DOI: https://doi.org/10.21203/rs.3.rs-2900726/v1
Introduction and Objectives
Globally, hospitals have faced substantial problems because of healthcare-associated infections (HAIs). This study was intended to assess knowledge, attitude and associated factors towards instrument processing among nurses working in Asella Referral and Teaching Hospital, Ethiopia.
Methods
Cross-sectional survey was done on 335 nurses working at Asella Referral and Teaching Hospital, Oromia regional state, Ethiopia. The data were collected from December 20 to 29/2021 by face-to-face interview.
Result
A total of 335 nurses were participated in the study and the response rate was 99.11%. This study showed that the level of good knowledge and attitude towards Instrument processing among nurses working at Asella referral and teaching hospital was 61.8%, and 65.4% respectively. The Multivariable logistic regression analysis showed that; average monthly income, working experience, awareness on Instrument processing methods, availability of guideline on instrument processing and department currently serving were factors significantly associated with knowledge towards instrument processing. Gender, awareness on instrument processing, department currently serving and knowledge towards instrument processing were factors significantly associated with attitude towards instrument processing.
Conclusions
The level of good knowledge and positive attitude towards instrument processing among nurses was low. Health educational programs, training, and demonstrations on instrument processing are essential to solve these problems.
Instrument processing is important in working to create an environment which is free of infection. It is important that the clinic staff, including healthcare providers to cleaning and maintenance, should clearly understand the rationale for each of the recommended infection prevention processes 1. In health care facilities, infections are the foremost public health problems. This problem has a worldwide distribution. The transmission of infection could be from client to client, staff to client, client to staff, and from the health institution’s environment to clients and staff 2.
Hospital cleaning is an element of infection control which is neglected. Comprehensive was cleaning found to interrupt the chain of infection between the organisms and patients 3. In health care environments, using chemicals with toxic characteristics necessitates further protection for health care workers. In addition to worker safety, patient safety is needed to be considered when selecting probably hazardous chemicals to be used in the health care setting 4.
There is contact between a surgical instrument or medical device and a sterile tissue or mucous membrane of the patient during all the invasive procedures involved. During these procedures, there is a substantial risk of pathogenic microbes introduction that could lead to infection 5. Since there has been an increase in many infectious diseases because of inadequate sterilization, sterilization and disinfection in hospitals is a significant concern for both medical and community 6. Reuse happens frequently for both single use and multiuse medical devices. The protocols for reprocessing and sterilization exist for many devices that are commonly reused 7.
Reusable medical equipment carries a risk which is associated with breach of the host barriers, if there is a failure to properly disinfect or sterilize them. The level of disinfection or sterilization dependent on the intended use of the object like critical items, semicritical items, and noncritical items which require sterilization, high-level disinfection, and low-level disinfection, respectively 5.
HAIs are among the main complications of modern medical therapy, of which those related to invasive devices are the most important HAIs: These are; central line-associated bloodstream infection, catheter associated urinary tract infection, ventilator-associated pneumonia, and surgical site infection 8. The hospitals in all countries around the world have faced common problems and difficulties because of HAIs 9.
HAIs leads to momentous morbidity and mortality. Despite the considerable progress in HAIs prevention has been made over the past decade, many chances for upgrading remain and new challenges continue to arise 10. HAIs increases patients’ length of stay, higher inpatient costs, and of mortality 11. HAIs are a substantial public health concern both in the United States and abroad. It contributes to augmented morbidity, mortality, and health care costs 12. HAIs are a major cause of morbidity and mortality in hospitalized patients 13. HAIs occur commonly and cause momentous harm to patients and lead to excess healthcare expenditure 14. HAIs leads to considerable increases in healthcare costs, morbidity, and mortality. The case fatality rate from 2.3–14.4%, which depends on the type of infection 8.
Estimating the burden of HAIs compared to other communicable diseases is a continuing challenge 15. HAIs caused by antibiotic-resistant gram-negative pathogens were led to a noteworthy enlarged length of stay and higher hospital costs when compared to those caused by their susceptible counterparts 16. Disinfection and sterilization in hospitals is of increasing concern because nosocomial infections affect 1 out of 10 patients admitted to the hospital and it is associated with major morbidity, mortality, and increased financial burden 17. However, the evidence revealed that at least 20% of all nosocomial infections as probably preventable 18. Infections by multidrug-resistant organisms are common in hospitals in particular and are a worldwide threat 19.
The patients and their careers would be benefited from an effective infection control programme. It will release significant health care resources for alternative use 20. The study revealed that about 65–70% of cases of catheter-associated bloodstream infections, and 55% of cases of ventilator-associated pneumonia and surgical site infections may be preventable 21. It is likely that restoring hygienic standards in hospitals is a method of controlling HAIs, which is would be cost-effective 3.
However, the control of infection and prevention of healthcare associated infections is a continuing problem globally. The healthcare workers’ practice is still reported as suboptimal and these infections persist, despite the initiatives and strategies to lessen the burden of infection 22. The protection of patients from the problems related to HAIs necessitates the allocation of adequate financial resources, scientific research, and a strong commitment from all healthcare providers 10. The standard precautions are suggested to avoid transmission of infection in hospitals. But, the implementation is reliant on the knowledge and attitudes of healthcare workers 23. Having poor level of awareness and practice of infection control creating a significant risk of HAIs for patients and staff 24.
As explained above, the magnitude of HAIs is growing globally. This causes considerable morbidity and mortality. However, there is a limitation of the studies that have addressed knowledge, attitude and associated factors of instrument processing among nurses working in the study setting, including worldwide. Therefore, this study was intended to assess knowledge, attitude and associated factors of instrument processing among nurses working at Asella Referral and Teaching Hospital, Oromia Regional State, Ethiopia.
Asella Referral and Teaching Hospitals is one of the oldest public hospitals in the country. It is located in Asella town; 175 km far to southeast of Addis Ababa, the capital city of Ethiopia. It provides services for approximately 3.5 million population to Arsi zone and nearby zones like Bale and West Arsi Zones. The hospital serves as teaching and clinical services in surgery, internal medicine, gynecology and obstetrics, pediatrics and child health, maxillofacial surgery, psychiatry, ophthalmology, pathology, and radiology. The inpatient department services include general surgery, urologic surgery, neurosurgery, and renal surgery. The study was conducted from December 20 to 29/2021.
Institution based cross sectional survey was done at Asella Referral and Teaching Hospital.
The source population for this study were all nurses working at Asella Teaching and Referral Hospital.
The study population for this study were all nurses working at Asella Teaching and Referral hospital and who fulfilled the inclusion criteria.
Inclusive criteria
All nurses working at all clinical departments and who were willing to participate in the study were included.
Exclusion criteria
Nurses who were on study leave and annual leave were excluded from this study.
Since we did complete survey, all nurses working at Asella Teaching and Referral hospital were included into this study. By using the census method, we have included all nurses who were working at Asella Teaching and Referral hospital and who fulfilled the inclusion criteria during the data collection period. Lastly, we obtain the sample size of 335 for this study.
During this study, initially we have checked the eligibility of the nurses using the Asella Teaching and Referral hospital nursing staff registration, which we got from nursing matron. After this, Then, all nurses available during a day of data collection period and nurses who fulfilled the inclusion criteria and volunteers to participate in this study were included in to this survey.
Knowledge toward instrument processing
Attitude toward instrument processing
Sociodemographic factors: Gender, age, level of education, marital status, and average monthly income.
Institutional and personal related factors: Working experience, ever had infection prevention training, awareness on instrument processing methods, availability of posters on instrument processing, availability of guideline on instrument processing, vaccination against hepatitis B, and department currently serving.
Good Knowledge toward Instrument Processing
If nurses scored the mean and above the mean value on knowledge questions related to instrument processing 25.
Poor Knowledge toward Instrument Processing
If nurses scored below the mean value on the knowledge questions related to instrument processing 25.
Positive Attitude
If nurses scored mean and above the mean value for the attitude questions related to instrument processing.
Negative attitude
If nurses scored below the mean value on the attitude questions related to instrument processing.
Data were collected by using a semistructured face-to-face interviewer-based questionnaire. The questionnaire was prepared in English from relevant literature reviewed 25. The questionnaire includes 5 parts; sociodemographic characteristics of nurses, institutional and personal related factors, knowledge and attitude toward on instrument processing. There were 12 questions to assess knowledge towards instrument processing and 10 questions to assess attitude towards instrument processing were used. We have done a pretest on 15 nurses out of the study settings and the reliability of the questionnaire was checked by using reliability analysis. Training was provided on the data collection tools and procedures for data collectors for one day. Supervision was carried out at the time of data collection period.
EpiData version 4.2.0.0 was used for data entry. The data were exported to Statistical Package for the Social Sciences (SPSS) window version 23. The descriptive statistics, and frequency distribution were used to present the descriptive results. The results were presented by text, tables, and pie chart. Bivariable logistic regression was used to analyze the association between outcome and potential predictor variables. Then independent variables with P value less than 0.25 were considered as a candidate for Multivariable logistic regression analysis. During this, to display the strength of the association, crude odds ratio (COR) and adjusted odds ratio (AOR) with 95% confidence interval (CI) was calculated. Model fitness was checked by Hosmer-Lemeshow’s goodness-of-fit test for knowledge and attitude while the result was (p-value = 0.127) and (p-value = 0.899) respectively, which was p-value > 0.05. Finally, p value < 0.05 was considered as statistically significant for independent variables in the Multivariable logistic regression analysis.
A total of 335 nurses were participated in the study, providing a response rate of 99.11%. The mean age of the nurse was 31.16 years (standard deviation = 5.253). About 184(54.9%) of the nurses were aged below 31 years. The majority 182(54.3%) of the nurses were male. Most 305(91.0%) of the nurses were qualified for BSc degree and above. About 150(44.8%) of the nurses were orthodox followers (Table 1).
|
Variables |
Category |
Frequency |
Percent |
|---|---|---|---|
|
Age |
< 31 years |
184 |
54.9 |
|
≥ 31 years |
151 |
45.1 |
|
|
Gender |
Male |
182 |
54.3 |
|
Female |
153 |
45.7 |
|
|
Marital status |
Without husband |
123 |
36.7 |
|
With husband |
212 |
63.3 |
|
|
Educational level |
Diploma |
30 |
9.0 |
|
BSc degree and above |
305 |
91.0 |
|
|
Religion |
Orthodox |
150 |
44.8 |
|
Protestant |
73 |
21.8 |
|
|
Muslim |
104 |
31.0 |
|
|
Catholic |
8 |
2.4 |
|
|
Ethnicity |
Oromo |
243 |
72.5 |
|
Amhara |
86 |
25.7 |
|
|
Tigre |
6 |
1.8 |
|
|
Average monthly income |
< 7000 ETB |
124 |
37.0 |
|
≥ 7000 ETB |
211 |
63.0 |
The majority 284(84.8%) of the nurses were served for less than 10 years. About two-third 222(66.3%) of nurses ever had infection prevention training. The majority 301(89.9%) of nurses responded as they had awareness about instrument processing methods (Table 2).
|
Variables |
Category |
Frequency |
Percent |
|---|---|---|---|
|
Working experience |
< 10Years |
284 |
84.8 |
|
≥ 10 Years |
51 |
15.2 |
|
|
Ever had infection prevention training |
Yes |
222 |
66.3 |
|
No |
113 |
33.7 |
|
|
Awareness on Instrument processing methods |
Yes |
301 |
89.9 |
|
No |
34 |
10.1 |
|
|
Availability of posters on instrument processing |
Yes |
201 |
60.0 |
|
No |
134 |
40.0 |
|
|
Availability of guideline on instrument processing |
Yes |
184 |
54.9 |
|
No |
151 |
45.1 |
|
|
Vaccination against hepatitis B |
Yes |
226 |
67.5 |
|
No |
109 |
32.5 |
|
|
Department currently serving |
Surgical ward |
64 |
19.1 |
|
Gynecologic and Obstetrics ward |
40 |
11.9 |
|
|
Emergency |
46 |
13.7 |
|
|
Medical ward |
24 |
7.2 |
|
|
ART, EPI, TB, and OPD |
123 |
36.7 |
|
|
Pediatric ward |
38 |
11.4 |
|
|
Note: ART = Antiretroviral Therapy, EPI = Expanded Programme on Immunization, TB = Tuberculosis, OPD = Outpatient Department. |
|||
In this study, the nurses’ good level of knowledge about instrument processing was 61.8% (n = 207, 95%CI; 56.5, 66.9) (Fig. 1).
In this study, the nurses’ positive level of attitude about Instrument processing was 65.4% (n = 219, 95%CI; 60.5, 70.4) (Fig. 2).
Age, gender, marital status, educational level, average monthly income, working experience, ever trained on infection prevention, having awareness on instrument processing, availability of posters on instrument processing, availability of guideline on instrument processing, being vaccinated against hepatitis B, and department currently serving were checked for their association with knowledge towards instrument processing. In Bivariable logistic regression, only gender was factor that had a p-value > 0.25 and they were omitted from the final model, Multivariable logistic regression while the rest factors had a p-value < 0.25. However, in Multivariable logistic regression, only average monthly income, working experience, awareness on Instrument processing methods, availability of guideline on instrument processing and department currently serving were factors significantly associated with knowledge towards instrument processing.
The odds of having good knowledge towards instrument processing among nurses who had an average monthly income of ≥ 7000 ETB was 2.595 times (AOR = 2.595, 95%CI: 1.49,4.53; p = 0.001) higher when compared with nurses who had an average monthly income of < 70000 ETB. The likelihood of having good knowledge towards instrument processing among nurses who had a working experience of ≥ 10 Years was 5.06 (AOR = 5.06, 95%CI:1.90,13.45: p = 0.001) more likely than nurses who had a working experience of < 10 Years.
The odds of having good knowledge towards instrument processing among nurses who had an awareness on Instrument processing methods was 5.366 times (AOR = 5.366, 95%CI: 2.05,14.05; p = 0.001) higher when compared with their contrary. The likelihood of having good knowledge towards instrument processing among nurses who responded the availability of guideline on instrument processing within their department was 3.611 (AOR = 3.611, 95%CI: 1.897,6.88; p = 0.000) more likely than nurses who responded that the was no availability of guideline on instrument processing within their department.
Moreover, the odds of having good knowledge towards instrument processing among nurses who were currently working in surgical ward was 2.495 times (AOR = 2.495, 95%CI: 1.008,6.18; p = 0.048), currently working in ART, EPI, TB, and OPD was 2.29 times (AOR = 2.29, 95%CI: 1.029,5.098; p = 0.042), and currently working in pediatric ward was 4.74 times (AOR = 4.74, 95%CI: 1.536,14.63; p = 0.007) higher when compared with nurses currently working in emergency department (Table 3).
|
Variables |
Category |
Knowledge |
COR (95%CI) |
AOR (95%CI |
p-value |
|
|
Good |
Poor |
|||||
|
Age |
< 31 years |
99(53.8%) |
85(46.2%) |
1 |
1 |
|
|
≥ 31 years |
108(71.5%) |
43(28.5%) |
2.156(1.36,3.41) |
1.40(0.796,2.47) |
0.242 |
|
|
Gender |
Male |
113(62.1%) |
69(37.9%) |
1.028(0.66,1.60) |
NA |
|
|
Female |
94(61.4%) |
59(38.6%) |
1 |
|||
|
Marital status |
Without husband |
68(55.3%) |
55(44.7%) |
1 |
1 |
|
|
With husband |
139(65.6%) |
73(34.4%) |
1.54(0.978,2.426) |
0.91(0.51,1.597) |
0.732 |
|
|
Educational level |
Diploma |
18(60.0%) |
12(40.0%) |
1 |
||
|
BSc degree and above |
189(62.0%) |
116(38.0%) |
1.086(0.505,2.34) |
NA |
||
|
Average monthly income |
< 7000 ETB |
61(49.2%) |
63(50.8%) |
1 |
1 |
|
|
≥ 7000 ETB |
146(69.2%) |
65(30.8%) |
2.32(1.468,3.67) |
2.595(1.49,4.53) |
0.001 |
|
|
Working experience |
< 10Years |
163(57.4%) |
121(42.6%) |
1 |
1 |
|
|
≥ 10 Years |
44(86.3%) |
7(13.7%) |
4.666(2.03,10.72) |
5.06(1.90,13.45) |
0.001 |
|
|
Ever had infection prevention training |
Yes |
149(67.1%) |
73(32.9%) |
1.936(1.22,3.076) |
0.78(0.424,1.44) |
0.424 |
|
No |
58(51.3%) |
55(48.7%) |
1 |
1 |
||
|
Awareness on Instrument processing methods |
Yes |
197(65.4%) |
104(34.6%) |
4.546(2.09,9.868) |
5.366(2.05,14.05) |
0.001 |
|
No |
10(29.4%) |
24(70.6%) |
1 |
1 |
||
|
Availability of posters on instrument processing |
Yes |
138(68.7%) |
63(31.3%) |
2.063(1.314,3.24) |
1.05(0.573,1.93) |
0.874 |
|
No |
69(51.5%) |
65(48.5%) |
1 |
1 |
||
|
Availability of guideline on instrument processing |
Yes |
137(74.5%) |
47(25.5%) |
3.373(2.128,5.35) |
3.611(1.897,6.88) |
0.000 |
|
No |
70(46.4%) |
81(53.6%) |
1 |
1 |
||
|
Vaccination against hepatitis B |
Yes |
156(69.0%) |
70(31.0%) |
2.534(1.584,4.06) |
1.414(0.79,2.52) |
0.242 |
|
No |
51(46.8%) |
58(53.2%) |
1 |
1 |
||
|
Department currently serving |
Emergency |
23(50.0%) |
23(50.0%) |
1 |
1 |
|
|
Gynecologic and Obstetrics ward |
24(60.0%) |
16(40.0%) |
1.50(0.637,3.534) |
1.252(0.46,3.40) |
0.659 |
|
|
Surgical ward |
42(65.6%) |
22(34.4%) |
1.909(0.88,4.142) |
2.495(1.008,6.18) |
0.048 |
|
|
Medical ward |
15(62.5%) |
9(37.5%) |
1.667(0.608,4.57) |
1.225(0.383,3.92) |
0.732 |
|
|
ART, EPI, TB, and OPD |
74(60.2%) |
49(39.8%) |
1.51(0.764,2.985) |
2.29(1.029,5.098) |
0.042 |
|
|
Pediatric ward |
29(76.3%) |
9(23.7%) |
3.22(1.252,8.292) |
4.74(1.536,14.63) |
0.007 |
|
| Notes: Figures in bold show statistically significant (p < 0.05), number 1 represents the reference category, NA refers to variables omitted from Multivariable logistic regression analysis because of their p-value > 0.25 in Bivariable logistic regression analysis. The currency for the monthly income is Ethiopian birr. Abbreviations: COR = Crude Odds Ratio; AOR = Adjusted Odds Ratio; CI = Confidence Interval; ETB = Ethiopian Birr, NA = not applicable. | ||||||
Age, gender, marital status, educational level, average monthly income, working experience, ever trained on infection prevention, having awareness on instrument processing, availability of posters on instrument processing, availability of guideline on instrument processing, being vaccinated against hepatitis B, department currently serving and knowledge towards instrument processing were checked for their association with attitude towards instrument processing. In Bivariable logistic regression, only educational level and average monthly income were factors that had a p-value > 0.25 and they were omitted from the final model, Multivariable logistic regression. However, in Multivariable logistic regression, only gender, awareness on instrument processing, department currently serving and knowledge towards instrument processing were factors significantly associated with attitude towards instrument processing.
The odds of having positive attitude towards instrument processing among nurses who were male was 1.697 times (AOR = 1.697, 95%CI: 1.005,2.865; p = 0.048) higher when compared with female nurses. The likelihood of having positive attitude towards instrument processing among nurses who had awareness about Instrument processing methods was 3.789 (AOR = 3.789, 95%CI: 1.50,9.573; p = 0.005) more likely than nurses who had no awareness about Instrument processing methods.
The odds of having positive attitude towards instrument processing among nurses who were currently working in surgical ward was 39.7% times (AOR = 0.397, 95%CI: 0.159,0.989; p = 0.047) less likely when compared with nurses currently working in emergency department. The likelihood of having positive attitude towards instrument processing among nurses who had good knowledge towards instrument processing was 4.041 (AOR = 4.041, 95%CI: 2.303,7.092; p = 0.000) more likely than their contrary (Table 4).
|
Variables |
Category |
Attitude |
COR (95%CI) |
AOR (95%CI |
p-value |
|
|
Positive |
Negative |
|||||
|
Age |
< 31 years |
105(57.1%) |
79(42.9%) |
1 |
||
|
≥ 31 years |
114(75.5%) |
37(24.5%) |
2.318(1.446,3.716) |
1.622(0.909,2.895) |
0.102 |
|
|
Gender |
Male |
127(69.8%) |
55(30.2%) |
1.531(0.974,2.407) |
1.697(1.005,2.865) |
0.048 |
|
Female |
92(60.1%) |
61(39.9%) |
1 |
|||
|
Marital status |
Without husband |
74(60.2%) |
49(39.8%) |
1 |
||
|
With husband |
145(68.4%) |
67(31.6%) |
1.433(0.902,2.276) |
0.880(0.495,1.565) |
0.665 |
|
|
Educational level |
Diploma |
20(66.7%) |
10(33.3%) |
1 |
||
|
BSc degree and above |
199(65.2%) |
106(34.8%) |
0.939(0.424,2.078) |
NA |
||
|
Average monthly income |
< 7000 ETB |
77(62.1%) |
47(37.9%) |
1 |
||
|
≥ 7000 ETB |
142(67.3%) |
69(32.7%) |
1.256(0.791,1.996) |
NA |
||
|
Working experience |
< 10Years |
179(63.0%) |
105(37.0%) |
1 |
||
|
≥ 10 Years |
40(78.4%) |
11(21.6%) |
2.133(1.049,4.336) |
1.239(0.534,2.871) |
0.618 |
|
|
Ever had infection prevention training |
Yes |
159(71.6%) |
63(28.4%) |
2.229(1.392,3.570) |
1.373(0.754,2.502) |
0.300 |
|
No |
60(53.1%) |
53(46.9%) |
1 |
|||
|
Awareness on Instrument processing methods |
Yes |
210(69.8%) |
91(30.2%) |
6.410(2.879,14.275) |
3.789(1.50,9.573) |
0.005 |
|
No |
9(26.5%) |
25(73.5%) |
1 |
|||
|
Availability of posters on instrument processing |
Yes |
142(70.6%) |
59(29.4%) |
1.782(1.127,2.816) |
1.40(0.754,2.601) |
0.287 |
|
No |
77(57.5%) |
57(42.5%) |
1 |
|||
|
Availability of guideline on instrument processing |
Yes |
131(71.2%) |
53(28.8%) |
1.770(1.123,2.787) |
0.921(047,1.802) |
0.809 |
|
No |
88(58.3%) |
63(41.7%) |
1 |
|||
|
Vaccination against hepatitis B |
Yes |
156(69.0%) |
70(31.0%) |
1.627(1.014,2.612) |
0.929(0.509,1.694) |
0.809 |
|
No |
63(57.8%) |
46(42.2%) |
1 |
|||
|
Department currently serving |
Emergency |
32(69.6%) |
14(30.4%) |
1 |
||
|
Gynecologic and Obstetrics ward |
29(72.5%) |
11(27.5%) |
1.153(0.452,2.941) |
1.294(0.449,3.734) |
0.633 |
|
|
Surgical ward |
36(56.3%) |
28(43.8%) |
0.563(0.253,1.251) |
0.397(0.159,0.989) |
0.047 |
|
|
Medical ward |
14(58.3%) |
10(41.7%) |
0.613(0.22,1.709) |
0.445(0.141,1.411) |
0.169 |
|
|
ART, EPI, TB, and OPD |
78(63.4%) |
45(36.6%) |
0.758(0.366,1.569) |
0.686(0.297,1.582) |
0.377 |
|
|
Pediatric ward |
30(78.9%) |
8(21.1%) |
1.641(0.603,4.466) |
1.168(0.374,3.648) |
0.790 |
|
|
Knowledge towards instrument processing |
Poor |
56(43.8%) |
72(56.3%) |
1 |
||
|
Good |
163(78.7%) |
44(21.3%) |
4.763(2.94,7.717) |
4.041(2.303,7.092) |
0.000 |
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In this study, the nurses’ good level of knowledge about Instrument processing were 61.8% (n = 207, 95%CI; 56.5, 66.9). This finding was higher than the study conducted in Addis Ababa, Ethiopia (46.3%) 25. The variation might be due to that the difference in the study population, the study of Addis Ababa, Ethiopia was done among healthcare workers. This finding was also higher than the study conducted in Trinidad and Tobago (20.3%)26. The possible justification would be that the study of Trinidad and Tobago was conducted the assessment of knowledge towards infection prevention. Besides, it was done among healthcare workers. This finding was lower than the study done in Saudi Arabia (68.4%%) 27. The variation might be due to that the study of Saudi Arabia was conducted the assessment of knowledge about infection control, and also difference in study population, while the study of Saudi Arabia was done among primary care professionals.
The odds of having good knowledge towards instrument processing among nurses who had an awareness on Instrument processing methods was 5.366 times (AOR = 5.366, 95%CI: 2.05,14.05; p = 0.001) higher when compared with their contrary. The likelihood of having good knowledge towards instrument processing among nurses who responded the availability of guideline on instrument processing within their department was 3.611 (AOR = 3.611, 95%CI: 1.897,6.88; p = 0.000) more likely than nurses who responded that there was no availability of guideline on instrument processing within their department. The odds of having good knowledge towards instrument processing among nurses who were currently working in surgical ward was 2.495 times (AOR = 2.495, 95%CI: 1.008,6.18; p = 0.048), currently working in ART, EPI, TB, and OPD was 2.29 times (AOR = 2.29, 95%CI: 1.029,5.098; p = 0.042), and currently working in pediatric ward was 4.74 times (AOR = 4.74, 95%CI: 1.536,14.63; p = 0.007) higher when compared with nurses currently working in emergency department.
In this study, the nurses’ positive level of attitude about Instrument processing was 65.4% (n = 219, 95%CI; 60.5, 70.4). This finding was higher than the study conducted in Trinidad and Tobago (46.7%) 26. The possible justification would be that the study of Trinidad and Tobago was conducted the assessment of attitude towards infection prevention. Besides, it was done among healthcare workers. This finding was lower when compared with the study done in Saudi Arabia (88.2%)27. The variation might be due to that the study of Saudi Arabia was conducted the assessment of attitude toward infection control policy and procedures, and also difference in study population, while the study of Saudi Arabia was done among primary care professionals.
The odds of having positive attitude towards instrument processing among nurses who were male was 1.697 times (AOR = 1.697, 95%CI: 1.005,2.865; p = 0.048) higher when compared with female nurses. The likelihood of having positive attitude towards instrument processing among nurses who had awareness about Instrument processing methods was 3.789 (AOR = 3.789, 95%CI: 1.50,9.573; p = 0.005) more likely than nurses who had no awareness about Instrument processing methods. The odds of having positive attitude towards instrument processing among nurses who were currently working in surgical ward was 39.7% times (AOR = 0.397, 95%CI: 0.159,0.989; p = 0.047) less likely when compared with nurses currently working in emergency department. The likelihood of having positive attitude towards instrument processing among nurses who had good knowledge towards instrument processing was 4.041 (AOR = 4.041, 95%CI: 2.303,7.092; p = 0.000) more likely than their contrary.
This study was not finalized in the absence of limitations. Starting from the study design used, which was a cross-sectional. A cross-sectional design does permit to determine the cause-and-effect relationship. Furthermore, there were limitations of the studies that had addressed this crucial topic, even worldwide. Hopefully, this study would support in minimizing such challenges for future researchers who will conduct a study on these problems.
This study showed that the level of good knowledge, attitude towards Instrument processing among nurses working at Asella referral and teaching hospital was 61.8% (n = 207, 95%CI; 56.5, 66.9) and 65.4% (n = 219, 95%CI; 60.5, 70.4), respectively. The Multivariable logistic regression analysis showed that; average monthly income, working experience, awareness on Instrument processing methods, availability of guideline on instrument processing and department currently serving were factors significantly associated with knowledge towards instrument processing. Gender, awareness on instrument processing, department currently serving and knowledge towards instrument processing were factors significantly associated with attitude towards instrument processing. We recommend that health educational programs, training, and demonstrations on instrument processing are essential to improve the knowledge and attitude towards instrument processing.
Ethical clearance was received from Arsi University, College of Health Sciences, and Department of Nursing. Then the official letter was submitted to Asella Referral and Teaching Hospital. Then, permission was obtained from the concerned body. The necessary information about the study was explained to all nurses recruited to the study before data collection. Moreover, the nurses were assured about the confidentiality of the information they provide us for this study. Finally, we have received the written informed consent from the nurses were participated in this study.
The authors have designed the study and supervised the data collection, contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
The data used to support the findings of this study are included within the article.
Not applicable.
The authors would like to acknowledge Asella Referral and Teaching Hospital, Supervisor, data collectors, and the study participants.
The authors received no financial support for this study.
The authors declare that they have no conflicts of interest in this work.