The knowledge, attitude, and practice of physicians and medical students of
Rafsanjan University of Medical Sciences, Iran, regarding standard precautions
Asadpour M, PhD1,
Vazirinejad R, PhD*2, Esmaeili A, PhD 3, Bazyar Sh, MD4,
Fallah A, MSc5
1-Assistant Prof., Dept. of Health
Promotion and Health Services, School of Medicine,
Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 2- Professor of
Epidemiology, Dept. of Social Medicine, Occupational Environmental Research
Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. 3- Assistant
Prof., Dept. of Social Medicine, Occupational Environmental Research Center, Rafsanjan
University of Medical Sciences, Rafsanjan, Iran 4- General Physician, Rafsanjan
University of Medical Sciences, Rafsanjan, Iran. 5. MSc of Epidemiology,
Dept. of Social Medicine, Rafsanjan University of Medical Sciences, Rafsanjan,
Iran.
Abstract Received: June 2014, Accepted: February 2015
Background: Physicians and medical students are at risk of
exposure to a broad range of viral pathogens through percutaneous injury,
contact of mucous membrane with blood, and other potentially infectious body
fluids. The objective of this study was to determine the knowledge, attitude,
and practice (KAP) of physicians and medical students of Rafsanjan University
of Medical Sciences, Iran, regarding standard precautions. Materials and Methods: This was a cross-sectional research based on a
survey performed in 3 teaching hospitals affiliated with Rafsanjan University
of Medical Sciences. Data were collected using a self-administered structured
questionnaire. Subsequently, researchers distributed the questionnaires among
the individuals who agreed to participate in the study. The participants were
given instructions on completing the questionnaires. After completion of the
questionnaires, they were collected and statistically processed with SPSS
software using frequencies, percentages, the averages and standard
deviations, and the independent t-test. All P values equal to or less than
0.05 were considered as statistically significant. Results: The
response rate in this study was 95%. The mean age of subjects was 27.6 ± 5.3
years. The majority of subjects were female (62.1%), single (66.3%), and
medical interns (78.9%). Most subjects were untrained on standard precautions
(64.5%). The mean and standard deviations of KAP scores were 37.6 ± 7.4 (out
of 46), 32.6 ± 4.5 (out of 45), and 33.06 ± 6.5 (out of 44), respectively.
The independent t-test showed significant differences between knowledge and
practice scores and marital status. It also showed significant differences
between the practice score and training on standard precautions (P <
0.05). Conclusions:
The results showed that the knowledge score was desirable, but the attitude
and practice scores were not desirable. Thus,
educational programs with the foundation of blood-borne infections, infection
control, safety recommendations, and different aspects of standard
precautions are recommended. |
Keywords: Physicians, Medical student, Knowledge, Attitudes, Precautions
Introduction
Hospital infections (HIs) can arise
through the spreading of microorganisms, through personal hands, equipment,
patient’s blood, body fluid, secretions, and/or used solutions (1-3).
Nosocomial infections, His, or health care-associated infections, are a serious
problem in the healthcare services as they are common causes of illness and
mortality among hospitalized patients (4,5). Physicians and medical students
are at risk of hospital-acquired viral infections and exposure to a broad range
of viral pathogens, including hepatitis B virus (HBV), hepatitis*C
virus (HCV), and human immunodeficiency virus (HIV), through percutaneous
injury (e.g., needle stick and cut with a sharp object), contact of mucous
membrane or nonintact skin with blood, tissue, or other potentially infectious
body fluids (6).
After recognizing this threat, the
United States Centers for Disease Control and Prevention (CDC) proposed a
series of procedures for preventing occupational exposures, reducing the risk
of transmission of blood-borne pathogens (BBPs), and handling potentially
infectious materials such as blood and body fluids. These procedures are known
as standard precautions (SPs) (6-8).
According to the SPs regulations,
patient blood, body fluid, secretions, and excrement have infectivity, and
thus, have an effect on both patients and medical staff. SPs include regular
personal hygiene, hand washing, performing sterilization, and the safe removal
of sharp instruments, handling and disposal of needles, sharp things, and use
of protective barriers and personal protection equipment such as gloves, gown,
face shields, and eye protection gear whenever there is contact with mucous
membranes, blood, and body fluids of patients, and appropriate disposal of
sharp instruments, body fluids, and other clinical wastes (3, 5, 7, 9, 10).
The HBV,
HCV, and HIV infections are considered as a serious health problem worldwide (11, 12). The World Health Organization (WHO)
estimates that about 3 million health care workers (HCWs) face occupational
exposure to blood-borne viruses each year, and 90% of the infections occur in
low income countries (7, 13). Some Reports indicate that SPs are effective in
preventing both occupational exposure incidents and their associated infections
(5, 8). Surveillance and follow-up of HCWs’ compliance to SPs is an essential
factor of occupational infection control as it enables assessment of risks of
occupational exposure to infection and research programs are currently being
performed on SPs regulations in many countries (7, 14-16).
Many
studies have demonstrated that knowledge, attitude, and practice (KAP) of HCWs
regarding the risk factors related to needle stick injuries (NSIs), use of
preventative measures, and agreement with SPs, routes of spreading of HBV and
HCV are insufficient and unsatisfactory (10, 17, 18). Consequently, the field
of SPs has attracted increasing attention from all medical workers, and
research programs are currently being performed on SPs regulations in many
countries.
Therefore,
the objectives of this study were to assess the rate of KAP of physicians and
medical students of Rafsanjan University of Medical Sciences, Iran, regarding
SPs.
Materials and Methods
This was a
cross-sectional research based on a survey on 100 physicians and medical
students in 3 teaching hospitals affiliated to Rafsanjan University of Medical
Sciences. Data were collected using a self-administered structured
questionnaire which comprised of 4 main sections including demographic
variables, and KAP of physicians and medical students regarding SPs. The
validity and reliability of the questionnaire were measured using content
validity and Cronbach's alpha coefficient, respectively.
The mean knowledge of SPs was
measured with the use of 23 items with 3 answer choices (true, false, and I do
not know); 2 points for a correct answer, 0 for wrong answers, and 1 point was
considered for not knowing (scores ranged from 0 to 46). The mean attitude
toward the SPs was measured with the use of 9 items with 5-point Likert scale (completely disagree, disagree, disagree a little, agree a
little, agree, completely agree). To the completely agree answer 6 points was
given and completely disagree received only 1 point (scores ranged from 9 to
45). The mean practice of the SPs was measured with the use of 11 items with 4
answer choices (never, sometimes, many times, always); where the answer was
completely agree 6 points was given and completely disagree 1 point. Scores
ranged from 11 to 44. A higher score means a higher KAP of the SPs.
Subsequently, researchers visited
subjects and distributed the questionnaires among those who agreed to
participate in the study. They were given instructions on completing the
questionnaires. A total of 100 questionnaires had been distributed. After their
completion, the questionnaires were collected.
Collected data were statistically
processed using SPSS software (version 16, SPSS Inc., Chicago, IL, USA).
Frequencies and percentages of the demographic variables of the participants,
and the averages and standard deviations of the scores of knowledge, attitude,
and practice of SPs were obtained. The independent t-test was used to analyze
the scores of KAP of SPs by demographic variables of the subjects. All P values
equal to or less than 0.05 were considered statistically significant.
Results
In the
present study, 100 questionnaires were distributed among the samples and 95 of
them were completed and returned and had faithful responses (response rate of
95%). The mean age of subjects was 27.6 ± 5.3 years. The majority of samples
were female (62.1%), single (66.3%), and medical interns (78.9%). In addition,
most subjects were untrained on SPs (64.5%) (Table 1).
Table 1: Distribution
of samples by age, gender, marital status, occupation, and training on SPs
Number (%) |
Answer |
Variable |
46 (50) |
< 26 y |
Age |
30 (32.6) |
26-30 y |
|
5 (5.4) |
31-35 y |
|
8
(8.7) |
36-40
y |
|
3
(3.3) |
> 40 y |
|
3
(3.3) |
Missing |
|
36
(37.9) |
Male |
Gender |
59
(62.1) |
Female |
|
63
(66.3) |
Single |
Marital
status |
32
(33.7) |
Married |
|
75
(78.9) |
Medical
Intern |
Occupation |
20
(21.1) |
Physician |
|
33
(35.5) |
Yes |
Trained about
SPs |
60 (64.5) |
No |
The mean and standard deviations of
KAP scores of subjects were 37.6 ± 7.4 (out of 46), 32.6 ± 4.5 (out of 45), and
33.06 ± 6.5 (out of 44), respectively (Table 2).
Table 2: The
indicative mean and standard deviation of the scores of KAP of SPs
Variable |
Mean ± SD |
The range of scores |
Min Scores |
Max Scores |
Knowledge |
37.6 ± 7.4 |
0-46 |
14 |
46 |
Attitude |
32.6 ± 4.5 |
9-45 |
15 |
45 |
Practice |
33.06 ± 6.5 |
11-44 |
18 |
44 |
The independent t-test showed
significant differences between knowledge and practice scores and marital
status; the score of married subjects was higher than single subjects. The
attitude score of married subjects was higher than single subjects, but this
difference was not significant. Moreover, significant differences were observed
between practice score and training on SPs; the score of trained subjects was higher
than untrained subjects. Differences in knowledge and attitude scores were not
significant (Table 3).
Table 3: Comparison of
mean and standard deviation of the score of KAP of SPs with marital status and
training on SPs
Variable |
Mean ± SD |
P-value |
||
Knowledge |
Marital status |
Single |
36.17 ± 7.77 |
0.01 |
Married |
40.28 ± 5.70 |
|||
Training on SPs |
Trained |
37.2 ± 8.61 |
0.89 |
|
Untrained |
37.4 ± 6.58 |
|||
Attitude |
Marital status |
Single |
32.24 ± 4.08 |
0.30 |
Married |
32.21 ± 5.14 |
|||
Training on SPs |
Trained |
33.12 ± 4.85 |
0.38 |
|
Untrained |
32.26 ± 4.32 |
|||
Practice |
Marital status |
Single |
32.00 ± 6.23 |
0.02 |
Married |
35.15 ± 6.65 |
|||
Training on SPs |
Trained |
35.45 ± 6.34 |
0.01 |
|
Untrained |
31.81 ± 6.39 |
The independent t-test showed significant
differences between practice score and training on SPs; the score of subjects
trained on SPs was higher than untrained subjects. Nevertheless, this
difference was not significant in knowledge and attitude scores.
The
independent t-test did not show any significant differences between KAP scores
with demographic variables such as age, gender, location of residence,
occupation, location of work, and years of health care employment (P >
0.05).
Discussion
In this study, the response rate was
95%, the mean age of subjects was 27.6 years. The majority of participants were
female (62.1%), single (66.3%), and medical interns (78.9%). In addition, most
subjects were untrained on SPs (64.5%). However, the response rate in the study
by Hosoglu was 40.7%, the average age of the respondents was 31.4 years, and
the majority were female (63.6%) (19). The response rate in the study by Melo
was 91.1%, the average age of the respondents was 39.6 years, and the majority
were female (91.5%). In the study by Doebbeling, the response rate was 63% (8),
and in the study by Reda, it was 84.4% and the mean age of the respondents was
30.8 (7)
The results of this study showed that
35.5% of subjects had received training on SPs. Abou El-Enein and El Mahdy
reported that none of the subjects had received training in the field of
infection control (20). Ghofranipour et
al. reported that 36.1% of their study samples had received training on
universal precaution prior to their job (21).
The results of this research are more satisfactory than those of the study by
Abou El-Enein and El Mahdy (20), and Ghofranipour et al (21).
The results of this study showed that
the knowledge score was desirable but attitude and practice scores were not
desirable. In the study by Melo, 75.6% of subjects understood SPs as protective
measures and a strategy in daily health care activities (5). In the study by
Doebbeling, mean rates of hand washing, avoiding needle recapping, and
underreporting sharp injuries were 32–54%, 29–70%, 22-62% (overall: 32%),
respectively. That varied by occupation and adherence to SPs and was found to
be suboptimal. Researchers believed that a new strategy for preventing
exposures, training, and monitoring adherence was needed (8).
The results of the study by Abou
El-Enein and El Mahdy showed that less than half of the nurses (47.1%) of a
dialysis unit in Alexandria, Egypt, were aware of washing their hands before
and after patient care (20).
Cirelli, in his research, in the
knowledge evaluation stage reported that only 9 of 29 professionals identified
the professional’s concept correctly (22).
Previous studies have shown that misconceptions persist regarding universal
precautions (16, 23, 24).
Previous studies have shown
inadequate adherence to preventive measures, such as recapping needles, routine
use of gloves, and hand washing after glove removal (7, 8, 25).
Results of the study by Amoran and Onwube implied that HCWs had inadequate knowledge about infection
control (26). Nevertheless, the results of our research showed a desirable
knowledge score.
Our study results emphasized the need
for the evaluation of education on infection control practices and SPs in
general. Moreover, they highlighted the necessity of performing structured
infection control programs among all HCWs such as physicians, and nursing and
midwifery staff, and all of the medical sciences students. Our results are in line with the study by
Askarian et al., who showed that almost all of the participants reported that
they required additional infection control education, especially on standard
isolation precautions (27).
Sharma et al., in India, reported that only 50.2% of HCWs gave correct answers to
questions regarding disease transmission through needle stick and sharp injury (28). In general,
the results of the current research were similar to those of other studies
(28-30).
Conclusion
Based on the results obtained in this research, educational programs with
the foundation of blood-borne infections, infection control, safety
recommendations, and different aspects of SPs training program are recommended.
Acknowledgement
We would
like to thank the physicians and medical students who participated in this
study, and also the research committee of the Rafsanjan University of Medical
Sciences who approved and supported our research. This article is taken from a
thesis on medical education.
Conflict of interests: None declared.
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* Corresponding author: Reza Vazirinejad, Professor, Dept. of Social Medicine, Rafsanjan University
of Medical Sciences, Rafsanjan, Iran.
Email Address: rvazirinejad@yahoo.co.uk