Level of awareness and practice in Standard Precautions
Good awareness in standard precautions was found in 11.38% only. Among doctors, it was still lower (5.1%) and no lab technician could answer all the questions correctly. These findings are in line with a 2012 Nigerian study, by Abdulraheem et al, where only 13% of the respondents had adequate knowledge of universal precautions.(18) But the findings are in contrast to a 2013 French study, which showed that 39.3% of subjects had good knowledge of standard precautions.(19) The difference could be due to the background settings, as the present study and the Nigerian study took place in public sector institutions in low- and middle-income countries, where health care spending is significantly lower than that of a high-income country like France.(20)
Good awareness was seen the most among nurses (15.9%), and Nursing Assistants (11.3%), similar to a study in Jamaica, where more nurses were very knowledgeable of the universal precautions than the respondents in other job categories.(21)
The respondents, in general, exhibited varying levels of awareness in the different elements of standard precautions. In hand hygiene 86.5% had good awareness, which was in line with a Nigerian study(22) where it was 83%. Good awareness in personal protective equipment use was found in 64% of the respondents, cough hygiene in 78.8% and safe injection practices in 93.5%. This points to the relative importance given by the health personnel to each precautionary element. Importance of self-protection, and respiratory hygiene has been underestimated by the staff, and the sensitizations and job-trainings in these aspects of the standard precautions are not having the desired impact.
It was also noted that the respondents in different job-categories had varying levels of knowledge in the different aspects of the standard precautions. Nurses were the most to have good awareness in waste disposal and decontamination (24.5%). Nursing assistants were the most to have good awareness in hand hygiene (97.5%), use of PPE (78.8%), safe injection practices (98.8%), and respiratory hygiene (82.3%). Doctors had better awareness in hand hygiene (91%), and respiratory hygiene (80.8%), than use of PPE (51.3%), safe injection practices (84.6%), while lab technicians exhibited better awareness of safe injection practices (75%), use of PPE (56.3%), and respiratory hygiene (56.3%), and least in waste disposal (6.25%). This shows that the awareness of the respondents tends to be more on the aspects of standard precautions which they put into practice more in relation to their routine duties.
Good practice is seen in 5.5% of respondents, similar to a recent Ethiopian study.(23) Good practice in personal protective equipment use, cough hygiene, safe injection practices and waste disposal were seen in 69.5%, 94.2%, 86.8% and 97.8% respectively. Only 9.2% had good practice in hand hygiene which is in line with a study from Kolkata which showed only 12.5% washed their hands before injection.(24)
Doctors were most likely to have good practice (8.97%), whereas none of the lab technicians had good practice in standard precautions. Doctors were the most likely to have good practice in hand hygiene (15.4%) and safe injection practices (96.15%) when the components are taken separately. Nurses were the most likely to have good practice in cough hygiene (98%) and PPE use (73.5%) which confirms a Jamaican study in which more frequent use of protective equipment was seen among nurses.(21)
4.2. Factors affecting Practice
Good practice of hand hygiene was seen more towards older age groups and among males. Training received, length of service and availability of resources also had positive association. These findings are in confirmation with a 2002 Geneva study which showed that availability of alcohol-based hand rubs increased hand hygiene compliance.(25)
Good practice in PPE use also increased with age. Female gender, training received length of service and availability of resources also had positive association. This finding is in line with a Jamaican study by Vaz et al.(21)
Good practice in SIP is similar to that in hand hygiene as there is positive association with increasing age, male sex, training received, increase in total years of service, specific protocol uses and availability of resources.
There was significant association for training attendance and availability of resources with practice of respiratory hygiene. Practice of respiratory hygiene and waste disposal and decontamination was also almost equal among different age groups and between the two sexes. Use of specific protocol and availability of resources both had positive association with good practice of waste disposal.
Hindrances to Practice
There was a positive effect for availability of resources on practice of standard precautions. So, lack of these resources was a hindrance to the practice of standard precaution. The essential resources readily available were gloves (94.8%) puncture free containers (86.5%), colour coded bags (77.8%) and signboards (71%). Alcohol based hand rub (9.2%) and safe receptacles (0.9%) were least available. This could be one of the reasons due to which good awareness in hand hygiene was not reflected in the practice.
Significant positive association was noted between increasing age and awareness in respiratory hygiene and hand hygiene. There was significant association between profession and training attendance. Trainings in standard precautions and blood safety were more likely to be attended by lab technicians.
The Hepatitis B vaccination was taken by 68.6% of respondents only. This was comparable with the findings of a study among nurses in Kolkata where only about 52.5% respondents were protected by hepatitis B vaccination(24). Doctors were most likely to be vaccinated (97.4%). Only 33.7% of nursing assistants were vaccinated.