Assessment of Nurses ' Knowledge and Attitude toward Infection Standards Precautions in Primary Health Care Settings

Background: Standards precautions are designed to protect staff from risks resulting from exposure to blood and body fluids and to protect patients from potential cross infection. Knowledge of clinical infection control practices is continually growing and changing. Objectives: the present study was conducted to assess nurses' Knowledge about Infection control standards precautions in primary health care settings. Methods: This study was cross sectional study that was conducted in six primary health care settings (PHC) in Manzala District affiliated to the Ministry of Health and Population. PHC settings were selected by stratified random sample method. Seventy nine nurses were included in the study. Data were collected by using open ended questions sheet, which was self-administered. Results: The nurses showed a poor level of knowledge regarding most categories of standard precautions. Conclusion and Recommendations: Mandatory regular base educational program must be planned to overcome the weak level of knowledge and improve and update the nursing performance regarding standard precautions. Key wards: Standard precautions; Knowledge; Attitude; Nurses


INTRODUCTION
Infection control practice is a corner stone of modern health care (1) .Universal precautions are simple infection prevention control measures that reduce the risk of transmission of blood borne pathogens through exposure to blood and body fluids among patients and health care workers (HCWs).Compliance with these universal precautions has significantly reduced the risk of exposure to blood and body fluids that workers will contract in the course of their work (2) .The term "standard precautions" is replacing "universal precautions," as it expands the coverage of universal precautions by recognizing that any body fluid may contain contagious and harmful microorganisms (3) .Standards precautions are designed to protect staff from risks that resulting from exposure to blood and body fluids and to protect patients from potential cross infection.poor adherence to standard precautions. (6) Egypt, it was reported that nurses' knowledge regarding universal precautions was below the average score. (7)Therefore, the present study was conducted to assess nurses' Knowledge about infection control precautions.

Study design:
Cross-sectional study was used to assess the knowledge of nurses about infection control standard precautions.

Setting:
The

Statistical analysis:
SPSS package (version 0.9) was used for the statistical analysis of the obtained data; Independent t-test was used to estimate the significant differences between different variables.

RESULTS
Table

DISCUSSION:
Standard precautions are effective strategies to prevent and control nosocomial infections.Nurses must be knowledgeable about the principles of standard precautions (3) .
)(9) These researches support the present study, which revealed that most of nurses in general showed poor knowledge level regarding standard precautions.
Transmission of microorganisms from the hands of healthcare workers is the main source of cross-infection in health care settings and can be prevented by hand washing.Akyol (2007) revealed that nurses have a poor level of knowledge concerning quality of hand washing (8) .This study is in agreement with the present study which found a minor number of nurses described the appropriate technique of hand washing, although they have a good knowledge and attitude about appropriate times for hand washing.
A minor percentage of nurses mentioned personal protective equipment as one of the standard precaution components, although they showed a good level of knowledge regarding identification of these items.This is in agreement with a Brazilian study which revealed that 75.6% of nurses understand standard precautions as protective measures. (10)In addition to the reported results of Ganczak and Szych 2007, that indicated low knowledge regarding personal protective equipment among nurses in Poland (11) .

Regarding to decontamination
process; the majority of nurses lacked in knowledge about the disinfection and sterilization process.These results are in agreement with Grillo et al., (2004), who reported that a large number of nurses do not know the correct procedures of disinfection and sterilization procedures. (12).Also, Beder and Michel (2004) found that only 12% of nurses have satisfactory knowledge level about sterilization process (13) .
As regards to needle stick injury, studies showed that 40% out of 110 nurses reported multiple needle stick injuries but staff frequently don't report the injury despite their awareness of the risk of blood borne pathogenesis (14,15) .These findings supported the present results as nurses showed a poor knowledge about the action taken when needle stick occurred, although 12.6% exposed to multiple needle stick injury.In addition, Bennett and Mansell (2004) found that the majority of community nurses reported compliance with standard precautions, although a small number of nurses stated that they re-sheathed needles and inadequately wore gloves (16) .In addition, most of the studied nurses have a good knowledge and attitude toward the occupational hazards that they are exposed such as hepatitis B, C, and HIV.This is in agreement with a study in Gaza done by Massrouje 2001 who found that nurses knew that viral hepatitis and HIV infection could be transmitted as a result of the improper management of medical waste. (17)garding all the general principles of infection prevention and control to minimize the spread of infection (18) .El-Shafie et al., (7) 1995, and Beder and Michel (2004) (13) , reported that nurses need training programs in a regularbasis.

Conclusion and Recommendations
It was conclude that most of nurses who involved in the study showed poor knowledge level regarding standard precautions.The study recommended that: 1

a-
Official approval was obtained from the Ministry of Health and Population 2-Development of the study tool: a-The researcher developed the tool after reviewing of recent literatures.c-Validity of tool was tested by experts in that field b-A pilot study was carried out on 10 nurses were chosen randomly from MCH centers to ensure the clarity of the knowledge test.Bull High Inst Public Health Vol.37No.1[2007]3-Data collection: Data were collected by using the self-administered structured questionnaire sheet, during actual visit to MCH.
to infection control training the present result revealed insignificant difference between nurses who received training program about infection control and those who did not receive training program.The Royal College of Nursing believed that all health care staff should receive mandatory infection control training as part of their education and on an ongoing annual basis.It is important that knowledge and skills be continually updated.The training should cover