CHAPTER FOUR: RESULTS

4.0 Introduction

This chapter presents the findings of the study, presented according to the objectives, in main tabular form

4.1 Respondent bio data

Table 1: Socio demographic characteristics of the respondents

Table 1 above shows the demographic characteristics of the respondents who were interviewed in this study. It is shown that the majority of them were female 42(71.2%). Less than half of the respondents were in the age range of 31 – 41 years 24(40.7%), and slightly more than half of them were reportedly married 31(52.5%). The majority of the respondents were Catholics 37 (62.7%), and the biggest proportion of them were Nurses by profession at the hospital 25 (42.4%).

4.1 Compliance to standard infection control precautions among health workers

Table 2: Characteristics of compliance to standard infection control precautions among health workers

Table 2 above shows the infection control practices of the health workers at Al Shabbah hospital – Juba. It is shown that more than half of the health workers reported that they sometimes washed their hands before touching the patient or the patient’s surroundings 32(54.2%). More than three quarters of them reported that they always washed hands before an aseptic procedure 47(79.7%). Almost half of them reported that they always washed their hands after a body fluid exposure risk 26(44.1%). More than half of them reported that they sometimes washed their hands after touching the patient 34(57.6%). More than a third of the health workers interviewed reported that they sometimes washed their hands after physical contact with a patient 25(42.4%), while almost all of them reported that they sometimes washed hands after touching the patient’s surroundings 35(59.3%).

Almost all the health workers reported that they Always wore gloves for invasive procedures 58 (98.3%), and almost of them reported that they always Put on mask and eye protection or face shield during procedures 28(47.5%), and that they sometimes performed a 2-3 minute scrub with an antiseptic soap 28(47.5%). More than three quarters of the health workers reported that they always put used needles and other sharp objects into the designated 51(86.4%). Almost half of the health workers reported they sometimes wore waterproof apron whenever there is a possibility of blood 27(45.8%). More than three quarters of the health workers reported that they Always did not recap needles that have been contaminated with blood or Body fluids 47(79.7%), and the majority of them said they always reported needle stick injury when it occurs by recording it in a book 38 (64.4%).

Figure 1: The level of compliance to standard infection control precautions among health workers in Al-Shabbah children hospital, Juba, South Sudan

Following the scale mentioned in section 3.10, it was computed and found out that slightly more than half of the health workers who were interviewed at Al Shabbah hospital were compliant to infection control precautions 30(51%).

4.2 Institutional factors and compliance to standard infection control precautions

Table 3: The institutional factors associated level of compliance to standard infection control precautions among health workers in Al-Shabbah children hospital, Juba, South Sudan

The univariate section of the findings in table 3 above shows that less than half of the health workers who were interviewed reported that there was no high availability of infection control equipment at this health facility 26 (44.1%). More than half of the health workers interviewed agreed that the Institutional work schedule was so tight, that one could hardly get time to wash hands or wear gloves 32(54.2%), but disagreed when it came to most of the patients handled at the health facility having contagious illnesses 34 (57.6%). More than half of the health workers reported that there wasn’t a lot of administrative leadership support and rewards for hand washing at the health facility 32(54.2%). The majority of the health workers reported that they were not given written infection control guidelines by management 36(61.0%), but agreed that there was high institutional support of occupational health and safety compliance for health workers Agree 36(61.0%). More than half of the health workers reported that as staffs, they had been provided with adequate training on how to protect ourselves from infection with HIV 35(59.3%), and that management at the facility, always enforced the infection control guidelines, as a routine 40(67.8%). More than three quarters of the respondents were of the view that Staffing levels were adequate at this hospital 50(84.7%).

The bivariate section of the table shows that two institutional characteristics had a statistically significant relationship with compliance to infection control precautions. They are; availability of infection control equipment at the health facility (X² = 12.646, P = 0.000), and the nature of patients handled at health facility (X² = 9.061, P = 0.003). The descriptive cross tabulations show that of the health workers who agreed that there was a high availability of infection control equipment at the health facility, the majority were compliant to the infection control precautions (69.7%), compared to those who disagreed. Of the health workers who agreed that most of the patients handled at the health facility had contagious illnesses, the majority of them (72.0%) were compliant to the infection control precautions compared to those who disagreed.

4.3 Individual factors and compliance to standard infection control precautions

Table 4: The individual factors associated level of compliance to standard infection control precautions among health workers in Al-Shabbah children hospital, Juba, South Sudan

The descriptive findings in table 4 above show that the majority of the health workers had Diplomas 38(64.4%), and almost three quarters of them had been in the health care profession for  5 to 8 years 44(74.6%). The majority of the health workers reported that they sometime had contact with contagious status patients Sometimes 39(66.1). Almost half of the health workers reported that they used gloves Very often 27 (45.8%). The majority of the health workers reported that they had never suffered from a nosocomial infection 37(62.7%), however, almost three quarters of them reported that they had ever been exposed to infectious agents during duties 43 (72.9%). More than half of the health workers reported that they sometimes forgot to wash hands 35 (59.3%), and had a perception that following infection control precautions interrupts workflow and redundancy 33(55.9%).  The majority of the health workers reported that they had ever had an injury due to needle puncture 36(61.0%).

The bivariate findings in the table above show that only one individual characteristic had a statistically significant relationship with compliance to infection control precautions. It was the frequency of using gloves (X² = 7.667, P = 0.022).

CHAPTER FIVE: DISCUSSION

5.0 Introduction

5.1 The level of compliance to standard infection control precautions among health workers in Al-Shabbah children hospital, Juba, South Sudan

The findings of this study showed that the level of compliance to standard infection control precautions among health care workers at Al-Shabbah children’s hospital was 51%, the implication of which was that about 5 out every 10 health workers were compliant to the infection control precautions. It is thus possible that 5 out of every 10 health care workers at the health center are exposed to occupational hazards especially the nosocomial infections. That is a considerable proportion since it is almost half of the health worker proportion at the health center, of which if they are infected, it will not only hinder health service delivery at the health center due to hours lost in recovery but will also cause reinfections in the patients.

The level of compliance reported in this study is higher than what was reported in studies by Jain &Dogra (2012), Wasswa(2015), Admasu, 2013), Kelemua (2014), Alice (2015), and by Haile (2017), all of which reported compliances rates exceeding 70%.  The difference between those studies and the current study is because of the difference in the measurement of compliance between some of those studies. The current study assessed compliance basing on practice of infection control “always” while some of those studies based on general practice of a precaution.

Similar to findings by Arinze-Onyia (2018), hand hygiene was sub optimally practiced which is not good because aside from being an important component of SP, regular hand hygiene is very crucial in infection control. The Present finding is significantly lower than the previous report from south India in which the practice of hand hygiene was 95% (Punia, 2017). The probable reason for the poor practice could be irregular access to materials for hand hygiene. On the other hand, it could be due to nonchalance on the part of HCWs who may believe that hand hygiene before patient’s care is irrelevant. Higher rates of hand washing have been reported in studies by Wasswa (2015), Kelemua (2014), Alice (2015) and Haile (2017) where rates of hand washing were less than 90%. The difference between the findings could be related a higher availability of hand washing stations at the facilities where those other studies were conducted; it should be noted that those studies were done in many facilities, as opposed to the current study which was done in only one study. Almost half of the health worker population washed hands after physical contact with a patient (45%), while many of them washed hands after removing gloves (42.5%). This shows some gaps in hand washing practices and indicates that a considerable proportion of the health workers could be prone to nosocomial infections especially after patient contact.

More than three quarters of the respondents reported that they wore gloves for invasive procedures, contact with sterile sites, and non-intact skin, mucous membranes (87.5%), higher than the finding by Kelemua (2014) but lower than the glove use rate found by Imara et al (2012). Higher findings by Imara et al., (2012) are because that study was conducted in a hospital, with probably more infection control materials that the health center in which this study was conducted.

Eliminating needle recapping is one of the effective measures to prevent infections from occupational exposure of HCWs to blood (Wilburn, 2004). Surprisingly, about 20% of the respondents still recapped needles before discarding them. Similar unfortunate trend has been reported, and this is not good for the safety of the HCWs as recapping has been noted to be the most common cause of needle-stick injuries (Bidira, 2014; Rogowska-Szadkowska, 2010). Thus, concerted efforts should be made to completely eliminate this dangerous old habit from the health-care industry. The finding of this study is however contrary to the findings in Ethiopia by Ethiopia Tadesse (2009) were (57%) of the health workers reported risky practices such as needle recapping. Needle stick injuries are the commonest occupational injuries among health workers; hence the fact that more than three quarters of the health workers at Al-Shabbah children’s hospital never recapped needles is an indicator that there is some level of occupational safety among them.

5.2 The institutional factors associated level of compliance to standard infection control precautions among health workers in Al-Shabbah children hospital, Juba, South Sudan

The bivariate section of the table shows that two institutional characteristics had a statistically significant relationship with compliance to infection control precautions. They are; availability of infection control equipment at the health facility (X² = 12.646, P = 0.000), and the nature of patients handled at health facility (X² = 9.061, P = 0.003). The descriptive cross tabulations show that of the health workers who agreed that there was a high availability of infection control equipment at the health facility, the majority were compliant to the infection control precautions (69.7%), compared to those who disagreed. Of the health workers who agreed that most of the patients handled at the health facility had contagious illnesses, the majority of them (72.0%) were compliant to the infection control precautions compared to those who disagreed.

5.3 The individual factors associated level of compliance to standard infection control precautions among health workers in Al-Shabbah children hospital, Juba, South Sudan

bivariate findings in the table above show that only one individual characteristic had a statistically significant relationship with compliance to infection control precautions. It was the frequency of using gloves (X² = 7.667, P = 0.022).

CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS

6.0 Introduction

This chapter presents the conclusion of the study, based on the significant findings of the study, as was obtained from each of the study objectives. The chapter also includes a set of recommendations for policy and action, still based on the significant findings of the study

6.1 Conclusion

Objective 1: The level of compliance to standard infection control precautions among health workers in Al-Shabbah children hospital, Juba, South Sudan

The level of compliance to standard infection control precautions among health workers in Al-Shabbah children hospital, Juba, South Sudan is 51%. Thus, about 5 of every 10 health workers at Al-Shabbah children hospital, Juba comply with the infection control precautions during their routine health care service provision.

Objective 2: The institutional factors associated level of compliance to standard infection control precautions among health workers in Al-Shabbah children hospital, Juba, South Sudan

Only two institutional characteristics are associated with the level of compliance to standard infection control precautions among health workers at Al-Shabbah children hospital, Juba, South Sudan. They are the availability of infection control equipment at the health facility and the nature of patients handled at health facility in terms of the nature of illnesses they are diagnosed with.

Objective 3: The individual factors associated level of compliance to standard infection control precautions among health workers in Al-Shabbah children hospital, Juba, South Sudan

Only one individual characteristic significantly associates with the level of compliance to infection control precautions, among health workers in Al-Shabbah children hospital, Juba, South Sudan. It is the frequency of using gloves.

6.2 Recommendations

Recommendations based on findings from objective 1

Generally speaking, the level of compliance to infection control precautions among health workers at Al- Shabbah hospital can be improved if emphasis is put on the promotion of hand washing behavior among those health workers, given that is gaps in hand washing practice that contributed to low level of compliance to the precautions. The task of hand washing promotion should be taken by hospital administrators and departmental heads as well. Focus should be put on hand washing before touching the patient or the patient’s surroundings, after touching the patient, performance of a 2-3 minute scrub with an antiseptic soap, and hand washing after touching the patient’s surroundings.

Recommendations based on findings from objective 2

The management of Al-Shabbah hospital should make it a point to procure all necessary infection control equipment especially personal protective equipment (PPE) and hand washing equipment, more so in quantities that much the number of staff available at the facility.

The management of Al-Shabbah hospital has to organize continuous medical education sessions and/or trainings with the health workers with an aim of informing that the hospital does not have to be handling patients with contagious diseases before they (health workers) can comply with the infection control precautions. They should be informed that infection control precautions should be complied to for as long as patients are being provided with health services despite their severity of disease.

Recommendations based on findings from objective 1

Health care workers at Al-Shabbah hospital are advised that putting on gloves when handling patients is indeed one of the infection control precautions; however it is an end in its self. They should know that nosocomial infection transmissions can occur through other means besides the hands, and so putting on gloves frequently does not guarantee safety, and as such they should also embrace other PPEs as well.