Prevention of Nosocomial Infection as perceived by Staff Nurses of Far Eastern

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PREVENTION OF NASOCOMIAL INFECTION AS PERCEIVED BY STAFF NURSES OF DR. FERNANDO B. DURAN SR. MEMORIAL HOSPITAL

Bicol University

Graduate School, Gubat CampusGubat Sorsogon

Dhonnalyn Amene- Caballero

2015

CHAPTER I

The Problem and Its Background

INTRODUCTION

Nursing is a profession of art and science that involves interaction with the client equipped with a touch of care. Unlike the other jobs, it opts to give care to those who are sick with a sense of desire to promote wellness and provide treatment. As promoters of health, nurses teach, give care, and treat patients who are physically, emotionally, mentally and socially sick and ill. It is a profession that offers the individual the chance to touch other peoples lives and be sensitive to them.

Nurses are the heart and hands of the team and they are sensitive to the needs of the client that enables them to have a good nurse-client relationship by being more emphatic as well as rendering services in a hands-on manner. This would mean constant contact and exposure with the various nosocomial infections present in the hospital setting. It is the duty and responsibility of the nurse to strictly comply and adhere to the hospitals preventive measures against nosocomial infections and other infectious diseases. Furthermore, nurses as health care workers should be aware of the ways to slow or prevent the transmission of infectious diseases and be knowledgeable of its potential risk to the client and hospital staffs.

As future nurses, the study aims to identify the ways of preventing nosocomial infections in Dr. Fernando B. Duran Sr. Memorial Hospital as well as the different kinds of preventive measures that are implemented and foreseen as an effective way in breaking down the chain of infection.

This study would serve as a baseline guide for further development and growth of nursing care and enhance the preventive strategies used to minimize nosocomial infection from the patient or client, hospital setting, and care giver itself.

STATEMENT OF THE PROBLEM

The study aims to determine the prevention of nosocomial infection as perceived by staff nurses of Dr. Fernando B. Duran Sr. Memorial Hospital. Specifically, it attempts to answer the following questions:

1. What is the demographic profile of the respondents in terms of:

1.1 Age

1.2 Gender

1.3 Educational Attainment

1.4 Length of service2. What is the nature of nosocomial infection in terms of:

2.1 Mode of transmission

2.2 Prognosis

2.3 Prevention and treatment

3. How effective are the preventive measures implemented by Dr. Fernando B. Duran Sr. Memorial Hospital in terms of:

3.1 Hand washing

3.2 Use of protective gears

3.3 Proper sanitation

3.4 Controlling spread of infection3.5 Sterilization

3.6 Surveillance

3.7 Isolation

3.8 Personal hygiene

3.9 Safe injection practices

3.10 Cleaning of the hospital environment

3.11 Disinfection of patients equipments

4. What are the implications of results and findings of the study to the improvement of nursing profession and service of the institution?

SCOPE AND PRELIMITATIONThis study is focus on the prevention of nosocomial infections as perceived by staff nurses of Dr. Fernando B. Duran Sr. Memorial Hospital with a particular description of the preventive measures implemented and foreseen as effective in preventing the spread of nosocomial infections.

It is limited to the hospital settings in terms of the preventive measures and modes of control that are implemented, practiced and seen as effective in slowing down and preventing the transmission of nosocomial infections among the clients, hospital setting, and care giver itself.

SIGNIFICANCE OF THE STUDY

The researcher believes that the study could further help and contribute to the following:

To the nurse. This study is significant in the sense that it could improve the nurses health awareness and early prevention skills and method thus, suppressing the possibility of the spread and transmission of nosocomial infections. It could also further contribute to the growth of the nursing profession thus allowing them to grow professionally.

To the hospital administrators. This study may determine the most effective preventive measures in slowing down or preventing the spread of nosocomial infections. Thus, can serve as bases of promoting and implementing standard precautionary measures for the clients, care givers and hospital administrators welfare.

To the future researchers. The findings in this research can help other studies that are related to prevention of nosocomial infection.

NOTES

Fundamentals of Nursing; Seventh Edition, Kozier and Erb, 2004

Analysis of Risk Factors, R. Littaua, MD.

Nurses on Duty, by John Smith;2009

CHAPTER llREVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents the literature, reading, and studies that are related to the present study which is prevention of nosocomial infections as perceived by staff nurses of Dr. Fernando B. Duran Sr. Memorial Hospital. RELATED LITERATUREForeign LiteratureKatrena Wells (2009) in her article Best Ways to Prevent Nosocomial Infections suggests five ways to help prevent the spread of infections in hospital. These are hand hygiene, avoiding infecting others if you are sick, using a tissue when you cough or sneeze, ensuring that you are up-to-date on any necessary vaccines, and supplies should be sanitized before they touch your skin.Other methods of preventing nosocomial infections include observance of aseptic technique, frequent hand washing especially between patients, careful handling, cleaning, and disinfection of fomites, air filtration within the hospital, and use of single-use disposable items (Abedon, Stephen 2009).

Hospitals may bring diseases and infections to nurses while attending to all the patients' needs because they are the primary caregivers of patients and are more in contact with the patients. Preventive measures are being implemented for the patients and to the nurses as well in order to prevent nosocomial infections. Some precautionary measures must be implemented in the event of any social conflict within the area like using of gloves as a protective gear to prevent transmission of diseases from patients onto the nurses and proper hand washing. The head nurse must be informed immediately as soon as the nurse starts to manifest any signs and symptoms of a possible communicable disease (Smith, John 2009).

According to John Bosso (2004), Hand washing by health care workers is crucial in preventing and controlling the spread of nosocomial infection. Only through staff education and awareness, ongoing surveillance, and appropriate intervention can this common problem be alleviated.

Maggie Edgar (1996) in her article Preventing the Spread of Disease: Tips for Providers, stated that care providers can stay healthier by following these guidelines: wash hands properly and frequently, maintain current immunizations, especially tetanus, take scheduled breaks and vacations, observe good nutrition, exercise regularly, rest sufficiently each day, and engage in hobbies or other activities that do not involve caring for someone else. Care providers who are ill should take care of themselves because they cannot provide the usual quality of care and they can spread germs to others. A healthy care provider is the key to a healthy, happy client care experience for clients and their families.Local Literature

Nosocomial infections according to Rep. Narciso D. Santiago III (Party-list, ARC), is a result of treatment in a hospital or a health care service unit, but secondary to the patients original condition. It is a hospital- acquired infection or more generally known as healthcare-associated infections that is responsible for the large number of deaths in the world. Hand washing and improving hygiene practices in the hospital is the most effective way for reducing the spread of these infectious agents.

The House Bill 5905 suggests that all hospitals should maintain and gather records of data on the hospital-acquired infection cases for a particular surgical procedure and surveillance in the intensive care units. Under the house bill, the Secretary of Health shall determine the different types of infections present in the hospital. (Camero, Jazmin, 2009)

House Bill 5905 also known as the "Hospital-Acquired Infections Disclosure Act of 2009" requires all hospitals to submit a yearly report of all the collected data regarding hospital- acquired infection cases to the Department of Health then, the DOH will submit a report to the congress summarizing all the data submitted by the hospitals. (Camero, Jazmin, 2009)

The Department of health shall also appoint members of the advisory committee which includes the physicians, representation of infection control department of both private and public hospitals, academic researchers, epidemiologists, health maintenance organization and health insurers who will help the department formulate and establish standards, rules and regulations needed to execute this bill. (Camero, Jazmin, 2009)

According to Tessa Tan-Torres, M.D., surveillance is the close and continuing observation of an individual or group. Its goal, in the hospital is the collection of accurate, reliable and timely data on infections and notifiable diseases acquired within the hospital. Surveillance data also includes information on risk factors, etiologic agents and antimicrobial susceptibility.

The specific aims of surveillance are the following:

1. detect the areas of concern in terms of infection control;

2. identify potential epidemics;

3. assess and consider the effectiveness of infection control measures;

4. remind the personnel about the infection control practices.

5. give and provide a basis for comparison with other services.

Surveillance of nosocomial infections is not a control measure by itself and the presence of ICC personnel can possibly lead to a stricter adherence on infection control practices among the hospital staff.

In the Philippine journal of microbiology and infectious diseases, it was stated that nosocomial infections continue to be of major clinical and epidemiological importance and this might be because of the continuous incidence of transmission of nosocomial infections; which is greatly associated with improper delivery of health. This kind of infection develops during a clients confinement at the clinical facility, but not also that this can be manifested even after the client is discharge. Moreover, nosocomial infections are not limited to patients but also the health care workers can also acquire this situation which usually gives a significant effect on the health workers lifestyle.

RELATED STUDIES

Foreign Study

JC Bridger (1997) conducted a study entitled a study of nurses views about the nosocomial urinary tract infections which was conducted at school of nursing, Middlesex university, Royal Free Hospital at London, UK. This study sought to discover the contribution of nursing practice to the prevention of hospital-acquired or nosocomial urinary tract infections (NUTIs), the most commonly occurring nosocomial infection. This qualitative study utilized unstructured interviews to explore the views of 12 registered nurses about three key issues: first, what care do nurses give with the aim of preventing catheter-associated NUTIs; secondly, what improvements in practice would further prevent catheter-associated NUTIs; thirdly, what do nurses see as constraints to the prevention of catheter-associated NUTIs? The nurses identified many of the measures that were cited in the literature as effective for preventing NUTIs; however in reality, they stated that their practice differed because of a lack of time to give care and to update themselves. Those interviewed identified feelings of powerlessness in effecting preventative measures, and identified not only the role of medical staff in influencing NUTIs but also their inconsistent approach to care.

Improving Nurses Hand Washing Compliance (Journal of Hospital Infection, 2002) is a study that explored the effectiveness of teaching strategies and the availability of additional hand-carried alcohol dispensers on nurses' compliance with hand disinfection. (2) Registered nurses and nurse assistants (n = 480) received standardized instruction on alcohol hand disinfection. To determine the amount of disinfectant used, the volume of the solution was measured before and after each study period. The clinical implications are that hand disinfection is a critical step in minimizing nosocomial infections. This study supports the premise that nurses and nursing assistants improve compliance with hand washing when teaching is provided. It also supports the importance of having hand-washing supplies in adequate supply and readily available at the point of care.

A study was also conducted by Suzanne Beyea (2003) entitled Nosocomial Infections; Hand-washing Compliance; Comparing hand hygiene protocols; Sensor-operator faucets - Evidence For Practice. This prospective, controlled study was conducted in eight medium-sized hospitals and examined the effect of appropriate quality management activities on nosocomial infection rates during a 26-month period. The study focused on surgical departments. Intensive care units (ICUs) were included to capture data for patients requiring this type of treatment after surgery. The intervention group comprised four hospitals, and the control group comprised four hospitals. The result was Clinicians should be aware of opportunities to use quality improvement and surveillance activities as strategies to reduce the risks of infection. In this study, clinicians from the units involved were instrumental in evaluating infection control measures and relating and implementing strategies to reduce the risk of infection.

Another study was conducted by Sau-Pin Won et. al (2004) which is the hand washing program for the prevention of nosocomial infections in neonatal intensive care unit that was held at a level-III NICU in a teaching hospital. The participants are Nurses, physicians, and other healthcare workers in the NICU and the objective of this study is to To evaluate the effects of a hand hygiene program on compliance with hand hygiene and the rate of nosocomial infections in a neonatal intensive care unit (NICU). The result was improved compliance with hand washing was associated with a significance decrease in overall rates of nosocomial infection and respiratory infections in particular and that washing hands is a simple, economical and effective method for preventing nosocomial infections.

Another study was conducted by Torregrossa M.V., Valentino L., Cucchiara P., Masellis M., Sucameli M. (2000) entitled Prevention of Hospital-Acquired Infections in the Palermo Center. This study reports on an extensive epidemiological survey of the microbiological monitoring of the environment, staff, and patients in the Intensive Care Unit of the Palermo Bums Centre (Italy). The aim of the survey was to evaluate the presence and distribution of environmental sources of pathogens and opportunistic bacterial agents of nosocomial infection in immunocompromised hosts. Strains collected from air, tap water, and medical and nursing staff were compared with strains isolated from burn patients in order to study the potential transmission route of bacteria. The results showed environmental strains presenting a profile identical to that of the clinical strains, suggesting a link between the environment, staff, and the patients. A programme of routine microbiological monitoring proved to be effective as a surveillance programme for the reduction of nosocomial infection.Local Study

A study about the incidence of nosocomial infections within a tertiary hospital was formulated by Bienvido Alora, M.D., Enrique Carandang, M.D. and Ludovico Jurao, Jr M.D. they stated that the problem of hospital-acquired or nosocomial infections have baffled physicians for a long time. The awareness of the extent and significance of this problem became apparent in the past two or three decades as more studies have been published. With this the researchers can say that due to the increase of the studies made for this topic the incidence of nosocomial infection within a hospital is still on hand.

Moreover, according to Rebecca Littaua, M.D. and Thelma Tupasi, M.D, they stated, despite major advances in antimicrobial therapy, nosocomial infections continue to be of major clinical and epidemiologic importance. Because nosocomial infections constitute a major source of morbidity, mortality and expense for the hospitalized patient, a prospective study was undertaken to determine the incidence and identify the major determinants of morbidity and mortality to serve as basis for recommending preventive measures against nosocomial infection.

Another important contribution is Katz SS. M.D. who made an unpublished study about treatments and guidelines for nosocomial infections. According to her, Health care workers should be equipped with requisite knowledge, skills and attitudes for good infection control practices. The infection control team should: assess training needs of the staff and provide required training through awareness programs, in-service education and on-the-job training; organize regular training programs for the staff for essential infection control practices that are appropriate to their job description; provide periodic re-training or orientation of staff; and review the impact of training. Hence the researchers further belief that the study should not only focus on the frequency of the nosocomial infections but also the preventive strategies that can be used to lessen the incidence rate of the problem.THEORETICAL FRAMEWORK

Existing social cognitive models suggest that determinants that shape human behavior are acquired through socialization and may be susceptible to change. When reviewing the literature, two theories were found to offer a strong theoretical framework for research in this area: the social cognitive theory (SCT), and Theory of Reasoned Action I Theory of Planned Behavior (TRAlTPB)

The Social Cognitive Theory stems from the Social Learning Theory and was proposed by Alfred Bandura in 1986. This theory is based on the notion of a triad model that takes into account the interactions between three factors: environment, personal cognition and behavior. A central tenet of the Social Cognitive Theory asserts that behavior is uniquely determined by each of the three factors and that response consequences mediate behavior. Further, the theory asserts that people are most likely to learn and model behavior observed in persons with whom they identify through a phenomenon commonly referred to as "vicarious capacity". Vicarious capacity is defined as an observational learning mechanism governed by attention span, retention process, motor reproduction process and motivational processes Bandura asserted that people learn by modeling behaviors from significant others; and that behavior is determined by symbolizing capability, forethought, self-regulation, self-reflection, and vicarious capability. The theory also states that a bi-directional interaction occurs between the environment and personal characteristics and is thus central to the development of human expectations, beliefs, and cognitive competencies. In the context of Bandura's Social-Cognitive theory, the healthcare facility would be the environment I 23 where directional and personal interactions between the healthcare workers such as the experienced nurses would interact with the novice nurses. It is therefore possible to postulate that the nurses with less experience will model the behaviors of the more experienced nurses.

The literature reviewed suggests that it is possible to apply the constructs of the Health Belief Model to studies that explore health behaviors such as health prevention and promotion, and compliance with recommended guidelines for infection control. The behaviors of health care professionals, and in particular nurses, are also regulated by social and moral standards. Through foresight, the individual can think through the consequences of a behavior without actually performing the behavior oneself. It is documented in some studies that positive health behaviors by healthcare workers may decrease the occurrence of the unabated nosocomial infections. For example. if a nurse internalizes the notion that prevention of nosocomial infections is essential. he I she will take precautions in order to improve on the outcomes of the admitting disease or condition, and improve the delivery of quality standard of care. Furthermore, a study that examined compliance with hand-hygiene practices among medical staff showed that the frequency of healthcare workers' hand-hygiene was greatly influenced by role models (Lankford et aI., 2001). In this observational study, the researcher noted that healthcare workers were less complaint with hand hygiene protocols when a high ranking 24 person such as physician or nurse did not carry out hand hygiene practices. This observation implied that the effect of role model is significant in negatively influencing healthcare workers' compliance with recommended guidelines.

Another theory with tenets applicable to this area of study is the Theory of Reasoned Action / Theory of Planned Behavior (TRArrPB) developed by social psychologists Ajzen and Fishbein in 1967. This theory explains how attitude and motivation influences human behavior. The theory proposes that "intent' is the most important determinant of a person's "behavior"; and furthermore, that an individual's intention to perform a behavior is dependent upon the "attitude" toward the performance of the behavior. The theory also contends that behavioral beliefs and normative beliefs influence the individual's motivation to comply with performance of a certain behavior. According to Ajzen (1991), behavioral beliefs link the behavior to an expected outcome while normative beliefs are considered as the perceived behavioral expectations of individuals within a group. Altogether these referents lead to actual behavior beliefs control and may drive the individual's intention to perform the behavior (Ajzen, 2006). Another assumption of the TRAlTPB theory is that human beings are rational: they make systematic use of information available to them and consider the implications of their actions before they decide to engage or not engage in certain behaviors. They (human beings) have normative beliefs which arise from perceived behavioral expectations of individuals such as co-workers; for example, nurses. Therefore, the stronger a person's intention to perfonn a particular task (behavior) is, the more likely the person will perform the behavior (Ajzen, 2006).

THEORETICAL PARADIGM

CONCEPTUAL FRAMEWORK

In this area of study, the researchers present concepts tackled in the course of study. These concepts are essential in guiding and directing the researchers toward data analysis and interpretation.

One significant conceptual framework of this study was depicted from an integration of Leavell and Clarks Ecologic Model: Agent-Host-Environment. This is effective for assessing and examining the causes of disease in an individual. The agent, host and environment interact in a manner that creates risk factors, and understanding these is important for the maintenance and promotion of health. An agent is a stressor or an environmental factor that must be absent or present for a disease to occur. A host is a living organism capable of being infected by an agent. Leavell and Clark emphasize health concepts and disease acquisition as:

1. The model is used primarily in preventing illness rather than promoting wellness, although identification of risk factors that result from interaction of agent-host-environment is helpful in promoting and maintaining health.

2. The model consist of dynamic interaction of three elements:

2.1. Agent. Any environmental factor or stressor (biologic, chemical, mechanical, physical or psychosocial) that by its presence or absence can lead to illness or disease.

2.2. Host. Person(s) who may or may not be at risk of acquiring a disease.

2.3. Environment. All factors external to the host that may predispose the person to develop disease.

3. Defines health as ever-changing state; when variable are balanced, health is maintained, when variables are not in balanced, disease occurs.

Another significant conceptual framework of this study is one of Leavell and Clarks Three Levels of Prevention primarily the Primary Prevention which states that:

1. Primary prevention is the action taken prior to the onset of the disease that removes the possibility that the disease will occur.

2. Primary prevention can be accomplished by measures of specific protection and health promotion.

3. It signifies intervention in the pre-pathogenesis phase of a disease.

4. Primary prevention can be accomplished by measures or procedures designed to promote well-being, general health and quality of life of people or by certain protective measures.

5. Primary prevention includes the concept of positive health, a concept that promotes maintenance and achievement of an acceptable level and degree of health that will allow every individual to lead a normal and productive life.

6. The strategy for prevention starts from the identification of the populations at high disease risk, assessing their exposure, conducting research on mechanisms, applying population-based intervention programs, evaluating the intervention programs and ending by modifying the existing intervention programs.

7. Primary prevention is a holistic approach.

8. Primary prevention keeps the disease process from becoming established by increasing resistance to the disease or eliminating causes of disease.

9. Primary prevention refers to health promotion, which promotes wellness and thus reduces the likelihood of premature death, disease and disability in a nonspecific way, as well as particular protection against the inception of disease.

10. Primary prevention precedes dysfunction or disease and is applied to generally healthy individuals or groups.

CONCEPTUAL PARADIGMDEFINITION OF TERMS

Aerosolized- in the form of ultramicroscopic liquid or solid particles suspended in air.

Agent- an environmental factor that must be absent or present for a disease to occur.

Airborne transmission- occurs by dissemination of either small particles or airborne droplet nuclei containing the infectious agent.

Aseptic- using methods to keep free of pathological microorganisms.

Compliance- acting in accordance to certain accepted standards, procedures, rules and preventive measures.

Direct contact- involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host from an infected person.

Disease- a condition of abnormal functioning or an impairment of health.

Droplet transmission- contact of the mucous membranes of the mouth or nose or the conjunctivae of a susceptible person with large- particle droplets containing infectious microorganisms generated from a person who is a carrier of the microorganism or has a clinical disease.

Ecologic- interdependence of living organisms in an environment.

Effectiveness- capability of producing desired results.

Environment- all factors external to the host that may predispose the person to develop disease.

Epidemiology- branch of science that deals with the transmission and control of diseases.

Fomite- any inanimate object or substance capable of carrying infectious organisms and thus transferring them from one individual to another.

Hand washing- universal precaution in the prevention of the spread of disease.

Host- a living organism capable of being affected or infected by an agent. Implemented- ensure observance of rules, procedures and preventive measures or laws that are enforced and followed.

Inanimate- non-living things; object

Inception- an event that is a beginning; origin

Indirect- contact- involves contact of a susceptible host with a contaminated intermediate or inanimate object in the patients environment.

Infirm- lacking muscular or body strength.

Isolation- separation between infectious and non-infectious groups or persons.

Measure- steps or standards in preventing the acquisition of nosocomial diseases.

Morbidity- relative incidence of a particular disease.

Mortality- ratio of deaths in an area to the population of that area; expressed per 1000 per year.

Nosocomial Infections- hospital-acquired infection or infections that develop as a result of stay in the hospital or are produced by viruses and infectious agents acquired during hospitalization.

Preventive- slows or hinders the course of a disease or illness.

Process- particular course of action intended to achieve a result.

Rapport- a relationship of mutual trust and understanding between people.

Sanitation- making the environment free from germs or state of being clean, neat and conducive to health.

Surveillance- close observation of a person or group.

Vector- any agent that carries and transmits a disease.

Wellness- a healthy state of well-being free from disease and infirmity.

Acronyms:

AHA- American Hospital Association

CDC- Centers for Disease Control and Prevention

DOH- Department of Health

ICC- Infection Control Committee

JCAHO- Joint Commission on Accreditation of Health Care Organizations

SHEA- Society for Hospital Epidemiology of America

NOTES

Preventing the Spread of Disease: tips for Providers, by Margie Edgar; 1996

Treatment and guidelines for Nosocomial Infection, by Katz Ss.

Supplemental lecture, by Stephen abedon; 2009

Handwashing program for the prevention of nosocomial infections in neonatal intensive care unit. By sau-pin won et. al 2004

Surveillance of Nosocomial Infections, by Tan-Torres, Tessa M.D.; 1997

Solon moves to prevent the spread of hospital- acquired infection, by Jazmin Camero; 2009

Nosocomial Spread of Viral Disease, by Celia Aitken et. al., 2001

Best Ways to Prevent Nosocomial Infections by Katrena Wells, 2009

Bridger JC. A Study of Nurses Views about the Nosocomial Urinary Tract Infections 1997

Suzanne Beyea. Nosocomial Infections; Hand-washing Compliance; Comparing hand hygiene protocols; Sensor-operator faucets - Evidence For Practice 2003

Improving Nurses Hand Washing Compliance by Journal of Hospital Infection, 2002

CHAPTER III

Research Methodology

RESEARCH DESIGN

These studies use the descriptive research. It is use to determine if there is certain relationship between variables. Descriptive research was defined as research studies in which phenomena are described on the relationship between variables is examined; no attempt is made to determine the cause-and-effect relationships.

RESPONDENTS/ POPULATION OF THE STUDY

This study about the prevention of nosocomial infections as perceived by the staff nurses involved a target total of 30 nurses positioned within the service wards of selected station of Dr. Fernando B. Duran Sr. Memorial Hospital as our respondents. RESEARCH INSTRUMENTS

The researchers used the questionnaire for gathering and researching the information needed in the study. It is aimed towards determining the prevention of nosocomial infections as perceived by staff nurses of Dr. Fernando B. Duran Sr. Memorial Hospital. The questionnaire was formulated with the use of the researchers basic knowledge acquired from literary sources and class discussions.

The questionnaire contains three parts. The first part was used to gather data about the personal profile of the respondents, including the name, age, civil status, educational attainment, nurses action and the length of service. The second part contains gathered data about the most common nosocomial infections present and encountered in the hospital as perceived by the staff nurses of Dr. Fernando B. Duran Sr. Memorial Hospital. The third part contains gathered data about the respondents practiced precautionary measures.

DATA GATHERING PROCEDURE

The descriptive method was use by the researchers of this study. After the retrieval of the questionnaires, the obtained data are carefully and manually tabulated and tallied by the researchers. The items with the most frequency were identified in order to arrive at an accurate interpretation of the results. The percentage of each item is also reflected on the tabulation to help the researchers have a clearer analysis of the surveys result.

STATISTICAL TREATMENT

The following are statistical tools we used to treat research data for in depth solution of problems:1. Slovins Formula- is the scientific way of determining a representative or acceptable sample size from any given population.

Formula: n = N

(1+Ne^2)

Where:

n= sample size

N= population size

e= margin of error (usually 0.05, since the preferred confidence level in sampling is 95%). 2. Frequency Distribution - is the tabulation of data by category or class intervals with corresponding frequency with each class.

3. Relative Frequency is used to convert distribution to percentage distribution.

Formula: % = f / n x 100

Where:% = is the relative frequency

f = frequency

n = number of respondents

4. Percentage- is computed to determine the proportional part to a whole such as given numbers of respondents in relation to the entire population.

Formula: P = f / n x 100

Where:P = percentage

f = frequency

n = total umber of respondents

5. Ranking is used to determine the order of decreasing or increasing magnitude of variables. The largest frequency is ranked 1 and the second is 2 and so and so on down to the last rank.

6. Weighted Mean is the sum of item values times the weight divided by the number of items; is used in determining the perceptions of the respondents on effects of physical environment in reducing nursing care.

7. Likert Scale summated rating scale; is the most widely used scale; the sum of all responses are calculated to arrive at degree at which an individual possesses the attribute measured.

NOTES

Prevention and Control of Nosocomial Infections, by John A. Bosso; 2004

Fourteenth Congress of the Republic of the Philippines, Second Regular Session, by Senator Miriam Santiago; 2009

Torregrossa M.V. et. al. Prevention of Hospital-Acquired Infections in the Palermo Center 2000Input

1. Demographic profile of the respondents

1.1 Age

1.2 Gender

1.3 Educational Attainment

1.4 Length of Service

2. Nature of the nosocomial infection

2.1 Mode of transmission

2.2 Prognosis

2.3 Prevention and treatment

3. Preventable Measures to avoid and minimize nosocomial infection and the transmission of other diseases.

3.1 Hand washing

3.2 Use of protective gears

3.3 Proper sanitation

3.4 Controlling spread of infection

3.5 Sterilization

3.6 Surveillance

3.7 Isolation

3.8 Personal hygiene

3.9 Safe injection practices

3.10 Cleaning of the hospital environment

3.11 Disinfection of patients equipments

4. Implications to the improvement of nursing profession and services

of the institution.

Throughput

Evaluation of the preventive measures implemented in Dr. Fernando B. Duran Sr. Memorial Hospital in slowing down or preventing the spread of nosocomial infections.

1. nosocomial infection encountered and acquired

2. Preventive measures

Output

Implication to Effective Preventive Measures and Modes of Control.