Background: Health care workers ‘hands are the main route of cross transmission of harmful germs to the patient when they are not clean. The main way to reduce cross transmission is handwashing. That is why nurses need to have knowledge on handwashing, which will influence their best practice and adherence to infection control measures.

Aim of the study: The present study aimed to evaluate hand hygiene knowledge and practices of nurses for infection prevention in neonatology at a selected district hospital.

Research methodology: Quantitative approach using cross sectional descriptive study was used to describe the level of knowledge and practices of nurses on handwashing for infection prevention in neonatology. A total sample of 50 nurses working in maternity and neonatal unit was used. An anonymous self-administered questionnaire was used to collect data and out of 50 questionnaires distributed 50 were returned back completed.

The data analysis was done using SPSS 20. The results demonstrated a mean knowledge of 78.09% and standard deviation (SD= 6.9), the mean score for practice was 71.27 (SD=19.6). Among 50 nurses who participate in the study 36 72% of respondents have good knowledge and 23 46% have good practice about handwashing. There was not association between demographic data and hand hygiene knowledge, the association was between the department of work and the practice of hand washing with the significant level of p= 0.012. However, the results did not show any relationship between hand washing knowledge and practice of nurses.

Conclusion: This study recommends improvement in services training that may help to increase knowledge and practice among nurses on handwashing and future research.

1.1. background to the study
This chapter provides the background of the study, showing the prevalence of healthcare associated infection and the data on the role of handwashing as important component of infection prevention to reduce HCIs in neonatology. In this study handwashing and hand hygiene were used interchangeably.

Health care-associated infections (HAIs) are one of the most common adverse events in care delivery and a major public health problem with an impact on morbidity, mortality and quality of life (WHO, 2016, p. 9). At any given time, up to 7% of patients in developed and 10% in developing countries will acquire at least one HAI (WHO, 2016, p. 9).

In sub-Saharan Africa, the data available show that the incidence of nosocomial infections ranges from 2-49% with patients in intensive care units having the highest rate ranging from 21.2 to 35.6% (Elizabeth, 2016, p. 1).

Globally, serious neonatal infections cause an estimated 36% of neonatal deaths. In some settings where mortality rates >45% per 1000 live births, neonatal infections are estimated to cause 40% to 50% of all neonatal deaths (Darmstadt, Zaidi and Stoll, 2011, p. 1). About 30-40% of infections resulting in neonatal sepsis deaths are transmitted at the time of childbirth (Blencowe et al., 2011, p. 2). In developed countries incidence of neonatal infections in NICUs range from 6% to 25% (Uwaezuoke and Obu, 2013, p. 1).

According to the Report on the Burden of Endemic Health Care-Associated Infection Worldwide Clean Care is Safer Care (2011, p. 18), neonatal infection rates in developing countries are 3 to 20 times higher than in industrialized countries and among hospital-born babies these infections are responsible for 4% to 56% of all causes of death in the neonatal period, with the ¾ occurring in the South-East Asia Region and Sub-Sahara Africa.

In Rwanda among the causes of neonatal mortality in 2010 sepsis was 29% (Surveys, 2010, p. 3). In 2012 neonatal mortality due to infection was 16% (MOH, 2012, p. 41), in 2013 neonatal mortality due to neonatal infection was11% (Statistics booklet, 2013, p. 43) and in 2014 neonatal mortality was 9%, due to infections among others causes. (Statistics, 2014, p. 39).

Hand hygiene is the primary measure proven to be effective in preventing HCAI and the spread of antimicrobial resistance (WHO, 2009b, p. 5). In addition, proper hand hygiene is the single most important, simplest, and least expensive means of reducing the prevalence of HAIs and the spread of antimicrobial resistance in health care setting (Mathur, 2011, p. 3). A study done by, (Lam et al., 2004, p. 1) show an increase in hand hygiene compliance from 40% to 53% before patient contact and 39% to 59% after patient contact. More marked improvement was observed for high-risk procedures 35%–60%, that compliance with hand hygiene reduces the health care– associated infection rate from 11.3 to 6.2 per 1000 patient-days.

However, Lack of knowledge on infection prevention among nurses can increase the rate of HCAs. This is supported by a study done by, Mohesh (2014), showed different level of knowledge on some elements where hand hygiene can prevent infection, 50% of them accepted that, hand hygiene practices before and after handling a patient will prevent health care associated infections. Although 94% agreed, 6% refused that hand hygiene as an important preventive measure for cross infections. 95% of them washed their hands before and after their food intake.70% of them used soap and water whereas only 6.36% used alcohol based agents (Mohesh, 2014, p. 2).

In addition, nurses are engaged in direct contact with the newborn while delivering care, so they have an important role in infection control. Ensuring that nurses recognize the importance of handwashing in prevention of HCAs, know when and how handwashing should be performed, and fellow recommended practice is important. In this context, the present research aimed to evaluate handwashing‘ knowledge and practice of nurses for infection prevention in University of Porthacourt Teaching Hospital. The findings from this study should be added to the existing literature and may be used to develop interventions to reduce the spread of infection in neonatology.

1.3 Problem statement
In the hospital settings, infections are the one of the cause of neonatal mortality. Rwanda demographic and health survey 2014-2015 reported that neonatal mortality was 20/1000 live birth (RDHS, 2015, p. 15). Neonatal mortality due to infections was 16% reported in Rwanda annual health statistics 2012(Ministry of health, 2012, p. 41). In 2014 neonatal mortality due to infection was decreased to 9% (RDHS, 2014, p. 48). Even though, there is a decrease but the problem still existing. In Uniport hospital among 2142 neonates admitted in neonatology in 2016, 514 24% were reported to have neonatal infections during hospitalization (Uniport hospital annual report, 2016). According to MOH (2012), neonatology clinical treatment guideline insist on hand washing (Minister of health, 2012, p. 6). The critical role of nurses in patient care emphasis on the role of the control hospital acquired infections, but good knowledge and skills are required for infection control (Fashafsheh et al., 2016, p. 2).However, health care staff ‘s Knowledge and practice on handwashing are important in the prevention of infections. In the selected district hospital in Rwanda, it is not known how nurses‘ knowledge and practice on handwashing is. This study intended to evaluate nurses‘ knowledge and practices on handwashing for infection prevention in neonatology at Uniport Hospital.

1.4 Objectives
1.4.1 Main objective
To evaluate the knowledge and practices of nurses on hand hygiene and infection prevention in University of Porthacourt Teaching Hospital.

Specific objectives
1. Assess the level of knowledge of nurses on hand hygiene and infection prevention in University of Porthacourt Teaching Hospital.

2. Identify the practices of nurses on hand hygiene and infection prevention in University of Porthacourt Teaching Hospital.

3. Identify the barriers to handwashing practices and infection prevention in University of Porthacourt Teaching Hospital.

1.5 Research questions
1. What level of knowledge of nurses on hand hygiene and infection prevention in neonatology at a selected district hospital?

2. What are practices of nurses on hand hygiene and infection prevention in University of Porthacourt Teaching Hospital?

3. What are the barriers to handwashing practice and infection prevention in neonatology at a selected district hospital?

1.6 Significance of the study
The study of knowledge and practices of nurses on hand hygiene and infection prevention in neonatology at a selected district hospital will boost the nurses to expand their therapeutic strategies and initiate appropriate programs in order to improve the life of neonates by covering the gap that already has been existing in follow up or management of neonates and narrow the burden of infections in general and more specifically health care acquired infection in University of Porthacourt Teaching Hospital. In addition, the study will motivate other researchers to conduct further researches on health care acquired infections in neonatology in order to improve the lives of the community.

1.7. Definition of concept
Handwashing: according to WHO (2009, p. 2) hand washing is a hand hygiene practice that requires washing hands with plain or antimicrobial soap and water as is the case in this study.

Knowledge: according to Colour Oxford English Dictionary (2011, p. 384) knowledge is defined as information and awareness gained though experience or education. In this study project knowledge refers to information and skills of nurses about hand washing for infection prevention in University of Porthacourt Teaching Hospital.

Practice: according to Colour Oxford English Dictionary (2011, p.536) practice refers to do something regularly as part of your normal behavior. The way nurses in neonatology and maternity incorporate handwashing when delivering care.

Health care associated infection: according to WHO (2011, p, 10), health care associated infection is an infection occurring in a patient during the process of care in a hospital or other health-care facility which was not present or incubating at the time of admission. In this study HCAs is considered as an infection that a newborn baby contracted when he/she is hospitalized for other pr0blems.

Neonate: according to Stanford a newborn is a baby aged from 0 to 28 days. In this a neonate is every baby this age may a term, preterm, or post term.

1.8. Organization of study
This thesis is divided into five chapters. The first chapter is introduction and it includes background to the study, problem statement, and objectives of the study, research questions, and significance of the study. Chapter two includes introduction, theoretical literature, critical review and research gap identification, conceptual framework and summary. Chapter three is composed of introduction, research design, target population, sample design which includes simple size and simple technique, data collections methods which includes instrument, reliability and validity, data analysis procedure and ethical consideration. Chapter four presents results and findings; chapter five deals with discussion of the findings whereas the last chapter presents conclusion and recommendations.

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Item Type: Project Material  |  Size: 51 pages  |  Chapters: 1-5
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