Healthcare students and their knowledge of

Healthcare students and their knowledge of healthcare infections

Ann Ig 2011; 23: 11

Healthcare students and their knowledge of healthcare infections A. Colosi*, G. Ergasti*, G. Murzilli*, V. Paolini*, V. Semeraro*, M.M. Trapani*, D. D’Alessandro** Key words: Hand hygiene, HCAI, HCAI prevention Parole chiave: Igiene delle mani, infezioni associate all’assistenza, prevenzione delle infezioni associate all’assistenza

Riassunto Livelli di conoscenza degli studenti delle lauree sanitarie circa la prevenzione delle infezioni associate all’assistenza. Studio pilota presso la Sapienza Università di Roma Il fine dello studio era di rilevare il livello di conoscenza degli studenti di medicina e di quelli di infermieristica circa la prevenzione delle infezioni associate all’assistenza e di misurare eventuali differenze tra questi due gruppi. Si trattava di uno studio pilota per un’indagine a livello nazionale ed è stato effettuato utilizzando un questionario con sei quesiti a scelta multipla riguardanti tre aree: precauzioni standardizzate, igiene delle mani e infezioni nosocomiali. Sono stati intervistati 117 studenti (di cui 89 studenti di medicina e 28 di infermieristica). Lo score globale medio (+/- SD) risultò pari a 17,63 (+/-3,8) rispetto ad uno score globale massimo raggiungibile di 25. Lo score medio ottenuto dagli studenti di infermieristica (18,.5+/-3,3) risultò superiore a quello degli studenti di medicina (17,4+/-3,.9), benché la differenza non fosse statisticamente significativa. Stratificando gli score per le tre specifiche aree, l’insieme degli studenti ha ottenuto score ponderati (+/-SD) di 6,74 (+/-1,61) per l’area delle precauzioni standardizzate, di 4,7 (+/-1,5) per l’area dell’igiene delle mani e 4,51 (+/-1,71) per l’area delle infezioni nosocomiali. Il livello di conoscenza per l’area dell’igiene delle mani risultò differente tra studenti di medicina e studenti di infermieristica (p=0,.013), a favore dei secondi. Sulla base del tasso delle risposte corrette, tutti gli studenti dell’area sanitaria conoscono quali presidi medici individuali devono essere usarti, ed anche come; viceversa denunciano una carenza nelle conoscenze sull’igiene delle mani. Questo studio pilota indica l’importanza di verificare l’efficacia dell’insegnamento, e sottolinea la necessità di una continua revisione clinica dei contenuti specifici dei corsi universitari per operatori sanitari di ogni livello.

Introduction Hand washing was introduced into daily clinical practice during the XIX century (1847), thanks to an hungarian physician: Ignaz Phillip Semmelweis. Even though more than a century and a half has elapsed since then, hand washing remains the most important precaution towards

the control of Healthcare Associated Infections (HCAIs) (10). First controlled clinical trials confirming this theory were performed during the 60’s of the 20th century in the United States (7), although in many countries the first guidelines on proper hand hygiene have been published after 1980, and enforced even later (15).

* Postgraduate School of Hygiene and Preventive Medicine (PSHPM), Sapienza University of Rome ** PSHPM Director, Sapienza University of Rome

A. Colosi et al.

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Despite the effectiveness of principles to control HCAIs, at the present time HCAIs affect 5–15% of overall patients admitted to hospitals in developed countries, and 9–37% of overall patients admitted to Intensive Care Units (ICUs) (15). These indicative percentages were the starting point to try to understand which are the reasons leading to this phenomenon. One of critical points analyzed is the effective level of knowledge and accomplishment of the healthcare and non-healthcare workers towards standard procedures to prevent HCAIs in hospital settings of many countries. Therefore several studies took place through administration of different types of questionnaires (2, 4, 11, 13-14) to assess substantial knowledge of healthcare workers (1, 4, 12, 8-9, 11, 13, 16) and of medical and nursing students enrolled in the courses of the final year of degree (2-3, 5-6, 8, 14). These studies have evaluated true compliance and accomplishment towards taking measures to decrease HCAIs’ incidence (1, 3-5, 8-9, 11-13). Since reports regarding the healthcare student’s knowledge about good practices to prevent HCAIs are not yet available in this Country, the aim of this study, that is the pilot study of an investigation to be performed at national level, was to fill this gap.

Methods The study employs the protocol, elaborated by the Italian Study Group on Hospital Hygiene (GISIO) of the Italian Society of Hygiene and Public Health, adapted from a previous French study (14). It consists in a prevalence survey by questionnaire addressed to medical students (MS) and nursing students (NS), enrolled in the final year of the university school. The questionnaire includes 6 questions with multiple choice answers (total = 25 answers) concerning 3

assessment areas: standard precautions (SP), hand hygiene (HH) and nosocomial infections (NI). Overall perfect score was 25. The NI area consists of one question composed of five answers with an overall score of 5. The SP area consists of three questions composed each one by four answers, with an overall score of 12. The HH area consists of two questions composed each one by four answers, with an overall score of 8. This anonymous questionnaire was handed to healthcare students at the end of a lesson in a lecture room, during the last week of university courses. Before the questionnaire administration, the researchers explained the aims of the survey, offering also information about how to complete the knowledge test. Remarking that questionnaire was to remain anonymous, it was strongly recommended to students not to cooperate and to complete the test in 30 minutes. Collected data were entered into a database prepared using Microsoft Office Excel 2003. The students’ knowledge mean score and standard deviation were calculated. The mean scores achieved by MS and NS were compared using a parametric test (t-Student test). Difference in knowledge among areas and, within each area, between overall sample and each health curriculum respectively was also obtained using t-Student test again. Because of the different number of questions within each specific area, to allow a best comparison, the results belonging to SP area and to NI area were weighed in respect of HH area, dividing the scores obtained by overall answers of each area (PS 12; IN 5) and multiplying the results by the number of HH area’s answers (8).

Results One hundred seventeen students (82 female and 35 male), 89 MS and 28 NS,

Healthcare students and their knowledge of healthcare infections

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Table 1 - Answers to the questionnaire. Weighed means (± standard deviation) by degree school and investigated areas Students MS NS Total

Standard precautions 6.68 (±1.68) 6.92 (±1.37) 6.74 (±1.61)

Hand hygiene 4.5 (±1.04) 5.28 (±1.2) 4.69 (±1.46)

were enrolled in this study. The mean age (±SD) was 25.25 years (±2.34) and 25.85 years (±5.18) for MS and NS, respectively (Table 1). Mean overall score (±SD) achieved by students was 17.63 (±3.8) on an overall perfect score of 25. Mean score obtained by NS (18.5 ±3.3) was higher than MS (17.4 ±3.9), even if the difference was not statistically significant (p= 0.186). Stratifying scores in the three assessed areas, the students reached a mean overall weighed scores of 6.74 (±1.61) for SP, 4.7 (±1.5) for HH and 4.51 (±1.71) for NI. The mean score achieved by NS was 6.92 (±1.37) for SP, 5.28 (±1.2) for HH, and 4.45 (±3.15) for NI, while MS achieved 6.68 (±1.68) for SP, 4.5 (±1.04) for HH and 4.52 (±1.65) for NI. The knowledge level of HH showed a significant difference between NS and MS (p=0.031), in favour of NS.

Nosocomial infections 4.52 (±1.65) 4.45 (±3.15) 4.51 (±1.71)

Total 17.4 (±3.9) 18.5 (±3.3) 17.63 (±3.8)

Only comparing weighed areas we observed a statistically significant differences between SP area and HH area (p