الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Infections acquired in the health-care setting have emerged as an important public health problem worldwide and a leading cause of morbidity and mortality in developed and developing countries. The impact of health-care acquired infections (HAIs) implies prolonged hospital stay, long term disability, increased resistance of micro-organisms to antimicrobials, massive additional financial burden, high costs for patients and their families, and excess deaths.The risk of acquiring HAIs is universal. It is an issue which pervades every health-care facility and system around the world, regardless the available resources
Infection control (IC) refers to all policies, procedures and activities which aim to prevent or minimize the risk of transmitting infectious diseases from patient to patient, from patient to staff member and from staff member to patient. Standard precautions are a group of infection prevention practices that apply to all patients, regardless of suspected or confirmed diagnosis or presumed infection status. It helps to break the infection’ cycle.
Both patients and health-care workers (HCWs) are exposed to a wide variety of blood borne pathogens. The most important of these pathogens are hepatitis B virus (HBV), hepatitis C virus (HCV) and immunodeficiency virus (HIV). Infection can also occur through contact with blood, respiratory secretions and contaminated equipment. Proper IC procedures can prevent transmission of any infection to both patients and HCWs and can particularly reduce the risk of transmission of blood borne pathogens.
Effective nursing interventions can control and prevent infection; the nurse should review the assessment data, considers the cycle of events that result in the development of infection. Using infection control technique and application of standard precautions including hand hygiene, use of appropriate personal protective equipment (PPE), use of aseptic technique, safe injection practices, respiratory hygiene and cough etiquette, reprocessing of reusable medical equipment, environmental cleaning, safe waste disposal, linen management and proper storage and handling of medications are nurses’ responsibilities to control and prevent infection transmission in hemodialysis units.
The current study aimed to assess the infection control knowledge and practices of nurses in hemodialysis units of governmental hospitals in El-Behiera Governorate, and to identify some determinants affecting knowledge and practices of nurses about infection control.
A cross-sectional design was used to conduct the study. The study was conducted in governmental hospitals in El-Behiera Governorate, 350 nurses working in ten hemodialysis units from nine health districts chosen randomly from the eighteenhealth districts in El-Behiera Governorate.
Two techniques were applied in collecting the required data: a self-administered structured questionnaire and an observational checklist for IC practices.The questionnaire sheet includeditems related to socio-demographic characteristics such as: age, marital status, educational level, years of experience in HD units, attending training programs on IC and also it included data about nurses’ knowledge about infection, infection control standard precautions and factors affecting application of standard precautions in HD unit. On the other hand the observational checklist included observations on key components of standard precautions applied by nurses in the selected hemodialysis units.
In the light of data analysis the results could be summarized as follows:
• A total of 350 nurses participated in the study, their age ranged from 21-59 years with a mean age 32.65± 8.48 years, more than one third (39.1%) of the studied sample had less than 5 years of experience, and 37.7% of them did not received any training on infection control measures.
• As regards the total knowledge score, more than three quarters (78.6%) of the studied sample had satisfactory knowledge score and about 20.0% had fair score, while only 1.4% had unsatisfactory score with the mean knowledge score of 114.19 ± 14.82.
• The majority (87.4%) of studied nurses defined the infection, nosocomial infection correctly and 77.4%of them were knowledgeable about the meaning of infection control.
• More than three quarters (77.2%) of the studied sample gave correct answer regarding definition of standard precautions, while only 22.9% of them knew all the elements of standard precautions.
• Most (97.1%) of the nurses reported that deficiency of hospital resources and required supplies were the most common factors that affect application of standard precautions.
• Regarding total practice score of studied nurses concerning application of standard precautions, most of the studied sample (92.9% and 84%) scored average practice in morning and evening shifts respectively.
• Regarding hand washing in the morning shift, the majority (94.9% and 93.7%) of nurses did not practice hand washing before entering the dialysis unit and before providing nursing care to the patient and 75.1% did not wash their hands between one patient and another.
• No one in the studied sample used protective eyewear during dealing with hemodialysis patients, and only 0.6% of nurses used a surgical mask at required times
• There was a significant relationship between the knowledge score and years of experience of the studied sample as well as attendance of training in infection control.
• There was a significant relationship between the performance score and years of experience of the studied sample as well as frequency of their training in infection control.
• There was a significant relationship between the knowledge score and the performance score of the studied sample.
In order to improve nurses’ knowledge and practices regarding infection control standard precautions, the following proposed recommendations are suggested:
1. Educational training programs should be multidisciplinary in the era of quality control to help HCWs realize the importance of basic infection control policies in reducing morbidity and mortality as well as improving the quality of care.
2. Providing sufficient resources to conduct training programs that are both educational and motivational.
3. Encouraging the adherence to recommended universal precautions and safety practices should be an integral part of providing high quality care.
4. Continuous supervision and evaluation of nurses’ performance related to infection control measures to improve quality of care given in relation to prevent and control of infection in dialysis units.
5. Activation of infection control committee to provide education, surveillance, infection control policies and manual with procedural guidelines.
6. Availability of all facilities and equipment those are required for applying standard precautions in hemodialysis units.
7. Proper distribution of nurses to maintain reasonable nurse-patient ratio to permit a high quality of care.
8. Improve the working conditions through increase of rewards, incentives for nurses to increase work interest.
9. Disseminate educational materials throughout the hemodialysis units about infection control procedures.
10. Further studies are highly needed to evaluate knowledge and practices of HCWs regarding IC in other hemodialysis units and in other Governorates.