1. Introduction

A nosocomial (or healthcare-associated) infection is defined as an infection acquired in hospital or other health care facility by a patient in whom the infection was not present or incubating at the time of admission ^[1]. These include infectionsacquired in the hospital but appearing after discharge, andalso occupational infections among staff of the facility ^{[2, 3]}. These patients are usually admitted for a reason other than that of infection.

It has alsobeen defined as infections which are as a result of treatment in a hospital or healthcare unit, but secondary to the patient’s original condition ^[3].These infections first appear 48hours or more after hospital admission or within 30days after discharge from the hospital.

Studies have shown that 6 to 10%of patients admitted to a hospital in the United States acquired a nosocomial infection ^[3],and it has been estimated by the Centers for Disease Prevention and Control (CDC) that nearly two million patients each year become infected during their hospital stay.Nosocomial infection is one of the leading causes of death and increased morbidity for hospitalized patients ^{[4, 5]}.

The World Health Organization (WHO) established that the rate of nosocomial infections will continue to rise as a result of four factors which include: Crowded hospital conditions, increasing number of people with compromised immune system, new microorganisms and increasing bacterial resistance ^[6]. Similarly, Toni and Lee identified the following risk factors as the causes of nosocomial infections: prolonged hospital stay, severity of underlying illness, compromised nutritional or immune status, use of indwelling catheters, failure of health care workers to wash hand between handling of patients or before any procedure and prevalence of antibiotic resistance bacteria from a prolonged use or misuse of antibiotics ^[7].

Nosocomial infections are commonly cause by bacteria, it can also be caused by viruses, fungi and parasites, but these types of infection occur less frequently, especially those cause by parasites,for example scabies and often do not carry the same morbidity and mortality as bacterial infections.

Viral nosocomial infections are more common in children than in adults and carry a high epidemic risk ^[8] and fungal nosocomial infections frequency occurs during prolonged treatment with antibiotics and in patients who have compromised immune systems ^[6].

Nosocomial infections occur worldwide and itaffects both developed and developing countries. Over 1.4 million people worldwide suffer from infection complications acquired in the hospital ^[6].Nosocomial infections contribute to 80,000 deaths annually and carry an estimated yearly cost of nearly $2 billion ^[9].Nosocomial infections have socio-economic impact on the society ^[10]; it affects more than 2million patients each year or about 5- 10% of hospitalized patients leading to approximately 90,000 deaths per year. Average cost of $ 14,000 to $38,000 per infection, adding more than $4.5 billion to the total national health care costs ^[11].

A similar study listed the following measures in preventing and controlling nosocomial infections which includes: mounting surveillance onnosocomial infections, development of policies regarding prevention and control such as hand hygiene and practice of universal precaution, adherence to healthy environmental practices and regular training of hospital staff on nosocomial infections and its control ^[12].This study assessed the knowledge of healthcare workers on nosocomial infections in secondary health institutions of Zaria Local Government Area, Nigeria.

2. Materials and Methods

The study area is Zaria local Government where the two selected secondary health institutions were located. Zaria is one of the ancient cities in the northern Nigeria. The total estimated population is 406,990 according to the 2006 census ^[13].The two secondary health institutions selected for the study were St. Luke’s Hospital Wusasa Zaria and HajiyaGamboSawaba General Hospital, KofanGayan.

Wusasa hospital is one of the oldest missionary hospitals in the Northern Nigeria and it is a secondary Health care facility. It was founded in 1929 by the missionary people from England under the denomination of Anglican Church. At the time of the study the hospital had the following categories of health personnel: nurses, doctors, pharmacists, laboratory scientists among others.

HajiyaGamboSawaba General Hospital was founded and opened on 3^rd March 1975 as a health center Zaria. It is a secondary Health care facility with Nurses, Doctors, Pharmacists and Laboratory scientists among others.

It was a cross sectional descriptive study carried out in October, 2010 to assess the knowledge of healthcare workers on nosocomial infections in the 2 selected secondary health institutions in Zaria Local Government Area.

It was a whole population based study which comprised of 160 healthcare workers: 18 doctors, 107 nurses, 21 pharmacists and14 laboratory scientists in the selected hospitals.

A self-administered semi-structured questionnaire onknowledge of healthcare workers on nosocomial infections in secondary health institutions of Zaria Local Government was administered to the 160 healthcare workers.The questionnaire was divided into two sections, A and B. section A contains the socio-demographic characteristics of the participants while section B which contained questions on knowledge of nosocomial infections.

Data analysis was done using SPSS 16.0 version and the results presented in charts and statistical significance was at p value of < 0.05.

Ethical approval was obtained from the Directors of the Secondary Health Institutions and also only the staff that gave consent to participate in the study were given the questionnaire.

3. Results

Table showed that majority of the respondents 124 (77.2 %) fall within the age range of 20-39 years, 106 (66.2%) were female, 107 (66.9%) were nurses, 107(66.9%) were in nurses department, 55(34.4%) were from other wards while 116(72.5%) had 1-10 years of experience.

Majority of the respondents 92(57.5%) gave fully correct definition of nosocomial infection, 123 (75.9%) were of the opinion that bacteria is the most common cause of nosocomial infection. 72(45.0%) were of the opinion that improper aseptic technique and contamination of healthcare workers is one of the common risk factors of nosocomial infection, 80 (50.0%) were of the opinion that the sources of nosocomial infection can be as a result of environmental factors, patient-related factors and iatrogenic factors. 61(38.1%) were of the opinion that surgical wound infection is the commonest type of nosocomial infection (Table 2).

Table 1. Socio-demographic characteristics of the respondents (n=160)

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Table 2. Respondents’ knowledge on nosocomial infection (n=160)

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Figure 1. Respondents’ opinion on the most vulnerable patients in the hospital that easily contact Nosocomial infection (n=160)

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Figure 1 showed that majority of the respondents 59 (36.9%) were of the opinion that surgical operated patients are the most vulnerable to nosocomial infection just like patient with low immune status, patients on labour ward and others (patients on steroid or cancer therapy, HIV/AIDS).

Majority of the respondents 75 (46.9) were of the opinion that: increase length of hospital stay, increase cost of laboratory investigation, increase cost of drugs, surgical intervention and supportive needs and increase personnel work hour were 16.9%, 5.0%, 23.7%, 7.5% and 46.9% respectively (Table 3).

Table 3. Respondents’ opinion on economic implication of nosocomial infection(n=160)

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Figure 2. Respondents’ opinion on the best way to prevent Nosocomial infection (n=160)

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About 46.9% of the respondents were of the opinion that: strict aseptic technique while attending to surgical patients, proper isolation and barrier nursing of infectious diseases. Regular nasal and throat swab investigation of the health workers and education of the healthcare workers or preventions and control of nosocomial infections are the best ways of preventing nosocomial infections (Figure 2).

Figure 3. Respondents’ opinion on the way which personnel can adopt to protect themselves (n=160)

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Figure 3 showed that majority of the respondents 118 (73.8%) were of the opinion that proper wearing of face mask while attending infectious cases, proper handling of sharp instruments and discarding them to the appropriate containers after used and proper wearing of gloves before procedure that involves contact with patients body fluid are good way which the personnel can adopt to protect themselves against infection.

Figure 4. respondents’ opinion on the way which personnel can adopt to protect their patients (n=160)

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Majority of the respondents 112 (70.0%) were of the opinion that proper isolation of infections cases proper barrier nursing of patients in the ward, frequent washing of hands and gloving in-between patients procedures and adherence to aseptic technique in surgical wound procedures are the effective ways which the personnel can adopt to protect their patients against any infection (Figure 4).

4. Discussion

Majority of the respondents (77.2%) are within the productive age group of 20 -39 years, with mean age of 34 ± 12years and age range of 20-60 years. Majority of the respondents (62.2%) were female and 66.9% were nurses by professiondistantly followed by pharmacist with 13.1%. The respondents’ working experience mean is 10 ± 9 years.

About 57.5% of the respondents gave fully correct definition of nosocomial infection. This tallied with the result of a similar study by McBryde et al ^[13].

A significant percentage (76.9%) of the respondents had knowledge that nosocomial infections can be caused by bacteria, and also bacteria is the most common cause of nosocomial infection. This is inline with the study carried out by some researchers [18].

In addition, 45% of the respondents areaware that improper aseptic technique and contamination by healthcare workers are risk factors associated with the infection which is consistent with the findings of the study by Toni and Lee-Culvert who stated that risk factors that increase the opportunity for hospital adult and children to acquire infection are improper aseptic techniques and contamination by healthcare workers ^[7].

Half of the respondents had knowledge that the main sources of nosocomial infections are environments factors, patient-related factors and iatrogenic factors, similar to result by WHO ^[16]. Also the study showed that 38.1% of the respondents were aware that surgical site infection is the commonest type of nosocomial infection in the hospital which is inline with the study by Zhan and Miller which showed that surgical site infections account for approximately 40% of infections acquired in a healthcare setting and are costly in terms of length of stay, morbidity, mortality and actual cost ^[14]. About 38.8% of the respondents stated that contact transmission, airborne transmissions, vehicle transmission and vector transmission are the commonest route of acquiring nosocomial infections similar to the result of study by Prescott et al that stated that transmission is the link in the infectious disease cycle and occur by four main routes: airborne, contact vehicle and vector ^[15].Likewise, the study showed that, 36.9% of the respondents had knowledge that surgically operated patients are the most vulnerable patients in the hospital.

This study also revealed that increase cost of drugs, surgical intervention and supportive needs are the economic implications of nosocomial infection. This is in agreement with the study by Zhan and Miller who stated that post-operative sepsis, post-operative wound dehiscence and infection due to medical care were the three indicators associated with highest cost in term of length of stay charges and mortality ^[14].

The suggested ways of prevention of nosocomial infections by 46.9% of the respondents are: strictly adherence to aseptic technique while attending to surgical patients, proper isolation and barrier nursing of infectious cases, regular nasal and throat swab investigation of the healthcare workers and education of the healthcare workers on prevention and control of nosocomial infections which are in line with the study carried out by WHO ^[6] which established that nosocomial infections are better prevented through strict adherence to aseptic techniques, proper isolation and barrier nursing of infectious cases, regular nasal and throat swab investigation of healthcare workers and education of healthcare workers on the causes and control of nosocomial infections.

A good percentage of the respondents (73.8%) had knowledge of the various ways which personnel can adopt to protect themselves from nosocomial infections which include: proper wearing of face mask while attending to infectious cases, proper handling of sharp instruments and discarding to their appropriate containers after use and proper wearing of gloves before procedure that involves contact with the patient’s body fluid.

Furthermore, it showed that 70% of the respondents were aware that proper isolation of infectious cases, proper barrier nursing of patients in the ward, frequent washing of hands and gloving in between patients’ procedures and adherence to aseptic technique in surgical wound procedures are the ways health personnel can adopt in protecting their patient. These are in line with the study carried out by who stated that the healthcare workers can adequately prevent themselves and their patients against nosocomial infections when they ensure wearing of protective equipment, handling of sharp objects with care and avoiding contact with patients’ body fluids and droplet infectious cases while performing their procedures ^[16].

5. Conclusion

This study showed that 66.9% of the respondents were nurseswho are mostly female. The study revealed that, 57.5% of the respondents were aware of nosocomial infection as infection that manifests after 48hours of hospital admission and bacteria is the most common cause of nosocomial infection in relation to other causes. The routes of transmission are contact transmission, airborne transmission, vehicle transmission and vector transmission and the most vulnerable patients are the surgically operated patients. The preventive measures to be adopted can be through protection of personnel themselves and through protecting their patient.

1. There should be regular training for healthcare workers on topical public health issues such as nosocomial infection and its control by the management of the hospitals and the various professional bodies.

2. Healthcare workers should be regularly screened by their employers to identify carriers of pathogen organism for subsequent treatment.

3. The practice of universal precaution should be intensified.

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