الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 139 |  |  |
| | | from | 139 | | |
Abstract
Hemodialysis (HD) is the main renal replacement therapy for
patients with end stage renal disease (ESRD). This treatment modality
carries risk of transmitting blood borne infections such as hepatitis B
virus (HBV), hepatitis C virus (HCV), and human immunodeficiency
virus (HIV), which could be caused by suppressed immunity of patients,
multiple blood transfusions, contaminated devices and equipment, and
environmental surfaces. Blood borne infections are important causes of
morbidity and mortality among patients on maintenance HD.
Preventive measures for blood borne infections include HBV
vaccination, proper screening of donated blood products, separation of
HBV dedicated dialysis machines, and periodic test for hepatitis B
surface antigens (HBsAg) and anti-HBV antibodies, while HCV
transmission within the dialysis environment can be minimized by strict
adherence to infection control precautions recommended for HD
patients.
It is important that nurses in hemodialysis units understand their
responsibility in breaking the chain of infection. This responsibility
includes prevention of spread of pathogens from patient to patient, and
from the health team member to the patients. In addition, they have an
active role for applying the necessary precautions to control this
infection. Therefore, nurse’s awareness and constant application of these
precautions will ensure that the accidental exposure of patient to blood
borne infections will be reduced to an absolute minimum.
The aim of this study was:
To identify the risk factors exposing hemodialysis patients to blood
borne infections.
Materials and method
Research Design: A descriptive research design was utilized for this
study.
Setting: This study was conducted at the hemodialysis unit of
Elmowasah University Hospital which is affiliated to Alexandria
University.
Subject: The sample of this study comprised all the nurses working at
the hemodialysis unit of Elmowasah University Hospital (25nurses)
and the hemodialysis patients (78) were considered eligible to
participate in the study, if they meet the following criteria:
• Adult patients of both sexes aged from 21-60 years.
• Patients diagnosed with renal failure on maintenance
hemodialysis.
Tools of the study:
Two tools were used for the purpose of data collection.
Tool I: Blood borne infections control measures knowledge
structured interview schedule:
The tool consisted of three parts as the following:
Part I: Biosociodemographic data; which consisted of nurse’s
biosociodemographic data, patient’s biosociodemographic data, patient
risk factors to blood borne infections.
Part II: Hemodialysis nurse’s knowledge structured interview
schedule; which consisted of blood borne infections, standard
precautions to prevent blood borne infections at HD units, and
hospital policy.
Part III: Patients knowledge regarding hemodialysis and blood
borne infections structured interview schedule, which consisted of
knowledge related to hemodialysis, blood borne infections, and safety
precautions.
Tool II: Hemodialysis blood borne infections control and prevention
of nurse’s practices observational checklist.
Method:
• Study tools were developed by the researcher based on reviewing
the relevant literature and was tested for its content validity by 3
experts in the field of Medical Surgical Nursing and 2 experts in
Nephrology, and modifications were done.
• Tool (1) was translated into Arabic language by researcher after a
thorough review of the relevant literatures.
The reliability of all tools was tested using Cronbach’s alpha.
Reliability coefficient for tool I (part II) was 0.834, (part III) 0.657,
and tool II was 0.961, which means all tools were reliable.
• A pilot study was conducted on 3 patients and 3 nurses out of the
sample for testing feasibility, and applicability of the developed
tools and modifications were introduced accordingly. Those
patients and nurses were excluded from the study.
• Every nurse was interviewed individually once for 30-45 minutes,
using tool 1 part (I, II) to collect data related to knowledge about
risk factors for blood borne infections and standard infection
control precautions.
Every nurse was observed three times throughout the morning,
evening and night shifts, using tool 2 to assess her practices related
to infection control precautions in hemodialysis process.
• Assessment of the hemodialysis unit infra-structure and hospital
policy was done as a part of nurse’s interview and observational
checklist.
• Each patient was interviewed individually once for 30-45 minutes
by the researcher using tool 1 part (I, III) to collect data related to
knowledge about medical history, hemodialysis and risk factors for
blood borne infections.
The main results of this study were:
1. Findings of this study revealed that more than half of the studied
patients were in the age group of 50-60 years, also the highest
percentage of the studied patients were males, married, illiterate, came
from urban areas, and had insufficient monthly income to fulfill the
daily requirements.
2. Nearly half of the studied nurses were in the age group of 20-30 years,
also nearly two thirds of them were females, more than half of the
studied nurses had secondary school of nursing, had five years or more
of work experience, and attended courses about infection control
precautions, and the majority of them were vaccinated against hepatitis
B virus.
3. Surgery is most common cited risk factor 100.0% followed by blood
transfusion and dental care (82.1%, 71.8 % respectively), also more than
half of the studied patients (62.8%, 61.5%, and 51.3% respectively)
were sharing sharp tools as nail calipers, and razors, and had ear piercing by unsterilized or inadequate sterilized instruments.