Aisha Final Proposal 17-11

KNOWLEDGE, ATTITUDE, AND PRACTICE ON NOSOCOMIAL INFECTION PREVENTION AND ITS
ASSOCIATED FACTORS AMONG NURSES AT BANADIR HOSPITAL IN MOGADISHU SOMALIA
By
AISHA ALI SHEIKH MOHAMUD
MPH21106461
SUPERVISOR: DR. NAHLAH ABDULJLEEL ALSAIDI
1
This proposal aims to partially complete the qualifications for the degree of Master of public
health at Mahsa University
Table of
Content
s
CHAPTER ONE: INTRODUCTION
NO TITLE PAGE
1.1 Introduction 4
1.2 Background of the study 4
1.3 Problem statement 5
1.3 Research questions 7
1.4 Objective of the study 7
1.4.1 General objectives 8
1.4.2 Specific objectives 8
2
1.5 Research hypothesis 8
1.6 Significance of the study 9
1.7 Conceptual framework 10
1.8 Operational definitions and variables 11
CHAPTER TWO: LITERATURE VIEW 11
2.0 Introduction 13
2.1 Prevalence nosocomial infection in the world 13
2.2 Prevalence nosocomial infections in developing countries 14
2.3 Prevalence nosocomial infections in Somalia 15
2.4 Knowledge of the nurses on nosocomial infection 16
2.5 Attitude of the nurse on nosocomial infection 17
2.6 Practice of the nurses on nosocomial infection 18
2.7 The association factors of nosocomial among nurses 19
2.8 Knowledge of nurses about Infection control measures 20
2.9 Prevention of nosocomial among nurses 20
CHAPTER THREE: METHODOLOGY 23
3.1 Study design 23
3.2 Setting of the study 23
3.3 Study population 23
3
3.4 Eligibility criteria 23
3.5 Sample size calculation 24
3.6 Sample method 27
3.7 Study instrument 27
3.8 Data quality control 27
3.9 Plan for the data analysis 27
3.10 Ethical consideration 30
CHAPTER FIVE: FINDINGS 31
4.1 Dummy tables 31
REFERENCE 38
CHAPTER FIVE: APPENDIX 44
5.1 Informed consent 44
5.2 Gantt’s chart 45
5.3 questionnaire 45
4
DECLARATION
I hereby declare that this research proposal is my original work and has not been submitted
to any institution for any award or published in any form and where the work of others has
been included, due acknowledgment has been made.
Sign ……………………………………………. Date ………………………………………….
Name______________________________________________
5
APPROVAL
This is to certify that the research proposal of AISHA ALI SHEIKH MOHAMUD, and has been
done under my supervision and is now ready to be submitted in partial fulfillment of the
requirements for the award of a Master’s Degree in Public Health of Mahsa university with
my approval.
Sign ……………………………….. Date ………………………………
SUPERVISOR: DR. NAHLAH ABDULJLEEL ALSAIDI
6
DEDICATION
This report is dedicated to my beloved parents and family members for their
encouragement during my studies. May Allah bless you all abundantly.
7
ACKNOWLEDGEMENT
All praise is to Allah almighty, who gave me the energy and chance to accomplish this work
successfully.
I would also like to thank my supervisor, for the immense support, continuous
encouragement and motivation throughout my studies. This thesis would not have been
completed without his help, support, efforts and constant support. His valuable help of
constructive comments and suggestions throughout the experimental and thesis works have
contributed to the success of this research. I would like to thank my dear mother parents
for their unconditional support, both financially and emotionally throughout my studies
thank you for your constant support through the ups and downs of my academic years.
Finally, I would like to thank my lecturers at Mahsa University who thought their dedicated
teaching, I was able to achieve this academic status and also produce this research report
may the almighty Allah reward you abundantly.
8
CHAPTER ONE
1.0 Introduction
This chapter presents the background of the study, the problem statement, the
Objectives and hypothesis of the study, the Significance of the study, and conceptual
framework.
1.1 Background of the study
Nosocomial infections, commonly referred to as hospital-acquired infections, are

"infections obtained health care facility by the patient who'd been hospitalized for a
purpose other than for that infection," based on the World Health Organization. It
covers diseases contracted while hospitalized but developing after discharge, as well
as workplace infections among facility workers. Nosocomial infections are defined as
infections that are first noticed 48 hours or over later hospitalization or 30 days after
discharge following in-patient care and were acquired in a hospital or healthcare
(WHO,2021)
9
The World Health Organization, in 2019 nosocomial infections summary report
estimates that 100 million patients worldwide are impacted annually. The study also
said that in developed and LMICs nations, respectively, the overall prevalence of
nosocomial were found the range of 3.5 to twelve percent as well as 5.7 to
19.1percent. Healthcare infections raise the risk of disease, death, permanent
impairment, length of stay in the hospital, microbial antibiotic resistance, and medical
expenses for families and patients. (Bayih, 2020)
Nosocomial infections are diseases that appear while a patient is receiving medical
care but weren't present when they were admitted. These could appear in a wide
range of healthcare delivery settings, such as hospitals, long-term care facilities, and
outpatient clinics, as well as following discharge. When pathogens infect a patient
host who is vulnerable, infection results. the infection's source and the germ
responsible for it which could be fungi, bacterial, or viral, determine the etiology of
nosocomial infection ( (Sikora et al., n.d.)
The intensive care unit, where nurses handle serious illnesses, is one of the wards
where nosocomial infections happen most frequently. One in ten patients who are
admitted to a hospital will develop a nosocomial infection. Nosocomial infections are
also more common in developing countries. According to studies, nosocomial
infections are the cause of 5 to 10% of hospitalizations in Europe as well as North
America. It exceeds forty percent in regions like Latin America, Sub-Saharan Africa,
and Asia. (Sikora et al., n.d.)
In the Intensive care unit, patients with nosocomial infections had a twenty-five
percent death rate, according to an international study based on previous research.
CDC claims that numerous intrusive techniques as well as equipment used in
contemporary healthcare it can aid in the transmission of infections. Ventilation
systems, catheterization, surgical, prosthetics inserts, and inserted medical devices
are some of these methods and equipment (Anon., n.d.)
10
Other than healthcare workers in the hospital, nurses have a special opportunity to
enhance the standard of patient care by acting as the first line of defence against the
spread of infections. Having updated knowledge and abilities for preventing the
spread of infections and using them safely and competently at all times is a
professional and ethical necessity for nurses.
Different workers, such as doctors, nurses, as well as specialists, are needed to

perform healthcare services. Additionally, these individuals can be encountered in a
variety of work environments, such as emergency response settings, clinics, and
outpatient centers. It is particularly difficult to avoid occupational exposure to
infectious diseases because of the diversity of nurses and their environments. Due to
scarce resources, unsanitary surroundings, and inadequate hygiene standards,
standardized infection control programs were disregarded, which is why there is
such a high incidence of nosocomial infections. (Benamma., 2018,).
1.2 Problem Statement
One of the most significant global public health problems is nosocomial infection.
According to estimates from the World Health Organization, 15 to 20 individuals
were admitted to ICU. with a minimum of one infection. Additionally, according to the
World Health Organization, of the 1,900,000 people who are admitted to medical
centers, 9,000,000 of them have nosocomial illnesses, and nearly 1,000,000 of them
pass away each year. Moreover, according to the WHO, the risk of such an infection
is increased two to twenty times and can reach over twenty-five percent in
undeveloped nations, with the Eastern Mediterranean Region having the highest
incidence rate of nosocomial infections at 11.8percent (WHO, 2019).
Nosocomial infections increase hospital expenditures, length of stay, disease, and

fatality. Patients are crowded in most clinics and poor infection control methods
among nurses are two determinants of nosocomial infection transmission in
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hospitals. Beyond its effect on sickness and death statistics in any nation, the
significance of hospital-acquired infections has significant financial implications.
(Motbainor, Bereded, and Mulu, 2020)
According to the United States CDC, about 1.700.000 hospitalized patients each
year are infected with nosocomial infection while receiving treatment for other
medical conditions, and more than ninety-eight thousand individuals (1 in 17) pass
away as a result of these infections. Numerous studies show that simple infection-
control measures, such as washing, and hand sanitizer, can prevent nosocomial
infections, save lives, reduce morbidity, and minimize medical care costs. (Haque,
Sartelli and Bakar, n.d.)
Cleansing, sterilization, and dressing are all duties of nurses. Compared to other

healthcare professionals, they interact with patients more frequently. Consequently,
individuals are more likely to be exposed to certain nosocomial illnesses. Due to this,
nurses are crucial in the spread of nosocomial infections, and their adherence to
infection control protocols appears to be essential for avoiding and treating
nosocomial infections. As a result, they must be knowledgeable of the best ways to
stop the spread of nosocomial illnesses and the possible risks that they pose to
patients, other members of the staff, and visitors. Although numerous prior cross-
sectional studies have shown that, to the best of the researcher's knowledge, the
levels of nurses' knowledge and practice are relatively low and insufficient.
(Alrubaiee et al., 2017)
In order to reduce the prevalence rate of nosocomial infections, any training program
must focus on improving nurses' knowledge, attitude, and practice in this area. For
example, any infection control program in a hospital should aim to safeguard the
staff, patients, and visitors in an effective and affordable manner. These can be
accomplished from a hospital's management perspective by offering instruction on
infection control, and prevention as well as an essential requirement for boosting
KAP and procedures and enhancing compliance among the nurses, hence lowering
the rate of Nosocomial infections.
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Previous research in a number of countries, including, Iran, and Yemen, suggested
that nurses' inadequate knowledge, attitudes, and practice may contribute to the
spread of nosocomial infections (Gawad, 2017). According to the authors, a lack of
understanding of knowledge, attitude, and practice results in disobedience to rules
and increases the possibility of nosocomial infection. Therefore, nurses must
increase their expertise in order to increase compliance and decrease the spread of
nosocomial infections. The nurses in Somalia would also get a better understanding
of the significance of using nosocomial infection KAP and their involvement in
preventing such infections if they were educated on the issue.
No study was conducted in Somalia. Therefore, this study will find out the gap in
nurses' knowledge, attitude, and practice on nosocomial infection prevention and its
associated factors in order to enhance future good practice
1.3. Research questions
1. What is the level of knowledge of Nurses at Banadir Hospital regarding

Nosocomial Infection (NIs) prevention and its associated factors?
2. What is the level of attitude of Nurses at Banadir Hospital regarding Nosocomial
Infection (NIs) prevention and its associated factors?
3. What is the level of practice of Nurses at Banadir Hospital regarding Nosocomial
Infection (NIs) prevention and its associated factors?
4. Is there any association between levels of knowledge, attitude and practice
among the nurses at Banadir Hospital?
5. Is there any association between knowledge, attitude and practice level of
Nurses at Banadir Hospital and sociodemographic factors, in terms of age,
gender, educational status, work experience, profession and working department
of participants?
6. Is there any association between knowledge, attitude and practice level of
Nurses at Banadir Hospital and factors related to infection control measures, in
terms of attending workshops on infection control measures and receiving
Hepatitis B vaccine?
13
1.4. Objective of the study
1.4.1 General objectives
To assess the levels of knowledge, attitude, and practice towards nosocomial

infection prevention and its associated factors among the nurses at Banadir Hospital.
1.4.2 Specific objectives of the study
1. To assess the level of knowledge of Nurses at Banadir Hospital regarding

Nosocomial Infection (NIs) prevention and its associated factors.
2. To determine the level of attitude of Nurses at Banadir Hospital regarding
3. To evaluate the level of practice of Nurses at Banadir Hospital regarding
4. To determine the association between levels of knowledge, attitude and
practice among the nurses at Banadir Hospital.
5. To determine the association between knowledge, attitude and practice level
of Nurses at Banadir Hospital and sociodemographic factors, in terms of age,
gender, educational status, work experience, profession and working
department of participants.
6. To determine the association between knowledge, attitude and practice level
of Nurses at Banadir Hospital and factors related to infection control
measures, in terms of attending workshops on infection control measures and
receiving Hepatitis B vaccine.
1.5. Research Hypothesis
1. There is a low level of knowledge of Nurses at Banadir Hospital regarding

14
2. There is a low level of attitude of Nurses at Banadir Hospital regarding
3. There is a low level of practice of Nurses at Banadir Hospital regarding
4. There is a significant association between levels of knowledge, attitude and
practice among the nurses at Banadir Hospital.
5. There is a significant association between knowledge, attitude and practice
level of Nurses at Banadir Hospital and sociodemographic factors, in terms of
age, gender, educational status, work experience, profession and working
department of participants.
6. There is a significant association between knowledge, attitude and practice
level of Nurses at Banadir Hospital and factors related to infection control
measures, in terms of attending workshops on infection control measures and
receiving Hepatitis B vaccine.
1.6. Significance of the study
The finding of our study will highlight the level of knowledge, attitude, and practice of
the nurses toward regarding Nis prevention among nurses in Somalia. It will give
nurses the crucial knowledge they need about infection control to improve their skills
for enhancing compliance
This study may alert nurses to follow the infection prevention guideline to prevent
infection and consequently enhance the quality of hospital care. The study will also
emphasize the need for regular, structured, and standardized training programs
focussing on the gaps in the knowledge, attitude, and practice on preventing Nis
among health care personnel
1.7 Conceptual Framework
Knowledge of
15 Nurses about
the Nosocomial
Infection
prevention
Sociodemographic
factors
• Age
Infection-control
• Gender
related factors
• Educational
status Attitude of • Attended
Nurses about Infection
• Work Control
the Nosocomial Workshop
experience
Infection
• Profession prevention • Received
Hepatitis B
• Department Vaccination
Practice of
Nurses about
the Nosocomial
Infection
prevention
1.8 Operational Definitions and Variables
Variable Variable Type Code Definition
Age Independent 1 - 20-25 Age of nurses in

study
2 - 26-30
16
3 - 31-35
4 - ≥36
1 - Male Gender of nurses

Gender Independent
in study
2 - Female
1 - Diploma
Educational Education level of
Independent 2 - Degree
status nurses in study
3 - Master
1 - < five years Work experience

Work experience Independent level of nurses in
2 -  five years study
1 - Nurse
Professional level
Profession Independent 2 - Assistance of nurses in study
nurse
Department Independent 1- intensive care Department in

unit which participating
nurses work
2. Paediatric
3. Obstetrics and
gynaecology
4. internal
medicine
5. surgery
6. emergency
7. radiology
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8. Haemodialysis
9. Orthopaedic
10. HIV canter
11. TB center
0 – No
Nurses who have
Attending 1 – Yes attended training
Infection Control Independent
for infection control
Workshop
workshop
0 – No
Nurses who have
Hepatitis B
Independent 1 – Yes received Hepatitis
Vaccination
B vaccine
Level of
1 – Good knowledge of Nis
Knowledge Dependent
prevention among
2 – Poor
nurses
1 – Positive Level of attitude of

Attitude Dependent Nis prevention
2 – Negative among nurses
1 – Good Level of practice of

Practice Dependent Nis prevention
2 – Bad among nurses
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CHAPTER TWO
LITERATURE REVIEW
2.0 INTRODUCTION
19
In this section, various empirical and theoretical works of many scholars who
conducted on the subject matter are reviewed so that the study had its own side on
the knowledge, Attitude and practices among nurses at Banadir hospital in
Mogadishu Somalia towards nosocomial infection prevention and associated factors.
This chapter therefore reviews the previous studies from other similar research
works done before in order to conceptualize and operationalize the study. The
chapter also highlights the theories associated with nosocomial infection prevention
and associated factors in developing countries.
2.1 prevalence of nosocomial infections around the world
Nosocomial infections are a public health concern worldwide and extend to

drastically regardless of infection control efforts in hospitals, contributing significantly
to death, disease and financial burden. The severity of the issue is further impacted
by a lack of infection control policies, procedures, and nurses’ workers. Nosocomial
infections are frequently seen as a result of nurse’s lack of knowledge, attitude and
practice in the health sector. (Gasaba 2020)
Nosocomial infections are those contracted within forty-eight hours of a patient being
admitted to a particular hospital or even another healthcare facility as a result of
providing patient care. Morbidity and death also contribute to nosocomial infections.
This infections seriously affect the effectiveness of patient care quality. They also
increase illness, which causes avoidable deaths and raises healthcare expenses.
Numerous patients worldwide are impacted by nosocomial infections, which

considerably increase rates of death and financial losses. Approximately fifteen
percent of hospitalized patients, according to a World Health Organization estimate,
have these infections. Including an estimated incidence of seventy-five percent in
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SEA as well as Sub-Saharan Africa, these diseases are to blame for four percent to
fifty-six percent of all neonatal deaths. The incidence ranges from 5.7percent -
19.1percent in middle and low-income countries, although it is high enough in high-
income ones (between 3.5percent and 12 percent). While the incidence of infections
is 3 times greater generally in low-income nations than in high-income ones, it is
between three and twenty times higher in new-borns.
The World Health Organization figures, these illnesses affect fifteen percent of all
hospitalized patients. The patient is susceptible to infections while in the hospital
through a variety of settings, medical workers, as well as other affected patients. In
order to prevent these illnesses, transmission should be limited. Hospital waste is a
possible source of germs, with twenty percent to twenty-five percent of it being
classified as considered hazardous. (Khan, Baig, and Mehboob, 2017)
2.2 prevalence of nosocomial in developing countries
The prevalence of nosocomial infections is thought to be 5.7 to 19.1 times higher in
low and middle-income nations than in the industrialized world. And over 2,500,000
nosocomial infection cases were estimated to occur annually in both developing and
industrialized countries, with about ninety percent of infections taking place in
environments with minimal resources. As a result, there has been a rise in

nosocomial infections throughout the world. In high-income nations, five to five teen
percent of hospitalized patients get a nosocomial infection, that can impact nine
percent to thirty-seven percent of patients who were admitted to intensive
(Bayleyegnall., 2021).
In developed nations, in which it infects five percent to fifteen percent of hospitalized

patients in ordinary departments as well as fifty percent as well as 50% more than of
21
patients in intensive care units, the burden of nosocomial infections is already
significant in ICUs. The scope of the issue is still mostly unknown or underestimated
in developing nations, and the surveillance operations that will inform responses
demand knowledge and funding. (NejadPittet, n.d.)
Nosocomial infections appear to have a higher endemic burden in underdeveloped

nations. The frequency of nosocomial infections was found to be 15.5percent in
developing nations, with the majority of cases being ventilator-associated pneumonia
as well as neonatal illnesses in the intensive care unit. The overall prevalence of
nosocomial infections was found to be 9.1percent in SEA nations after a
comprehensive review % (Sikora et al., n.d.)
At hospitals and other healthcare facilities, nurses are largely in charge of carrying
out routine patient care tasks that require more direct patient contact than those
performed by other healthcare workers. As a consequence, nurses are more likely to
be exposed to different Nosocomial infections which are crucial in Nosocomial
infection transmission. As a result, to prevent and manage nosocomial infection,
nursing personnel must adhere to infection control procedures. But for nurses to
adhere to infection control measures, a sufficient level of education is necessary so
that they can implement suitable infection control procedures in the care setting.
According to the World Health Organization, poor sanitary and waste storage

practice, lack of equipment and resources, overpopulation, an absence of national
guidelines, poor knowledge of and poor infection prevention measures, and poor
infrastructure are the main causes of nosocomial infections. (Abalkhail et al., 2021)
2.3 prevalence nosocomial infection in Somalia
There is retrospective study was carried out to assess the nosocomial infections in
Mogadishu-Istanbul hospital. Comparing to previous research carried out in the Sub-
Saharan regions of Africa, the findings of this study showed that bacteremia is the
22
most frequent cause of nosocomial infections, with comparable rates and
prevalence. Intensive care unit where the patient is being treated was shown to be
important factors in terms of HAI mortality. The fatality rate for patients in the ICU
was Fourteen times greater. We also discovered that the probability of death rises by
two percent.(Hassan n.d.)
Nosocomial infection are still a significant cause of illness and death in Somalia. The
quality of life for patients can be improved by enhancing and improving infection
control and incorporating preventative techniques. Additionally, in order to create a
culture of patient safety, nurses must be encouraged to participate in cleanliness
initiatives. Research should determine nosocomial infections causes and treatments
for more effective management.
2.4 Knowledge of nurses on Nosocomial Infections
Nigeria nurses' knowledge, attitudes, and practice about infection control were
examined in the research there. The research involved a questionnaire survey of
281 nurses in Abuja, Nigeria's acute care facilities. 258 nurses in all took part, with
31% of them receiving infection control courses. Only 19%, 14%, and 0.3% of
respondents, respectively, scored the highest marks in the knowledge, attitude, and
practice categories. As compared to interns, twenty-seven third-year students (or
67.5percent) did not know the proper way to dispose of disposable syringes and
needles. About thirty-one (26percent) stated they would provide several bleeding at
the location of the injury, and 37 (30 percent) said they would use post-exposure
prophylactic needles (Gambhir,2018).
In Nigeria, researchers assessed the awareness of and adherence to global

precautions across two hundred seventy-six nurses. Only fifty percent of participants
said they were aware of all precautions. Thirteen percent had an excellent
understanding of general precautions, while thirty-seven percent had mediocre
knowledge. Women were more knowledgeable of general precautions than men
23
significantly, and nurses 85.5percent were more knowledgeable than other health
professionals (IS & MO, 2019).
research done in Nigeria This survey found that 56.7% of the nurses recognised that
washing their hands before and after patient treatment was required and that they
should do so. Only 38.7percent of the skilled healthcare professionals were found to
be adhering to hand hygiene, and 3 (three percent of them) did not wash their hands
before or after providing patient care.
2.5 Attitude of nurses on Nosocomial Infections
according to a study conducted by the nursing of the teaching hospital at

Kemanshah University , showed Positive attitude is significantly essential in the
reduction of healthcare infections. The results of the statistical tests revealed that
there is a significant difference between attitude and education but it’s not between
attitude and gender, age, and work experience. The findings of comparing the
knowledge and practise correlation coefficient with the attitude and practise
correlation coefficient revealed that attitude is much more useful than knowledge in
enhancing nurses' practise. Increasing knowledge is vital, but so is changing
mindset. The same outcomes were observed in Askarian study which discovered a
significant difference between knowledge and attitude with regard to the standard
safety precautions used by surgeons and physicians.. (Anon., n.d.)
Despite the fact that both industrialized and developing countries have low hand
hygiene compliance rates, resource-constrained environments may face various
implementation challenges. Other elements mentioned in the research include cost
control, logistical challenges, and organizational and individual attitudes toward
actions like hand washing. All kinds of health professionals' maintenance of KAP to
avoid infections is positively impacted by education about Hospital-acquired infection
(Tenna et al., 2020).
The main goal of the Clean Care means Better Service project, a World Health
Organization initiative, is to reduce hospital-acquired infection by enhancing hand
hygiene among medical professionals. Even though hand hygiene is a
24
straightforward and highly successful strategy to lower hospital-acquired infections,
adherence to the guidelines has remained a challenge despite the World Health
Organization campaign's presentation of a framework. Hand washing is one of the
recommended standard measures and is regarded as the most crucial. The proper
use of gloves, which serve to safeguard both healthcare workers and patients, is
another crucial precaution (Yakob et al., 2019).
The opinions of medical students regarding how satisfied they are with the existing
curriculum and the instruction they have received regarding infection control and
standard procedures. According to the included students, 69.9percent objected and
totally disagree that the college offers extracurricular activities training or training
workshops for infection control and standard procedures, and 61.4percent
disapproved and strongly disagreed also that the education system gives them
sufficient info on infection prevention and control and standard procedures.
Nearly 80percent of the participant's students agreed or completely agreed that they
needed to learn skills and attitudes towards infection prevention and control and
Standard procedures. However, 60.1percent objected and simply disagree more
about the role of their instructors as well as teaching staff in educating them on how
to prevent health facility-related infectious diseases whenever they entered medical
training at hospitals (Amin et al., 2018).
2.6 The practice of nurses on Nosocomial Infections
A study on safe practice and infection prevention and control, medical students'
awareness and attitude at a Saudi university was carried out in Saudi Arabia: sixty-
seven (26.7%) participants scored less than twenty-four (from out forty-one points),
which has been regarded as a good knowledge level in the fourth year, 20.5percent
in the fifth year, and 36.8percent in the sixth year of the study, which comprised a
total of two hundred fifty-five students.
The providers' understanding of personal protective equipment, sharp injuries, and

nurses were the lowest. The primary information sources were informal bedside
behaviours as well as self-learning. The large majority of students thought that their
25
present instruction and training were inadequate to provide students with the
knowledge and skills they needed to practice standard precautions (Amin et al.,
2018).
Nurses must have the knowledge of IC protocols that provide guidance on how to
treat a workplace illness, especially concise specific instructions on what to do in the
event of a needle stick as well as other exposures to bodily fluids or blood patients
diagnosed or other healthcare workers. Workers are urged to report workplace
hazards right away, as well as all testing processes and subsequent care should be
thoroughly recorded.
2.7 The associated factors on nosocomial infection among nurses
In developing nations, the risk of nosocomial infection is two – twenty times greater
than in developed nations. Protecting nurses is a tremendous challenge, particularly
in underdeveloped nations in which even the most basic hospital services are
challenging to deliver and where the protection of nurses doesn't really figure on any
rankings of healthcare needs. Due to the prevalence of these pathogens in many of
the world's poorer regions, nurses in these nations are unquestionably at serious risk
of contracting diseases like Mycobacterium tuberculosis as well as other blood-borne
pathogens, especially Hepatitis B, Hepatitis C virus, and Human immunodeficiency
virus.
The absence of dedication to health care services by regulation in the developing

world, the frequently disproportionate utilization of resources to the plans laid by
suppliers, recurring fraud and non-formal payouts, and underdeveloped information
systems are all cited by the Occupational Health and Safety Act (2018). There is less
research funding available, no laws requiring hospitals or infection control systems to
be accredited, and there is very little in-service training provided for employees, all of
which are risk factors.
26
Transmission over contact. In the healthcare environment, it is the most significant
and common method of transmission. Whenever a contaminated patient contact and
contaminates a door, which is then handled by nurses and conveyed to another
patient, the transmission of bacteria occurs directly between the person infected and
the vulnerable nurses. Breathing, droplets, coughing, tube feeding, and endoscopy
can all cause the production of droplet-size bodily fluids harboring bacteria. They
travel only a short distance before crashing into something.
Bacteria can spread illness by being directly deposited onto a vulnerable individual's
mucosal surface, such as the conjunctivae, mouth, and nose, or by being spread
onto surrounding surfaces and equipment, which vulnerable people can then contact
and subsequently infect its own mucous layer. spread via the air. Small-particle
microbes can spread to other people when they hang floating in the air for a long
time, including viruses and bacteria, TB, and rubeola virus.
2.8 Knowledge of nurses about Infection control measures.
It has become more challenging for infection prevention and control committees and
healthcare systems to achieve the goal of eliminating intervals due to the rising
prevalence of nosocomial infections and antibiotic resistance. Nevertheless, by
applying suitable antimicrobial usage techniques and following sound and
healthcare delivery procedures developed through infection prevention and control
committees, it is possible to significantly limit the resistance of developing bacteria to
antimicrobials. Nosocomial infections can be decreased by properly training hospital
employees in biosafety, proper disposal, health reform, and raising public awareness
of these endemic illnesses. (Khan, 2019)
According to studies, vaccination is crucial for preventing nosocomial infections.

Immunization is particularly important for defense against nosocomial infections
caused by hepatitis B. According to nurses who participated in a study done in
Turkey, isolation and the Hepatitis B vaccine are both essential for preventing
nosocomial infections. (BULUT, 2021)
27
The major objective of infection control operations is to reduce or prevent the
transmission of nosocomial healthcare-associated diseases to staff and patients.
Therefore, it is vital that infection control efforts be combined with an optimized,
effective, and extremely restrictive antimicrobial-use policy in order to further reduce
and prevent the development of antibiotic resistance. The most important step in
preventing nosocomial infections is hand washing. Gloves must be cleansed
immediately after removal so as not to replace hand washing. (Revelas, 2018)
2.9 How can we prevent nosocomial infections among nurses
Implementing infection control procedures in hospital environments is the first step in

preventing nosocomial infections. The most crucial part of infection control and
prevention of nosocomial infection management is hand washing. Routine hand
hygiene can easily eradicate pathogenic bacteria that are momentarily on a nurse,
reducing the chance of transfer to the patient. nurses should be protected by
common sense practices. Such as the use of PPE, masks, gloves, and protective
eyewear against blood and bodily fluids. To stop airborne, droplet, and contact
transmission, use measures based on transmission. (Sikora et al., n.d.)
personal protective equipment, which is used to shield healthcare workers from

touching or contact with harmful agents (CDC, 2018). Gloves, aprons, and protective
eyewear are a few examples. The kind of safety gear needed depends on the
procedure's nature, the tools being used, and the operator's expertise.
Handling blood and other bodily fluids, conducting venepuncture, interacting with
mucous membranes, contacting with skin that isn't intact, dealing with contaminated
sharps, carrying out invasive operations, and cleaning bodily fluid spills all require
the use of gloves. When performing procedures where there is a chance of blood or
other bodily fluids splashing, smearing or pouring, protective eyewear must be worn.
As a result, eye protection prevents infectious contaminants from reaching the eye
and therefore is frequently used in combination with other Personal protective
equipment.
28
Sunglasses, face shields, protective eyewear, and face-covering respirators are
common eye protection tools. To prevent clothing and skin from becoming
contaminated with bodily fluids and blood, it is recommended that patients wear
impermeable gowns, disposable masks, and protective footwear.
In conclusion, strong infection control systems must be implemented among nurses,

and continuing surveillance is needed to recognize and stop epidemics. By
implementing protocols that enhance surgical technique, regulate the operating room
environment, reduce the number of germs that staff members are likely to shed, and
shorten operations, nurses can reduce the risk of nosocomial infections while also
identifying underlying patient factors that may increase that risk.(Anon., n.d.)
nurses should avoid using indwelling devices unnecessarily and should remove them
as soon as appropriate. Finally, using adequate aseptic and/or sterile practices while
inserting and maintaining devices is another way to reduce nosocomial infection.
For example, An appropriate waste management strategy would include routinely
sterilizing workspaces, medical equipment, and medical instruments.t (Anon., n.d.)
29
CHAPTER THREE
METHODOLOGY
3.1 Research Study design
The research design will be an Analytical cross-sectional study. We will assess the
Knowledge, attitude, and practice of nosocomial infection among nurses at banadir
hospital
3.2 Setting of the study
This study will carry out in Banadir hospital. It is a government hospital, its mother
and child hospital. Banadir hospital was constructed in 1976 as a component of the
development program for Somalis launched by the Chinese government. It’s the
biggest hospital in Somalia and it's located in the capital city of Mogadishu. The
hospital is controlled by FMOH, but only 550 of its 700 beds are actually being used.
more than three thousand people.
3.3 Study Population
The study population is the registered nursing working in the banadir hospital
3.4. Eligibility Criteria
Inclusion criteria
i. nurse that work at Banadir hospital.

ii. The nurse who is above 18 years old.
iii. The Nurse consented to speak and agreed to do so.
30
Exclusion criteria
I. the nurse students who are under training.
II. The nurse that doesn’t give consent
III. ii) The nurse who under 18 years old
3.5 Sample size calculation
The sample size of the study was calculated using the Krejcie & Morgan table which
use the following formula:
However, this formula wasn’t used because the table is applicable to any defined
population.
With total number of nurses working at Banadir Hospital 296 nurse with 95%
confidence level and margin of error at 5%, the total sample size will be 169. 10%
(19.6) of the calculated sample size was added for attrition rate, so the minimum
sample size will be
169+19.6= 188.6 ≈189
Table 3.1 Krejcie & Morgan table
31
Table 3.2 shows the total number and percentage of nurses in each ward and
sample size of nurses from each ward in this study.
Table 3.2 Total population and sample
Name of the ward Population Population Sample

Percentage
Frequency
ICU 34 11.49% 22
32
Peadiatrics 38 12.84% 24
O&G 37 12.50% 24
Internal medicine 26 8.78% 17
Surgery 27 9.12% 17
Emergency 35 11.82% 22
Radiology 23 7.77% 15
Hemodialysis 17 5.74% 11
Orthopedic 25 8.45% 16
HIV center 18 6.08% 11
TB center 16 5.41% 10
total 296 100% 189
33
3.6 Sampling method
Convenience sample method
My sample procedure will be in multiple stages. first, I will select nurses from
different departments of Banadir hospital-based cluster sampling. This will help to
define an equal proportion of my study population based on hospital groups. After
that, I will do simple random sampling to randomly select participants from each
department based on a proportional ration.
3.7 Study instruments
The data will be collected through a questionnaire. The questionnaire will be self-
administered, we will ask the nurses who frequently interact with the patients in the
various departments. The questionnaire will be closed-ended questions. It will have
6 sections with total 31 questions.
Section 1 – informed consent: 1 question
Section 2 – sociodemographic characteristics: 6 questions
Section 3 – infection-control related factors: 2 questions
Section 4 – questions on knowledge of nurses about NIs: 10 questions
Section 5 – questions on attitude of nurses about NIs: 6 questions
Section 6 – questions on practice of nurses about NIs: 6 questions
3.8. Data quality controls
We will ensure all the participants answer all the questions, if any question is not
answered we will approach the nurse to complete this question, in order to decrease
mistakes caused by incorrect interpretations.
34
3.9. Plan for data analysis
Data will be analyzed using IBM SPSS version 23.0 software. The data will screen
again if any data is missing. The frequency and percentage will be used to describe
categorical data, and the mean and standard deviation will be used to describe
numerical data. association between variables will be used in the chia square test, if
there is any significant result we will do multiple logistic regression to get the best
explanation of our dependent variables.
The statistical significance will be assessed by p-value > 0.05
Scoring for knowledge of nurses about NIs:
Question Response code Scores
1=1
Question 1 0–1
2=0
1=1
Question 2 0–1
2=0
1=1
Question 3 0–1
2=0
1=1
Question 4 0–1
2=0
1=1
Question 5 0–1
2=0
Question 6 1=1 0–1
35
2=0
1=1
Question 7 0–1
2=0
1=1
Question 8 0–1
2=0
1=1
Question 9 0–1
2=0
1=1
Question 10 0–1
2=0
Total Score 0 – 10
Interpretation of scores for Knowledge of NIs among nurses:
7
≥7= x 100% = 70% or more; Knowledge = Good
10
1 6
<7= x 100% to x 100%= 10% - 60% (less than 70%); Knowledge = Poor
10 10
Scoring for the attitude of nurses about NIs:
Question 1 1=1 0–1
36
2=0
1=1
Question 2 0–1
2=0
1=1
Question 3 0–1
2=0
1=1
Question 4 0–1
2=0
1=1
Question 5 0–1
2=0
1=1
Question 6 0–1
2=0
Total Score 0–6
Interpretation of scores for Attitude of NIs among nurses:
5
≥5= x 100% = 83% or more; Attitude = Positive
6
1 4
<5= x 100% to x 100% = 16% - 66% (less than 83%); Attitude = Negative
6 6
Scoring for practice of nurses about NIs:
Question 1 1/2=1 0–1
37
3/4=0
1/2=1
Question 2 0–1
3/4=0
1/2=1
Question 3 0–1
3/4=0
1/2=1
Question 4 0–1
3/4=0
1/2=1
Question 5 0–1
3/4=0
1/2=1
Question 6 0–1
3/4=0
Total Score 0–6
Interpretation of scores for Practice of NIs among nurses:
5
≥5= x 100% = 83% or more; Practice = Good
6
1 4
<5= x 100% to x 100% = 16% - 66% (less than 83%); Practice = Bad
6 6
3.10. Ethical Consideration
The study will be conducted after obtaining approval from the ethical committee of
Mahsa University, after that, I will seek permission from the administration of the
38
Banadir hospital, and after I get the approval, I will start the data collection of my
study.
I will be maintaining respondents' privacy and confidentiality, which means keeping

their personal matters private and refraining from disclosing specific respondents'
comments in order to uphold objectivity and safeguard them from future
victimization.
CHAPTER IV
Results and Data Analysis
4.1 INTRODUCTION
39
In this chapter, we are going to present the findings of our study. The study aimed to
determine the knowledge, attitude, and practice of nosocomial infection prevention
among nurses at Banadir Hospital in Mogadishu Somalia.
4.2 DATA SCREEN
Before conducting the data analysis, we checked for missing data and found that no
data was missing.
4.3 DATA ANALYSIS
A total of 189 questionnaires were distributed among participants. And the response
rate was 100%. The data were analyzed using descriptive statistics to determine the
frequency and percentage of the sociodemographic characteristics, knowledge,
attitude, and practice of the nurses. After that, we conducted a chi-square test to
study the association between dependent variables and independent variables.
4.4 DESCRIPTIVE STATISTICS ANALYSIS
4.4.1 Socio-Demographic Characteristics of Respondents
Table 4.1: sociodemographic of the respondents (n=189)
Table 4.1, About 189 nurses enrolled in our study. most of the nurses fall in the age
group between 26-30 years old 68 (36%). Slightly more than half 100 (52.9%) were
female and nearly half of the participants 89 (47.1%) were Male. in terms of
educational status, most of the respondents 125 (66.1%) had a bachelor's degree
while 125 (66.1%) had a diploma. majority of the participant 146 (77.2%) were
nursing while a few respondents 43 (22.8%) were assistant nurses. Most of the
participants came from these departments, obstetrics and gynecology, intensive care
unit, and surgery ((12.7%), (11.6%), and (9%) respectively). Finally, more than half
of the respondents (58.2%) have more than five years of experience while 79
(41.8%) had less than five years of experience. for more details, go to table 4.1
40
Variable Frequency, n (%)
Age
20–25 47 (24.9)
26–30 68 (36)
31–35 57(30.2)
≥36 17 (9)
Sex
Male 89 (47.1)
Female 100 (52.9)
Educational status
Diploma 36 (18.5)
Degree 125 (66.1)
Master 29 (15.3)
Work of experience in years
< five years 79 (41.8)
 five years 110 (58.2)
Profession
Nurse
Assistant Nurse 146 (77.2)
43 (22.8)
Department
41
Intensive care unit. 22 (11.6)
Pediatric 22 (11.6)
Obstetrics and Gynecology 24 (12.7)
Internal medicine 17 (9)
Surgery 17 (9)
Emergency 22 (11.5)
Radiology 15 (7.9)
Hemodialysis 11 (5.8)
Orthopedic 16 (8.5)
HIV canter 13 (6.9)
TB center 10 (5.3)
4.4.2 Training related to prevention of infection Among Respondents
Table 4.2. the table presents the participant who attended training for the infection
control workshop compared to the participant who didn’t attend the workshop. As
well as the participant who had been vaccinated for hepatitis B for the last 5 years
and those who didn’t get a vaccination for hepatitis B. According to this table 4.2,
more than half 102 (54%) of the respondents hadn’t attended training for infection
control workshops and only 87 (46%) had ever attended for infection control
workshop. Of these participants, 110 (58.3%) reported that they had been
vaccinated for Hepatitis B, while the remaining participants 79 (41.8%) stated that
they had not been vaccinated.
42
Variable Yes No
Frequency, n Frequency, n
(%) (%)
Have you attended any nosocomial infection

102 (54) 87 (46)
control workshops within the past 6 months?
Have you received a vaccination for Hepatitis B

110 (58.3) 79 (41.8)
within the past 5 years?
4.4.3 Knowledge of nosocomial infection among respondents
43
Figure 1. knowledge of the respondents about nosocomial infection (n:189). This
figure shows that the majority of the respondents 119 (63%), don’t have a good
knowledge of nosocomial infection while 70 (37%) have a bad knowledge of
nosocomial infection prevention.
4.4.4 Attitude of nosocomial infection among respondents
Figure 2. attitude of the respondents about nosocomial infection (n:189).
More than half of the participants 130 (68.8%) had a favorable attitude toward
nosocomial infection prevention while 59 (31.2%) had an unfavorable attitude toward
this infection.
4.4.5 Practice of nosocomial infection among respondents
44
Figure 3, the practice of the respondents regarding nosocomial infection (n:189).
The result is shown in figure 3 Regarding nosocomial infection preventive practice,

more than half of the participants 104 (55%) had bad practices regarding infection
prevention, whereas nearly half 85 (45%) of the participant demonstrated good
practices towards nosocomial infection prevention.
4.4.6. knowledge among respondents
Table 4.3 distribution of the knowledge of nosocomial infection among nurses

(n:189).
Table 4.3, ten questions were designed with yes or no responses to obtain nurses’
knowledge regarding nosocomial infection prevention. The data showed that the
highest proportion of the respondents 132 (69.8%) had known that wearing masks
during the surgical procedure is vital to prevent nosocomial infections. A big number
of participants 131 (69.3%) believe that Safe handling and disposal of waste can
also prevent nosocomial infections, on the other hand, (30.7%) of our participants
don’t know that safe injection practices can prevent nosocomial infections. Similarly,
(30.2) of the respondents doesn’t aware that wearing a mask is essential to prevent
nosocomial disease.
45
Yes No
Frequen
(%) Frequency (%)
Variables cy
113 (59.8) 76 (40.8)

Hospital environments can lead to
nosocomial infections
Pneumonia, Tuberculosis, Urinary

Tract Infection and Gastroenteritis 116 (61.4) 73 (38.6)
are nosocomial infections
Nosocomial infections can be caused

130 (68.8) 59 (31.2)
by Hepatitis B Virus.
Gloves should always be worn during

111 (58.7) 78 (41.3)
contact with patients or any surfaces.
Use of Personal Protective

Equipment (PPE) is a standard
115 (60.8) 74 (39.2)
precautionary measure to prevent
nosocomial infections.
Hand hygiene is a standard

precautionary measure to prevent 126 (66.7) 63 (33.3)
Wearing masks (during surgical 132 (69.8) 57 (30.2)

procedures and otherwise) is
important to prevent nosocomial
infections (including airborne
infections).
46
Safe injection practices can prevent
131 (69.3) 58 (30.7)
Safe handling and disposal of waste

can prevent nosocomial infections. 129 (69.3) 60 (31.7)
Practice for decontamination and

disinfection of instruments and
equipment as a standard 125 (66.1) 64 (33.9)
precautionary measure helps to
prevent nosocomial infections
4.4.7. Attitude among respondents
Table 4.4 Attitude of nosocomial infection among nurses (n:189).
According to Table 4.4, six questions with “Agree” or “disagree” response was
designed to obtain nurses' attuite. two third of the participant 136 (72%) agreed that
Categorizing hospital waste is necessary. about (129 (68.3%) of the respondents
agreed that nurses are a source of infection. furthermore, 68 (36%) of the
participants don’t wash their hands frequently. Similarly, 53 (28%) disagreed that
Categorizing hospital waste is necessary for preventing nosocomial infection.
Agree Disagree
Variables
Frequenc Frequenc
(%) (%)
y y
47
Nurses are a source for transmission of
129 (68.3) 60 (31.7)
nosocomial infections?
It is necessary to review patient history

and diagnosis of patients’ illness
112 (59.3) 77 (40.7)
thoroughly in order to select the correct
Personal Protective Equipment for use
Frequent washing of hands and washing

hands before and after patient interaction 121 (64) 68 (36)
is an infection control measure
It is necessary to wear masks during

surgical procedures and change them 124 (64.6) 65 (34.4)
every time we need to see new patients
Categorizing hospital waste is necessary

136 (72) 53 (28)
for safe waste management and disposal
It is necessary to sanitize instruments

and equipment to prevent nosocomial 131 (69.3) 58 (30.7)
infections
4.4.8. Practice among respondents
Table 4.5 Practice of nosocomial infection among nurses (n:189).
according to this table, six questions with “Always”, Often, Sometimes or “Never”
response was designed for the nurse’s practice. The result shown in table 4.5,
Nearly half of the respondents 77 (40.7%) always follow safe injection guidelines.
About 70 (37%) of the respondents often change their gloves while (5.8) never
change their gloves after interacting with new patients. Regarding washing hands,
(32.8) of the respondents always wash their hands. however, 8 of (4.2%) participants
never wash their hands when interacting with a new patient.
Variable Always Often Sometimes Never
48
Frequency, n Frequency, n Frequency, n Frequency, n
(%) (%) (%) (%)
Do you wash your

hands before and
62 (32.8) 68 (36) 51 (27) 8 (4.2)
after patient
interaction and/or
surgical
procedures?
Do you change your

gloves before and
after interacting with 60 (31.7) 70 (37) 48 (25.4) 11 (5.8)
new patients and/or
doing surgery?
Do you wear masks

when interacting
with patients and/or 68 (36) 63 (33.3) 47 (24.9) 11 (5.8)
during surgical
procedures?
Do you follow safe

injection guidelines
77 (40.7) 52 (27.5) 45 (23.8) 15 (7.9)
before any needling
procedure?
Do you categorize
and safely dispose
hospital waste 83 (43.9) 60 (31.7) 36 (19) 10 (5.3)
including infectious
materials?
Do you sanitize and 68 (36) 64 (33.9) 48 (25.4) 9 (4.8)
49
disinfect instruments
and equipment
before and after
each use?
4.5 INFERENTIAL STATISTICS ANALYSIS
4.5.1 Association between socio-demographic characteristics and knowledge
Table 4.6. in this table, we run the chi-square to examine the association between
knowledge of nosocomial infection and the socio-demographic characteristic of the
respondents, The result finds there is no significant between age and knowledge
regarding nosocomial infection (X²=2.808, df =3 and p-value =0.422). in terms of
gender, there is no significant association between gender and knowledge of
nosocomial infection (X²=0.84, df=1, and p-value=0.771). According to the
educational status, there is no significant association between the level of education
of nurses and their knowledge of nosocomial infection. in this study, we found that
there is no significant association between the sociodemographic characteristics of
the nurses and their knowledge regarding nosocomial infection. for more details,
refer to table 4.6. However, we found that there is a significant association between
knowledge of nosocomial infection and respondents who had training related to the
prevention of infection. and those who don’t have training are more likely to have
poor knowledge of nosocomial infection.
Knowledge
variables Poor Good X² p-

value
Age 2.808 0.422
25-25 years 28 (59.9) 19

(40.4)
50
26-30 years 46 (67.6) 22
(32.4)
31-36 years 37 (64.9)
20
≥36 years 8 (47.1)
(35.1)
9 (42.9)
Gender 0.84 0.771
Male 57 (64) 32 (36)
Female 62 (62) 38 (38)
Educational status 3.336 0.189
Diploma 24 (68.6) 11
(31.4)
Degree 81 (64.8)
44
Master 14 (48.3)
(35.2)
15
(51.7)
Work experience 0.991 0.320
< five years 53 (67.1) 26

(32.9)
 five years 66 (60%)
44 (40)
Profession 0.111 0.739
Nurse 91 (62.3) 55
51
Assistant nurse 28 (65.1) (37.7)
15
(34.9)
Department 12.57 0.248

9
Intensive care unit 14 8 (36.4)
(63.60)
Pediatric 10
12 (54.5) (45.5)
Obstetrics &gynecology
20 (83.3) 4 (16.7)
Internal medicine
12 (70.6) 5 (29.4)
Surgery
11 (64.7) 6 (35.3)
Emergency
12 (54.5) 10
Radiology
(45.5)
9 (60)
Hemodialysis
6 (40)
6 (54.5)
Orthopedic
5 (45.5)
7 (53.8)
HIV center
9 (56.3)
7 (53.8)
TB center
6 (46.2)
9 (90)
1 (10)
yes 53 (52) 49 (48) 11.50 0.001

Attended Infection Control 2
Workshop no 66 (75.5) 21
(24.1)
52
4.5.2 Association between sociodemographic characteristics and Attitude.
Table 4.7, this table presents if there is an association between sociodemographic

characteristics and Attitude. According to this table, there is a significant association
between gender and attitude toward nosocomial infection (χ2 = 5.151, df=1, and p-
value = 0.023). however, the participant who had training are more likely to have
favorable attitudes compared to those who didn’t have training.
Attitude
variables unfavorable favorable X² p-value
Age 5.705 0.127
25-25 years 15 (31.9) 32 (68.1)
26-30 years 23 (33.8) 45 (66.2)
31-36 years 20 (35.1) 37 (64.9)
≥36 years 1 (5.9) 16 (94.1)
Gender 5.151 0.023
Male 35 (39.3) 54 (60.7)
Female 24 (24) 76 (76)
Diploma 9 (25.7) 26 (74.3)
Degree 45(36) 80 (64)
Master 5 1(7.2) 24 (82.8)
53
< five years 30 (38) 49 (62)
 five years 29 (26.4) 81 (73.6)
Nurse 45 (30.8) 101 (69.2)
Assistant nurse 14 (32.6) 29 (67.4)
Intensive care unit 9 (40.9) 13 (59.1)
Pediatric 8 (36.4) 14 (63.6)
Obstetrics &gynecology 9 (37.5) 15 (62.5)
Internal medicine 7 (41.2) 10 (58.8)
Surgery 5 (29.4) 12 (70.6)
Emergency 7(31.8) 15 (68.2)
Radiology 5 (33.3) 10 (66.7)
Hemodialysis 2 (18.2) 9 (81.8)
Orthopedic 3 (18.8) 13 (81.3)
HIV center 3 (23.1) 10 (76.9)
TB center 1 (10) 9 (90)
no 30 (34.5) 57 (65.5)
Attended Infection
Control Workshop
yes 29 (28.4) 73 (71.6)
54
4.5.3 Association between sociodemographic characteristics and practice.
Table 4.8 This table presents the association between sociodemographic

characteristics and practice. According to this table, the respondents who received a
diploma (62.9%) had bad practices compared to (37.1%) who had good practices.
Similarly, 57.4% of the age group 26-30 had bad practices towards nosocomial.
therefore, there is a significant difference in the proportion between the different
departments.
practice
variables Bad practice Good practice X² p-value
Age 0.677 0.879
25-25 years 25 (53.2) 22 (46.8)
26-30 years 39 (57.4) 29 (42.6)
31-36 years 32 (56.1) 25 (43.9)
≥36 years 8 (47.1) 9 (52.9)
Gender 0.334 0.563
Male 47 (52.8) 42 (47.2)
Female 57 (57) 43 (43)
Diploma 22 (62.9) 13 (37.1)
Degree 66 (52.8) 59 (56.2)
55
Master 16 (55.2) 13(44.8)
< five years 41 (51.9) 38 (48.1)
 five years 63 (57.3) 47 (42.7)
Nurse 85 (58.2) 61 (41.8)
Assistant nurse 19 (44.2) 24 (55.8)
Intensive care unit 18 (81.8) 4 (18.2)
Pediatric 12 (54.5) 10 (45.5)
Obstetrics &gynecology 16 (66.7) 8 (33.3)
Internal medicine 13 (76.5) 4 (23.5)
Surgery 14 (82.4) 3 (17.6)
Emergency 13 (59.1) 9 (40.9)
Radiology 4 (26.7) 11 (73.3)
Hemodialysis 4 (36.4) 7 (63.6)
Orthopedic 5 (31.3) 11 (68.8)
HIV center 2 (15.4) 11 (84.6)
TB center 3 (30) 7 (70)
56
CHAPTER FIVE
DISCUSSION OF THE FINDINGS
5.0 Introduction
This chapter summarizes the findings of the study basing on the overall objective
which was “To assess the levels of knowledge, attitude, and practice towards
nosocomial infection prevention and its associated factors among the nurses at
Banadir Hospital”
5.1 Findings on the demographic features of the study respondents
The study found out that most of the nurses were in the age group between 26-30
years old 68 (36%). Slightly more than half 100 (52.9%) were female and nearly half
of the participants 89 (47.1%) were Male. in terms of educational status, most of the
respondents 125 (66.1%) had a bachelor's degree while 125 (66.1%) had a diploma.
majority of the participant 146 (77.2%) were nursing while a few respondents 43
(22.8%) were assistant nurses. Most of the participants came from these
departments, obstetrics and gynecology, intensive care unit, and surgery ((12.7%),
(11.6%), and (9%) respectively). Finally, more than half of the respondents (58.2%)
had more than five years of experience while 79 (41.8%) had less than five years of
experience.
5.2. General findings of the study
5.2.1 Training related to prevention of infection Among Respondents
The study found out that more than half 102 (54%) of the respondents hadn’t
attended training for infection control workshops and only 87 (46%) had ever
attended for infection control workshop. Of these participants, 110 (58.3%) reported
that they had been vaccinated for Hepatitis B, while the remaining participants 79
(41.8%) stated that they had not been vaccinated. However, even though nurses in
the current study had good knowledge. It is indicated that they do not attend in-
service training regarding infection prevention and control. Nurses need to update
57
knowledge through continuous educational programs. Furthermore, Fashafsheh,
Ayed, Eqtait and Harazneh (2016) recommended updating knowledge and practice
of nurses through continuing in-service educational programs emphasizing the
importance of following latest evidence-based practices of infection control.
5.2.2 Knowledge of nosocomial infection among respondents
The study revealed that 63% of the participants had poor knowledge (Sarani et al.,
2016). According to Florence Nightingale’s conceptual framework applied to the
current study, nurses play an important role in the translation of knowledge to
attitude and practice in infection prevention and control. Nightingale acted out
prevention and control practices through her knowledge, attitudes regarding infection
prevention and control which placed the patient in the best possible position for
healing. That is why Eskander, Morsy and Elfeky (2013), who assessed nurses’
knowledge and evaluated their practice regarding infection control standard
precautions, recommended updating knowledge and performance of intensive care
unit nurses through continuing in-service educational programs.
Ghalya and Ibrahim (2014) assessed knowledge, attitudes and sources of

information among nursing students towards infection control (IC) and standard
precautions (SPs). Ghalya and Ibrahim (2014) indicated that IC and SPs are
evidence-based practices that can reduce the risk of transmission of microorganism.
5.2.3 Attitude of nosocomial infection among respondents
The study found that more than half of the participants 130 (68.8%) had a favorable
attitude toward nosocomial infection prevention while 59 (31.2%) had an unfavorable
attitude toward this infection. However, if nurses have to comply with policies and
procedures on infection control at all times, the hospital should have enough
infection control policies and guidelines. In agreement with the current study,
Tirivanhu et al., (2014) determined barriers of infection prevention and control
practices among nurses at Bindura Provincial Hospital in Zimbabwe.
Arthi et al. (2016) indicated that the overall attitude of the respondents towards hand
hygiene was not satisfactory (good attitude- Medical students was 9%, nursing
58
students was 14%, and only a few (medical students-3%, nursing student5%)
showed good hand hygiene practices.
5.2.3 Practice of nosocomial infection among respondents
The current study revealed that 55% of the participants (all nursing categories) were
unable to apply infection prevention guidelines regarding infection prevention due to
workload. That’s the workload affects their ability to apply infection prevention
guidelines. That is why 55% of the participants lacked enough time to comply with
infection prevention guidelines, though 45% of the participant demonstrated good
practices towards nosocomial infection prevention. The findings of the study
revealed that nurses who attended an educational program, their knowledge and
practice towards compliance with universal precautions of infection control were
improved in post-test than in pre-test. FDA (2016) indicates: that PPE acts as a
barrier between infectious material such as viral and bacterial contaminants and the
care givers skin, mouth, nose, or eyes (mucous membranes).
PPE also protects patients who are at high risk for contracting infections (FDA,
2016). DHS (2015) indicates that goggles or face shields are used to protect eyes
from splashes or sprays of blood/body fluids. Surgical masks are used to protect the
mouth and nose from splashes or sprays of blood/body fluids, or respiratory
secretions. Thus, the lack of PPE can, therefore, promote cross infection leading to
hospital acquired infections.
5.2.4. Knowledge among respondents
The study found out that the highest proportion of the respondents 132(69.8%) had
known that wearing masks during the surgical procedure is vital to prevent
nosocomial infections. A big number of participants 131 (69.3%) believe that Safe
handling and disposal of waste can also prevent nosocomial infections, on the other
hand, (30.7%) of our participants don’t know that safe injection practices can
prevent nosocomial infections. Similarly, (30.2) of the respondents doesn’t aware
that wearing a mask is essential to prevent nosocomial disease. That’s if nurses
have to comply with policies and procedures on infection control at all times, the
hospital should have enough infection control policies and guidelines.
59
However, the current study reviewed that (30.7%) of the participants indicated that
they don’t know that safe injection practices can prevent nosocomial infections. In
agreement with the current study, Tirivanhu et al., (2014) determined barriers of
infection prevention and control practices among nurses at Bindura Provincial
Hospital in Zimbabwe. The study showed that utilization of infection control manuals
was poor as n=21(42%) of the nurses did not utilize the infection control manuals,
either because they did not know about it n=12 (24%) or it was not available n=9
(18%). According to Nightingale’s Conceptual framework applied to the current
study, nurses’ attitudes have an effect on the clinical environment which in turn have
an impact on the patient’s exposure to infection-related diseases. Nightingale
focused on caring for patients with an emphasis on the importance of hygiene in
preventing and controlling infection (Hegge, 2013 and Gurler, 2014).
The current study showed that nearly half of the respondents 77 (40.7%) always
follow safe injection guidelines. About 70 (37%) of the respondents often change
their gloves while (5.8) never change their gloves after interacting with new patients.
Regarding washing hands, (32.8) of the respondents always wash their hands.
However, 8 of (4.2%) participants never wash their hands when interacting with a
new patient. This is in agreement Tirivanhu et al. (2014) revealed that infection
control workshops were poorly organised. Some health-care workers feel that they
do not have to wash their hands after using gloves because after all hands are not
contaminated. However, Tomas, Kundrapu, Thota, Sunkesula, Cadnum, Mana,
Jencson, O’Donnell, Zabarsky, Hecker, Ray, Wilson and Donskey (2015) assessed
the frequency and sites of contamination on the skin and clothing of personnel during
personal protective equipment removal. The study revealed that, contamination of
the skin and clothing of health care personnel occurs frequently during removal of
contaminated gloves or gowns.
According to Labib and Spasojevic (2013), in order to reduce CAUTIs catheter

system should be closed. However, lack of urine bags are predisposing factors for
CAUTIs. Nurses are accountable for catheter insertion as well as for catheter care
and removal. Nurses have an influence on catheter use.
60
5.3 Conclusions
Despite the nurses being knowledgeable and having a positive attitude towards
infection prevention and control the practices were very poor. However if nurses are
knowledgeable and have a positive attitude towards infection prevention and control,
then the practices of nurses are expected to be good.
Furthermore, according to Florence Nightingale’s Environmental theory, the nurse

plays an important role in the translation of knowledge, attitude and practices to the
clinical environment, it is concluded that the patients are exposed to infection related
diseases due to poor infection prevention and control practices. As a result of these
findings the researcher has concluded that there could be barriers to good practice in
infection prevention and control which require further research.
Further, based on the findings, it is evident that lack of personal protective

equipment is one of the barriers to infection prevention and control. The study further
revealed that workshops relating to infection prevention and control (IPC) are poorly
organized as most nurses did not attend workshops related to IPC yearly.
Vaccination against preventable infections is not a priority as most of the nurses did
not receive any vaccinations. Therefore, it can be concluded that nurses in the
current study have a satisfactory level of knowledge and positive attitude towards
infection prevention and control. However, the practice of infection prevention and
control scores were poor, hence posing a risk of infection transmission leading to
increased rates of hospital acquired infections.
5.4 Recommendations for the Future Practices
Based upon the scientific evidence generated during the study, the following
recommendations are discussed below:
The Minister of Health to lobby for sufficient funds from the government so that the
Permanent Secretary can allocate enough resources specifically for Infection
Prevention and Control. The economic recession that began in 2007 and Covid19
61
outbreak led to austerity measures and public sector cut breaks in many European
countries. Reduced resource allocation to infection prevention and control (IPC)
programmes is impeding prevention and control of tuberculosis, HIV and vaccine-
preventable infections. To mitigate the negative effects of recession, there is need to
educate our political leaders about the economic benefits of IPC; better quantify the
costs of health-care associated infection; and evaluate the effects of budget cuts on
health-care outcomes and IPC activities (O’Riordan & Fitzpatricck, 2015).
Permanent Secretary to ensure that the resources allocated for infection prevention
and control are not deviated to other things. This can be achieved by performing
random infection control spot checks of the hospitals.
Resources should be allocated for Infection prevention and control conferences

locally and internationally. This will enable infection control team/committee to attend
such conferences so that they are updated with the latest evidence-based
information. According to the current study, of the nurses indicated that they do not
attend in-service training/workshops related to infection prevention and control.
Nursing schools should emphasise the importance of infection prevention and

control (Hospital acquired infections) in the syllabus. Ojulong, Mitonga and Lipinge
(2013) assessed students’ knowledge and attitudes of infection prevention and
control and their sources of information.
The infection control committee should be more proactive so that they can be able to
monitor the rate of Hospital Acquired infections as well as giving feedback to nurses
and relevant authorities. This will make problems visible and hence actionable.
The case study (Garowe hospital) where the research study was done should ensure
adequate facilities for hand hygiene. For example hand basins with running water
available as well as disposable hand towels. This will help with compliance with hand
hygiene. A study conducted by Mearkle, Houghton, Bwonya and Lindfield (2016) in
which current hand washing practices, barriers to hand washing and available
facilities in two Ugandan Specialist eye hospital was assessed. The study revealed
that facilities for hand washing were inadequate in some key areas having no
provisions for hand hygiene. The study indicated that interventions to improve hand
hygiene could include increased provision of hand towels and running water as well
62
as improve staff education to challenge their views and perceived barriers to hand
hygiene.
The Hospital should ensure that new members of staff (nurses) receive in-service
training in infection prevention and control as part of induction.
5.5 Recommendations for Future Research
 Barriers affecting compliance to infection prevention and control measures

among nurses.
 The role of policy makers, stakeholders and government leaders in infection
prevention and control in a clinical setup.
 The impact of the shortage of nurses on infection prevention practices.
 The perceptions and knowledge of nurses against Hepatitis B vaccinations
with regard to infection prevention and control.
 The wrong usage of antibiotic and its impact on infection prevention and
control.
63
DUMMY TABLES
1. Table for socio-demographic characteristics of the nurses.
Variable Frequency Percentage
Age
20-25
26-30
31-35
≥36
Gender
- Male
- Female
Educational status
- Diploma
- Degree
- Master
Work experience
 five years
 five years
Profession
64
- Nurse
- Assistance nurse
Department
- Obstetrics and gynecology

- Pediatric
- Surgical
- Intensive Care Unit
- Accident and Emergency
(A&E)
2. Table for the level of Knowledge, Attitude, and Practice on nosocomial

infection among the nurses.
Variables Frequency Percentage
Good
Knowledge
Poor
Attitude Positive
Negative
Good
Practice
Bad
65
3.Table for association between Sociodemographic Characteristics (SDC) and
Knowledge level among the nurses
Knowledge
Chi-
Good Poor
Variables square P-value
(Frequency (Frequency & value
&%) %)
Age
20-25
26-30
31-35
 36
Gender
- Male
- Female
Educational status
- Diploma
- Degree
- Master
Work experience
66
 five years
 five years
Department
- Obstetrics and
gynecology
- Pediatric
- Surgical
- Intensive Care
Unit
- Accident and
Emergency
(A&E)
4.Table for association between Sociodemographic Characteristics (SDC) and

Attitude level among the nurses.
Attitude
Chi-
Positive Negative
(Frequency (Frequency value
&%) &%)
Age
20-25
26-30
31-35
 36
67
Gender
- Male
- Female
Educational status
- Diploma
- Degree
Master
Work experience
 five years
 five years
Department
- Obstetrics and
gynecology
- Pediatric
- Surgical
- Intensive Care
Unit
- Accident and
Emergency
(A&E)
5. Table for association between Sociodemographic Characteristics (SDC) and

Practice level among the nurses.
Variables Practice Chi- P-value
68
Good Bad
square
&%) &%)
Age
20-25
26-30
31-35
 36
Gender
- Male
- Female
Educational status
- Diploma
- Degree
- Master
Work experience
 five years
 five years
Department
- Obstetrics and
gynecology
- Pediatric
69
- Surgical
- Intensive Care
Unit
- Accident and
Emergency
(A&E)
6. Table for association between Infection-control related factors and

Knowledge level among the nurses.
Knowledge
Chi-
Good Poor
&%) &%)
Attended Yes
Infection
Control
No
Workshop
Received Yes
Hepatitis B
Vaccination No
7. Table for association between Infection-control related factors and Attitude

level among the nurses.
Variables Attitude Chi- P-value

square
Positive Negative
value
70
(Frequency (Frequency
&%) &%)
Attended Yes
Infection
Control
No
Workshop
Received Yes
Hepatitis B
Vaccination No
8. Table for association between Infection-control related factors and Practice

level among the nurses.
Practice
Chi-
Good Bad
&%) &%)
Attended Yes
Infection
Control
No
Workshop
Received Yes
Hepatitis B
Vaccination No
71
9. Table for association between Knowledge, attitude and Practice level among
the nurses.
Practice
Good Bad
Chi-square Chi-square
P-value P-value
value value
Good
Knowledge
Poor
Positive
Attitude
Negative
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Knowledge and practices of nurses regarding nosocomial infection control measures
in private hospitals in Sana’a City, Yemen. Safety in Health, 3(1).
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Alrubaiee, G.G., Baharom, A., Faisal, I., Shahar, H.K., Daud, S.M. and Basaleem,
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Measures among Healthcare Workers: Knowledge, Attitude and Practice. Open
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Haque, M., Sartelli, M. and Bakar, M.A., n.d. Health care-associated infections-an
overview. [online] Available at:
Hassan, M.A., Sheikh, N.M., Osman5, M.M., Akuku, I.G. and Hassan, M.A., n.d.
Retrospective evaluation of Nosocomial infections and resistance pattern among
patients admitted at tertiary hospital in Mogadishu. [online] Available at:
<https://ssrn.com/abstract=4078658>.
Khan, H.A., Baig, F.K. and Mehboob, R., 2017a. Nosocomial infections:
Khan, H.A., Baig, F.K. and Mehboob, R., 2017b. Nosocomial infections:
Motbainor, H., Bereded, F. and Mulu, W., 2020. Multi-drug resistance of blood
stream, urinary tract and surgical site nosocomial infections of Acinetobacter
baumannii and Pseudomonas aeruginosa among patients hospitalized at
Felegehiwot referral hospital, Northwest Ethiopia: A cross-sectional study. BMC
Infectious Diseases, 20(1). https://doi.org/10.1186/s12879-020-4811-8.
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Africa: a systematic review. [online] Available at:
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Nigerian Medical Journal, 53(2), p.59. https://doi.org/10.4103/0300-1652.103543.
78
79
Chapter 5: Appendix
5.1 informed consent
Title Knowledge, attitude, and practice on nosocomial infection prevention

and its associated factors among Nurses at Banadir hospital in
Mogadishu Somalia
Researchers Aisha Ali sheikh Mohamud
Objective To examine the knowledge, attitude, and practice on nosocomial

infection prevention and associated factors among nurses at Banadir
hospital
Participation Participation in this study is entirely optional. You are not subject to
in the Study any penalties or loss of benefits if you choose not to participate in the
study, you can decide to stop at any time.
Confidentialit The research team will be the only one having access to the study's
y records, which will be kept completely private. Records from the
research will be maintained in a secured file. The specific responses to
this questionnaire will only be known to the researcher.
agreement I have understood, read, and agreed to participate in this research
80
-Yes
-No
5.2. Gantt’s Chart
20- 5- 17- 24- 05- 25- 18 15- 10- 30-

Se Oct no no dece januar - marc april apr
pt v v m y fe h il
TASK NAME b
Selection topic
Preparation of
proposal
Final
presentation
Submission of
proposal
81
Data collection
Data entry
Data analysis
Preparation
thesis
Final
preparation
Final
presentation of
thesis
Correction of
thesis
Submission of
thesis
5.3 Questionnaire
Section 1 – Informed Consent
Section 2 – Sociodemographic Characteristics
Q1) Age:
1 - 20-25
2 - 26-30
3 - 31-35
4 - ≥36
82
Q2) Gender:
1 - Male
2 - Female
Q3) Educational status:
1 - Diploma
2 - Degree
3 - Master
Q4) Work Experience:
1 - < Five years

2 - ≥ Five years
Q5) Profession:
1 - Nurse
2 - Assistance nurse
Q6) Department:
1 - Obstetrics and gynecology

2 - Pediatric
3 - Surgical
4 - Intensive Care Unit
5 - Accident and Emergency (A&E)
6 - Others
Section 3 – Infection-control Related Factors
Q1) Have you attended any nosocomial infection control workshop within the past 6
months?
1 - Yes
2 - No
Q2) Have you received a vaccination for Hepatitis B within the past 5 years?
83
1 - Yes
2 - No
Section 4 – Questions on Knowledge about Nosocomial Infection prevention
Q1) Hospital environments can lead to nosocomial infections.
1 - True
2 - False
Q2) Pneumonia, Tuberculosis, Urinary Tract Infection and Gastroenteritis are

nosocomial infections.
1 - True
2 - False
Q3) Nosocomial infections can be caused by Hepatitis B Virus.
1 - True
2 - False
Q4) Gloves should always be worn during contact with patients or any surfaces.
1 - True
2 - False
Q5) Use of Personal Protective Equipment (PPE) is a standard precautionary

measure to prevent nosocomial infections.
1 - True
2 - False
Q6) Hand hygiene is a standard precautionary measure to prevent nosocomial

infections.
1 - True
2 - False
84
Q7) Wearing masks (during surgical procedures and otherwise) is important to
prevent nosocomial infections (including airborne infections).
1 - True
2 - False
Q8) Safe injection practices can prevent nosocomial infections.
1 - True
2 - False
Q9) Safe handling and disposal of waste can prevent nosocomial infections.
1 - True
2 - False
Q10) Practice for decontamination and disinfection of instruments and equipment as

a standard precautionary measure helps to prevent nosocomial infections.
1 - True
2 - False
Section 5 – Questions on Attitude about Nosocomial Infection prevention
Q1) Nurses are a source for transmission of nosocomial infections.
1 - Agree
2 - Disagree
Q2) It is necessary to review patient history and diagnosis of patients illness

thoroughly in order to select the correct Personal Protective Equipment for use.
1 - Agree
2 - Disagree
Q3) Frequent washing of hands and washing hands before and after patient
interaction is an infection control measure.
1 - Agree
85
2 - Disagree
Q4) It is necessary to wear masks during surgical procedures and change them
every time we need to see new patients.
1 - Agree
2 - Disagree
Q5) Categorizing hospital waste is necessary for safe waste management and
disposal.
1 - Agree
2 - Disagree
Q6) It is necessary to sanitize instruments and equipment to prevent nosocomial

infections.
1 - Agree
2 - Disagree
Section 6 – Questions on Practice about Nosocomial Infection prevention
Q1) Do you wash your hands before and after patient interaction and/or surgical
procedures?
1 - Always
2 - Often
3 - Sometimes
4 - Never
Q2) Do you change your gloves before and after interacting with new patients and/or
doing surgery?
1 - Always
2 - Often
86
3 - Sometimes
4 - Never
Q3) Do you wear masks when interacting with patients and/or during surgical
procedures?
1 - Always
2 - Often
3 - Sometimes
4 - Never
Q4) Do you follow safe injection guidelines before any needling procedure?
1 - Always
2 - Often
3 - Sometimes
4 - Never
Q5) Do you categorize and safely dispose hospital waste including infectious
materials?
1 - Always
2 - Often
3 - Sometimes
4 - Never
Q6) Do you sanitize and disinfect instruments and equipment before and after each
use?
1 - Always
2 - Often
3 - Sometimes
4 - Never
87
88

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KNOWLEDGE, ATTITUDE, AND PRACTICE ON NOSOCOMIAL INFECTION PREVENTION AND ITS

ASSOCIATED FACTORS AMONG NURSES AT BANADIR HOSPITAL IN MOGADISHU SOMALIA

AISHA ALI SHEIKH MOHAMUD

SUPERVISOR: DR. NAHLAH ABDULJLEEL ALSAIDI

CHAPTER ONE: INTRODUCTION

1.2 Background of the study 4

1.3 Problem statement 5

1.3 Research questions 7

1.4 Objective of the study 7

1.4.1 General objectives 8

1.4.2 Specific objectives 8

1.6 Significance of the study 9

1.7 Conceptual framework 10

1.8 Operational definitions and variables 11

CHAPTER TWO: LITERATURE VIEW 11

2.1 Prevalence nosocomial infection in the world 13

2.2 Prevalence nosocomial infections in developing countries 14

2.3 Prevalence nosocomial infections in Somalia 15

2.4 Knowledge of the nurses on nosocomial infection 16

2.5 Attitude of the nurse on nosocomial infection 17

2.6 Practice of the nurses on nosocomial infection 18

2.7 The association factors of nosocomial among nurses 19

2.8 Knowledge of nurses about Infection control measures 20

2.9 Prevention of nosocomial among nurses 20

CHAPTER THREE: METHODOLOGY 23

3.1 Study design 23

3.2 Setting of the study 23

3.3 Study population 23

3.5 Sample size calculation 24

3.6 Sample method 27

3.7 Study instrument 27

3.8 Data quality control 27

3.9 Plan for the data analysis 27

3.10 Ethical consideration 30

CHAPTER FIVE: FINDINGS 31

4.1 Dummy tables 31

CHAPTER FIVE: APPENDIX 44

5.1 Informed consent 44

5.2 Gantt’s chart 45

Sign ……………………………………………. Date ………………………………………….

Sign ……………………………….. Date ………………………………

SUPERVISOR: DR. NAHLAH ABDULJLEEL ALSAIDI

1.1 Background of the study

Nosocomial infections, commonly referred to as hospital-acquired infections, are

Different workers, such as doctors, nurses, as well as specialists, are needed to

1.2 Problem Statement

Nosocomial infections increase hospital expenditures, length of stay, disease, and

Cleansing, sterilization, and dressing are all duties of nurses. Compared to other

1.3. Research questions

1. What is the level of knowledge of Nurses at Banadir Hospital regarding

1.4.1 General objectives

To assess the levels of knowledge, attitude, and practice towards nosocomial

1.4.2 Specific objectives of the study

1. To assess the level of knowledge of Nurses at Banadir Hospital regarding

1.5. Research Hypothesis

1. There is a low level of knowledge of Nurses at Banadir Hospital regarding

1.6. Significance of the study

1.7 Conceptual Framework

Variable Variable Type Code Definition

Age Independent 1 - 20-25 Age of nurses in

1 - Male Gender of nurses

1 - < five years Work experience

Department Independent 1- intensive care Department in