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J Med Allied Sci 2014; 4 (1): 09-16

Medical
www.jmas.in
Print I SSN: 22311696 Onl ine ISSN: 2231170X
& Allied
Sciences

Original article
Prevention of nosocomial infections and standard
precautions: knowledge and practice among
radiographers in Sri Lanka
Ruwan Duminda Jayasinghe1and Bimali Sanjeevani Weerakoon2
1
Department of Oral Medicine and Periodontology, Faculty of Dental Sciences;
2
Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences,
University of Peradeniya, Peradeniya-20400, Sri Lanka
Article history: Abstract
Received 13 September 2013
Nosocomial infection is an infection if it becomes positive 48 hours or
Revised 11 February 2014
Accepted 12 February 2014 more after admission to the hospital or within 30 days of discharge.
Early online 25 February 2014 Health care workers can be a major source of vectors for pathogens.
Print 28 February 2014 Nowadays, interventional radiology and other radiological imaging
modalities have undergone vast development and the tendency for ac-
Corresponding author cidental exposure to blood and other infectious pathogens are on the
increase. Therefore, all the health care works are expected to follow the
Ruwan Duminda Jayasinghe
standard precautions to prevent accidental injuries during the service.
Senior Lecturer, This study was carried out to assess the knowledge and the practice of
Department of Oral Medicine and
Periodontology, radiographers on nosocomial infection control and standard precau-
Faculty of Dental Sciences, tions. A postal survey was conducted to all registered practicing radio-
University of Peradeniya, graphers in Sri Lanka. A pre-designed, pre-tested, anonymous self-
Peradeniya-20400, Sri Lanka. administered, structured questionnaire was circulated among radio-
Phone: 0094 812397456
Email: ruwanja@pdn.ac.lk graphers and for each correct answer one point was assigned. In the
knowledge section scores < 25%, 25% - 50%, 51%- 75 %, and > 75%
were considered as weak, moderate, good, and excellent knowledge,
respectively. In the practice section scores < 50%, 50% - 75% and > 75
% was considered as bad moderate and good practice, respectively.
The good practice was considered as professional practice for the clini-
cal radiology units. Data entry, management and analysis were carried
out using MS excel and SPSS statistical software package. The total
response rate was 37.9 %. The mean overall age of the respondents
was 30 to 39 years and males composed (72.3%) the majority of study
population. Most of the respondents (84.98 %) were qualified as diplo-
ma radiographers and 78.87 % of the respondents were practicing in
government hospitals. More than half (51.6%) of the respondents have
worked for < 10 years and 93.4% have never attended any occupation-
al training program regarding infection control. Majority (43.19%) of the
respondents have scored 50% from the total knowledge score and
more than half (73.2%) believed that the environment is the major
source for nosocomial infections. There was no association between
the knowledge and the education levels or knowledge between the
years of practice (p< 0.05). The highest recorded score for practice was
66.66%. More than half of the respondents (53.5%) washed their hands
infrequently, before touching the patients but 51.2% washed their
hands frequently after touching the patients and every clinical expo-

09
Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections

sure. 11.7% respondents never wear a mask or a respirator when there

is a potential to be exposed to infectious aerosols. No association be-
tween the infection control practice and the education levels or the in-
fection control practice between the years of practice (p< 0.05) was
identified. This study reveals that the radiographers‟ knowledge and
practice regarding nosocomial infections and standard precautions
were moderate.

Key words: infections, knowledge, practice, radiographers

© 2014 Deccan College of Medical Sciences. All rights reserved.

N
osocomial infection is an infection if it be-
comes positive 48 hours or more after ad-
mission to the hospital or within 30 days of
discharge. Although infection is mostly present in
patients, health care workers also can be a major
source of vectors for pathogenic agents1. Health
care associated infections have long been recog-
nized as crucial factors bedeviling the quality and
outcomes of health care delivery2. Developing
countries have reported to have up to 20 times the
risk of contracting a nosocomial infection com-
pared with developed countries3. Thus, spread of
infection serves as a major source of worry for
health care practice, particularly in developing
countries where the health care system is already
overstretched.
Hospitals provide a favorable transmission path-
way for the spread of nosocomial infections, owing
partly to poor infection control practices among
health workers on one hand and overcrowding of
1
patients in most clinical settings on the other .The
importance of hospital-acquired infections goes
beyond its impact on morbidity and mortality fig-
ures in any country, and has profound economic
implications. Prevention of health care-associated
infections (HAIs) is the duty of all health care
workers. Infection control professionals require
evidence-based educational content that facilitates
reduction in HAIs. Clinical and support staff in
health care institutions are inundated with required
training facilitated by accrediting bodies and institu-
4 of infections at the radiology units, this study was
tional mandates .Standard precautions are de-
signed to reduce the risk of acquiring occupational
infection from both known and unexpected sources
in the healthcare setting5.Strict adherence by
healthcare workers to standard infection control
precautions may prevent a percentage of these
6 A cross-sectional prospective postal survey was
risks . For that healthcare workers should have
adequate knowledge and practice about standard
infection control precautions.
Over the last decades, radiological services have
undergone many changes and with the introduc-
tion of interventional radiology and other special
imaging modalities, the tendency for accidental
blood and infectious pathogens exposure is on the
increase. Standard precautions are implemented to
reduce the potentiality of acquiring occupational
infections from both unexpected and well-known
sources during the healthcare system. Stern con-
formation to standard precautions can reduce a
percentage of these risks5.
There are several studies which reveal the impor-
tance of infection control practice in other profes-
sions. Nurses‟ and physicians‟ knowledge of stan-
dard and isolation precautions have been reported
7-9
to be insufficient . Few studies have reported on
medical students‟ knowledge of standard isolation
precautions or sharp injuries10-13 and noted a lack
of adequate knowledge of standard precautions12.
In one survey, 27% of participating health care
students reported insufficient emphasis on teach-
ing about infection control in their training program,
whilst 50% expressed a desire for more emphasis
on isolation procedures during their training14.
Several other targeted studies15-19 have detected
poor adherence to universal precautions among
multiple health care providers, including gastroen-
terologists and their staff, emergency room physi-
cians and hemodialysis practitioners.
Considering the lack of information describing ra-
diographers‟ knowledge and the practice of the
preventive measures necessary to limit the spread
carried out to assess the knowledge and the prac-
tice of radiographers on nosocomial infection con-
trol and standard precautions in Sri Lanka.
Materials and methods
conducted on all the registered radiographers vo-
luntary participants and who were attached to vari-
ous hospitals and radiology clinics in both govern-
ment and private sectors in Sri Lanka. The survey
instrument was a pre-designed, pre-tested, self-

J Med Allied Sci 2014; 4(1) 10

Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections

administered structured questionnaire designed
according to the international standards on preven-
tion of nosocomial infections in line with the objec-
tives of the study.
The questionnaire consisted of three major do-
mains such as demographic factors of the partici-
pants, knowledge and practice of nosocomial infec-
tions and standard precautions. There were six
questions about knowledge of nosocomial infec-
tions and standard precautions and answered us-
ing the options “Agreed”, “Disagreed” and “Don‟t
Know”. For each correct answer one point was
assigned and therefore, the total score for know-
ledge was ranged between 0% (0) to 100% (6)
.Scores < 25%, between 25% and 49.9%, between
50% and 75 %, and > 75 % were considered weak,
moderate, good and excellent respectively. A
higher score indicated a greater level of know-
ledge. Six questions addressed the practice of
standard precautions and there were three possi-
ble answers (always; sometimes; never) for each
question. One point was allocated to „always‟ op-
tion and zero points were assigned for each incor-
rect or don‟t know answer. The total scores were
ranged from 0% (0) to 100% (6). Scores < 50 %,
between 50% and 75% and > 75 % was consi-
dered as bad, moderate and good practice respec-
Table 1: Respondents according to age, gender, qualifications and place of work
Gender/Age 20-29 years 30-39 years
Male 21.13% (45) 23.94% (51)
Female 10.33% (22) 7.98% (17)
tively. The good practice was considered as pro-
fessional practice for the clinical radiology units.
A covering letter describing the purpose of the
study with the questionnaire was sent to all the
registered radiographers together with a stamped
self addressed envelope. Voluntary participation
and confidentiality of responses were also empha-
sized in the mail. To maximize response rate,
monthly reminder (total of 4) mails were sent to
those who have not responded. Ethical clearance
was obtained from the Research and Ethical Re-
view committee of the Faculty Allied Health
Sciences, University of Peradeniya, and all the
other ethical aspects were considered. Data and
other information of the study were only accessible
to the researcher and the supervisor and the par-
ticipation was anonymous. Data editing was car-
ried out along with the process of data collection.
Received data was analyzed using SPSS statistic-
al software.
Results
A total of 213 questionnaires were returned out of
562, giving a total response rate of 37.9 %.
The demographic characteristics of respondents
who returned duly completed questionnaires are
shown in table 1 and 2.
>50 years
40-49 years Total
7.98% (17) 19.25% (41) 72.3%(154)
4.69% ( (10) 4.69% (10) 27.7%(59)

Qualification and
Diploma B. Sc. M. Sc. Other Total
work place
44.60% (95) 1.41% (3) 0.47 % (1) 46.48 % (99)
Teaching hospital 0 % (0)
Government (other
31.46% (67) 0.94% (2) 32.4% (69)
than teaching ) hos- 0% (0) 0% (0)
pitals
2.35% (5) 2.35% (5)
University 0% (0) 0% (0) 0% (0)
Private hospitals/ 8.92% (19) 9.86% (21) 18.79% (40)
0% (0) 0% (0)
Clinics
Table 2: Respondents according to work experience and participation of training programmes
Work experience and participation
<1year 1-5 Years 6-10 Years >10 years
of training Programs
Participated 0.99% 0.94% 0.94% 3.76%

Not Participated 5.63% 33.33% 9.39% 44.13%

J Med Allied Sci 2014;4(1) 11

Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections

The mean overall age of the respondents was 30
to 39 years and males composed (72.3%) majority
of study population. Most of the respondents
(84.98%) were qualified as diploma radiographers
and 78.88% of the respondents were practicing at
government (with teaching hospitals) hospitals.
Duration of work experience was identified to be
less than 10 years in most (51.22%) of the respon-
dents and 93.4% have never attended any occupa-
tional training program regarding infection control.

Fig 1. Responses of knowledge related questions

Fig 2. Use of preventive methods

J Med Allied Sci 2014;4(1) 12

Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections
The total score of knowledge ranged from 0% to
100% and majority (75.59%) of the respondents
had scored 50% or above (good knowledge). More
than half (73.24%) believed that the environment is
the major source which is responsible for noso-
comial infections and only 44.6% respondents had
the knowledge that invasive procedures will in-
crease the risk of nosocomial infections. Almost all
the radiographers (97.2%) were aware that the
standard precautions should include the recom-
mendations to protect both patients and the health
workers but 70.9% believed that the gloves should
be used for each procedure. A high percentage of
respondents (79.8 %) were able to identify the ne-
cessity of wearing protective clothes when there is
a risk of splashes or spray of blood and body flu-
ids. 58.2% respondents were aware that instead of
surgical and antiseptic hand washing alcohol-
based hand rubs could be used. There was no as-
sociation found between the knowledge and the
education levels or knowledge between the years
of practice (p< 0.05) of the respondents.
The total score of practice ranged from 0% to
100%. Majority (20.18%) of the respondents
achieved a moderate score of 66.66%. In the study
group 47.9% infrequently wear protective clothes
during potential blood splatter. However, 66.56 %
recognized Hepatitis B or C as high risk infections
and they change the personal protective habits
accordingly. More than half of the percentage
(53.5%) washed their hands infrequently before
touching the patients, but 51.2% washed their
hands always after touching the patients. Higher
percentage (67.6%) was aware of the necessity of
adequate covering the open cuts and wounds al-
ways during their clinical work. Eleven point seven
percent (11.7 %) of the respondents never wears
mask or respirator although when there is a poten-
tial to be exposed to infectious respiratory aero-
sols. There was no statistical significance found
between their infection control practice and the
education levels or the infection control practice
between their years of practice (p<0.05).
Discussion
Standard precautions for infection control are very
vital that have been adopted to prevent health
workers from being occupationally infected. As-
sessment of knowledge of nosocomial infections
and standard precautions among radiographers is
very critical as without the background knowledge,
the awareness remains useless and void. In the
study, mean overall score for knowledge of noso-
comial infections and standard precautions among
radiographers are considered to be moderate.
J Med Allied Sci 2014;4(1)
However some gaps can be identified on radio-
graphers‟ knowledge in specific areas such as in-
fection origins and standard precautions. The re-
sults of the study show that the radiographers are
sufficiently aware that the standard precautions
lead to protect both patient and staff; however,
recommendation of using gloves was not sufficient-
ly concerned. The similar results can be found in
the three recent studies done by Bryce7, Bello8,
and Easton9.
The study indicates that more than half (73.24%) of
the participants identified that the environment is
the major source responsible for nosocomial infec-
tions. The knowledge deficit about the major
source of nosocomial infection is of concern be-
cause this relates to an important role for radio-
graphers; though this component can be ad-
dressed through education.
Health care workers could be at risk of infections
with blood-borne pathogens resulting from occupa-
tional blood exposure through injuries with sharp
instruments and needle sticks if the standard pre-
caution is not strictly adhered to. However this
study finding revealed 93.4% have never partici-
pated in any occupational training programs on
blood and body fluid universal precautions and it is
not in agreement with the findings made by various
other countries22. The study done by Okaro et al
(2010)21 in Nigeria revealed that radiographers
claimed to have awareness or recognition for uni-
versal blood and body fluid precautions, with vari-
ous proportions claiming different sources of
awareness, the largest proportion being through
clinical seminars or symposia.
Hospitals provide a good transmission pathway for
the spread of nosocomial infections, due to poor
infection control practices among health workers
.The study demonstrates that radiographers‟ prac-
tice of infection control was moderate and better
than the practice demonstrated in few other obser-
vational studies23,24. Hands should be washed after
attending to one patient but before attending to the
next. It must not be missed when contacted is
made with body fluids. The finding of this study is
far from what can be acknowledged as standard
practice but this is similar to finding of Suchitra et
14 21
al study. Okaro et al (2010) in Nigeria shows
that many radiographers do not clean couch, cas-
sette and wash hands after every patient making
spread of nosocomial pathogens likely.
There is no relationship between the infection con-
trol practice with the education level and the expe-
rience of the radiographers in this study. Radio-
graphers have lot of things to do in the area of
13
Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections
practicing standard precautions. Many of them are
far away from guidelines which are meant to be
followed in the area of hand washing. Findings of
this study clearly demonstrate a moderate know-
ledge and poor practice on infection control among
respondent radiographers in Sri Lanka and find-
ings are similar to some studies in other develop-
ing countries. Lack of proper infection control prac-
tices can put the patients as well as radiographers
life at a risk. This highlights the need of continuing
educational programmes to upgrade their know-
ledge on current practices.
Conclusion
This study reveals the radiographers‟ knowledge
and practice regarding nosocomial infections and
standard precautions were moderate.
Acknowledgments: None
Conflict of interest: None
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Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections

Appendix
A study on “Prevention of nosocomial infection and standard precautions: knowledge and practice
among radiographers in Sri Lanka”.
**INSTRUCTION: Please, tick the relevant box for any option chosen or write in the space provided for
additional answers.
[A] Personal Information:
1. Which age group do you belong to?
(a) 20-29 yrs
(b) 30-39 yrs
(c) 40 – 49 yrs
(d) 50 yrs and above
2. Gender
(a) Male
(b) Female
3. Place of work?
(a) Teaching Hospital
(b) Government hospital (other than teaching)
(c) University
(d) Private Hospital / Clinic
(e) Others, specify………………………………..
4. What is your highest educational qualification regarding to your profession?
(a) M Sc
(b) B Sc
(c) Diploma
(d) Others, specify.………………….
5. Number of years of radiography practice?
(a) Less than 1 year
(b) 1 – 5 years
(c) 6- 10 years
(d) More than 10 years
6. Have you ever received occupational training on blood and body fluid universal precautions
(a) Yes
(b) No
[B] Knowledge regarding infection control
7. The environment (air, water, inert surfaces) is the major source of bacteria responsible for no-
socomial infection.
(a) Agreed (b) Disagreed (c) Don‟t Know

J Med Allied Sci 2014;4(1) 15

Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections

8. Invasive procedures do not increase the risk of nosocomial infection.

(a) Agreed (b) Disagreed (c) Don‟t Know
9. Standard Precautions include the recommendations to protect both patients and the health
workers.
(a) Agreed (b) Disagreed (c) Don‟t Know
10. The standard precautions recommend use of gloves for each procedure
(a) Agreed (b) Disagreed (c) Don‟t Know
11. When there is a risk of splashes or spray of blood and body fluids, the healthcare workers
must wear nothing
(a) Agreed (b) Disagreed (c) Don‟t Know
12. Instead of surgical and antiseptic hand washing alcohol-based hand rub will be use
(a) Agreed (b) Disagreed (c) Don‟t Know
[C] Practice regarding infection control
13. Do you wear protective gloves & coats during procedures where there is the potential for
blood splatter?
(a) Always (b) Sometimes (c) Never
14. Do you change your personal protective habits if you know the patient has Hepatitis B or C ?
(a) Always (b) Sometimes (c) Never
15. Do you wash your hands before touching the patient?
(a) Always (b) Sometimes (c) Never
16. Do you wash your hands after touching the patient and every clinical exposure?
(a) Always (b) Sometimes (c) Never
17. Do you wear a mask or respirator when there is a potential to be exposed to respiratory aero-
sols?
(a) Always (b) Sometimes (c) Never
18. Do you cover the open cuts and wounds during clinical work?
(a) Always (b) Sometimes (c) Never

Thank you for your kind co-operation!!

J Med Allied Sci 2014;4(1) 16