Journal of

J Med Allied Sci 2014; 4 (1): 09-16

Medical
www.jmas.in
Print I SSN: 22311696 Onl ine ISSN: 2231170X
& Allied
Sciences

Original article
Prevention of nosocomial infections and standard
precautions: knowledge and practice among
radiographers in Sri Lanka
Ruwan Duminda Jayasinghe1and Bimali Sanjeevani Weerakoon2
1
Department of Oral Medicine and Periodontology, Faculty of Dental Sciences;
2
Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences,
University of Peradeniya, Peradeniya-20400, Sri Lanka
Article history: Abstract
Received 13 September 2013
Nosocomial infection is an infection if it becomes positive 48 hours or
Revised 11 February 2014
Accepted 12 February 2014 more after admission to the hospital or within 30 days of discharge.
Early online 25 February 2014 Health care workers can be a major source of vectors for pathogens.
Print 28 February 2014 Nowadays, interventional radiology and other radiological imaging
modalities have undergone vast development and the tendency for ac-
Corresponding author cidental exposure to blood and other infectious pathogens are on the
increase. Therefore, all the health care works are expected to follow the
Ruwan Duminda Jayasinghe
standard precautions to prevent accidental injuries during the service.
Senior Lecturer, This study was carried out to assess the knowledge and the practice of
Department of Oral Medicine and
Periodontology, radiographers on nosocomial infection control and standard precau-
Faculty of Dental Sciences, tions. A postal survey was conducted to all registered practicing radio-
University of Peradeniya, graphers in Sri Lanka. A pre-designed, pre-tested, anonymous self-
Peradeniya-20400, Sri Lanka. administered, structured questionnaire was circulated among radio-
Phone: 0094 812397456
Email: [email protected] graphers and for each correct answer one point was assigned. In the
knowledge section scores < 25%, 25% - 50%, 51%- 75 %, and > 75%
were considered as weak, moderate, good, and excellent knowledge,
respectively. In the practice section scores < 50%, 50% - 75% and > 75
% was considered as bad moderate and good practice, respectively.
The good practice was considered as professional practice for the clini-
cal radiology units. Data entry, management and analysis were carried
out using MS excel and SPSS statistical software package. The total
response rate was 37.9 %. The mean overall age of the respondents
was 30 to 39 years and males composed (72.3%) the majority of study
population. Most of the respondents (84.98 %) were qualified as diplo-
ma radiographers and 78.87 % of the respondents were practicing in
government hospitals. More than half (51.6%) of the respondents have
worked for < 10 years and 93.4% have never attended any occupation-
al training program regarding infection control. Majority (43.19%) of the
respondents have scored 50% from the total knowledge score and
more than half (73.2%) believed that the environment is the major
source for nosocomial infections. There was no association between
the knowledge and the education levels or knowledge between the
years of practice (p< 0.05). The highest recorded score for practice was
66.66%. More than half of the respondents (53.5%) washed their hands
infrequently, before touching the patients but 51.2% washed their
hands frequently after touching the patients and every clinical expo-

09
Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections

sure. 11.7% respondents never wear a mask or a respirator when there

is a potential to be exposed to infectious aerosols. No association be-
tween the infection control practice and the education levels or the in-
fection control practice between the years of practice (p< 0.05) was
identified. This study reveals that the radiographers‟ knowledge and
practice regarding nosocomial infections and standard precautions
were moderate.

Key words: infections, knowledge, practice, radiographers

© 2014 Deccan College of Medical Sciences. All rights reserved.

N
osocomial infection is an infection if it be- tion of interventional radiology and other special
comes positive 48 hours or more after ad- imaging modalities, the tendency for accidental
mission to the hospital or within 30 days of blood and infectious pathogens exposure is on the
discharge. Although infection is mostly present in increase. Standard precautions are implemented to
patients, health care workers also can be a major reduce the potentiality of acquiring occupational
source of vectors for pathogenic agents1. Health infections from both unexpected and well-known
care associated infections have long been recog- sources during the healthcare system. Stern con-
nized as crucial factors bedeviling the quality and formation to standard precautions can reduce a
outcomes of health care delivery2. Developing percentage of these risks5.
countries have reported to have up to 20 times the
There are several studies which reveal the impor-
risk of contracting a nosocomial infection com-
tance of infection control practice in other profes-
pared with developed countries3. Thus, spread of
sions. Nurses‟ and physicians‟ knowledge of stan-
infection serves as a major source of worry for
dard and isolation precautions have been reported
health care practice, particularly in developing 7-9
to be insufficient . Few studies have reported on
countries where the health care system is already
medical students‟ knowledge of standard isolation
overstretched.
precautions or sharp injuries10-13 and noted a lack
Hospitals provide a favorable transmission path- of adequate knowledge of standard precautions12.
way for the spread of nosocomial infections, owing In one survey, 27% of participating health care
partly to poor infection control practices among students reported insufficient emphasis on teach-
health workers on one hand and overcrowding of ing about infection control in their training program,
1
patients in most clinical settings on the other .The whilst 50% expressed a desire for more emphasis
importance of hospital-acquired infections goes on isolation procedures during their training14.
beyond its impact on morbidity and mortality fig- Several other targeted studies15-19 have detected
ures in any country, and has profound economic poor adherence to universal precautions among
implications. Prevention of health care-associated multiple health care providers, including gastroen-
infections (HAIs) is the duty of all health care terologists and their staff, emergency room physi-
workers. Infection control professionals require cians and hemodialysis practitioners.
evidence-based educational content that facilitates
Considering the lack of information describing ra-
reduction in HAIs. Clinical and support staff in
diographers‟ knowledge and the practice of the
health care institutions are inundated with required
preventive measures necessary to limit the spread
training facilitated by accrediting bodies and institu-
4 of infections at the radiology units, this study was
tional mandates .Standard precautions are de-
carried out to assess the knowledge and the prac-
signed to reduce the risk of acquiring occupational
tice of radiographers on nosocomial infection con-
infection from both known and unexpected sources
trol and standard precautions in Sri Lanka.
in the healthcare setting5.Strict adherence by
healthcare workers to standard infection control Materials and methods
precautions may prevent a percentage of these
6 A cross-sectional prospective postal survey was
risks . For that healthcare workers should have
adequate knowledge and practice about standard conducted on all the registered radiographers vo-
infection control precautions. luntary participants and who were attached to vari-
ous hospitals and radiology clinics in both govern-
Over the last decades, radiological services have ment and private sectors in Sri Lanka. The survey
undergone many changes and with the introduc- instrument was a pre-designed, pre-tested, self-

J Med Allied Sci 2014; 4(1) 10

Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections

administered structured questionnaire designed tively. The good practice was considered as pro-
according to the international standards on preven- fessional practice for the clinical radiology units.
tion of nosocomial infections in line with the objec-
A covering letter describing the purpose of the
tives of the study.
study with the questionnaire was sent to all the
The questionnaire consisted of three major do- registered radiographers together with a stamped
mains such as demographic factors of the partici- self addressed envelope. Voluntary participation
pants, knowledge and practice of nosocomial infec- and confidentiality of responses were also empha-
tions and standard precautions. There were six sized in the mail. To maximize response rate,
questions about knowledge of nosocomial infec- monthly reminder (total of 4) mails were sent to
tions and standard precautions and answered us- those who have not responded. Ethical clearance
ing the options “Agreed”, “Disagreed” and “Don‟t was obtained from the Research and Ethical Re-
Know”. For each correct answer one point was view committee of the Faculty Allied Health
assigned and therefore, the total score for know- Sciences, University of Peradeniya, and all the
ledge was ranged between 0% (0) to 100% (6) other ethical aspects were considered. Data and
.Scores < 25%, between 25% and 49.9%, between other information of the study were only accessible
50% and 75 %, and > 75 % were considered weak, to the researcher and the supervisor and the par-
moderate, good and excellent respectively. A ticipation was anonymous. Data editing was car-
higher score indicated a greater level of know- ried out along with the process of data collection.
ledge. Six questions addressed the practice of Received data was analyzed using SPSS statistic-
standard precautions and there were three possi- al software.
ble answers (always; sometimes; never) for each
Results
question. One point was allocated to „always‟ op-
tion and zero points were assigned for each incor- A total of 213 questionnaires were returned out of
rect or don‟t know answer. The total scores were 562, giving a total response rate of 37.9 %.
ranged from 0% (0) to 100% (6). Scores < 50 %,
The demographic characteristics of respondents
between 50% and 75% and > 75 % was consi-
who returned duly completed questionnaires are
dered as bad, moderate and good practice respec-
shown in table 1 and 2.
Table 1: Respondents according to age, gender, qualifications and place of work
>50 years
Gender/Age 20-29 years 30-39 years 40-49 years Total
Male 21.13% (45) 23.94% (51) 7.98% (17) 19.25% (41) 72.3%(154)
Female 10.33% (22) 7.98% (17) 4.69% ( (10) 4.69% (10) 27.7%(59)

Qualification and
Diploma B. Sc. M. Sc. Other Total
work place
44.60% (95) 1.41% (3) 0.47 % (1) 46.48 % (99)
Teaching hospital 0 % (0)
Government (other
31.46% (67) 0.94% (2) 32.4% (69)
than teaching ) hos- 0% (0) 0% (0)
pitals
2.35% (5) 2.35% (5)
University 0% (0) 0% (0) 0% (0)
Private hospitals/ 8.92% (19) 9.86% (21) 18.79% (40)
0% (0) 0% (0)
Clinics
Table 2: Respondents according to work experience and participation of training programmes
Work experience and participation
<1year 1-5 Years 6-10 Years >10 years
of training Programs
Participated 0.99% 0.94% 0.94% 3.76%

Not Participated 5.63% 33.33% 9.39% 44.13%

J Med Allied Sci 2014;4(1) 11

Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections

The mean overall age of the respondents was 30 government (with teaching hospitals) hospitals.
to 39 years and males composed (72.3%) majority Duration of work experience was identified to be
of study population. Most of the respondents less than 10 years in most (51.22%) of the respon-
(84.98%) were qualified as diploma radiographers dents and 93.4% have never attended any occupa-
and 78.88% of the respondents were practicing at tional training program regarding infection control.

Fig 1. Responses of knowledge related questions

Fig 2. Use of preventive methods

J Med Allied Sci 2014;4(1) 12

Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections

The total score of knowledge ranged from 0% to However some gaps can be identified on radio-
100% and majority (75.59%) of the respondents graphers‟ knowledge in specific areas such as in-
had scored 50% or above (good knowledge). More fection origins and standard precautions. The re-
than half (73.24%) believed that the environment is sults of the study show that the radiographers are
the major source which is responsible for noso- sufficiently aware that the standard precautions
comial infections and only 44.6% respondents had lead to protect both patient and staff; however,
the knowledge that invasive procedures will in- recommendation of using gloves was not sufficient-
crease the risk of nosocomial infections. Almost all ly concerned. The similar results can be found in
the radiographers (97.2%) were aware that the the three recent studies done by Bryce7, Bello8,
standard precautions should include the recom- and Easton9.
mendations to protect both patients and the health
The study indicates that more than half (73.24%) of
workers but 70.9% believed that the gloves should
the participants identified that the environment is
be used for each procedure. A high percentage of
the major source responsible for nosocomial infec-
respondents (79.8 %) were able to identify the ne-
tions. The knowledge deficit about the major
cessity of wearing protective clothes when there is
source of nosocomial infection is of concern be-
a risk of splashes or spray of blood and body flu-
cause this relates to an important role for radio-
ids. 58.2% respondents were aware that instead of
graphers; though this component can be ad-
surgical and antiseptic hand washing alcohol-
dressed through education.
based hand rubs could be used. There was no as-
sociation found between the knowledge and the Health care workers could be at risk of infections
education levels or knowledge between the years with blood-borne pathogens resulting from occupa-
of practice (p< 0.05) of the respondents. tional blood exposure through injuries with sharp
instruments and needle sticks if the standard pre-
The total score of practice ranged from 0% to
caution is not strictly adhered to. However this
100%. Majority (20.18%) of the respondents
study finding revealed 93.4% have never partici-
achieved a moderate score of 66.66%. In the study
pated in any occupational training programs on
group 47.9% infrequently wear protective clothes
blood and body fluid universal precautions and it is
during potential blood splatter. However, 66.56 %
not in agreement with the findings made by various
recognized Hepatitis B or C as high risk infections
other countries22. The study done by Okaro et al
and they change the personal protective habits
(2010)21 in Nigeria revealed that radiographers
accordingly. More than half of the percentage
claimed to have awareness or recognition for uni-
(53.5%) washed their hands infrequently before
versal blood and body fluid precautions, with vari-
touching the patients, but 51.2% washed their
ous proportions claiming different sources of
hands always after touching the patients. Higher
awareness, the largest proportion being through
percentage (67.6%) was aware of the necessity of
clinical seminars or symposia.
adequate covering the open cuts and wounds al-
ways during their clinical work. Eleven point seven Hospitals provide a good transmission pathway for
percent (11.7 %) of the respondents never wears the spread of nosocomial infections, due to poor
mask or respirator although when there is a poten- infection control practices among health workers
tial to be exposed to infectious respiratory aero- .The study demonstrates that radiographers‟ prac-
sols. There was no statistical significance found tice of infection control was moderate and better
between their infection control practice and the than the practice demonstrated in few other obser-
education levels or the infection control practice vational studies23,24. Hands should be washed after
between their years of practice (p<0.05). attending to one patient but before attending to the
next. It must not be missed when contacted is
Discussion
made with body fluids. The finding of this study is
Standard precautions for infection control are very far from what can be acknowledged as standard
vital that have been adopted to prevent health practice but this is similar to finding of Suchitra et
14 21
workers from being occupationally infected. As- al study. Okaro et al (2010) in Nigeria shows
sessment of knowledge of nosocomial infections that many radiographers do not clean couch, cas-
and standard precautions among radiographers is sette and wash hands after every patient making
very critical as without the background knowledge, spread of nosocomial pathogens likely.
the awareness remains useless and void. In the
There is no relationship between the infection con-
study, mean overall score for knowledge of noso-
trol practice with the education level and the expe-
comial infections and standard precautions among
rience of the radiographers in this study. Radio-
radiographers are considered to be moderate.
graphers have lot of things to do in the area of

J Med Allied Sci 2014;4(1) 13

Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections

practicing standard precautions. Many of them are knowledge and source of information among clinical health
care students in Ghana. Int J Gen Med. 2011; 4:571-574.
far away from guidelines which are meant to be
9. Easton PM, Sarma A, Williams FLR, Marwick CA, Phillips
followed in the area of hand washing. Findings of G, Nathwani D. Infection control and management of
this study clearly demonstrate a moderate know- MRSA: assessing the knowledge of staff in an acute hos-
ledge and poor practice on infection control among pital setting. J Hosp Infect 2007; 66:29-33.
10. Askarian M, Honarvr B, Tabatabaee HR, Assadian O.
respondent radiographers in Sri Lanka and find- Knowledge, practice and attitude towards standard isola-
ings are similar to some studies in other develop- tion precaution in Iranian medical students. J Hosp Infect
ing countries. Lack of proper infection control prac- 2004; 58:292-296.
tices can put the patients as well as radiographers 11. Mann CM, Wood A. How much do medical students know
life at a risk. This highlights the need of continuing about infection control? J Hosp Infect 2006; 64:366-370.
12. Koenig S and Chu J. Senior medical students‟ knowledge
educational programmes to upgrade their know- of universal precautions. Acad Med 1993; 68:372-374.
ledge on current practices. 13. Elliott SKF, Keeton A, Holt A. Medical students‟ knowledge
of sharps injuries. J Hosp Infect 2005; 60:374-377.
Conclusion 14. Suchitra JB, Lakshmidevi N. Impact of education on know-
ledge, attitudes and practices among various categories of
This study reveals the radiographers‟ knowledge health care workers on nosocomial infections. Indian J
and practice regarding nosocomial infections and Med Microbiol. 2007; 25:181-187.
standard precautions were moderate. 15. Angtuaco TL, Oprescu FG, Lal SK, et al. Universal precau-
tions guideline: self-reported compliance by gastroenterol-
Acknowledgments: None ogists and gastrointestinal endoscopy nurses–a decade's
lack of progress Am J Gastroenterol 2003; 98:2420-2423.
Conflict of interest: None 16. Huang JJ, Lee WC, Ruaan MK,. Wang MC, Chang TT,
Young KC. Incidence, transmission, and clinical signific-
References ance of hepatitis G virus infection in hemodialysis patients
Eur J Clin Microbiol Infect Dis 2001; 20:374-379.
1. Samuel SO, Kayode OO, Musa OI, et al. Nosocomial in- 17. Kim LE, Evanoff BA, Parks RL, et al. Compliance with
fections and the challenges of control in developing coun- universal precautions among emergency department per-
tries. Afr J Clin Exp Microbiol 2009; 11:102-110. sonnel: implications for prevention programs Am J Infect
2. Horan TC and Gaynes RP. Surveillance of nosocomial Control1999; 27:453-455.
rd
infections. In: Hospital Epidemiology and Infection, 3 edn, 18. Jimenez MDA, Sanchez-Paya J, Gonzales C, Rivera F,
Mayall CG (editor). Philadelphia: Lippincott, Williams & Antolin A. Audit on the degree of application of universal
Wilkins, 2004. precautions in a haemodialysis unit. Nephrol Dial Trans-
3. World Health Organization. 10 facts on patient safety. plant 1999; 14:1001-1003.
Available from: 19. Evanoff B, Kim L, Mutha S, et al. Compliance with univer-
http://www.who.int/feature/factsfile/patientsafety/en/index.h sal precautions among emergency department personnel
tml [Last accessed on January 27, 2012]. caring for trauma patients Ann Emerg Med 1999; 33:160-
4. Wright SB, Ostrowsky B, Fishman N, Deloney VM, Mermel 165.
L, Perl TM. Expanding roles of healthcare epidemiology 20. Pittet D and Boyce JM. Hand hygiene and patient care:
and infection control in spite of limited resources and com- pursuing the Semmelweis legacy. Lancet Infect Dis 2001;
pensation. Infect Control Hosp Epidemiol 2010; 31:127- 9-20.
132. 21. Okaro AO, Eze CU, Ohagwu CC. Knowledge and attitude
5. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Health- of radiographers towards HIV/AIDS patients attending ra-
care Infection Control Practices Advisory Committee 2007. diology clinics in Enugu state, Nigeria. European Journal
Guideline for isolation precautions: preventing transmis- of Scientific Research 2010; 39(3):440-447.
sion of infectious agents in healthcare settings. Available 22. Mehrdad A, Ziad AM, Ashraf AK. Knowledge, practice and
at http://www.cdc.gov/ncidod/dhqp/pdf/isolation2007.pdf attitude Among Iranian nurses, midwives and students re-
6. Phillips G and Ker J. Champion students! Experience with garding standard isolation precautions. Infect Control Hosp
a standardized infection control training package in medi- Epidemiol. 2007, 28(2):241-244.
cal students. J Hosp Infect 2006; 62:518-519. 23. Muto C, Sistrom M, Farr B. Hand hygiene rates unaffected
7. Bryce EA, Scharf S, Walker M, Walsh A. The infection by installation of dispensers of a rapidly acting hand anti-
control audit: the standardized audit as a tool for change. septic. American Journal of Infection Control 2000;
Am J Infect Control 2007; 35:271-283. 28(3):273‑276.
8. Bello AI, Asiedu EN, Adegoke BOA, Quartey JNA, Ap-
24. Pittet D, Mourouga Pl, Perneger T. Compliance with hand
piah-Kubi KO, Owusu-Ansah B. Nosocomial infections:
washing in a teaching hospital. Annals of Internal Medicine
1999; 130:126-130.

J Med Allied Sci 2014;4(1) 14

Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections

Appendix
A study on “Prevention of nosocomial infection and standard precautions: knowledge and practice
among radiographers in Sri Lanka”.
**INSTRUCTION: Please, tick the relevant box for any option chosen or write in the space provided for
additional answers.
[A] Personal Information:
1. Which age group do you belong to?
(a) 20-29 yrs
(b) 30-39 yrs
(c) 40 – 49 yrs
(d) 50 yrs and above
2. Gender
(a) Male
(b) Female
3. Place of work?
(a) Teaching Hospital
(b) Government hospital (other than teaching)
(c) University
(d) Private Hospital / Clinic
(e) Others, specify………………………………..
4. What is your highest educational qualification regarding to your profession?
(a) M Sc
(b) B Sc
(c) Diploma
(d) Others, specify.………………….
5. Number of years of radiography practice?
(a) Less than 1 year
(b) 1 – 5 years
(c) 6- 10 years
(d) More than 10 years
6. Have you ever received occupational training on blood and body fluid universal precautions
(a) Yes
(b) No
[B] Knowledge regarding infection control
7. The environment (air, water, inert surfaces) is the major source of bacteria responsible for no-
socomial infection.
(a) Agreed (b) Disagreed (c) Don‟t Know

J Med Allied Sci 2014;4(1) 15

Jayasinghe RD et al. Knowledge of radiographers in prevention of nosocomial infections

8. Invasive procedures do not increase the risk of nosocomial infection.

(a) Agreed (b) Disagreed (c) Don‟t Know
9. Standard Precautions include the recommendations to protect both patients and the health
workers.
(a) Agreed (b) Disagreed (c) Don‟t Know
10. The standard precautions recommend use of gloves for each procedure
(a) Agreed (b) Disagreed (c) Don‟t Know
11. When there is a risk of splashes or spray of blood and body fluids, the healthcare workers
must wear nothing
(a) Agreed (b) Disagreed (c) Don‟t Know
12. Instead of surgical and antiseptic hand washing alcohol-based hand rub will be use
(a) Agreed (b) Disagreed (c) Don‟t Know
[C] Practice regarding infection control
13. Do you wear protective gloves & coats during procedures where there is the potential for
blood splatter?
(a) Always (b) Sometimes (c) Never
14. Do you change your personal protective habits if you know the patient has Hepatitis B or C ?
(a) Always (b) Sometimes (c) Never
15. Do you wash your hands before touching the patient?
(a) Always (b) Sometimes (c) Never
16. Do you wash your hands after touching the patient and every clinical exposure?
(a) Always (b) Sometimes (c) Never
17. Do you wear a mask or respirator when there is a potential to be exposed to respiratory aero-
sols?
(a) Always (b) Sometimes (c) Never
18. Do you cover the open cuts and wounds during clinical work?
(a) Always (b) Sometimes (c) Never

Thank you for your kind co-operation!!

J Med Allied Sci 2014;4(1) 16