“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE AND PRACTICE REGARDING

INFECTION CONTROL MEASURES IN LABOUR ROOM

AMONG FOURTH YEAR BSC NURSING STUDENTS

IN SELECTED NURSING COLLEGES OF

TUMKUR.”

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.

M. PRIYAOBSTERICS AND GYNAECOLOGICAL NURSING

ARUNA COLLEGE OF NURSINGRING ROAD, MARALUR, TUMKUR

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION.

1. Name of the Candidate : MISS. M.PRIYA

And Address MSc Nursing Ist Year

Aruna College of Nursing

Ring Road, Maralur

Tumkur.

2. Name of the Institution : Aruna College of Nursing

3. Course of Study And : MSc Nursing Ist Year

Subject Obstetrics & Gynaecological Nursing

4. Date of Admission : 10.06.2009

5. Title of the Topic : “A Study to assess the effectiveness of

structured teaching programme on

knowledge and practice regarding

infection control measures in labour room

among fourth year BSc Nursing students

in selected nursing colleges of Tumkur

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6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“We are always looking for better ways to serve birthing women.”

Raymond derives

“Advanced education creates a more powerful workforce.”

Pregnancy and child birth are the most important events of a women’s life.

Pregnancy, delivery is a normal physiological process. Most of the time the women

achieves normal pregnancy outcome without any complication. But too many mothers

and children in the world are dying and suffering from the effects ill health, poor nutrition

and inadequate health care. Many of the deaths could be prevented using existing

knowledge and affordable tools.1

WHO reported that every minute a mother dies from complication in pregnancy

and child birth that means 1400 mothers die every day more than half a million mother

die every year. The birth of baby is a momentous occasion in the life of a couple. The

aim of modern management of labour should be to ensure optimum condition for the

mother and the fetus during and after delivery as well as emotional satisfaction of all

involved. The place of delivery plays an important role in child survival and safe

motherhood. The child born in unhygienic condition is more to get infection. A properly

assisted delivery with skilled personnel and following aseptic precaution is highly

advantageous to both mother and fetus during delivery.2

Health can be neither be demanded nor given, It can be neither be bought, nor

sold; but the circumstances and services that are prerequisite to health can certainly be

demanded and received as a right. A protective environment in the hospital unit is very

essential as a prerequisite particularly, when considering the services provided in the

labour room provision for a safe and protective environment is a priority need.3

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Puerperal infection is defined as a bacterial infection originating in the

reproductive tract during labour or the puerperium. Mode of transmission of puerperal

infection are carelessness regarding hand washing, numerous Vaginal infections, breaks

in aseptic techniques, improper perineal care, prolonged labour, especially with ruptured

membranes. The common micro organisms of puerperal infections are bacteria that are

present in the hands of attending health care personnel or in the labour room. i.e E.coli,

Proteus, Mycoplasma, N.gonorrhea4.

6.1 NEED FOR THE STUDY

“Right practice is the safest investment towards hazard-free care.”

Today’s student nurses are tomorrow staff nurses who can contribute themselves

more in the field of treatment. But today this nursing curriculum does not give much

importance to infection control measures, so naturally student have less exposure to that

field make them vulnerable in knowledge and practice. “Educating these students and

creating awareness in helping them to learn more about infection control measures in

labour room, and they will be able to control the infection in the labour room.

WHO, UNICEF, UNFPA reported that in 2008, there are 5,29,000/year maternal

death in 13 countries. The causes for maternal deaths are hemorrhage, PIH, puerperal

sepsis are direct causes for maternal death5.

Puerperal sepsis is the 2nd leading cause for maternal mortality i.e. 19.2% of

maternal death due to puerperal sepsis. Worldwide the puerperal sepsis rate is 15%. In

our India the puerperal sepsis rate is 11%. In our India maternal mortality rate is 5.29

lakhs 1.36 lakhs due to puerperal sepsis. In December 2008 in our India 16% peoples

were died by maternal complications. The main cause for this is PIH, hemorrhage,

sepsis, anemia, abortion in this 50 to 71% peoples were died in the post partum period. In

2008 UNICEF stated that there are 880 HIV cases are positive by mother to child

transmission. Especially in 17% of case of HIV was transmitted during labour because

lack of aseptic techniques6.

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In 2010 MMR was reduced to less than 100. The suggestion were 3 antenatal

checkup, 3 postnatal check up, clean safe delivery, given by National health and family

welfare department. Services to make motherhood safe include care by skilled health

personnel, aseptic delivery, before, during, after, child birth, health education for women

their families and decision makers. Most maternal deaths and pregnancy complication

can be prevented, if efficient care is given during perinatal care7.

Nursing personnel working in the labour room unit should be knowledgeable and

skilful in prevention of maternal infection. The Nursing personnel fail to adopt the

infection control techniques then it will leads to septicemia and maternal death. In order

to reduce the maternal mortality rate the midwifery students (at the base level) should be

knowledgeable and skillful in providing infection free nursing care. So the nurses

concerned with care and prevention of infection occurring through all sources, they hold

a responsible position of involvement., So they have an important role in the prevention

of infection in labour room. So the student midwifes has to be knowledgeable and as

good practice activities, regarding Infection control measures in labour room to prevent

the puerperal infection8.

The investigator was observed that many times midwife students fail to practice

aseptic techniques in labour room. Practice of hand washing which is the single most

important measures in prevention and spread of infection from one person to other is not

being done often. Another important area of concern is where midwifery students should

be careful in doing vaginal examination, conducting delivery, aseptic precaution is very

important to prevent introduction of infection for the mother. The recognition of

ignorance is the beginning of wisdom’s. To understand the degree of knowledge and

related practices to help in future improvement thus the investigator felt that need to take

up the study i.e to assess the knowledge and practice among midwifery students in

selected nursing colleges.

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6.2 REVIEW OF LITERATURE

“Perfect tools are essential to validates perfect performance.”

Review of literature is the reading and organizing of previously written materials

relevant to the specific problem to be investigated; frame work and methods appropriate

to perform the study (Polit D.F.and B.P.Hunglur)9.

A study was conducted on knowledge application and confidence with standard and

additional precaution in infection control in Taiwan university of midwife

students(2009), A specific tool, the infection control evaluation was developed and

distributed. A cross-sectional survey was conducted. The results were based on an 88%

response rate and indicated that level of knowledge concerning standard and additional

precaution was low among Taiwan midwifery students. Their ability in applying these

precautions in clinical practice also appeared to be inadequate. Such findings indicate

that Taiwanese preservice nursing students required comprehensive foundation course in

infection control precaution before they enter the clinical environment. This will help to

ensure their protection and that of their patients. As the findings highlights the

importance of providing such information for students before they undertake any clinical

work, the information provided here can help nursing educators to develop specific

program10.

A study was conducted on knowledge and source of information among midwifery

students regarding prevention of Nosocomial Infection and standard precautions.

(2008). The objective of the study is evaluate the knowledge of midwife students after

four curricula on infection control and to identify sources of information to measure

students knowledge of infection control and their resources of information, 6 multiple

choice questions were asked about 3 specific areas. Standard precautions, hand hygiene,

and Nosocomial infection. 350 midwifery students were included in the study.

Midwifery students had mean overall score 23.2, the mean score for the component

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section of questionnaire were 3.5 for standard precaution, 7.4 for hand hygiene, 5.7 for

Nosocomial infection. The overall score for infection control indicated that instruction

was effective, ward training for daily infection control practice would be improved for

health care students11.

A study was conducted on knowledge practice among ironies nurse, midwifes

students regarding standard isolation procedures in labour room at Iran (2007). The goal

was to assess the knowledge and practice regarding infection control measures and

standard precaution among a group of nursing and midwifery students in Iran. A survey

questionnaire was completed by 273 midwife students and nurses at shiraz university of

medical sciences during the period from May to Nov 2002. 231 (90.9% ) of the

participants reported that they need additional infection control education especially on

standard isolation precaution. There was a linear positive correlation between knowledge

and practice for the group of Nursing, midwifery students. Our study shows that there is

an urgent need for evaluating education on infection control practices and standard

precautions in general as well as for structured teaching programme regarding infection

control programme among midwifery students12.

A study was conducted on accidental exposure to blood in midwifery students in

Tehran university(2007). Health care workers and midwifery students are at risk of

exposure to blood borne viruses such as HCV, HIV, HBV. Here the results of the survey

are of the frequency and cutaneous blood exposure students among midwifery students.

A definite exposure was defined as injury by a sharp object causing obvious bleeding,

where as possible exposure was defined as subtle or superficial injury due to contact with

a contaminated instrument or needle but without bleeding or contamination of an existing

wound with blood or other body fluids. 92% (184) subject were responded to

questionnaire. We recorded 121 definite exposure and 259 possible exposure over a

mean time interval of 14 months13.

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A study was conducted on mentors hand hygiene practices influence midwife

students hand hygiene in America (2006). A quasi experimental study conducted among

60 students enrolled in a certified Nursing program were selected to participate in the

study. The mentor’s practice of hand hygiene was the strongest predictor of the student’s

rate of hand hygiene for both observational periods P<(0.01). Students prior without

medical experience had a significant increased hand hygiene rates when comparing

observational period 1 to observational period-2. Students reported strongly positive

attitude toward hand hygiene is very low14

A cross sectional study was conducted on the prevalence of needle stick injuries in

midwifery students, nursing, medical at the university of teaching hospitals of shiraz

University at Iran (2006). The students were evaluated Needle stick injuries and

practices regarding protective strategies against blood born products in midwifery

students at shiraz university. The questionnaire was completed by 688 (53%) students.

71.1% of the students had Needle stick injuries that most commonly occurred in patient

room, non-reporting of Needle stick injuries were highly prevalent in these students.

Education about the transmission of blood-borne infections, standard precautions and

increasing availability of protection strategies must be provided15.

A Study was conducted on knowledge practice towards standard isolation precaution

in Iranians midwifery university students (2004). A questionnaire was filled out by 465

midwifery students in their study. Their mean knowledge, practice in level of standard

isolation precaution were 6.1, 2.3, statistically significant positive correlations were

observed between knowledge and practice ninety percents of midwifery students in shiraz

had received no education of students regarding isolation precaution and 75% of

respondents wanted more education on standard isolation precaution. Education on

infection control issues should not only be focused on health care workers but should also

to the midwifery students16.

A study was conducted on accidental exposure to blood by midwifery student in

2003. 241 hospital took part in national survey of blood borne injuries. The data were

processed by the co-ordination center for the fight against Nosocominal infection. 6973

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blood borne events reported during 2003 were signed by midwife students. The 1st 3 most

frequent accidents reported were ocular protection during child birth, pricks when

repairing episiotomy pricks or cuts when soiled instruments. Improving knowledge of

risk as well as promotion of protection measures well adapted to this profession should be

helpful in optimizing future attitudes17.

A study was conducted on knowledge perception and practice with regards to

occupational risk of HIV among midwifery students at babcock university in Nigeria

(2002). Midwifery students constitute a sub group of health care providers exposed to

occupational risk of HIV infection because of direct contact with blood and body fluids

during clinical practice. The study utilized both quantitative and qualitative method to

gather information from midwifery students. The results showed a poor knowledge of

WHO recommended universal precaution for preventing HIV transmission among

students in all colleges18.

A study was conducted on knowledge and performance of the universal

precaution by midwife students on 2001 in Korea St Mary Hospital. 714 midwife

students were participated for the period between Nov 2, 1998 to April 30, 2001. The

average knowledge level of universal precaution was 267.8 the correlation between

knowledge and performance of the universal precautions showed a weak and positive

correlation (r=0.319). The study demonstrated that the knowledge level of nursing

midwifes about universal precaution was low. The group that receives education about

universal precaution has a higher level of knowledge and prefer of the universal

precaution than that group that receives no such education19.

A study was conducted on midwife students knowledge of universal precaution

on 1993 in Washington. The 151 4th year students of the class at the Washington were

given a questionnaire. The questionnaire were completed by 139 (81%) of the students.

The mean % of correct answers by the responding students was 67% for 5 of 10

procedures from 104 to 123 of the students reported the proper level of protection. The

result of the study was worrisome, because many students before they graduated lacked

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adequate knowledge of universal precaution during study period. So infection control

education is needed20.

A study was conducted on perinatal continuing education program its effect on

knowledge and practice of health care professionals on 1995. Test data were derived

from health care providers 24 hospitals. Teaching programs of perinatal continuing

education pretest and post test scores at the P<0.001 level for each group of providers

studied. A continuing education program delivered. To a multi disciplinary group of

health care providers can increased knowledge and improve perinatal care to newborns21.

6.3 STATEMENT OF THE PROBLEM

A study to assess the effectiveness of structured teaching programme on

knowledge and practice regarding infection control measures in labour room among IVth

year BSc(N) students in selected Nursing colleges of Tumkur.

6.4 OBJECTIVES

To assess the knowledge of IV the year BSc Nursing students regarding infection control measures in labour room.

To identify the practice of IVth year BSc(N) students regarding infection control measures in labour room.

To educate the students with structured teaching programme regarding infection control measures among IVth year BSC(N) students.

To evaluate the effectiveness of structured teaching programme on knowledge & practice regarding infection control measures among IVth year BSc(N) students.

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To associate the demographic variables with knowledge and practice regarding infection control measures.

6.5 OPERATIONAL DEFINITION

Assess: It is the organized, systematic and continuous process of collecting data

from the IVth year BSc(N) regarding infection control measures.

Effectiveness: It refers to the extent to which the structured teaching programme

on infection control measures in labour room has achieved. The desired effect in

improving the knowledge and changing the practice of IVth year BSC(N) as

evident from gain in knowledge score and change in the practice score.

Structured Teaching Programme: It refers to systematically developed

instruction designed to provide information regarding infection control measures

to IVth year students

Knowledge: The sum of what is known regarding infection control measures.

Practice: It refers to actual activities done by the midwifery students to control

the infection.

Infection Control: The utilization of procedures and techniques to reduce the

spread of infection. Particularly hospital acquired infection.

Labour Room:.It refers to where the labour (delivery) process was going to take

Place.

IVth year BSc Nursing students It refers to those who are studying final year

BSc Nursing in selected nursing colleges.

6.6 HYPOTHESIS

H1 There will be significant relationship between knowledge and practice

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regarding infection control measures in labour room among midwifery

students.

H2 There will be significant relationship between structured teaching programme

and the changes in knowledge and practice of infection control measures

among midwifery students.

H3 There will be significant association between the knowledge and practice with

selected demographic variables of the BSc(N) students such as age,

sex, religion, family, income, etc.,

7.0 MATERIALS AND METHODS

The purpose of this study is to determine the effectiveness of structured teaching

programme on knowledge and practice regarding infection control measures among IVth

Year BSc(N) students in selected Nursing Colleges of Tumkur.”

7.1 SOURCES OF DATA

Research approach : The Pre experimental approach is used for the study

Research Design : One group pretest and post test pre experimental design is used

Setting of the study : Selected Nursing Colleges of Tumkur

Sample Size : 60 students

Sampling Technique : Simple random sampling

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Selected Variables Independent variable : Structured Teaching Programme

Dependent Variable : Knowledge and Practice of Infection

control measures.

Demographic variable : Age, Sex, Family income, Religion

Sampling criteria

Inclusion criteria

Student who are studying IVth year BSc(N)

Students who are willing to participate

Exclusion Criteria

Students who are not willing to participate

Students who are not available at the time of study.

7.2 METHODS OF DATA COLLECTION

7.2.1 Tools for data collection : Structured questionnaire

Tool 1 Part A : Proforma for collecting demographic

Data

Part B : Structured questionnaire to assess the

knowledge and practice on infection control

measures in labour room

Tool 2 : Structured teaching programme

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7.2.2 METHODS OF DATA ANALYSIS AND INTERPRETATION

Data will be analyzed according to the objectives of the study using

descriptive and inferential statistics and will be presented in the form of tables,

graphs and diagrams.

7.2.3 Duration of the study : 6 weeks

7.3 Does the study requires any investigation or intervention to be conducted on the

patient or other human being or animals. If so please describe briefly

NO

7.4 Has ethical clearance been obtained from your institution in case of the above?

Yes Ethical clearance has been obtained from the institutions ethical committee.

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8.0 LIST OF REFERENCES

1. Wong and Perry, Maternal and child Nursing care library of congredd.Cataloging

in publication data:2006.

2. Child survival safe Motherhood 1992. Care at the time of delivery. Ministery of

Health and family welfare.page No 29.110.

3. Maherbin Singh. Care of Newborn.6th edition. Sagar publication ; 2004. 56-57.225

4. Katharine, Amay.etal.Maternal and Neonatal Nursing.3rd edition ; page no. 270

5. K.Park.Textbooks of preventive and social medicine.Banarsidas publication.19th

edition ; Page no.450-453

6. http://nvonews.com./national-seminar-gynaec women-medicon 2008.

7. http://india.gov.in/sectors/health-family/maternl-health.PhP.

8. Bready MT.Health care associated infections in labour Room.Journal of infection

control 2005 June ; 33(5).265-75

9. Polit Denise and Hungler.Nursing Research Principles and method.J.B.lippincott

company 1991 ; page no 40.

10. WU CJ, Garden GE, changAMetal. Knowledge application and confidence with

standard and additional precautions in injection control Journal clinical nurse

2009 April ; 18(8): 1105-12

11. Tavolacci MP.Ladner J. etal \. Prevention of nosocomial infection and standard

precautions knowledge and source of information among midwifery students .

Infection control.Hospital epidemiology 2008.July ; 29(7) : 642-7

15

12. Menishza, Khan A A, Knowledge.Practice among Iranian midwife students

regarding standard isolation precautions. Infection control Hospital epidemiology

2007.Feb : 28 (2) : 241-4

13. Sheriati B, oveyST T, etal. Accidental exposure to blood of Tehran university of

Medical sciences among midwife students. Journal of occupationalhealth.2007.

July ; 49(4). 317-21

14. Snow M. white GL Jr et.al. Mentor’s hand hygiene practices influence student’s

hand hygiene rates. American Journal of infection control.2006.Feb;34(1): 18- 24.

15. Askarian M. Malakmakan L.The Prevalence of Needle stick injuries in midwifery

students. Indian Journal of medical sciences.2006.Jan 60 (6). 227-32.

16. Honarvar B, Tabatabace HR. Knowledge. Practice towards standard isolation

precaution in Iranian midwife students. Journal hospital infection.2004 Dec ; 58

(4) 292-6.

17. Vincent A. Cohe n. etal. Accidental exposure to blood by midwife students.

Journal gynaecology obstetrics biological reproduction 2003 May ; 35(3) : 247-56

18. Atulomah.No. oladopoo.knowledge, Perception and practice with regards to

occupational risk of HIV among midwifery students. African Journal medical

science.2002 Sep ; 31(3) : 223-7

19. Kim KM. chung ys et al. department of hospital infection control.st.mary

hospital.American Journal infection control.2001 oct ; 29(5) : 295-300.

20. Bauer, B.,&Kenney,J.Adverse exposure and use of universal precautions among

Perinatal Nurses. Journal of obstetrics,gynaecologic and Neonatal nursing, 1993

;22 ; 429-435

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21. Haris JK,Yates B.etal. A Perinatal continuing education program : its effect on

the knowledge and practice of midwifes students. Journal of obstetrics

gynaecology. Neonatal nurses. 1995.Nov-Dec ; 24(9) : 829-35

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9. Signature of Candidate :

10. Remarks of the Guide :

11. Name & Designattion :

11.1 Guide :

11.2 Signature :

11.3 Co-Guide (if any) :

11.4 Signature :

11.5 Head of Department :

11.6 Signature :

12. 12.1 Remarks of the Principal :

12.2 Signature :

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