Assessment of Knowledge about Standard Precautions and Nosocomial Infection among Nurses Working in Hospitals of Sana'a City, Yemen

Abstract

Background: Earlier research indicates that human beings after suffering often go through personal changes and dedicate to themselves a greater understanding of life. Aims: The aim of this study is to uncover the deeper dimensions in the understanding of life that the human being may dedicate to herself or himself after having lived through suffering. The research question is: what existential changes and deeper dimensions in the understanding of life may the human being dedicate to herself or himself after having lived through suffering? Methodology: A hermeneutical approach is used in this study. The material was collected through focused interviews with ten adults who had lived through personal suffering. The texts were interpreted through hermeneutical reading. Participation in the study, data storage and handling for research purposes were approved by the participants when they provided their informed consent. Permission to conduct the study was granted by an ethical committee. Results: The results show that human beings experience deeper gratitude, wisdom and meaning in life after suffering. Human beings show greater empathy and acceptance of others. The courage to create well-being is strengthened since they attain a greater awareness of their inner source of strength. Living in the present becomes important at the same time as a greater awareness of life's fragility and finiteness evolves. Conclusion: After having lived through suffering the human being has potential to grow and gain deeper gratitude in life thanks to a deeper awareness of the existential dimensions. The human being gains greater empathy and understanding of suffering. Further research should focus on uncovering the existential fragility that emerged as an interesting aspect in this study that adults experience after suffering.

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1692017 Volume 10 | Issue 1| Page April –January l Journal of Caring Sciences Internationa
www.internationaljournalofcaringsciences.org
Original Article
Assessment of Knowledge about Standard Precautions and Nosocomial
Infection among Nurses Working in Hospitals of Sana'a City, Yemen
Alwabr Gawad, MA, PhD
Assistant professor of Public Health & Environmental Safety, Department of Biomedical Engineering,
Sana'a Community College, Sana'a, Yemen
Correspondence:
Alwabr, Gawad, Assistant professor of Public Health & Environmental Safety,
Department of Biomedical Engineering, Sana'a Community College, Sana'a, Yemen
E-mail: alwabr2000@yahoo.com
Abstract
Background: Earlier research indicates that human beings after suffering often go through personal changes
and dedicate to themselves a greater understanding of life. Aims: The aim of this study is to uncover the deeper dimensions in the understanding of life that the human
being may dedicate to herself or himself after having lived through suffering. The research question is: what
existential changes and deeper dimensions in the understanding of life may the human being dedicate to herself
or himself after having lived through suffering? Methodology: A hermeneutical approach is used in this study. The material was collected through focused
interviews with ten adults who had lived through personal suffering. The texts were interpreted through
hermeneutical reading. Participation in the study, data storage and handling for research purposes were
approved by the participants when they provided their informed consent. Permission to conduct the study was
granted by an ethical committee. Results: The results show that human beings experience deeper gratitude, wisdom and meaning in life after
suffering. Human beings show greater empathy and acceptance of others. The courage to create well-being is
strengthened since they attain a greater awareness of their inner source of strength. Living in the present
becomes important at the same time as a greater awareness of life’s fragility and finiteness evolves. Conclusion: After having lived through suffering the human being has potential to grow and gain deeper
gratitude in life thanks to a deeper awareness of the existential dimensions. The human being gains greater
empathy and understanding of suffering. Further research should focus on uncovering the existential fragility
that emerged as an interesting aspect in this study that adults experience after suffering.
Keywords: suffering, existential issues, gratitude, meaning in life, well-being, quality of life, interviews,
hermeneutical reading
Introduction
Nosocomial infection refers to an infection that is
acquired during the process of patients' care
inside the healthcare facilities (Varshney et al.,
2014). It is an infection whose development is
favored by a hospital environment (Sternal,
Franek, and Pieńkus, 2014). There are many
different exposure routes: through injury (cut,
prick), through contact with the skin or mucous
membranes, through inhalation or through
ingestion (Alwabr et al., 2016).
Nosocomial infection poses a real and serious
threat to both patients and health care workers.
Nurses face a serious danger that may threaten
their life; it is their exposure to blood and body
fluids. Indeed, accidental exposure may lead to
infections by blood-borne pathogens, particularly
hepatitis B virus (HBV), hepatitis C virus (HCV),
and human immunodeficiency virus (HIV)
(Sabbah I et al., 2013). Data estimate that among
the 35 million health care workers worldwide,
approximately 3 million experience percutaneous
exposures to blood borne viruses each year (2
million HBV; 900,000 HCV and 300,000 HIV)
(Ahmed, Hassan, and Abd-Allah, 2008). These
injuries are estimated to result in 66,000 hepatitis
BV; 16,000 hepatitis CV and 2000 to 5000 HIV
infection. More than 90% of these infections are

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occurring in low-income countries, and most are
preventable (Vaz et al., 2010).
Common pathogens may easily be transmitted
through health care workers’ hands, equipment,
supplies and unhygienic practices (Gichuhi et al.,
2015). So, all health care workers should
routinely use appropriate barrier precautions to
prevent skin and mucous membrane exposure
during contact with any patient's blood or body
fluids that require universal precautions (Kaur R,
Kaur B, and Walia, 2008). Failure to comply with
policies and procedures that support the reduction
of nosocomial infection or hospital-acquired
infection is a recognized and complex problem
that may be contributing to the current trend in
the world (Abubakar et al., 2015). Therefore,
knowledge about the frequency and distribution
of nosocomial infection or hospital-acquired
infections is important to improve infection
control measures as well as to develop effective
preventive and curative strategies which, in turn,
will help us in decreasing the incidence,
morbidity, and mortality (Al-Jubouri, 2014;
Masavkar and Naikwadi, 2016). In Yemen, few
efforts have been undertaken to raise awareness
about infection control precautions among
healthcare workers and hospital managers.
Additionally, there is a lack of regulations and
policies to protect healthcare workers from
exposure (Sherah and Jaafar, 2015).
This study aimed to assess knowledge of
standard precautions and nosocomial infection
among nurses working in the governmental and
private hospitals in Sana'a city, Yemen.
Methodology
A cross-sectional study was conducted to assess
the knowledge about standard precautions and
nosocomial infection among 196 nurses working
in the departments of Emergency, Abdomen, and
surgery at governmental hospitals of (Police,
Republic, and 48th) and private hospitals of (Al-
Moutawakel, Consultant, and Azal) in Sana'a
city, Yemen, during the period from March to
May 2015. In total, from the 220 questionnaires
distributed, 196 were returned fully completed,
giving a response rate 89.09%. The inclusion
criteria are nursing staff working in departments
of Emergency, Abdomen, and surgery in (Police,
Republic, and 48th, Al-Moutawakel, Consultant,
and Azal) hospitals.
Data was collected using a structured self-
administered questionnaire, which had been
designed after an extensive literature search. This
questionnaire was used in a similar study
(Pratheeksha, 2010).
The questionnaire was divided into two main
components. The first part included socio-
demographic characteristics such as (age, gender,
qualification, years of experience , hospital type,
and place of work), the second part included
twenty-seven multiple choice questions reflecting
the knowledge of the nurses towards the concept
of standard precautions and nosocomial infection
such as (hand hygiene, hospital acquired
infection, needle stick injuries, immunization,
blood and body fluid isolation, and sterilization
of equipment). The participants were requested to
respond to questions according to their own
awareness about the subject. The questionnaire
was validated by experts at Ministry of Public
Health and Population, Yemen and the reliability
of the questionnaire was determined through a
test-retest method using 20 copies of the
questionnaire at Hospital of Sciences and
Technology, Sana'a. The Pearson’s coefficient
was calculated. The coefficient of 0.81 was
determined which indicated the reliability of the
questionnaire.
A scoring system was used giving a value of one
score of each correct item, and a value of zero
scores for the wrong item. Scores of each
respondent were calculated by adding the scores
of all items of the questionnaire. The score was
converted to percentage and level. The
knowledge score's levels were considered below
average with a percentage of ≤ 59%; average
knowledge with a percentage of 60-69%; good
knowledge with a percentage of 70-79%; and
very good knowledge with a percentage of 80-
100%. Data were coded and analyzed using
Statistical Package for Social Science (SPSS)
software version16. Data were presented using
descriptive statistics in form of frequencies and
percentages for qualitative variables, and mean
and standard deviation (SD) for quantitative
variables. Chi-square test was used to determine
association and a statistical significance was
assessed at P < 0.05.
Results
Table 1 shows demographic characteristics of the
studied sample. It clarifies that the nurses
working in governmental hospitals were (46.9%)
and (53.1%) of them works in private hospitals.
The majority of them were between 20-30 year-
old (63.3%) and male (64.8%).

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Table 1: Socio-demographic characteristics of respondents (n=196)
Variables Freq. %
Sex
Male
Female
127
69
64.8
35.2
Age Group (years)
20 - 30
> 30
124
72
63.3
36.7
Work Experience (years)
< 3
3-5
> 5
35
76
85
17.9
38.7
43.4
Level of Education
Diploma degree
Bachelor's degree
Postgraduate
121
68
7
61.7
34.7
3.6
Type of Hospital
Governmental
private
92
104
46.9
53.1
Name of Hospital
48
th
Police
Republic
Consultant
Al-Moutwakel
Azal
34
30
28
29
33
42
17.3
15.3
14.3
14.8
16.8
21.4
The department
Emergency
Abdomen
Surgical
67
71
58
34.2
36.2
29.6
Figure 1: Knowledge levels about standard precautions and nosocomial infection
(n= 196)

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Table 2: Association between the nurses' demographical characteristics and their
knowledge (n=196)
Variables Knowledge levels Total P -Value
Below
average
Average
Good
Very Good
Excellent
Sex
Male
Female
Total
41
19
60
44
21
65
29
15
44
11
13
24
2
1
3
127
69
196
0.357
Age Group (years)
20 - 30
> 30
Total
38
22
60
43
22
65
27
17
44
16
8
24
0
3
3
124
72
196
0.232
Work Experience (years)
< 3
3-5
> 5
Total
10
29
21
60
13
28
24
65
6
14
24
44
6
4
14
24
0
1
2
3
35
76
85
196
0.167
Level of Education
Diploma degree
Bachelor's degree
Postgraduate
Total
39
20
1
60
41
23'
1
65
26
15
3
44
13
9
2
24
2
1
0
3
121
68
7
196
0.779
Type of Hospital
Governmental
private
Total
29
31
60
27
38
65
24
20
44
9
15
24
3
0
3
92
104
196
0.193
Name of Hospital
48
th
Police
Republic
Consultant
Al-Moutwakel
Azal
Total
3
4
22
8
10
13
60
15
8
4
14
16
8
65
9
13
2
4
5
11
44
6
3
0
3
2
10
24
1
2
0
0
0
0
3
34
30
28
29
33
42
196
0.001
The department
Emergency
Abdomen
Surgical
Total
20
25
15
60
18
25
22
65
20
13
11
44
7
7
10
24
2
1
0
3
67
71
58
196
0.412
Respondents with diploma degree and bachelor's
degree made up the highest proportions, (61.7 %)
and (34.7%) respectively. Those with working
experience >5 years were about 85 respondents
(43.4%).Figure 1 indicates that the participating
knowledge was average, below average, good,
very good, and excellent (33.2%, 30.6%, 22.4%,
12.2%, and 1.2%) respectively. The knowledge
was significantly associated with the hospital's
name (P = 0.001). In addition, there was no
association with sex (P = 0.357), age (P = 0.232),
work experience (P = 0.167), education (P =
0.779), The hospital type (P = 0.193) and the
department (P = 0.412) (Table 2).
Discussion
This study assessed knowledge of nurses about
standard precautions and nosocomial infection. In
the present study, the majority of the nurses
(63.8%) had poor knowledge. The low level of
knowledge might be due to poor infection control
programs and policies. Additionally, attributed to
the insufficient information of knowledge the
lack of training and continuing education about
standard precautions and nosocomial infection.
This finding agreed with the results obtained
from previous studies. A previous study
conducted in Yemen revealed the low awareness

1732017 Volume 10 | Issue 1| Page April –January l Journal of Caring Sciences Internationa
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of knowledge about infection control (Sherah and
Jaafar, 2015). A study conducted in Saudi Arabia
indicated a significant lack of knowledge among
healthcare workers regarding personal protective
equipment uses as a standard precautionary
measure for infection control (AL-Saleh,
Ibrahim, and Lillian, 2014). A study conducted in
Iran indicated that 67.9% of the nursing staff had
an average knowledge and 29.9% had good
knowledge about infection control (Abubakar et
al., 2015). A study conducted in Iraq indicated
that the majority of the sample (69%) have poor
knowledge toward nosocomial infection (Al-
Jubouri, 2014). A study conducted in India
reported that knowledge about nosocomial
infection was the lowest among the nurses and
healthcare workers (72.54%) (Varshney et al.,
2014). Other study conducted in India reported
that 41.1% and 33.03% of the participants
respectively had intermediate and high level of
knowledge about infection control
(Kalantarzadeh et al., 2014). A study conducted
in Nepal reported that only 22% had correct
knowledge of universal precautions (Timilshina,
Ansari, and Dayal, 2011). A study conducted in
Nigeria indicated that only (28.75%) of the
respondents had good knowledge of the
components of standard precautions
(Ghadamgahi et al., 2011). This study agreed
with the previous studies mentioned above may
refer to the similarity of socio-economic and
cultural factors to those countries.
However, this study result disagreed with the
results obtained from previous studies. A
previous study conducted in Jamaica indicated
that the majority (64.0%) of the health care
workers had knowledge of universal precautions
while just over one-quarter had no knowledge
(Vaz et al., 2010). A study conducted in Australia
indicated that the participants demonstrated a
considerably stronger level of knowledge on the
topic of standard precautions (88.9%) (Mitchell
et al., 2014). A study conducted in Ethiopia
indicated that majority of the respondents
(84.2%) had good knowledge regarding infection
prevention (Gulilat and Tiruneh, 2014). A study
conducted in Vietnam indicated that the large
percentages of correct responses to the items
about knowledge of standard precautions (range
for individual items 83.9% -99.2%) (Thu et al.,
2012). This study disagreed with the previous
studies mentioned above may refer to the
difference of socio-economic and cultural factors
to those countries.
In this study, the results of table 2 reflects that
there is an insignificant relationship between
nurses' age and their knowledge toward standard
precautions and nosocomial infection, this results
might relate to inadequate training for the nurses
about standard precautions and nosocomial
infection. This result agreed with the results
obtained from a previous study done in Iraq
indicated that there is no relation between nurses'
age and their knowledge of nosocomial infection
(Al-Jubouri, 2014). However, is incompatible
with the results obtained from a study conducted
in Poland indicated that there is a significant
association between nurses' age and their
knowledge toward nosocomial infection
(P=0.001) (Sternal, Franek, and Pieńkus, 2014).
This study result also showed an insignificant
relationship with nurses' gender and their
knowledge toward standard precautions and
nosocomial infection. This result agreed with the
results obtained from a previous study conducted
in Iraq indicated that there is no relation between
nurse's gender and their knowledge toward
nosocomial infection (Al-Jubouri, 2014). While
incompatible with the results obtained from a
study conducted in Jamaica indicated that the
knowledge of universal precautions was highest
among women compared with men (Vaz et al.,
2010).
Relative to educational levels, this study results
showed an insignificant relationship between
nurses' educational level and their knowledge of
standard precautions and nosocomial infection.
This result incompatible with previous studies. A
study conducted in Iraq indicated that there is a
significant association between nurses'
educational level and their knowledge of
nosocomial infection (Al-Jubouri, 2014). A study
conducted in Poland indicated that there is a
significant association between nurses'
educational level and their knowledge of
nosocomial infection (P=0.000) (Sternal, Franek,
and Pieńkus, 2014).
Concerning to the nurses' work experience, this
study result showed an insignificant relationship
between the nurses' work experience and their
knowledge of standard precautions and
nosocomial infection, this might relate to
inadequate training for the nurses about standard
precautions and nosocomial infection during the
previous years of working. This result agreed
with the results obtained from a previous study
done in Iraq indicated that there is an

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insignificant association between the knowledge
and the years of employment (Al-Jubouri, 2014).
Regarding of the hospital type, this study results
showed an insignificant relationship between the
hospital type and their nurses' knowledge toward
standard precautions and nosocomial infection,
this might due to ignoring attention to
implementing training courses of standard
precautions and nosocomial infection in both the
governmental and private hospitals.
Relative to the nurses' working area, this study
results showed an insignificant relationship
between the nurses' working area and their
knowledge of standard precautions and
nosocomial infection, this might due to ignoring
to implement additional training courses of
standard precautions and nosocomial infection
for the nurses that working in the more sensitive
department.
In relation to the hospital name, this study results
showed a significant relationship between the
hospital name and their nurses' knowledge
toward standard precautions and nosocomial
infection, this might due to the facts that, some
hospitals might implement training courses
relative to standard precautions and nosocomial
infection more than others.
Conclusion
Nursing staff had inappropriate knowledge
regarding of standard precautions and nosocomial
infections, there is a significant need to
intervention programs that associated with
standard precautions and nosocomial infection
control to increase nurses' knowledge in order to
adopt appropriate health behaviors and positive
attitudes.
Acknowledgement
The researcher would like to express his gratitude
to the team working on this project (Esam
Alomise, Ali Alsolihe, Esam A. Alhagame, Faiz
A. Mohammed, Hemear Alsaleme, Radwan A.
Alhagame, Farouk M. Abdo, and Khaled M.
Yahya) for their assistance in the field of
working. Many thanks to Eng. Khalid Ali Al-
Salehi for revise the English language of this
manuscript.
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