Infection control and practice of standard precautions among healthcare workers in northern Nigeria

J Glob Infect Dis. 2013 Oct;5(4):156-63. doi: 10.4103/0974-777X.122010.


Background: Healthcare-associated infections (HAIs) have been reported to be a serious problem in the healthcare services as they are common causes of illness and mortality among hospitalized patients including healthcare workers (HCWs). Compliance with these standard precautions has been shown to reduce the risk of exposure to blood and body fluids.

Aims: This study therefore assesses the level of knowledge and compliance with standard precautions by the various cadre of HCWs and the factors influencing compliance in hospital environment in Nasarawa State, Northern Nigeria.

Settings and design: Nasarawa State has a current human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) prevalence rate of 10.0%, which was higher than most states in Nigeria with a high level of illiteracy and ignorance. Majority of the people reside in the rural areas while a few are found in the towns, informal settlements with no direct access to healthcare facilities are common.

Materials and methods: This study is an analytical, cross-sectional study. Proportional sampling technique was used to obtain a representative sample and a structured self-administered questionnaire was used to collect relevant information from the healthcare providers working in Nasarawa State from January to February 2009.

Statistical analysis used: To describe patient characteristics, we calculated proportions and medians. For categorical variables, we compared proportions using chi-square tests. A logistic regression model was produced with infection control as outcome variable to identify associated factors.

Results: A total of 421 HCWs were interviewed, Majority (77.9%) correctly describe universal precaution and infection control with 19.2, 19.2, and 28.0%, respectively unable to recognize vaccination, postexposure prophylaxis, and surveillance for emerging diseases as standard precaution for infection control. About 70.1% usually wear gloves before handling patients or patients' care products, 12.6% reported wash their hand before wearing the gloves, 10.7% washed hands after removal of gloves, and 72.4% changed gloves after each patient. Only 3.3% had a sharp disposal system in their various workplaces. Majority (98.6%) of the respondents reported that the major reason for noncompliance to universal precautions is the nonavailability of the equipments. There was a statistically significant difference in the practice of standard precaution among those that were exposed to blood products and body fluid compared to those that had not been exposed in the last 6 months (χ(2) = 3.96, P = 0.03), public healthcare providers when compared to private health workers (χ(2) = 22.32, P = 0.001), among those working in secondary and tertiary facilities compared to primary healthcare centers (χ(2) = 14.64, P = 0.001) and urban areas when compared to rural areas (χ(2) = 4.06, P = 0.02). The only predictor of practice of standard precaution was exposure to blood and body fluid in the last 6 months odds ratio (OR) = 4.56 (confidence interval (CI) = 1.00-21.28).

Conclusions: This study implies that inadequate workers' knowledge and environment related problems, including the lack of protective materials and other equipments and utilities required to ensure safety of HCWs is a crucial issue that need urgent attention. Institution of a surveillance system for hospital acquired infection to improve consistent use of standard precautions among health workers is recommended in Nigeria and other low income countries in Africa.

Keywords: Health workers; Infection control; Northern Nigeria; Standard precaution practice.