RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE CANDIDATE AND SHRITHI.M.T.

ADDRESS IST YEAR M.SC NURSING
ST.ANN’S COLLEGE OF NURSING MULKI
MANGALORE - 574154

2
NAME OF THE INSTITUTION ST.ANN’S COLLEGE OF NURSING
MULKI,
MANGALORE-574154.
3
COURSE OF STUDY AND M.SC NURSING
SUBJECT MEDICAL SURGICAL NURSING

4
DATE OF ADMISSION TO THE 12-06-2010
COURSE

5. TITLE OF THE STUDY

EFFECTIVENESS OF VIDEO ASSISTED TEACHING PROGRAMME (VATP) ON
KNOWLEDGE REGARDING PREVENTION OF TRANSMISSION OF
METHICILLIN - RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) AMONG
NURSING STUDENTS IN A SELECTED NURSING INSTITUTION OF,
MANGALORE.

1
6 BRIEF RESUME OF THE INTENDED STUDY
6.1 Need for the study

“Ill health, of body or of mind, is defeat .Health alone is victory .Let all men, if they can
manage it, contrive to be healthy.”

-Thomas Carlyle

Health in the broad sense of the world does not merely mean the absence of disease or
provision of diagnostic, curative and preventive services. It also includes a state of physical, mental and
social well-being. Disease results from a complex interaction between man, an agent and the
environment. Microorganism act as an agent factor for causing infection and disease .Microorganisms
are very diverse they include bacteria, fungi, protozoa, algae, nematodes and virus and are found in the
environment.
Successful prevention depends upon knowledge of prevention, dynamics of transmission, identification
of risk factors and risk group, early detection, treatment measures with organization for applying these
measures to appropriate persons or groups, and continuous evaluation of the development of procedures
applied1.
Nosocomial infections are commonly transmitted when hospital officials become complacent
and personnel do not practice correct hygiene regularly, since medical staff move from patient to
patient, staff and students themselves serve as a means for spreading pathogens. Thorough hand
washing use of alcohol rubs, before and after each patient contact is one of the most effective ways to
combat nosocomial infections. Among varies other categories of bacteria, Methycillin-resistant
staphylococcus MRSA (gram +ve bacteria) is the most known category of bacteria known to infect
patients.
MRSA usually shows resistance to methicillin group of drugs manifested by pus production in
the infected area mainly with boils(pus in hair follicles),abscesses(pus collection underneath the
skin),carbuncles(large abscesses with pus draining),stye(pus in the eyelid gland)and impetigo(pus in
blisters on the skin).Patients also showed signs of fever, chills, low bloodpressure,weakness,and mental
deterioration. A study in Italy conducted in 2000, revealed that 6.7% (4500 and 7000) of the deaths
were due to MRSA. A survey in Lombardy in 2000, also added a rate of 4.9% dying due to MRSA2.
The prevalence of staphylococcus aureus including MRSA in the nose of the patients and the
hospital staff resulted in the rapid dissemination of the same bacteria in various hospital environments
resulting in rapid colonization in the nose and skin of persons within the hospital. Throughout the world
about 20-30% of health personnel are carrying staphylococcus in their nose.3
A quantitative descriptive study was conducted to assess the effectiveness of visual aids for
improved infection control compliance among nurses, concentrating on community acquired
2
 Methycillin resistant staphylococcus aureus. Convenient sampling technique was used. Posters were
hung in the Emergency Department of a large Metro-Atlanta hospital in US, to be viewed by each care
team and were later discussed with nurses. The posters included an emphasis on hand hygiene and other
infection control practices, pictures of MRSA infected lesions, and the phone number of the infection
control department. The evaluation of the project was a follow-up observation of hand hygiene
behaviors, and discussion with the nursing staff regarding the effectiveness of the posters. The visual
trigger of the posters did remind the nurses to practice hand hygiene more frequently and use the hand
sanitizer with increased frequency.4
A study was conducted to assess the knowledge among nursing students regarding methicillin-
resistant Staphylococcus aureus in UK.A MRSA Survey was administered to nursing students to gauge
their general knowledge about MRSA. The scores from the MRSA Survey indicated that nursing
students had a knowledge deficit regarding MRSA. Nursing students need specific MRSA content in
the nursing curriculum and need role models in healthcare settings who follow infection control
guidelines. A variety of teaching strategies may be used to effectively teach this topic to nursing
students. The goal of the education was to prevent the spread of MRSA organisms and decrease the
related costs of treating MRSA infections.5
The above studies reveal that educational programmes are necessary to provide information to nursing
students so that they become aware of the seriousness of the disease and practice methods to prevent
transmission. Hence the investigator felt the need to provide a video assisted teaching programme in
order to improve the knowledge of nursing students on MRSA prevention
6.2 Review literature
A study was conducted to determine the prevalence of MRSA in a tertiary care hospital,
Chennai’. From various clinical specimens like blood, high vaginal swabs and cervical swabs, ear
swabs and conjuctival swabs, drains umbilical tips and aspirates etc.805 s. aureas were isolated, all the
isolates were identified by standard techniques. Each of the stains were screened for oxacillin resistance
method. The screening showed that 250(31%)were found to be MRSA.The study revealed that a
,regular surveillance of hospital associated infection monitoring of antibiotic sensitivity pattern and
formulation of definite antibiotic policy help to reduce the prevalence of MRSA.6

A study was conducted by the department of microbiology, Kasturba medical college to find out
prevalence of nosocomial infections due to methicillin resistant Staphylococcus aureus (MRSA) in
Mangalore. S. aureus strains isolated from different infections from hospitalized patients during January
1993 to June 1996 were tested for methicillin resistance using disc diffusion and agar dilution method.
7
Among 987 isolates of S. aureus, 210 (21.3 percent) were methicillin resistant and the remaining 762
(77.2 percent) were methicillin sensitive (15 strains were moderately sensitive). All strain were tested
for their susceptibility pattern to other individual antibiotic. Resistance was more common with MRSA

3
 strains. These findings clearly indicate that when antibiotics other than vanomycin are to be used for the
treatment of MRSA infection, their selection should be based on in vitro sensitivity results. 7

A study was conducted in UK to determine the effect of increased bed numbers due to MRSA
transmission in acute medical wards. An 18-month prospective survey was performed to examine the
effect of adding a fifth bed to four-bedded bays in three acute medical wards on colonization by
methicillin-resistant Staphylococcus aureus (MRSA). Screening procedures were in accordance with
the UK national guidelines. Data from the five-bedded bays were compared with those from four-
bedded bays in similar wards. Potential routes of transmission were investigated by observational
surveys. The relative risk of colonization in five-bedded medium dependency bays was 3·15 compared
with that of similar four-bedded bays (P < 0.005), and in the five-bedded low dependency bays was
3·16 (P < 0·005).These findings clearly indicated that increasing the number of beds in a fixed area
heightens the risk of cross-infection with MRSA.8
A study was conducted on senior staff nurses' perceptions about MRSA.A qualitative research
paradigm with semi-structured interview was carried out to examine the perceptions, attitudes and
beliefs of 10 senior staff nurses. In the study, 60% of participants believe that MRSA is out of control
and state 'why should they bother worrying about it'. Furthermore, 80% of participants commented that
prescribed courses of nasal mupirocin were frequently missed. The perception is that IV treatments
were more important and effective than topical agents. The study has established that a small section of
experienced staff nurses perceive MRSA to be out of control and they were not concerned about its
management.9
An epidemiological study was conducted to find the effectiveness of preemptive barrier
precautions in controlling nosocomial colonization and infection by methicillin-resistant
Staphylococcus aureus in a burn unit. During a six-month period, 12 patients in a seven-bed burn unit
were found to be colonized out of which seven were infected and five were being infected by MRSA.
Seven of the 10 strains of MRSA from patients that were available for DNA typing were clonally
identical. Early in the outbreak, a health care worker was found to be a concordant nasal carrier and was
successfully decolonized with nasal mupirocin. The outbreak was rapidly terminated after
implementing preemptive barrier precautions with all patients in the unit: a new, clean gown and gloves
for any physical contact with the patient or their environment. Although 25% of all nosocomial S.aureus
8
isolates in the hospital were resistant to methicillin, the incidence of endemic MRSA colonization and
infection in the burn unit had remained very low since implementing barrier precautions. The study
revealed that preemptive barrier precautions were highly effective in controlling the outbreak and, have
also been highly effective in maintaining a very low incidence of nosocomial MRSA infection .10

4
6.3 Problem Statement
Effectiveness Of Video Assisted Teaching Programme (VATP) On Knowledge Regarding
Prevention Of Transmission Of Methicillin - Resistant Staphylococcus Aureus (MRSA) Among
Nursing Students In A Selected Nursing Institution Of, Mangalore.
6.4 Objectives
The objectives of the study are
 to determine the level of knowledge regarding prevention of transmission of MRSA among
nursing students using structured knowledge questionnaire.
 to find the effectiveness of VATP on knowledge regarding prevention of transmission of MRSA
in terms of gain in knowledge scores.
 to find the association between pretest knowledge score and selected baseline characteristics
(education programme, source of information).

6.5 Operational Definitions

Effectiveness:
In this study, it refers to the extent to which the VATP has achieved the intended results in terms of
gain in mean knowledge scores.
Video assisted teaching programme:
In this study, it refers to the modified prerecorded scenes prepared with support of media
(internet) by the investigator to improve the knowledge on prevention of transmission of MRSA.
Knowledge:
In this study, it refers to the correct responses of the nursing students to the items on structured
knowledge questionnaire on prevention of transmission of MRSA.
Nursing students:
In this study it refers to students who are studying in third year GNM and fourth year Bsc
nursing, in the selected nursing institution of Mangalore.
Methicillin resistant Staphylococcus aureus (MRSA) :
In this study MRSA refers to a group of specific staphylococci bacteria which do not respond to
Methycillin group of drugs.
Prevention of transmission of MRSA:
In this study, it refers to actions taken to avoid spread of MRSA which includes proper hand
washing, use of barrier technique, use of aseptic dressing, isolation of patient with MRSA, and
sterilization of articles.

6.6 Assumptions
The study assumes that:
 nursing students may have some knowledge regarding prevention of transmission of MRSA.
 adequate knowledge helps in prevention of transmission of MRSA.

6.7 Delimitation
The study is delimited to:

5
  Students who are studying in third year GNM and fourth year Bsc nursing in selected college of
Mangalore.
 Students who are available at the time of data collection.
6.8 Hypotheses

Hypotheses will be tested at 0.05 level of significance:

 H1:There will be significant difference between the mean pretest and posttest knowledge scores
of nursing students on prevention of transmission of MRSA
 H2: There will be significance between the mean pretest knowledge scores of nursing students
on prevention of transmission of MRSA and selected baseline characteristics (education
programme and source of information).

MATERIALS AND METHOD

7.1 Source of data
Data will be collected from 60 students, studying in third year GNM and fourth year BSc nursing .
who fulfill the inclusion criteria.
7.1.1 Research design
A pre experimental (One group pre test and post test research design) will be used for the present study.

7.1.2 Setting
The study will be conducted in selected nursing college of Mulki.The college has a total strength of 422
students, of which there are 113 GNM, 182 Bsc, 89 PcBsc and 38 Msc nursing students. This college
offers GNM, Bsc, PcBsc and Msc nursing courses. Out of these students 3 rd year GNM and 4th Bsc
nursing students who meet the inclusion criteria will be selected for the study.
7.1.3 Population
The population consists of fourth year Bsc and third year GNM students studying in nursing institute of
Mangalore.

7.2 Methods of data collection

7.2.1 Sampling Procedure:

Samples will be selected by purposive sampling technique.
7.2.2 Sample size:
Study will be conducted among 60 students studying in selected nursing institute of Mangalore.
7.2.3 Inclusion criteria
 Students who are willing to participate in the study.
7.2.4 Exclusion criteria
 Students of other programmes (Msc, PcBsc).
 Students other than third year GNM and fourth year Bsc.
7.2.5 Instruments used

The tool designed for the study consists of

Tool.1: Structured knowledge questionnaire

6
  Part1:Baseline characteristics
 Part 2:Structured knowledge questionnaire on prevention of transmission of MRSA
Material used
Video assisted teaching programme along with lecture cum discussion on prevention of transmission of
MRSA which includes proper hand washing, use of barrier technique, use of aseptic dressing, isolation
of patients with MRSA and sterilization of articles.

7.2.6 Data collection method

 Prior to data collection permission will be obtained from the concerned authorities of the
institution.
 The investigator will introduce herself to the participants.
 The objectives of the study will be explained.
 Informed consent will be obtained from the participants.
 Pretest will be conducted by administering the structured knowledge questionnaire.
 Intervention in the form of video assisted teaching regarding prevention of transmission of
MRSA will be given to both final year GNM and fourth year Bsc nursing students on the same
day of pretest.
 Posttest will be conducted by administering the same knowledge questionnaire after seven days
following the video assisted teaching programme.

7.2.7 Data analysis plan

Data will be analyzed using descriptive (frequency, percentage, mean, median and standard deviation)
and inferential statistics. The data will be analyzed for significance of difference between the pretest
and post test knowledge scores using paired‘t’ test. The associations between pre test knowledge score
and selected baseline characteristics will be determined using chi–square test. The data will be
presented in the form of tables and graphs.

7.3 Does the study require any investigations or intervention to be conducted on patients or on
other humans or animals? If so please describe briefly.
Yes, VATP will be given to nursing students regarding prevention of transmission of MRSA.

7.4 Has ethical clearance been obtained from the institution in case of 7.3?
Yes, ethical clearance has been obtained from the concerned authority.

LIST OF REFERENCES
1. Park .k.Textbook of preventive medicine.17th edition. Jabalpur: bansaridas bhanot: 2002:34, 14.
2. www.en.wikepedia.org/wiki/nosocomial.in
7
3. www.en.wikipedia.org/wiki/mrsa

4. www.lagrange.edu/resources/pdf/citation/2007/nursing

5. Andrea Jennings-Sanders, LucyJury. Assessing methicillin-resistant Staphylococcus aureus

knowledge among nursing students. Journal of nurse education today.2010 apr ,30(8):789-793

6. Anbumani N, Kalyani J, Mallika M.Prevalence of mrsa in tertiary care hospital. Indian journal for
practicing doctors.2006-8: vol 3(4).
7. Bhat KG, Bhat MV. Prevalence of nosocomial infections due to methicillin resistant staphylococcus
aureus in Mangalore. Biomedicine. 1997; 17(1): 17-20.
8. Kibbler .C, Quick. A, Neill A.O. Journal of hospital infection. The effect of increased bed numbers
on MRSA transmission in acute medical wards. Journal of Hospital Infection. vol39 (3).213-219.
9. Lines L. Gates head .A study of senior staff nurses' perceptions about MRSA. Nursing
times.2006.april:102(15):32-35
10.http://www.ncbi.nlm.nih.gov/pubmed/16640211

8
9 Signature of the candidate

10 Remark of the guide

11 Name and designation of

11.1 Guide PROF. SR. LUCY RODRIGUES

HOD MEDICAL SURGICAL DEPARTMENT
ST.ANN’S COLLEGE OF NURSING
MULKI,MANGALORE

11.2 Signature

11.3 Co-Guide PROF.SR. LOREDHANA KORAH

DEPARTMENT OF OBSTERICS AND
GYNAECOLOGICAL NURSING
ST.ANN’S COLLEGE OF NURSING
MULKI,MANGALORE

11.4 Signature

11.5 Head of the department PROF.SR.LUCY RODRIGUES

11.6 Signature
12 12.1 Remark of the chairman and
principal

12.2 Signature