Effect of training in infection prevention and control on knowledge of healthcare professionals in a medical college, Kerala

INTRODUCTION

Out of every 100 patients in acute-care hospitals, seven patients in high-income countries and 15 patients in low- and middle-income countries will acquire at least one health care-associated infection (HAI) during their hospital stay. On average, 1 in every 10 affected patients will die from their HAI.¹

IPC is a clinical and public health specialty based on a practical, evidence-based approach which prevents patients, health workers, and visitors to health care facilities from being harmed by avoidable infections, including those caused by antimicrobial-resistant pathogens, acquired during the provision of health care services.¹ It occupies a unique position in the field of patient and health workers’ safety and quality of care, as it is universally relevant to every health worker and patient, at every health care interaction. Strong, effective IPC programmes have the ability to influence the quality of care, improve patient safety and protect all those providing care in the health system.²

Infection prevention and control is a cornerstone in delivering quality health care delivery, safeguarding against the spread of infectious diseases within the health care facility. For an IPC programme, WHO recommends six core components of which education and training is one.³ A comprehensive education strategy for health facilities should include IPC training and education, as well as new hire orientation and opportunities for ongoing professional development for all current employees, regardless of rank or level as per the recommendations.⁴

Inadequate IPC training and the need to focus on enhancing opportunities for education and training appears to be a recurring theme amongst the studies that have measured the levels of knowledge and preparedness regarding COVID-19 infection control among HCWs in low-resource settings.⁵ There are no published studies assessing the basic knowledge of the health professionals on basics of infection prevention and control and the change in knowledge after a training on the same. The objective of the study is to find out the effect of training in infection prevention and control on knowledge of healthcare professionals in a medical college of Kerala.

METHODS

Quasi experimental pretest/post-test study design conducted from November 2023- December 2023. Health care professional students of all the departments in Government Medical College, Thiruvananthapuram.

Sample size was calculated by the formula n=(((zα+zβ)]^2×[SD]^2 ))/d^2 where SD was taken as 10.05 according to the study done by Tchorz et.al in Bangalore (Mean score before and after study were 70.7±11.2 and 87.5±8.9) 6 and d as 1.6, non-response rate and drop-out rate as 5%, sample size was rounded to 325. The total no. of participants included in the study was 339 selected by convenient sampling.

Inclusion criteria

All health care professional students who were willing to give consent for the research and attend the training session.

Exclusion criteria

Health care professional students who have attended any specific training on infection prevention and control in last 1 year.

Study procedure

Training sessions included topics on standard precautions, sterilization and disinfection of instruments, prevention of hospital acquired infections and needle stick injury management. Pre-test questionnaire consisting of 25 questions on the above-mentioned topics was provided before the training and post test was conducted after the session.

Ethical approval

The research was conducted after the approval of Institutional Ethics Committee. Written informed consent was obtained from the participants. Confidentiality and anonymity of the participants were preserved.

Statistical analysis

Data was entered in MS Excel and analyzed using PASW’27. The total score was converted into 100 and scores above 90 -excellent, 80- 90- good, 70-80- average and <70- poor. Change in individual scores was analyzed and categorized. Paired t test was done to analyse the change in knowledge after training.

RESULTS

67% of the study participants were females as represented in the Figure 1. Health care professionals included interns, postgraduates, super specialty residents as well as nursing and paramedical students among which majority of the participants were post graduate students (Table 1).

The knowledge was assessed using pretest and post-test questionnaires and scores were categorized among which majority were having poor or average knowledge in pretest while good and excellent knowledge categories were majority in post-test (Table 2).

Mean score of pretest and post-test as well as individual topic scores were analyzed as depicted in Table 3. The total score in pretest was 71.50±11.787 which improved in post-test to 86.80±9.219.

To assess the effect of training, change in knowledge was analyzed using paired t-test as given in Table no.4. Statistically significant improvement in scores was observed in the total score of pretest and post-test as well as the individual topic wise scores.

*Total score is the sum of individual scores which is then converted into 100.

*p value <0.05 is considered statistically significant

DISCUSSION

In our study, the baseline assessment of knowledge of health care professionals revealed that majority had only poor and average knowledge on the basics of infection prevention and control which is different than the study conducted by Shrestha et.al where they found out the overall knowledge of their participants was fair. Assefa et al in their study in Ethiopia also noted that majority of their health care providers had adequate knowledge on infection control which is different than our findings.⁷ In our study lower scores in pretest were noted in hand hygiene and sterilization and disinfection domains while notable poor knowledge was noted in waste management among the participants of Shrestha et al study.⁸ Salu S et al in their study found a similar finding to our study that most of the participants (69.2%) were not knowledgeable about the preventive measures of NCIs.⁹ Relatively high knowledge was noted in other domains like standard precautions, personal protective measures, waste management, safe injection practices and hospital acquired infections in pretest in our study. A study on medical students of Karnataka also found that the knowledge of standard precautions was high among their participants similar to our finding.¹⁰

In this study, it was observed that with training, there is a significant improvement in knowledge of all health care professionals. While only 4% had excellent knowledge in pretest, it improved to 40.1% after the training which is similar to the study done by Ousman et.al in the context of Ebola.¹¹ A similar statistically significant increase in knowledge from the baseline value was observed after the training in the Savul et al study and also in a multi country study on infection prevention and control.^12,13

A significant improvement was noted in the knowledge in all the domains of infection prevention and control among all the health workers in our study which not only implies the effectiveness of training but emphasizes the need of training for all set of professionals. As per the recommendations of WHO in their publication, education and training is one of the components of infection control program.³ Different studies have recommended the need of training for all the health care workers during the context of COVID-19 similar to our finding.^14,15 Inclusion of training program can help decrease the risk of infections amongst HCWs was mentioned in study done by Moore et al also.¹⁶ Thazha SK et al also noted that the awareness of IPC among HCPs who reported receiving information from their hospitals via trainings was better than that among HCPs who obtained their IPC information from guidelines, books, articles (p=0.005), and other sources (p<0.001).¹⁷

Strength and limitations of the study

This study assesses the basic knowledge health care professionals had and shows the effect of training in improving the same thereby improving the whole health care delivery by preventing nosocomial infections and reducing incidence of antimicrobial resistance cases. However, a follow up on the practices of infection prevention and control by the training participants needed to be done which could not be covered in this study.

CONCLUSION

There was a significant improvement in knowledge in infection prevention and control practices after the training among all the health care professionals who attended the training. This shows the need of compulsory orientation trainings and periodical refresher trainings to all the health care workers. As a part of preparedness to any pandemic emergencies, prevention of nosocomial infections as well as reduction in antimicrobial resistance, every hospital shall take the responsibility of capacity building through trainings.

ACKNOWLEDGEMENTS

Authors express their sincere gratitude to Dr. Aravind R (HOD, Infectious Diseases Department), Dr. Anuja M (Associate professor of Health education), Infection control nurses Mrs. Deepa, Mrs. Salini and other staff of State Prevention of Epidemic and Infectious Diseases Cell, Kerala for their immense help for the training and data collection.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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