A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED …



A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING ASEPTIC TECHNIQUES AMONG STAFF NURSES IN A SELECTED HOSPITAL, BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

SUBMITTED BY

KANCHANA. M

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1. |NAME OF THE CANDIDATE AND ADDRESS |KANCHANA. M |

| | |I YEAR M.Sc.( NURSING ) |

| | |HARSHA COLLEGE OF NURSING, |

| | |193/4, SONDEKOPPA CIRCLE, NH4, NELAMANGALA, BANGALORE. |

|2. |NAME OF THE INSTITUTION |HARSHA COLLEGE OF NURSING |

| | |No. 193/4 SONDAKOPPA CIRCLE, |

| | |NH4 NELAMANGALA, |

| | |BANGALORE-562 123. |

|3. |COURSE OF STUDY AND SUBJECT |MASTER DEGREE IN NURSING, |

| | |MEDICAL SURGICAL NURSING. |

|4. |DATE OF ADMISSION TO COURSE | |

| | |06-07-2009 |

|5. |TITLE OF THE TOPIC |A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING |

| | |PROGRAMME REGARDING ASEPTIC TECHNIQUES AMONG STAFF NURSES IN A |

| | |SELECTED HOSPITAL, BANGALORE. |

1. NEED FOR THE STUDY

Nosocomial infections related to the development of catheter-related infections are a leading cause of morbidity and mortality among critically ill hospitalized patients. Despite important preventive efforts, these infections remain a daily concern for most clinicians. Significant improvements in the knowledge of their pathophysiology and diagnosis allow us to treat them more efficiently.1

A Study estimated that over 27 million surgical procedures are performed in the all over world every year. Surgical site infections are the third most common nosocomial (hospital-acquired) infection and are responsible for longer hospital stays and increased costs to the patient and hospital. Aseptic technique is vital in reducing the morbidity and mortality associated with surgical infection.2

A study was done on to analyse the pattern of nosocomial infection in geriatric patients admitted in Intensive Care Unit. incidence of nosocomial infections in geriatric patients was 19.7% (80/405 patients).urinary tract infections (45%) were the most frequent, followed by pneumonias (30%) and blood stream infections (16%). A direct correlation existed between the use of intensive devices in ICU and the occurrence of nosocomial infections.3

The incidence of nosocomial infections in children varies by age and hospital unit, ranging from 0.2% to 23.5% in prospective cohort studies. A recent multicenter European study demonstrated an overall hospital nosocomial infection rate of 2.5% , with the highest rates in pediatric ICUs (23.5%), hematology units (8.2%), and neonatal units(7%), and the lowest rate in general pediatric units(1%). A second prospective cohort study of 4684 pediatric patients found the highest nosocomial infection rates in children aged 23 months or younger (11.5%). 4

A prospective study was conducted on Intravascular Catheter Related infection. The results showed that 58 (86.6%) patients had their catheter related local infection and 9 (13.4%) patients had Catheter Related Local and Blood Stream Infections. The most common indicates was for administering parental antibiotics (88.1%). Infections were more common in triple lumen (55.2%) and in subclavian catheters (43.3%).5

A study was conducted on nosocomial infection in elderly trauma patients. The results showed that nosocomial infections were acquired by 147 patients (39%), with a total of 297 infections. Respiratory and genitourinary tract infections were the most common nosocomial infection.6

A prospective, single blinded observational study was done on hand hygiene and simple aseptic measures before invasive procedures are effective in reducing rates of health care associated infection. The results showed that hand hygiene between patient consultations was very low at 14% in the UK and 12 % in Newzeland.7

A comparative study was conducted on the detection of Methicillin-Resistant Staphylococcus aureus directly from Clinical Specimens by Multiplex Polymerase Chain Reaction and Conventional Culture Method. Out of 270 samples, Polymerase in Reaction could detect 29 (10.74%) Methicillin Resistant Staphylococcus Aureus isolates and conventional method 26(9.62%). Multiplex Polymerase Chain Reaction is a good alternative for rapid and accurate deduction of Methicillin Resistant Staphylococcus Aureus directly from clinical specimens.8

A study was done on selective decontamination for the prevention of nosocomial respiratory infection in Intensive Care Unit Patients. The study concluded that mortality was reduced by approximately 3.5% with selective digestive tract decontamination and by 2.9% with selective digestive tract decontamination.9

Issues in aseptic technique challenge every peri- operative practitioner equally challenging to creatively, present information to large groups of staff members in a way that facilitates learning. The process used to address practice issues in aseptic technique and to present educational in service programs to a large number of staff members and health care workers. 10

Nurses specializing in infection control as responsible for agency-wide policy development and program direction. Staff nurses play an important role in risk deduction by careful attention to hand washing and by following guidelines to reduce technical risks associated with patient care.11

The practice of aseptic techniques among staff nurses is not up to the mark.In order to improve the knowledge of staff nurse regarding aseptic techniques, the investigator has chosen this study to find out the effectiveness of structured teaching programme on aseptic techniques among staff nurses.

2. REVIEW OF LITERATURE

A review of literature is an essential aspect of scientific research. It involves the systematic identification, scrutiny and summary of written material that contains information on the research problems.

Review of literature is discussed under the following headings.

1. Studies related to aseptic techniques

2. Studies related to nurses knowledge on aseptic techniques

1. Studies related to aseptic techniques

A study was done on improving standards of aseptic practice through an Aseptic Non Touch Technique (ANTT). The study revealed that the an effective tool for standardizing aseptic practice across large clinical workforces.12

A retrospective survey study was done on evaluation of aseptic measures in the performance of epidural catheterization and perception of its risk of infection. The results showed that good aseptic practice in epidural catheterization should be clarified by a consensus conference. There is an obvious lack of knowledge concerning features of epidural abscess.13

A study was sought to determine if the use of only daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream infection because of methicillin resistant staphylococcus aureus and vancomycin-resistant enterococcus among ICU patients. A study concluded and daily chlorhexidine bathing among intencive care unit patients may reduce the acquisition of methicillin resistant staphylococcus aureus and vancomycin-resistant enterococcus.14

A study was done on outcomes in drug resistant acinetobacter infection. The results showed that multidrug resistant are associated with significant mortality and greater duration of hospital stay.15

2. Studies related to nurses knowledge on aseptic techniques

A study was done on prevalence of hospital- acquired infection (HAI) and research factors associated with its occurrence. The results showed that the hospital acquired infection is linked to the medical category, the use of intravascular devices and antibiotic prophylaxis.16

A study investigated the epidemiology of nosocomial bloodstream infection in elderly intensive care unit patients. The study conclude that over the past 15 years, an increasing number of elderly patients were admitted to intensive care unit. The incidence of nosocomial bloodstream infection is lower among very old intensive care unit patients when compared to middle –aged and old patients.17

A study was conducted on the incidence of nosocomial pneumonia in a medical intensive care unit and journal medical ward patients in a public hospital in Bombay, India. The results showed that crude mortality in general ward patients was 88.9% vs 14.6% in patients without pneumonia. The corresponding figures for Intensive Care Unit patients were 67.4 vs 37.1%;40% of the crude mortality in Intensive care unit patients with pneumonia was attributed to the infection. Infected patients stayed an additional 5.8 days in the intensive care unit and 6.7 days in general ward.18

A study was conducted on pediatric infectious disease on intensive care unit of sepsis. Among infants in the retrospective cohort group, 88(77%) of 115 had clinical sepsis, and 59 (51%) died. In the case series group, we septic ................
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