hand washing should be
considered. 9e do not recommend a continuing surveillance strategy in these units
%$
9
A study conducted to determine the neonatal nosocomial infections. Jifty,two
patients had been diagnosed having nosocomial infections. N3) /Neonatal ntensive
3are )nit1 showed the highest portion of infections /!$'1 followed by neonatal surgery
ward /#&'1 and neonates ward /%&'1. Jrequencies of nosocomial infection by site were
as follows> eyes /%<'1, septicemia, surgical wounds and location of drain or catheter
/each one %1'1, 3*J /<'1 and urinary /%'1. The most common pathogenic organisms
were Fnterobacter /%<'1, aurues *taphilococcus /%1'1, Hlebsiella /1"'1, F.coli /1!'1
and epidermis *taphilococcus /E'1. Total number of hospitali(ed patients was &EE$ and
total number of hospitali(ed days was #E,$E& in the five years. nfections per 1$$ hospital
discharges and 1$$ hospital days by service were as follows, respectively> N3) /%.E,
$.%;1, neonatal surgery /1.<, $.1"1 and neonates /$.#, $.$;1. The differences were
significantly meaningful /p value 6 $.$$11. These findings provide useful information for
future surveillance in association with prevention programs. *ubsequently, surveillance
should be focused on high,ris5 patients in intensive care unit and=or who have undergone
surgery and invasive procedures
%1
.
STUDIES RELATED TO RISK FACTORS OF NOSOCOMIAL INFECTIONS IN
NE%BORNS
A cohort study conducted to newborns who were nosocomially infected with
rotavirus during their first days of life were followed twice wee5ly for 1!,%# months to
determine whether neonatal infection protected them against subsequent episodes of
rotavirus diarrhea. nfection occurred in ;$' by the fourth day of life, was asymptomatic,
and was caused predominantly by an unusual rotavirus strain /:E 2ll1 not previously
identified in humans. The 1!" children with neonatal rotavirus infection had !;' fewer
attac5s of rotavirus diarrhea in the follow,up period than the &; infants without
nosocomial infection /$.%# vs. $.!% episodes=child,year, 2 6 .$&1. This protection was
concentrated among infants in their first year of life and was not associated with a
significant decrease in disease severity. 3onsideration of this strain as a vaccine candidate
will require further assessment of its natural protection under field conditions
%%
.
A 3ohort study conducted to determine the profile and ris5 factors of neonatal
nosocomial infections and determine the antibiotic susceptibilities of these isolates
10
.Neonates admitted for more than forty,eight hours in the N3), who developed
infections=sepsis as evidenced by the clinical findings were included in the study. 3hi,
square test, 2roportion tests were used. F.tended spectrum beta lactamase /F*-81
producing Hlebsiella species and Gethicillin resistant *taphylococcus aureus /G4*A1
were the predominant nosocomial pathogens. *ignificant ris5 factors included
prematurity, low birth weight and increased duration of hospital stay .therefore a revised
infection control program with emphasis on handwashing techniques and antibiotic
cycling helped to control these hospital infection
%#
A retrospective study conducted on the ris5 factors for nosocomial blood,
stream infection /-*1 in a neonatal intensive care unit /N3)1 .A total of 1 %E$
neonates were included. ?verall, 1<& nosocomial -*s occurred. 3atheter,related -*s
accounted for ;%.#' /1$E cases1. The incidence of nosocomial -* was !.%% per 1 $$$
patient,days. 8ogistic regression analysis revealed that low gestational age, low Apgar
scores at & minutes, use of central venous catheter /3731, and longer 373 use were ris5
factors for the development of nosocomial -*. n the subgroup of neonates with 373,
mechanical ventilation was an additional independent ris5 factor for -* .The conclusion
was 3atheter,related -* is the major source of nosocomial -* in the N3).
2rematurity, low Apgar scores at birth and prolonged 373 use are ris5 factors for the
development of -*
%!
.
A retrospective cohort study conducted to determine the nosocomial infections
/N1 in the neonatal intensive care unit /N3)1 .The most common infection site was
pneumonia and bloodstream infection. 8ow admission age, long N3) stay, and
mechanical ventilation were significant ris5 factors for N. Hlebsiella pneumoniae was
the most common pathogen, followed by Acinetobacter baumannii, *taphylococcus
epidermidi, 2seudomonas aeruginosa, Fnterobacter cloacae, and *tenotrophomonas
maltophilia. Antibiotic resistance of the isolated bacterium was high. n conclusion, this
study described the clinical characteristics of N in a 3hinese N3), which might
contribute to implementation of more effective therapeutic and preventive strategies
%&
.
A retrospective cohort study conducted on the incidence and ris5 factors for,
nosocomial infections in neonates during and after treatment with e.tracorporeal
11
membrane o.ygenation /F3G?1.in a large urban childrenKs hospital.. %; neonates
e.periencing #% nosocomial infections, and &! neonates with no nosocomial infections. >
#$' of neonates treated with F3G? e.perienced at least one nosocomial infection. The
rate of nosocomial infections was 1$.# per 1,$$$ patient,days. 4is5 factors significantly
associated with nosocomial infection included duration of F3G? I< days .neonatal
intensive care,unit stay I%1 days.@ hospitali(ation I&$ days@ and surgical procedure
before or during F3G?. Therefore Nosocomial infections occurred in #$' of patients
undergoing F3G?. Although nosocomial infections were not associated with an
increase in mortality, hospitali(ation was prolonged.
%;
STUDIES RELATED TO KNO%LEDGE AND PREVENTION OF HOSPITAL
AC>UARED INFECTIONS IN NE%BORNS AMONG HEALTH CARE
%ORKERS.
A study conducted to describes measures ta5en to reduce the prevalence of
nosocomial infection within a #!,bed neonatal intensive care unit. nterventions included
a one,to,one education programme for nursing staff /n M #$1@ the education of cleaners
and health,care assistants allocated to wor5 in the unit@ and the introduction of routine
/wee5ly1 screening procedure for all infants with feedbac5 given to staff. The education
programme for nurses focused on the application of standard precautions to three
common clinical procedures> hand washing, tracheobronchial suctioning and nasogastric
tube feeding. These were evaluated using competency chec5lists. The prevalence of
nosocomial blood and respiratory tract infections declined over the <,month study period.
This study highlights the importance of education in contributing to the control of
nosocomial infection in the neonatal intensive care unit
%<
.
A study conducted to assess the nature of patient contact and the hand hygiene
practice of nurses and physicians in the N3) .The patient to nurse=physician ratio
varied from E>1 to 1%>1.There were E< patient contacts of which !E were high ris5 and !"
low ris5 .Gost /<#'1 patient contacts were from nurses .3ompliance to hand hygiene
recommendations before versus after patient contact was 1&.!' versus #".&' for
physicians and 1!.1' versusE.E' for nurses .:loves were used for ;$."' patient
12
contacts/"&.<' high ris5,#&.!' low ris51however compliance to recommended
procedure occurred n only 1%.%' of high ris5 contacts and none of the low ris5
contacts. :loves were not changed between patients in !#.<' of high ris5 contacts and
"".%' of low ris5 contacts .+and washing protocol was generally followed. Alcohol hand
rub was always available but was not used for hand hygiene .Therefore the hand hygiene
compliance of physician and nurses was low.:loves and alcohol rub were not used
according to recommended guidelines. ncorporating effective education programs that
improve adherence to hand hygiene guidelines in to the continuing education curriculam
of health professional is recommended
%"
.
A survey conducted to assess the 5nowledge, beliefs, and practices of neonatal
intensive care unit /N3)1 healthcare wor5ers /+39s1on N3) +39sNNM%1&.O Ninety,
two percent 5new central venous catheters /373s1 should be capped, clamped, or
connected to running fluids at all times. Ninety,five percent 5new when to change gloves.
Thirty,one percent 5new the recommended duration for handwashing. Gost +39s
believed sterile technique in 373 care /E;'1, gloves /E1'1, and handwashing /EE'1
prevent nosocomial infection /N1. *i.ty,seven percent used sterile barriers to insert
373s, <;' reported wearing gloves, "1' reported routine handwashing, #&' 5new that
bacterial hand counts are higher with rings, #$' 5new that long fingernails are associated
with higher gram,negative bacterial hand contamination, and #&' 5new that artificial
fingernails are associated with higher gram,negative bacterial hand contamination. Gost
/E#'1 believed +39s can affect outcomes of patients with Ns. Jewer believed rings
/!$'1, artificial fingernails /;1'1, and long fingernails /!"'1 play a role in Ns, or that
policies concerning number of rings /&$'1, cutting fingernails /#&'1, or prohibiting
artificial fingernails /!<'1 would prevent Ns. *i.ty,one percent of +39s regularly
wore at least one ring to wor5, &;' wore their fingernails shorter than the fingertip, and
"' wore artificial fingernails. The study concludes that +39s did not 5now the
relationship between bacterial hand counts and rings and fingernails, and did not believe
rings or long or artificial fingernails increased the ris5 of Nis
%E
13
STATEMENT OF THE PROBLEM
A ,(6;+ (5 *,,-,, (7- -99-3(28-/-,, 59 ,(.63(6.-; (-*372/0 1.50.*))-
5/ </5?4-;0- .-0*.;2/0 /5,535)2*4 2/9-3(25/, */; 2(, 1.-8-/(25/ 2/ /-?@5./,
*)5/0 2/(-./,721 ,(6;-/(, *( ,-4-3(-; ,37554, 59 /6.,2/0, H*,,*/.
&.3 OBJECTIVES OF THE STUDY
1. To assess the 5nowledge regarding nosocomial infections of newborns among
internship nursing students
% To determine the effectiveness of structured teaching programme regarding
nosocomial infections among internship nursing students
#. To e.plore the association between the 5nowledge scores and selected
demographic variables
&.3.1 HYPOTHESIS.
+1.There will be a significant difference 5nowledge scores after *T2 among
internship students regarding nosocomial infections of newborn
+%. There will be a significant association between 5nowledge score and selected
demographic variables.
&.3.2 ASSUMPTIONS
nternship students will get adequate 5nowledge regarding nosocomial infections
and its prevention in newborns before they enter in to clinical practice.
&.3.3 OPERATIONAL DEFINITION
E99-3(28-/-,,> 4efers to difference in 5nowledge scores on nosocomial infection
of new born.
14
S(.63(6.-; (-*372/0 1.50.*))-> 4efers to a teaching learning aid which is a
systematically organi(ed information regarding incidence, ris5 factor, prevention
and control measures of nosocomial infection of newborns which will be provided
for !& minutes.
N5,535)2*4 2/9-3(25/,> 4efers to the infection developing among newborns after
admission to the hospital ,which was neither present nor in the incubation period
at the time of hospitali(ation. The main nosocomial infections are blood stream
infection pneumonia ,urinary tract infection, diarrhea and surgical wound
infections.
N-?@5./> 4efers to babies from birth to %" days of age.
I/(-./,721 N6.,2/0 ,(6;-/(,> 4efers to students who are undergoing internship
training after three year :eneral nursing and midwifery course.
&.3.! CONCEPTUAL FRAME %ORK
The conceptual frame wor5 of this study is based on 7on -ertalanffyKs :eneral
system theory.
&.3.$ DELIMITATION
*tudy is delimited to
nternship students in selected schools of nursing, +assan
! to ; wee5s of data collection
2re,e.perimental design
;$ internship students.
A. MATERIALS AND METHODS OF STUDY
A.1. SOURCE OF DATAB
15
Aata will be collected from the internship students at selected schools of nursing,
+assan
A.1.1. SIGNIFICANCE OF THE STUDY
*T2 will help in providing adequate 5nowledge regarding nosocomial infections
and its prevention among internship students before they are e.posed to clinical
field.
A.1.2. RESEARCH DESIGN >
2re e.perimental one group pre test, post test design
F ?1 P ?%
KEY
F ,F.perimental group /nternship students1
?1 ,2re, test 5nowledge of internship students regarding nosocomial infections
in newborns.
P , *tructured teaching programme on nosocomial infections and its prevention.
?% ,post test 5nowledge of internship students regarding nosocomial infection.
A.2. METHOD OF DATA COLLECTION
The tool for the study is semi structured questionnaire which include two
sections,
2art 1@ *elected *ocio demographic variables.
2art %@ *tructured 5nowledge questionnaire regarding nosocomial infections and
its prevention in newborns.
A.2.1. SAMPLING PROCESS
CRITERIA FOR SAMPLE SELECTION
16
I/346,25/ 3.2(-.2*B-
*tudents who are under internship training
9ho can read and write Fnglish.
9ho are present during the time of data collection
EC346,25/ 3.2(-.2*B-
*tudents who are not willing to participate in the study
A.2.2. SAMPLING PROCEDURE
A.2.2.1. POPULATIONB
All the internship students from selected nursing schools at +assan.
A.2.2.2. SAMPLEB
The internship students who fulfill the inclusion criteria.
A.2.2.3. SAMPLE SIDEB
*ample si(e is ;$
A.2.2.!. SAMPLING TECHNI>UESB
Non probability convenient sampling technique.
A.2.2.$. SETTINGB
*etting is the general location and condition in which data collection ta5e place in
the study.
The setting for this study is 4athna school of nursing, 4ajeev school of nursing and
2: school of nursingN Appro.imately the total number of students in each schools
are %$,%$ and #$ respectively.O
A.2.2.&. PILOT STUDYB E
17
2ilot study is planned with 1$'sample.
A.2.2.A. VARIABLES
I/;-1-/;-/( 8*.2*@4- >
n this study the independent variable is *tructured teaching programme.
D-1-/;-/( 8*.2*@4->
Hnowledge of internship students regarding nosocomial infections and its prevention
in newborns.
EC(.*/-56, 8*.2*@4-B
*elected socio demographic variables such as age, se., religion, habitant,and source
of information.
A.2.2.F..PLAN FOR DATA ANALYSIS .
t includes descriptive and inferential statistics.
Aescriptive statistics analysis includes percentage, mean ,frequency and standard
deviation .
nferential statistics includes , paired t Qtest to find out the effectiveness of *T2 by
comparing the pre and post test 5nowledge scores,and chi square test for the
association of 5nowledge and socio demographic variables
.A.3. DOES THE STUDY RE>UIRE ANY INVESTIGATION OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALSG
Res, the study requires intervention to be conducted on internship students.
18
A.!. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTIONG
Res, 2ermission obtained from the research committee of 4athna college of Nursing
and authorities of selected schools of nursing in +assan. nformed consent will be
obtained from subjects who are selected for the study.
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