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Efficacy of Implementation Management program about Infection Control practices for Nursing Staff

Back ground: Management program about infection control is important to help head nurses gain knowledge to perform their roles, and for nurses to comply with standard infection control measures . Objective: Evaluate efficacy of implementing management program about infection control practices for nursing staff. Setting: All departments in Tanta University Emergency Hospital. Subjects: All head nurses (N= 31) and nurses (N =175) working in all departments of emergency hospital. Tools: (1) Infection Control Knowledge Questionnaire sheet, (2) Head Nurses' Performance Role on Infection Control Assessment Scale and, (3) Observational checklist, related to Infection Control practices. Results: Head nurses 58.1% and nurses 80.0% had poor level of total knowledge about infection control preprogram , while majority (90.3%86%) were at high level post program. Head nurses 61.3% had poor level of total specific knowledge pre-program, changed to be 90.3% and 87.1% had good level of knowledge post program . Pre-program majority (90.3%) of head nurses had mild level of performance of educational , consultation, research and support team in surveillance roles decreased to (3.2%) post program. Nurses range (15.4% 22.9%) showed compliance level to infection control practices preprogram, improved to range (75.4% 84.0%) post program with highly statistically significant differences (p= < 0.001). Conclusion: At Tanta University Emergency Hospital nursing staff basic knowledge, head nurses specific knowledge and role performance and nurses' compliance were low and statistically improved after implementation of needed management program. Recommendation: conduct regular training programs for nursing staff and encourage culture of compliance to infection control practices.


Introduction
Health care-associated infections, affect patients in a hospital or other health-care facility, and are not present or incubating at the time of admission (1) . They also include infections acquired by patients in the hospital or facility but appearing after discharge, and occupational infections among staff (2) . Infections prolong hospital stays, create long-term disability, increase resistance to antimicrobials, represent a massive additional financial burden for health systems, generate high costs for patients and their family, and cause unnecessary deaths (3) .
The magnitude of the problem is more in developing countries than developed countries due to poor hygiene and sanitation which play an important role in increasing the risk of infection (4) .
In Egypt, limited data exist on the morbidity, mortality and costs associated with nosocomial infections (4,5) . Nursing staff play a vital role in preventing the development and spread of infections among hospital patients. Some nurses, called infection control nurses, specialize in this, but all nurses in a hospital share responsibility for monitoring patients, practicing good hygiene and implementing all other methods designed to keep hospitals sterile and patients safe (8) . They will be personally accountable for their action and are responsible for ensuring that they comply with Infection Prevention and Control policies (9) . They must understand their legal duty to take reasonable care of their health, safety and security and that of other persons who may be affected by their actions and for reporting untoward incidents and areas of concern (7) .
Head nurse play vital role in reducing risks for infection through a variety of roles (educational, consultation, administration, supervision, research, support team in surveillance and risk management rols). While nurses share responsibility with other health care personnel for infection risk reduction in patients across entire continuum of direct care activities (10) . Head nurses have an active roles, they regulary monitoring, evaluating and reporting of outcomes, processed and strategies at national level and in health-care facilities (9) . In addition the nurse should follows principles and practices including standard precautions to prevent and control of infection and it spread (8) . 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 (9) .
Nursing staff education is an important component of the hospital infection control program (8,9) . The efficiency of infection control measures is highly dependent on the compliance of the hospital staff (11) . To secure their compliance, education is needed to inform the staff and to convince them that these measures are really worthwhile. Without an effective in-service education program, the work of infection control be rendered ineffective (12,13) .
So, training programs are needed for both nurses and head nurses to maintain infection control measures (14) .
Infection control and prevention in a healthcare setting requires a comprehensive, coordinated program designed to prevent and control nosocomial or healthcare-associated infections. Implementation of patient care practices for infection control is the role of the nursing staff (11) . Nurses should be familiar with practices to prevent the occurrence and spread of infection, and maintain appropriate practices for all patients throughout the duration of their hospital stay (13,14) .

Aim of the study
To evaluate efficacy of implementing management program about infection control practices for nursing staff.

Research hypothesis
Implementing of management program expected to enhance head nurses' role and nurses' compliance with infection control practices

Study design
Quasi experimental research design was used to achieve the aim of the present research. Such design fits the nature of the problem under investigation. A quasi-experiment is an empirical interventional study used to estimate the causal impact of an intervention on its target population without random assignment.

Setting
The nurses.

Subjects
The study subject consisted of nursing staff 206 working at the 8 departments understudy including nurses n=175 and head nurses n=31.

Tools
The data of the study collected using three tools as follows:- This tool will be used to assess nurses' compliance to infection control practices at word level related to:--Hand hygiene.
-Respiratory hygiene and cough etiquette.
-Management of sharps and needle stick injuries.
-Environmental cleaning and spills-management.
-Handling and disposal of linen.
-Management of patient equipment.
-Isolation precautions. Nurses' level of compliance will be as follow -Minimal compliance = < 60%.

1-
-Head nurses divided into four groups and nurses into ten groups. The program time for nursing staff was one hour every session for nurses 5 session.
Head nurses only get specific additional 5 sessions.
Nursing staff prepared to get sessions at their work place hospital during their work shifts morning, afternoon or night.
-The researcher was given direction for nursing staff duration of 3 months at their ward. 10-Data collection started from February month until end of July month. It takes 6 months.

Design of the program
First step was the statement of general and specific objectives

General objective
At the end of the program implementation the nursing staff knowledge, nurses' compliance and head nurses' role performance in infection control will be enhanced.

Specific objectives
At the end of the program nursing staff should be able to understand, apply, comply and manage infection control activities through: -Introduction of infection control.
-Health care associated infection.
-Infection control principles and practices.
-Standard of infection control precautions.
-Role of head nurses on infection control.
-skills of head nurses for infection control.

Program content
The content was selected after carful assessment of subject needs. Simple and scientific language was used. This content was designed to provide knowledge related to infection control. The program includes 5 sessions for nursing staff and 5 sessions for specific knowledge to head nurses as follows: Sessions for nursing staff:--Session (1) Introduction of infection control.
-Session (6) Role of head nurse on infection control.

Teaching-learning strategies
Selections of teaching methods were governed by studying the subject themselves and content of program. The methods used were lecture, role play, group discussion, power point, demonstration, and procedures for practical contents.

Teaching aids
The teaching aids used for attainment of program objectives were data show, posters, handouts, flow sheets, pens, and papers. Qualitative data were described using number and percent Quantitative data were described using mean, standard deviation. Significance of the obtained results was judged at the 5% level (19) .