The importance of this study is to measure the Knowledge, Practice and Attitude among nursing students on standard precautions and its impact on improving the quality of health care and substantially reduced nosocomial infections and cross-contamination of multi resistant infections in hospitals. Also through this study we will identify main factor that effect on compline of standard precaution practice due to the student Knowledge, Practice and Attitude has a great effect on their safety as well in patient safety. Preforming standard precaution well helps in Life-Saving, and reduces the morbidity and mortality of clients in all health care settings and increase cost-effective. The results of the study will give the level of Knowledge, attitude and practice of among nursing students in Oman which could affect patients care during their nursing training years or when they become registered nurses. Since many years ago the ministry of health in Oman interested in infection control reflecting that in specifying experts in each hospital are responsible for stander precaution among health care providers. Because they observe that many patients are deteriorating due to breaking of barrier of infection disease transmutation. Thus, increase mortality rate and increase the duration of inpatient. So putting standard precaution in curriculum enhances awareness of it among students.
Standard Precaution Practice (SPP) or infection control prevention is systematic process of steps and policies that health professional takes to protect both patient and health care worker or nursing students corresponding with increase rate of occupational hazards among healthcare facilities and hospitals.it is also aimed to prevent health care worker from transmitting infectious disease to their patients by careful compliance [1].
During normal clinical routine Nursing students with other health care providers are significantly face the occupational hazards due to direct contact to body fluid, rashes and mucous membranes and blood-borne pathogens like (HBV and HCV). And the nature of the environment of the hospital makes a chance for transmission of the contagious agents to nurses which are the front line of exposure. The most infectious disease due to break down of the barrier of transmission includes filovirus infection and nosocomial infections [2,3].
Other than the compliance of SPP, there are associated factors that contribute to ineffective use of standard precautions consist of knowledge, attitude and practice which varies among health care providers. Knowledge of standard precautions, signs and symptoms of infectious disease however attitude focused on abilities to treat and handling such patients. While the use of PPE, proper waste and sharp management, sterilization and disinfection reflect practice sessions [2].
According to Mfuh et al., [4], majority 62% of nursing students have good knowledge and attitude regarding the effectiveness of hand hygiene in the prevention of cross-infection in hospitals, result from a microorganism in the hand of the health care. about 61. % of students practicing hand hygiene and this approve relationship between knowledge and practice of hand hygiene. other studies support this relationship as in 2017, Ndu. et al., [5], show a lack of knowledge and attitude about nosocomial infections with medical college students resulting in insufficient practice approach towards nosocomial infection. Also low nursing practice score recording in dealing with a child with hepatitis B when they don’t have adequate knowledge about isolation techniques for children with hepatitis.
As the blood borne pathogens are the most cause of infectious disease among nursing students due to the direct contact to the blood or Needle Stick Injury (NSI) several studies focused insignificant of knowledge and practice of SPP in prevention HBV infection among nursing and medical student worldwide. According to Adenlewo et al. [6], about 83.2% of participants take the HBV vaccine and consider the patient as a risk so they wash hands and wear gloves before contact with open mucosa. This indicates that better health behavior associated with high health literacy. In Pate. et al., [3], found that the majority 60% of students now about Post-Exposure Prophylaxis (PEP) after needle stick injury, however, 28% of students didn’t know that they should report after needle stick injury or to home to report. Thus, make them at risk of developing hepatitis and HIV disease.
Therefore, most of these studies and researchers aimed to measure knowledge, attitude and practice of standard precaution among nursing students in the clinical area. And to define the relationship between knowledge of SPP and practice among Omani nursing students.
Research Objectives
Specific aims for this study include:
To describe the knowledge about Standard Precautions Practice (SPP) among medical field Omani students
To identify the practice of SPP among nursing students in Oman
To identify the attitude towards SPP among Omani nursing students
Research Approach
In this study will be adopted quantitative research approach.
Research Design
Cross sectional correlational research design will be chosen for the study. For that reason, there is no intervention will be applied in this study. Additional to this, data will be collected one time only The level of knowledge, attitude and practices among health care students about standard precaution will be explored.
Setting
This study will be conducted in Colleges of Nursing at Sultan Qaboos University (SQU), Nizwa and Buraimi University.
Study Population (Target and Accessible Population)
Target Population: Nursing students in Oman
Accessible Population: Nursing student how trained in hospital at colleges of nursing at Sultan Qaboos University (SQU), Nizwa and Buraimi university
Sample and Sample Size Including Sample Calculation
Sample of population who will be included in this study are selected from colleges of nursing at Sultan Qaboos University (SQU), Nizwa and Buraimi university.
Sample and Sample Size
The sample size of the study is calculated by using Slovin’s formula (e = 0.05) margin of error
The following formula was used for calculating sample size:
n = N/ (1+N.e2)
Where:
n : Sample size
N : Population size,
E : Desired margin of error
The sample size will be
n = N/ (1+N.e2)
Sampling Technique
This study will be utilized sample random sampling technique.
Sample Inclusion Criteria
The inclusion criteria for this study will include the following:
At 2th level of studying and above
At 2level of studying and have clinical course
Student in SQU, Nizwa and Buraimi university
Willing to give consent to participate in this study
Exclusion Criteria
Under 2 level of studying
Not nursing students
Students in level 2 or above of studying but not start clinical course
Ethical Consideration
Ethical approval for this study will obtain from research and ethic committee at the college of nursing at Sultan Quaboos University, Nizwa and Buraimi university. Inform consent will be taken from all participants before starting in the study and participants will have enough explanation about purpose and objectives of this study and will have right to ask any question or discontinue at any time. During data collection, anonymity and confidentiality will be ensured. Data will be coded and locked password protected. Only the Primary investigator will be given the access to reach the data. Students name or other identification’s will not be collected for any other purpose. No gifts or remunerations will be given to the participants.
Validity and Reliability
We use self-determination questionnaire for data collection in this study and this questionnaire is developed by Hussen SH. Before start data collection we review the questionnaire item with experts in nursing college to a chive concept of validity and also pretest of questionnaire done for students how are not included in the study. The reliability (inter content) peer reviewed [7].
Instrument for Data Collection
The researcher uses standardized questionnaire instrument for data collection which is formulated by Hussen SH and modified by expert in college of nursing. The questionnaire consists of 4 parts based on the study objectives. Part 1 about demographic data, part 2 about Knowledge on infection prevention measures, it consists of 14 (Yes\No) question to assess knowledge on infection prevention measures, part 3 about Attitude on infection prevention and control measures use categorical version, it consists of 10 positively worded items on a 5-point Likert-type scale (1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree to some extent, 5 = strongly agree). Finally, part 4 about Practice towards infection prevention measures, it consists of 9(Yes\No) question to assess practice on infection prevention. It found suitable after checked validity and reliability [7].
Pilot Study
We chose 10 of undergraduate students how started work in the hospital from college of medicine and college of nursing for self-determination questionnaire for determination of validity and feasibility of the study. During pilot study we will do pretest for study objective prior performance of a full- scale research project. Participants in pilot study will excluded from actual study students.
Data Collection
We use English self-determination and online form questionnaire to collect data on knowledge, attitude and practice of standard precaution among nursing students. Data collection from college of nursing at SQU, Nizwa and Buraimi university. About nursing students in SQU, we distribute website for online form questionnaire to nursing students in our college. And send copy of this questionnaire to our colleagues in Nizwa and Buraimi universities after getting approval. Finally, researcher will collect the questionnaire from students and make sure they answer all question. And ensure anonymity and privacy during data collection.
Data Processing
The data are going to be writing in computer and arranged for data analysis. The processed data are going to be compared to the data from filling questionnaire to avoid any error within the getting into. throughout data improvement, the researchers can seek for reliable of the data in every questionnaire and if there are any missing information.
Data Analysis
Data are going to be analyzed using descriptive Statistical measures such as percentages and frequency distribution will be used in the analysis the data to provide descriptions of the population through numerical calculations. Inferential statistics makes inferences and predictions about a population based on a sample of data taken from the population in question and inferential statistics by the Statistical Packages for Social Sciences (SPSS) software program- Version twenty-four, using frequencies, perctange, main, standard deviation and Chi-Square Tests for correlation.
A total 150 nursing students where 50 students from each university (SQU, nizwa and ALburymi) participated with response rate (98.7%) were complete and included in analysis. These students are from different academic level about 29 (20.9%) from level 2, most of them from Level4 74 (45.3%) and 47 (33.8%) from level 3. Concerning the clinical course of the respondents include Fundamental – advance, 63 (45%) of students where studding advance course. The GPA of these students are between 2 to 3.8, about 20 (20.8%) of respondents have 3 GPA. From the study participants, (33.1%) of students were in age group of 18-32 years and 52 (36.9%) were 22 years old. Among 150 students 57 (39%) male and 89 (61%) (Table 1).
Table 1: Socio-Demographic Characteristics of Nursing Students
| University | SQU (50) | Nizwa (50) | ALburymi (50) |
| Academic level Response (139) | Level 2 29 (20.9%) | Level 3 47 (33.8%) | Level 4 74 (45.3%) |
| Clinical course Response ( 140) | Fundamental – advance/mostly advance course 63 (45%) | ||
| GPA Response ( 96 ) | 2-3.8/mostly 3 20 (20.8%) | ||
| Age Response(141) | 18- 32/mostly 22 years 52(36.9%) | ||
| Gender Response (146) | Male 57(39%) | Female 89 (61%) | |
Among nursing students 139 (93,3 %) were know when to use standard precautions however 137 (91.9%) of students were know the objective of standard precautions. From the nursing students 143 (96%) were knew there is infection control team in hospital. In general, 86 (42.4%) of students were receive training in hand hygiene and standard precautions and 135 (91.2%) of nursing students aware of recommended guide lines for hand hygiene and there is a system for reporting accidental exposure to blood. Among nursing students 140 (94.6%) were know when to perform hand washing and 132 (89.2%) of students know the effectiveness of hand washing in preventing HCAIs (Healthcare-associated infections). also, 126 (86.3%) of nursing students know the impact of HCAIs in clinical outcomes. In general, 140 (98.6%) know nosocomial infections can be transmitted through medical equipment’s. 139 (93.3%) of nursing students know about safety precautions for disposal of needles syringes and any wastes and about 136 (91.9%) of nursing students Know about safety precautions for disposal of needles this supported by Just only 115 (77.7%) of students think glove is effective substitute for hand washing.
From nursing students 129 (87.2%) were know by what mechanism bacteria and virus spread through can. and 125/84.5%of students knew what to do in the room with TB patients. In general, 140 (94.6%) of nursing students have good knowledge towards infection prevention and control measures and 10 (3.4%) have poor knowledge (Table 2).
Table 2: Knowledge on Standard Precaution Practice(SPP) of Nursing Students
| No | Variable | Frequency | Mean | SD |
| % | ||||
| 1 | Do you know when to use standard precautions? 149 responses | 139/ 93,3 % | 1.07 | 0.249 |
| 2 | Do you know the objective of standard precautions? 149 responses | 137 /91.9% | 1.09 | 0.288 |
| 3 | Is there infection control team? 149 responses | 143 / 96% | 1.03 | 0.179 |
| 4 | Did you receive training in hand hygiene and standard precautions? 148 responses | 86 / 42.4% | 1.35 | 0.480 |
| 5 | Aware of recommended guide lines for hand hygiene. Is there a system for reporting accidental exposure to blood and body fluids? 148 responses | 135 / 91.2% | 1.09 | 0.289 |
| 6 | Do you know when to perform hand washing? 148 responses | 140 / 94.6% | 1.10 | 0.299 |
| 7 | Do you know the effectiveness of hand washing in preventing HCAIs? 146 responses | 132 / 89.2% | 1.14 | 0.349 |
| 8 | Do you know the impact of HCAIs in clinical outcomes? 148 responses | 126 / 86.3% | 1.04 | 0.199 |
| 9 | Do you know nosocomial infections can be transmitted through medical equipment’s? 148 responses | 140 / 98.6% | 1.08 | 0.276 |
| 10 | Know about safety precautions for disposal of needles 148 responses | 136 / 91.9% | 1.25 | 0.432 |
| 11 | Do you think glove is effective substitute for hand washing? 148 responses | 115 / 77.7% | 1.14 | 0.349 |
| 12 | Do you know by what mechanism bacteria and virus spread through can? 148 responses | 129 / 87.2% | 1.07 | 0.249 |
| 13 | Do you know about safety precautions for disposal of needles syringes and any wastes 149 responses | 139 / 93.3% | 1.17 | 0.380 |
| 14 | Do you know what to do in room with TB patients to prevent the spread? 148 responses | 125 / 84.5% | 1.05 | 0.217 |
Total | 105 (77.2%) | 15.6610 | 1.96647 |
Out of 150 study participant 99(66.4%) of nursing students had positive attitude (Strongly agree and agree) towards that every patient should be asked for detail if they have any signs and symptoms of infection and 51 (33.6%) had negative (disagree, neutral and strongly disagree). From the total respondents 105 (77.2%) of students tell coughing patients to follow cough hygiene procedures such as using masks, covering mouth while coughing and sneezing and 45 (22.8%) had negative attitude (disagree, neutral and strongly disagree). Among 150 study participants 93 (62.4%) had positive attitude (agree and strongly agree) that opening windows and doors of the ward is important to make the ward ventilated and 57 (37.6%) of the respondents had negative (disagree, neutral and strongly disagree) to open windows and doors. About 123 (83.1%) of nursing students using EPP in clinical area while 27 (16.6%) of students does not use EPP in clinical area. Out of 150 study participant 128 (71.8%) of nursing students had pasittive attitude (Strongly agree and agree) that it is important to Washing hands before and after contact with patients however, 22 (28.2%) of them does nnot see it is important to do frequent hand ashing. From the total responddents 127 (71.8%) believe that PPE protect HCWs from infection and 23 (28.2%) does not believe that PPE protect HCWs from infection. About 119(79.7%) of nursing students had positive attitude (agree and strongly agree) that absence of universal precaution hospital facilities can be the source of infection and 31 (20.3%) of nursing students had negative attitude (disagree, neutral and strongly disagree) toward absence of universal precaution hospital facilities can be the source of infection. Among 150 participants 86 (50.6%) believe that nosocomial infection can pose serious outcome however 64 (49.4%) of them does not believe that nosocomial infection can pose serious outcome.
About 95 (63.8%) of respondents had positive attitude (agree and strongly agree) regard needles should be recapped after use and 55 (36.2%) of respondents had negative (disagree, neutral and strongly disagree) attitude that needles should be recapped after use. Also 124 (83.2%) of nursing students believe that recapping is the cause for needle prick injury however, 26 (16.8%) of them does not believe that recapping is the cause for needle prick injury. In general, 105 (77.2%) of nursing students had positive attitude regard standard precaution practice and 45 (22.8%) of nursing students had native attitude regard standard precaution practice (Table 3).
Table 3: Attitude on Standard Precaution Practice(SPP) on Nursing Students
| No | Variable | Category |
M |
SD | ||||
Strongly disagree (1) | Disagree (2) | Neither Agree Nor Disagree (3) | Agree (4) | Strongly agree (5) | ||||
| 1 | I feel comfortable asking every patient if they have any symptoms of infection 149 responses | 9 0.57% | 10 0.57% | 31 20.8% | 65 43.6% | 34 22.8% | 3.66 | 1.126 |
| 2 | Feeling comfortable to tell coughing patients to follow cough hygiene procedures 149 responses | 5 0.54% | 8 0.54% | 21 14.1% | 58 38.9% | 57 38.3% | 4.07 | 1.002 |
| 3 | Ventilating the ward by opening windows and door 148 responses | 14 9.4% | 12 1.08% | 36 20.1% | 48 32.2% | 45 30.2% | 4.28 | 0.878 |
| 4 | Using PPE 149 responses | 6 5.6% | 6 5.6% | 17 5.9% | 50 33.8% | 73 49.3% | 4.50 | 0.685 |
| 5 | Washing hands before and after contact with patients 149 responses | 2 4.5% | 2 4.5% | 19 4.5% | 42 28.8% | 86 57.7% | 4.28 | 0.730 |
| 6 | Do you believe PPE protect HCWs from infection 149 responses | 1 0.58% | 1 0.58% | 21 14.1% | 62 28.2% | 65 43.6% | 4.23 | 0.814 |
| 7 | Do you agree that in the absence of universal precaution hospital facilities can be the source of infection 149 responses | 1 0.75% | 1 0.75% | 28 18.8% | 51 34.2% | 68 45.5% | 3.30 | 1.493 |
| 8 | Do you believe needles should be recapped after use 149 responses | 25 30.9% | 15 2.65% | 14 2.65% | 49 32.9% | 46 30.9% | 3.30 | 1.443 |
| 9 | Do you believe that nosocomial infection can pose serious outcome 149 responses | 59 39.9% | 2 4.7% | 2 4.7% | 68 45.9% | 18 4.7% | 4.24 | 0.719 |
| 10 | Do you agree that recapping is the cause for needle pricinjury 149 responses | 3 2.6% | 3 2.6% | 19 7.6% | 63 42.3% | 61 40.9% | 4.21 | 0.805 |
| TOTAL | 40.457 | 4.7996 | ||||||
Among respondents 139 (93.3%) follow recommended guide lines for use of alcohol and other antiseptics after lifting and moving patient and 91 (61.5%) does not recap used needle and 138 (93.2%) discard wastes immediately in to their container and 139 (93.9%) remove rings and bracelets before beginning hand hygiene and 117 (79.1%) have written guideline for those who are exposed to HIV, HBV, HCV and 129 (86.6%) have written guide line on waste disposal and 105 (72.4%) of staffs apply the guide line and 137 (93.2%) have isolation criteria for those who are admitted with highly contagious diseases and 143 (96%) discard sharp materials separately from other wastes. In general, 135 (90%) of nursing students have good practice towards infection prevention and control measures and the remaining 15 (10%) of nursing students have poor practice (Table 4).
Table 4: Practice Towards Standard Precaution Practice (SPP) of Nursing Students
| No | Variable | Frequency | M | SD | |
| Yes | No | ||||
| 1 | Do you follow recommended guide lines for use of alcohol and other antiseptics after lifting and moving patient? 149 responses | 139 93.3% | 10 2.7% | 1.05 | 0.217 |
| 2 | Do you recap used needle? 148 responses | 57 38.5% | 91 61.5% | 1.10 | 0.299 |
| 3 | Do you discard wastes immediately in to their container? 148 responses | 138 93.2% | 10 6.8% | 1.14 | 0.349 |
| 4 | Do you remove rings and bracelets before beginning hand hygiene? 148 responses | 139 93.9% | 9 6.1% | 1.04 | 0.199 |
| 5 | Do you have written guideline for those who are exposed to HIV, HBV, HCV and etc.? 148 responses | 117 79.1% | 31 20.9% | 1.08 | 0.276 |
| 6 | Do you have written guide line on waste disposal? 149responses | 129 86.6% | 20 13.4% | 1.25 | 0.432 |
| 7 | If yes do all staffs apply the guide line? 145 responses | 105 72.4% | 40 27.6% | 1.14 | 0.349 |
| 8 | Do you have isolation criteria for those who are admitted with highly contagious diseases? 147 responses | 137 93.2% | 10 2.7% | 1.07 | 0.299 |
| 9 | Do you discard sharp materials separately from other wastes? 149 responses | 143 96% | 6 4% | 1.17 | 0.380 |
| TOTAL | 10.699 | 1.4597 | |||
According to this study, we found there are significant association between academic level and clinical course with knowledge, attitude and practice of standard precaution. And age, gender and GPA does not have any impact in level of knowledge, attitude and practice of standard precaution among nursing students in the clinical area.
This study result show that 94.6% of nursing students at Sultan Qaboos University had good knowledge while 3.4% of students their knowledge considered as poor knowledge about standard precaution. This study finding is higher when compare the result of this study with the result of study from teaching hospital of Zabol which revealed that 57% of participants had good knowledge and 43% of the participants had poor knowledge. While, we will find the percentage is less low when this study compared with finding from Wolaitta Sodo Otona Teaching and Referral Hospital in Ethiopia which show that 99.3% of health care participants had good knowledge and 0.7% had poor knowledge. The finding from Dessie referral hospital which show 4.81% had poor knowledge while 95.19% of the health care participants had good knowledge is almost similar with this study results. This study revealed that 105 (77.2%) of SQU nursing student had good attitude and 45 (22.8%) of SQU nursing student had poor attitude towards standard precautions. This finding is higher when compared with finding from Wolaitta Sodo Otona Teaching and Referral Hospital in Ethiopia which revealed 93.4% of participants had good attitude toward standard precaution while 6.6% of participant had poor attitude. And also, higher from the study result conducted from teaching hospital of Zabol which revealed 33% of health care participant had good attitude. Also, this study revealed that 135 (90%) of nursing student had good practice and 15 (10%) of SQU nursing student had poor practice on standard precaution. When do comparison between the result of this study and the finding from Zabol teaching hospital which showed 34% of the study participants had good practice we will find the percentage of participants with good practice of standard precaution is higher. This study finding is lower when compared with finding from Dessie referral hospital which show 87.5% of the study participants had good practice on standard precaution.
The variation in percentage of knowledge, attitude and practice among participants is related to difference in the size of sample, variation in setting of the study, difference in characteristics of participants, training and infection prevention guideline availability, difference in level of awareness among participants, participants not following recommended infection prevention guide lines.
This study revealed that there is significant statistical association in, Academic level and clinical course of students while GBA and gender statistically negative association with knowledge, attitude and practice of sandard precaution. The study in Amhara regional state referral hospital revealed that there is significant statistical association in age and educational status of participants.
Majority of nursing student s knowledge and practice of standard precaution at Sultan Qaboos University (SQU), Nizwa and Buraimi university were good and safe enough but attitude of nursing students towards standard precaution were not sufficient. So we need to improve the accepting of nursing students to SPP. Varibles sush Academic level and clinical course of students has association with SPP, but GPA and gender has no significant association with SPP.
Recommendation
Based on the study finding the following recommendations are forwarded: all 3 universities should encourage nursing studets on application of written guide lines on use of personal protective equipment’s encourage nursing students to use personal protective equipment’s. also they should apply written guide lines toward infection prevention and control measures responsibly.
Every instructor should follow nursing students closely and should take appropriate measure on student who fails to practice as per guideline and protocol. Also should focus on and supervise male health care workers. All these 3 university most provide training and preparing and introducing nursing student to infection prevention guidelines, protocol, rules, regulation
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