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

| | |KANCHANA M |

|1. |NAME OF THE CANDIDATE AND ADDRESS |I YEAR M.Sc.( NURSING ) |

| | |HARSHA COLLEGE OF NURSING, |

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

| | |HARSHA COLLEGE OF NURSING |

|2. |NAME OF THE INSTITUTION |No. 193/4 SONDAKOPPA CIRCLE, |

| | |NH4 NELAMANGALA, |

| | |BANGALORE-562 123. |

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

| | |MEDICAL SURGICAL NURSING. |

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|4. |DATE OF ADMISSION TO COURSE |06-07-2009 |

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| | |A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME |

| | |REGARDING ASEPTIC TECHNIQUES AMONG STAFF NURSES IN A SELECTED HOSPITAL, |

|5. |TITLE OF THE TOPIC |BANGALORE. |

|6 .BRIEF RESUME OF INTENDED WORK |

|INTRODUCTION |

|‘‘Prevention is better than cure’’ |

|-Indian Proverb |

|Infection is the attack on body by pathogenic microorganism or the entry of any disease producing factor in the body, developing and causing |

|damage to the body.1 |

|Nosocomial infection is an infection originating in a patient while in the hospital or other health care facility. It denotes a new disorder |

|cannulated to the patient’s primary condition associated with being in a hospital. It includes infections acquired in the hospital but appearing|

|after discharge, and also such infections among the staff of the facility.2 |

|Nosocomial infections are leading cause of death in the United States and are associated with significant morbidity. The rate of hospital |

|acquired infections has increased by 36% in the last 20 years, and 25% of the clients developed a nosocomoal infection. Infections present or |

|incubating at the time of admission to the hospital are referred to as community acquired. |

|The source of nosocomial pathogens in health care facilities varies, but both health care workers and clients are reservoirs in most instances. |

|The most common sites of nosocomial infection in clients are the urinary tract, lower respiratory tract, surgical wound, and the blood stream. |

|Prevention of nosocomial infections through hand washing, combined with principles of asepsis and proper use of gloves.3 |

|Asepsis is freedom from infection or prevention of contact with microorganisms. Aseptic technique is a set of specific practices and procedures |

|performed under carefully controlled conditions with goal of minimizing contamination by pathogens.4 |

|Medical asepsis practices are used to protect the clients and the environment from the transmission of disease producing organisms. Medical |

|asepsis is a ‘’ Clean technique’’. It consist of Sterilization of articles, Hand washing, Gown technique, Wearing gloves and face mask. |

|Surgical aseptic procedures are used to keep objects or areas Sterile or completely free from microorganisms. Surgical asepsis is a ‘’Sterile |

|technique’’.5 |

|The effectiveness of infection control practices depends on nurse’s conscientiousness and consistency in using effective aseptic technique. It |

|is human nature to forget key procedural steps, or when hurried, to take short cuts that break aseptic procedures. However, failure to comply |

|with basic procedures places the client at risk for an infection that can seriously impair recovery or lead to death.6 |

|The nurse follows certain principles and practices including standard precautions to prevent and control of infection and it spread. During |

|daily routing care the nurse basic medical aseptic techniques to break the infection change for example, use gloves and a mask during dressing |

|change to break the entry of pathogens. The term standard precaution applies to blood and body fluids, nonintact skin, mucous membrenes from |

|all clients. The precautions will protect the client and provide protection of healthcare staff as directed by the occupational safety and |

|health administration.7 |

|Infection control nurse is responsible for the surveillance, analysis, and responding of Hospital Acquired infection; educating employees about |

|infection control and ensuring the implementation of various infection control polices in the hospital. Assessing environmental control through |

|surveillance monitoring. Conduct environmental rounds in all inpatient and outpatient care areas. Collect data on the incidence of selected |

|device use in identified intensive care units. Participating in quality/performance improvement activities by assessing, monitoring, and |

|measuring hospital acquired infections and evaluation outcomes on a continuous basis.8 |

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|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.9 |

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|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.10 |

|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 infection.11 |

|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%).12 |

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|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 indication was for |

|administering parental antibiotics (88.1%). Infections were more common in triple lumen (55.2%) and in subclavian catheters (43.3%).13 |

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|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.14 |

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|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.15 |

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|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.16 |

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|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.17 |

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|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 is used to address practice issues in aseptic technique and to present |

|educational in service programs to a large number of staff members and healthcare workers.18 |

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|Nurses specializing in infection control is responsible for agency-wide policy development and program direction. Staff nurses play an important|

|role in risk reduction by careful attention to hand washing and by following guidelines to reduce technical risks associated with patient |

|care.19 |

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|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. |

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|6.2. REVIEW OF LITERATURE |

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|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. |

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|1.Studies related to aseptic techniques |

|2. Studies related to nurses knowledge on aseptic techniques |

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|1.Studies related to aseptic techniques |

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|A study was done on improving standards of aseptic practice through an Aseptic Non Touch Technique (ANTT). The study revealed that ANTT |

|implementation process is an effective tool for standardizing aseptic practice across large clinical workforces.20 |

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|A retrospective study was conducted 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.21 |

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|A study was sought to determine the use of 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. The study concluded that daily |

|chlorhexidine bathing among intensive care unit patients may reduce the acquisition of methicillin resistant staphylococcus aureus and |

|vancomycin-resistant enterococcus.22 |

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|A study was done on outcomes in drug resistant acinetobacter infection. The results showed that multidrug resistance are associated with |

|significant mortality and greater duration of hospital stay.23 |

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|2. Studies related to nurses knowledge on aseptic techniques |

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|A study was done on the 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.24 |

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|A study investigated the epidemiology of nosocomial bloodstream infection in elderly intensive care unit patients. The study concluded 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.25 |

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|A study was done on the incidence of nosocomial pneumonia in a medical intensive care unit and 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.26 |

|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. Extrinsically contaminated iv fluids resulted in sepsis and deaths. The result of the study |

|concluded that standard infection control precautions significantly improve mortality and sepsis rates and are prerequisites for safe Neonatal |

|Intensive Care Unit care.27 |

|A study was done on the factors influencing post operative wound infections, such as the patient’s age, sex, type and duration of surgical |

|procedure, length of hospital stay and the type of anti- biotic prophylaxis used. The results will provide hospital administrators with |

|strategic goals and actions that might have a significant impact on reducing infection control procedures, and new information on anti-microbial|

|resistance is recommended to increase detection and identification of surgical wound infections.28 |

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|A study was done on aseptic hand washing practices of nurses working in pediatric neonatal intensive care unit. The result of the study showed |

|that the need for standardization of practice in the current centers for disease control and prevention guidelines, including the introduction |

|of alcohol handrub.29 |

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|A study was conducted on sterile versus non-sterile gloves use and aseptic technique. The result of the study showed that the improvement of |

|aseptic technique and therefore clean or sterile gloves, using a risk assessment protocol.30 |

|The study was conducted on the prevalence of Methicillin Resistant Staphylococcus aureus in surgical wound infections at AIIMS in 2001-02 was |

|determined. The result of the study showed that high incidence of MRSA in this hospital warrants the use of antibiotics and application of |

|control measures to prevent the spread of such resistant strains.31 |

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|6.3. STATEMENT OF THE PROBLEM |

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

|BANGALORE. |

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|6.4. OBJECTIVES OF THE STUDY |

|To Assess the existing knowledge on aseptic techniques among staff nurses. |

|To determine the post test knowledge level regarding aseptic techniques among the staff nurses following structure teaching programme. |

|To compare the pre and post teaching knowledge scores on aseptic techniques among staff nurses. |

|To associate the post teaching knowledge scores on aseptic techniques with demographic variables. |

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|6.5.HYPOTHESIS |

|There will be a significant increase in knowledge on aseptic techniques among staff nurses after structured teaching programme. |

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|6.6.OPERATIONAL DEFINITIONS |

|Effectiveness |

|It is out come of structure teaching identified in terms of knowledge gained among nurses. |

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|Structured teaching programme |

|It refers to well planned instruction material on aseptic practices given through lecture, demonstration and discussion. |

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|Aseptic Technique |

|Aseptic technique refers to those activities or efforts used to keep the patient free from micro-organisms. |

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|Staff Nurse |

|Refers to those who have completed General Nursing Midwifery & Bachelor of Nursing who are engaged in direct patient care. |

|6.7. ASSUMPTIONS |

|Knowledge influence behavior |

|Infection leads to complication |

|Some of the nursing procedures requires aseptic precaution |

|Nurses are aware of infection control practices and care expected to practice it. |

|Practice of aseptic techniques is related to the work environment and hence may be influenced by it. |

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|6.8.DELIMITATIONS |

|Data collection period is delimited to 4 weeks. |

|Only aseptic techniques will be chosen for the study. |

|Staff nurses aged between 20 and 50 years are selected for study. |

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|6.9.PROJECTED OUTCOME |

|The study will improve the knowledge of staff nurses regarding aseptic techniques before and after Structure Teaching Programme. The results of |

|the study will help to follow correct aseptic techniques. |

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|7.MATERIALS AND METHODS |

|7.1.SOURCE OF DATA |

|Staff nurses working in a selected Hospital, Bangalore. |

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|7.1.1.Research design |

|Quasi Experimental design with one group pre test and post test method will be adopted for study. |

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|7.1.2. Setting of the study |

|Study will be conducted in a selected hospital, Bangalore. |

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|7.1.3. Population |

|Staff nurses who are all working in a selected hospital. |

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|7.2.METHODS OF COLLECTION OF DATA |

|7.2.1. Sampling procedure |

|Non probability convenient sampling will be used for the study. |

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|7.2.2 Sample size |

|The sample size will be 60. |

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|7.2.3. Inclusion criteria for sampling |

|Staff nurses who had completed General Nursing Midwifery and Bachelor of Nursing. |

|Staff nurses of both sexes. |

|Staff nurses between 20 and 50 years of age. |

|Staff nurses who were interested to participate in the research study. |

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|7.2.4 .Exclusion criteria for sampling |

|Staff nurses who are engaged in administrative work like ward sister and ward manager. |

|Staff nurses working in the operation theatre. |

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|7.2.5. Tool for Data collection |

|Section A. |

|Demographic variable which include age, sex, education, income, religion. |

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|Section B. |

|A structured questionnaire is used to assess the knowledge of staff nurses regarding aseptic techniques. It consists of 30 questions. |

|Structured questionnaire scoring and grading procedure. |

|Scoring: The correct answer of each question carries 1 mark; the wrong answer is marked 0. The maximum scores obtained by the sample is |

|converted to percentage and graded as follows. |

|Grading |

|Score (%) Level of knowledge |

|Below 50% Poor knowledge |

|50-75% Average knowledge |

|Above 75% Adequate knowledge |

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|7.2.6 Data collection method |

|Structured questionnaire will be used to collect the require data among the staff nurses. |

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|7.2.7.Method of Data analysis and interpretation |

|The researcher will use descriptive and inferential statistical technique for data analyzing by using mean, standard deviation & Chi square |

|test. |

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|7.2.8.Variables |

|Independent variable: Structured Teaching Programme regarding aseptic techniques among staff nurses. |

|Dependent variable: Knowledge of the staff nurses on aseptic techniques. |

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|7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INVENTIONTO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? |

|Yes. Structured Teaching Programme will be administered to the staff nurses. |

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|7.4. HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION? |

|Yes. Permission will be obtained from the research committee of the Harsha college of nursing Bangalore. |

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|LIST OF REFERENCES |

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|1. Keshav Swarnkar, ‘’ Community Health Nursing’’, 2nd edition NR.. publication,2006, page-454. |

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|2. K.Park, ‘’Preventive and Social Medicine’’ 18th edition, MS. Banarsidas Bhanot Publication, 2005, page-87. |

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|3. Patricia A, Potter, ‘’Fundamental of Nursing’’, Elsevier publication, 2009. |

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|4. Sr. Nancy, ‘’Principles and practice of nursing’’, 6th edition N.R. Publishing, 2008, page-113 to 121. |

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|5. Boyce Im, Pittet, ‘’ Evidence based aseptic practice’’, Guidelines for and igine in health care settings, mosby publishing, 2001, page-659 to|

|660. |

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|6. Dider, ‘’Hand hygiene and aseptic in the emergency department’’, American journal of infection control, vol-104, 2009, page-170 to 174. |

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|7.Mangram, Alicia, et.al, ‘’The center for disease control and prevention’’, Journal of infection control, 2007, page-110. |

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|A journal of Infection Control Nurse, Nov.,3. |

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|Jean-Luc Pagani, Phillippe Eggiman, ‘’ Management of Catheter- Related infection’’, 2008. |

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|Amam EL Kholy, Hospital acquired infection, ‘’The center of disease control and prevention’’, 2007. |

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|Mary Lou Morritt, Anne Senner, et.al, ‘’ Nursing practice development unit’’, Journal of geriatric critical care, vol-19, 2006, page-220. |

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|Gita Srinivasan, Medha Y. Rao, ‘’ Centre for nosocomial disease control and prevention’’, 2005. |

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|Ramanathan P, et.al, ‘’ Intravascular Catheter Related infection’’. |

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|Grant V. Bochicchio, et.al, ‘’Nosocomial infections in elderly trauma patients’’, 2002. |

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|Elsevier B.V, ‘’ Hand hygiene and simple aseptic techniques’’, 2009. |

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|Chawla K. Shetty Anoop, ‘’ A journal of Deduction of Methillicin Resistant Staphylococcus Aureus’’, vol 5. |

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|Greg E. Martin MD, ‘’ Selective decontamination for the prevention of nosocomial respiratory infection in ICU patients’’, 2009. |

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|Evaluation of aseptic techniques, ‘’ Journal of infection control’’. |

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|Grace, A, Rotter, et.al, ‘’ Medical Surging Nursing’’, Infection control, 3rd edition, Mosby publication, 1993, page-341. |

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|Stephen Rowley and Simon Clare, ‘’ Aseptic practices’’, 2009. |

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|Ann and Sleth JC, ‘’ Epidural Catheterization of aseptic measures’’, 2008. |

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|Michael W, Climo, et.al, ‘’Results of quasi experimental multicenter trail’’, 2009. |

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|Muralidhar Varma, ‘’Acinetobacter infections’’. |

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|‘’A creative process for reinforcing aseptic practices’’, 2001. |

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|Stijn Blot, et.al, ‘’Assess clinically focused nosocomial bloodstream infection’’. |

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|M. Merchant, D.R. Karnad, ‘’ Incidence of nosocomial pneumonia in a medical intencive care’’, 2004. |

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|Journal of Pedaitric infection disease control, 2006. |

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|Michlopoulous A, Sporos L, ‘’Post operative wound infection’’, 2003. |

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|Golway, et.al., ‘’Aseptic technique and hand washing practices’’, 2006. |

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|Flores A., ‘’Sterile vs. Non-Sterile gloves use in aseptic techniques’’, 2008. |

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|Anti Kapil, ‘’Department of medical sciences’’, AIIMS, 2002. |

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|8. |SIGNATURE OF THE CANDIDATE | |

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|9. |REMARKS OF THE GUIDE | |

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|10. |NAME AND DESIGNATION OF | |

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| |10.1. GUIDE | |

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| |10.2. SIGNATURE | |

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| |10.3.CO-GUIDE( IF ANY) | |

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| |10.4. SIGNATURE | |

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|11 |11.1. HEAD OF THE DEPARTMENT | |

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| |11.2. SIGNATURE | |

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|12. |12.1 REMARKS OF THE CHAIRMAN/ PRINCIPAL | |

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| |12.2 SIGNATURE | |

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HARSHA COLLEGE OF NURSING

BANGALORE -560 015

ETHICAL COMMITTEE

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|SL.NO |TITLE |NAME |SIGNATURE |

| | | | |

|01 |CHAIRPERSON | | |

| | | | |

|02 |MEDICAL SCIENTIST | | |

| | | | |

|03 |CLINICIAN | | |

| | | | |

|04 |SOCIAL SCIENTIST | | |

| | | | |

|05 |LEGAL EXPERT | | |

|06 |PHILOSOPHER & | | |

| |THEOLOGIAN | | |

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|07 |LAY PERSON | | |

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|08 |MEMBER SECRETARY | | |

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