الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 155 |  |  |
| | | from | 155 | | |
Abstract
Hemodialysis is the most effective and used method of RRT that sustains patients’ life, which improve Patients’ quality of life. Infection is considered the main reason for hospitalization and the second cause of mortality in HD patients. HD patients are risk factors for infection related to their immunosuppression state, HD process itself, contact with HCPs, contact with other patients, as well as non-adherence of infection prevention and control practices.Nurses are considered cornerstoneof managing patients safely, at HD units by adherence to infection prevention and control practices.
The nursing staff non-adherence to infection prevention and control practices couldbe related to understaffing, inadequate or lack of continuing education &training of HD staff, inadequate supplies and high patient rate. So implementation of infection prevention and control educational programsare recommended by the CDC and WHO, which include a bundle of interventions such as hand hygiene, use of PPE, VA care, safe injection and cleaning and disinfection of dialysis station, will reduce the infection in HD units.
The aim of this study was to:
Evaluate the effects of educational interventions on nurses’ knowledge and practices in thehemodialysis unit regarding infection control practices.
Materials and method:
Research design:
A quasi-experimental research design (pre-posttest) was utilized to fulfill the aim of the study.
Setting:
The study was conducted at the Hemodialysis Unit, Alexandria Fever Hospital.
Subjects:
All available nurses who were involved in providing direct care throughout thethree shifts for patients, at the above mentioned setting, were included in the study (n=30 nurses).
Tools of the study:
In order to fulfill the aim of the study, two tools were used for data collection
Tool I: Hemodialysis Nurses’ infection prevention and control practices knowledge Questionnaire.
A structured interview schedule tool was developed by the researcher based ona thorough review of recent related literature. It was utilized to assess nurses’ knowledge regarding Infection prevention and control practices. It included two parts as follows:
Part I: This part included nurses’ socio-demographic characteristics as: age, gender, level of education, marital status, and years of experience in dialysis units, attendance of pre-service and in-service training programs regarding infection prevention and control.
Part II: This part included a group of open, and closed ended questions to assess nurses’ knowledge related to the following domains with its sub ”practices” or ”competencies :
a) Blood borne infection.
b) Hand hygiene.
c) Personal protective equipment.
d) Cleaning and disinfection of environmental surfaces.
e) Cleaning and disinfection of external surfaces of HD machines.
f) Disinfection of the internal fluid pathway of hemodialysis machines.
g) Handling of disposable supplies and reusable items in HD units.
h) Water treatment.
i) Safe injection practices :
- Safe preparation of medication.
- Safe administration of medication.
j) Vascular access: care and prevention of infection.
k) Screening /routine serologic testing and patient placement.
l) Immunization of patients and health-care personnel.
Tool II: Infection Prevention and Control Practices: Nurses` Performance Observational Checklist.
This tool was developed based on CDC guidelines (2016) as well as the WHO Bundle of care, (2018). It was used to check nurses’ performances against international ideal guidelines and standards, related to the following domains and its sub practices/competencies:
a) Hemodialysis hand hygiene observation.
b) Personal protective equipment.
c) Arteriovenous fistula\graft cannulation observation.
d) Arteriovenous fistula\graft decannulation observation.
e) Catheter exit site care observation.
f) Catheter connection and disconnection observation.
g) Hemodialysis injectable medication preparation.
h) Hemodialysis injectable medication administration.
i) Hemodialysis station routine disinfection observation.
j) Cleaning and disinfection of external surfaces of HD machines.
k) Disinfection of the internal fluid pathway of hemodialysis machines.
l) Handling of disposable supplies and reusable items in HD units.
The main results of the study:
1. According to the studied nurses’ socio-demographic characteristics, the highest percentage of the studied nurses was in the age ranged between twenty to less than forty years, the majority of them were bachelor degree graduates and married.
2. More than half of the studied nurses had 10 years of experience.
3. The majority of studied nurses attended programs, more than half of them mentioned that they received their training through the Infection Prevention Control Committee of the Fever Hospital.
4. More than half of the studied nurses (63.3%) had poor nurses’ knowledge, while more than one third (36.7%) had ”fair” nurses knowledge, before nursing intervention.
5. The majority of the studied nurses (93.3%) had ”good”level of knowledge, while (6.7%) had fair level of knowledge, after the nursing interventions.
6. The results revealed that the majority of studied nurses had ”poor” knowledge level before nursing interventions, while after nursing intervention (immediately and one month later) they had good knowledge level.
7. Half of the studied nurses, 50.0% had ”poor” level of practice before application of the educational interventions, and the other half had ”satisfactory” level of practice.
8. The majority of the studied nurses (80.0%) achieved good level of practice immediately, and one month post application of the educational interventions.
9. No statistical significant relationships were detected between the studied nurses’ knowledge levels and their demographic characteristics after application of the educational interventions.
10. Statistical significant relationships were detected between the nurses’ age, level of education, and their practices level after application of the educational interventions.
The main recommendations are:
from the results of the present study, the following recommendations are derived &forwarded:
A. Recommendations fornurse managers:
- Supervise the staff nurses practice of infection prevention and control standards
- Monitor nursing adherence to policies of the hospital.
- Promote feedbacks on practice.
B. Recommendations for administrators:
- Regular infection prevention and control educational programs for HD nurses.
- Provision of standards and procedure manuals on infection prevention and control measure at HD units is mandatory.
- Policies and infection prevention and control procedures at HD units should be reviewed and updated to ensure strict implementation and compliance to infection prevention and control guidlines.
- Reward and punishment system should be applied.
C. Recommendations for Further studies:
– Nurse’s reasons for not compliance with infection prevention and control practices, need to be investigated.
– Patients’ satisfaction regarding to nurses’ compliance with infection prevention and control practices, is advocated.
– More studied are recommended to be done in other clinical settings, involving large samples to draw more general concolusion.