Infection Control Practices in Secondary Health Hospitals: Across-Sectional Study

ASSESSMENT OF INFECTION CONTROL PROGRAM & ITS PRACTICES IN SECONDARY CARE HOSPITALS OF PESHAWAR, KHYBERPAKHTUNKHWA: ACROSS-SECTIONAL STUDY

Chapter 1

Abstract

Background: – HAI is a major global health problem and is one of the most major cause of infection. It is the type of infection which is caused when patients are hospitalize or when staff or doctors are infected and transmit this infection to patient. HAI it is one of the most dangerous infection because it can transmit from one person to another. There are several ways of its transmission. In this thesis HAI and its impact on various hospitals of Peshawar is on various hospitals of Peshawar is been discussed. Many surveys around the world is discussed. All the important precaution and the cross-sectional studies of all the hospitals including the doctors, nurse and Para medical staff if briefly discussed. The data collected for this study was from five secondary hospitals of Peshawar. This present thesis aimed to explain the risk of HAI among people present in the hospitals. How this HAI can lead them to death. How they can protect themselves how the hospital authorities can prevent the dominance of HAI in hospitals and how government is supporting them all the studies and proves are listed in this study. According to these recorded data different graphs, tables and figures are made around 8 figures 17 tables are made from this survey which was held in five secondary hospitals of Peshawar. Bulk of data is recorded in the form of results, discussions, methodology, conclusion etc. this research totally describes the infection control program and its practices in secondary care hospitals of Peshawar KPK in detail. This research also describes the transmission models of HAI its precautions and cures briefly and enlightens are those factors which were collected from this survey.

Methods: – This comparative cross-sectional study was held in five secondary hospitals of Peshawar (KPK). Its aim was to provide an effective knowledge which can lower the risk of HAI which is spreading like fire in the forest. Many nurses, doctors, para medical staff participated in it. Various interview-based questionnaires were used to collect the important data from the hospital authority. Specific inclusion and exclusion criteria were also followed. Different points were noticed by the help of Statistics.

Results: – 704 participants were recorded around 250 were doctors, 220 were nurses and 234 were other staff members. 30 questionnaires were given to them for the collection of important information about HAI. Some of the hospital authorities followed inclusion criteria and while some of them followed exclusion criteria. According to this information different figures, tables and graphs are made which totally describes each and every factor of HAI infection. Many surveys are held globally for HAI all these surveys include that HAI is among the most lethal infection. The last survey which was held by WHO in 2015 was regarding HAI spread. Other than WHO many other policies regarding HAI were made in past 2 years. Lot of information was collected by them and this information played a vital role in precautions and cure of HAI.

Conclusion: In order to control HAI, the hospital authorities to start its practices to control HAI transmission and its production because it is one of the most lethal infection which can cause death.⁵ It is more lethal because of its transmission ways it can be transmitted by different ways so precautions in hospitals are very necessary to control the spread of it.

Chapter: 2

Introduction

One of the major and dangerous infection which is now evolving in healthcare region is known as nosocomial infection or hospital care associated infections (HAI).¹(HAI) is a lethal infectious disease which is basically acquired in hospitals or other health care centers. This research includes 5 secondary hospitals of Peshawar including Molvi Ameer Shah memorial hospital, services hospital, Naseer Ullah Khan Babar memorial hospital and Government Mumtaz maternity hospital, Hashtangri Peshawar Pakistan. The data for HAI is recorded by these secondary hospitals of Peshawar.²The collected data are in the form of questions.⁷ These collected data recorded and further studied on the basis of Statistics various parameters are focused. Many sample sizes are collected According to these sample sizes different information about HAI are recorded in this research the total samples were 704 and each sample was very important regarding HAI.⁸ The information collected and all method in this research and the important parameter which can destroy spread and production of HAI are also discussed in detail. This detailed information is not only about the samples.⁹ This research also includes the history and background of HAI evolution and how it became lethal. The important parameters for HAI and the surveys which were held for HAI is completely discussed and because of all these surveys the burden on WHO is also discussed.¹⁰

It is hospital associated disease but can also be caused in public places because the infected person carries it out from the hospital and can transmit it to other healthy person and then from this healthy person the infection can move on to another person. That’s why the risk of HAI is very high.⁹ Some secondary hospitals of Peshawar in fact all Pakistan is taking care of it while others are just neglecting and underestimating it. Even in other developed countries are facing unawareness issues.¹¹ That is why different surveys are held by WHO (World Health Organization) and others for the awareness and precautions but there are still many hospitals around the world are just neglecting it. They are just triggering the risk of infection. HAI is a very dangerous infection it can within 48 hours of your hospital admission and it remain there up to 3 days of your discharge.¹²When patient is operated and infection enters into its body within the process of operation the infection can live inside the body up to 30 days.¹³ It is very unusual disease because patient is admitted for some other reasons and they get infected their disease level becomes double not just the patients are the victims for this infection but the infection more precisely enters into the body of hospital authority.¹⁴ In most cases hospital is responsible for the transmission of HAI because of their unhygienic activities and carelessness.. HAI infection is majorly caused by fungus, bacterial viruses, fugus. Fungus can cause 40 cases of HAI.¹⁵ While Bacteria alone can cause around 80 percent of HAI cases. How people get in to HAI problem? While in hospital for many days some people with weak immune system gets infected by it.¹⁶ Because in hospital their immune system further suppresses and become weaker so the infection attack rate becomes higher and crosses peak.¹⁷ After this the patient become infected and the immune system cannot be protected anymore. How can we know if someone is infected or not?

Brief transmission methods: –

Transmission can be of two types.

Direct transmission
Indirect transmission.
Direct transmission: –

It involves direct body surface to body surface contact and physical transfer of microorganisms takes place between host and infected person.¹⁸ Transmission can take place between patient-patient or staff-patient.

Direct transmission can take place by following method:

There is only one type direct transmission:

(i) Contact transmission: –

The most frequent or fastest way of HAI transmission this transmission takes place by direct contact from surface to surface.¹⁹ It is the fastest among other types of transmissions.

Indirect transmission: –

It is indirect type of transmission in which infection enters the victim by indirect means.²⁰ Usually by objects like contaminated instruments, contaminated dressing, needles and contaminated gloves that are not changed during patient’s treatment in addition to that the improper use of syringes, bags and vials etc.

In direct transmission can take place by following methods:

There are four types of indirect transmission these are as following:

Droplet transmission: –

It is the first type of indirect transmission.²¹ When the droplet containing microbes or germs are transmitted from infected person to healthy one through coughing, sneezing through bronchoscopy and taking the microbe directly enters the body and person gets indirectly infected.²²

Airborne transmission: –

It is the second type of indirect transmission.²³ Air is medium for this type of transmission when air droplet contains microorganism for long time or it is present in dust when it is inhaled then the microbe directly enters the body and infect it.

Vector borne transmission: –

It is the third type of transmission when infection is transmitted by the help of vectors such as rats, mosquitoes, vermin and flies which directly transmit the infection into victim’s body.²⁴

Common vehicle transmission: –

It is the fourth type of indirect transmission. In this type of transmission, the microbes enter the body by the help of contaminated items such as medication equipment, food and water by this means infection enters the body.²⁵ In spite of other countries like Pakistan has very weak health system and polices which provides large space for these types of infections. Proper knowledge involving all workers is the special need of hour.²⁶ This study is particularly aimed to accelerate the knowledge along with the important practices among the health care workers and the patients.²⁷

As Pakistan is among the undeveloped countries to HAI rate is high because of lack of precautions the hospitals in Pakistan are not taking good care of hygiene of their hospitals.²⁸ The unhygienic atmosphere is one of the most common factors which cause HAI other than hygiene not proper sterilize equipment are used even the surgical equipment is not properly sterilized.²⁹ Beside other cities of Pakistan Peshawar also facing the same situation. And same hurdles in finding precaution and cure of HAI. There are different types of HAI so their symptoms also vary with their types.³⁰The most common types of symptoms are Urinary tract infection (UTIS), pneumonia, gastroenteritis, surgical infection etc. the main and mostly occurring symptoms of HAI are fever, headache, discharge from wounds, cough, nausea, diarrhea, shortness of breath etc. some people develops new type of symptoms some are hidden and some are visible like irritation pain etc.³¹ Many bacteria are involved in HAI production the most commonly and mostly studied bacteria responsible for HAI are enterococci, staphylococcus, enterococci etc. Just like Bacteria, fungi and viruses spread HAI very rapid.³² it can spread through person to person contact. This contact includes respiratory machines usage, unclean hands, some medical instruments and other tools of hospital can also cause HAI.³³ It can also be increased by excessive dose of antibiotics and can also be increased by unnecessary use of antibiotics and the infection which accelerates into the body already becomes resistant to antibiotics.

Anyone who is admitted in hospital is at the risk of HAI.³⁴ Generally, some factors or activities triggers the risk of HAI. These factors are:

When patient is in coma for long time.
When patient is gone through big trauma.
When patient’s immune system is weak.
When patient stayed into ICU for long time.
Unnecessary usage of antibiotics.
Age of patient specially if he/she is more than 75.
Un hygienic roommate.

The risk of HAI around 7.1% to 27.8%. a research found that there are nearly 10% who got infected after operation.³⁵ While contaminated regions can increase 9% of HAI risk. In present times large number of HAI were recorded and noticed in America and Africa. While in Asia it was greater around 12%. Symptoms is very important factor in terms of diagnosis many doctors can find its cure by observing symptoms.³⁶ If there is some other infection prior to the hospital stay patient must tell doctors and if any other symptoms appeared after the stay.³⁷ Doctor is required to take blood and urine test for the identification of infection. After the identification the treatment of the patient depends on the type of HAI.³⁸ Doctor most likely to recommend antibiotic and bed rest. The doctor will also recommend healthy diet, good water intake etc. Early treatment and detection of HAI is very vital.³⁹ Many of the patient are easily treated from HAI but most of the others spend 2.7 times longer in hospitals for their recovery. In some case HAI becomes big threat for life.⁴⁰ It was estimated by Centers for Disease Control and Prevention (CDC) that there is around 2.5 million in which 10,000 of them are falling due to HAI.⁴¹ Infection control is totally up to the hospital authority because risk of HAI is increasing day by day because of lack of awareness in hospital authority.

There are some general precautions:

Screening the ICU room is must to see who left the ICU is infected or not
Infected person must be isolated for the reduction of HAI
Cleaning of hospital
Hand hygiene must be followed
- Types of Hospital Care associated infections (HAI): –

HAI are of different types its major types are

Infections in urinary tract
Blood stream infection
Pneumonia
Puerperal fever

HCAI illuminate both non-hospital and hospital infectious situations.⁴² While HAI can only be use in hospitals means this disease can also be cause in non-hospital areas where infected patients are treated like in homes, rehabilitation facility laboratories but the most major areas in which chances of infection rate is very high are hospitals, diagnostic laboratories, clinics etc. transmission of infection.⁴³This infection can be spread by different ways such as

By using contaminated equipment
By another infected patient staff member
By environment
Some times after surgery some microorganism starts originating from the patient’s body that can be lethal for him as well as to its surroundings.

Impact of HAI on hospitals of Peshawar (KPK): –

Health care associated infection is one of the most evolving infection many countries are mourning from this issue despite huge efforts still this issue is not completely solved.⁴⁴ It is been demonstrated by world health organization (WHO) that large number of patients suffering from this infection globally. It is not only big threat for life.⁴⁵ But it is also a big threat for funding means large amount of country funds are drained by the infection⁴⁶. Infection Control (IC) is well-planned policy of health. It is believed that this policy not only reduces the chances of infection but also reduces the funds utilization for it.⁴⁷ In 1985 policy program known as Center for Disease Control (CDC) took very first step in introduction of main precautions required for (HAI). The main precaution by CDC was generally used to reduce the chances of blood borne pathogens transmission. Around 405 million infections and death rate around 38 thousand are generally reported in European Union (EU).⁴⁸ While in United States around 100 thousand deaths were recorded while the infection rate was around 2 million.

In 2012 in Israel around 4-6 thousand deaths were recorded. In 2005 the estimate rate in Italy was 6.7%. whereas in Switzerland, United Kingdom, and United States were 7.2%, 6.4% and 1.7%. The threat and the rate of this disease is double in Pakistan because it is developing Country.⁴⁹ The recorded percentage of this infection is around 40% while the rest of 60% is due to non—communicable diseases. While in Peshawar total percentage is around 1.9% this disease is most commonly caused by interaction and it is most commonly transmitted from those areas where most interactions occur.⁵⁰ Most commonly this disease is caused in hospitals because it is the place where maximum interactions take place between patients and staff.³ During hospital service large amount of waste are produced in which 30% of waste are toxic which causes huge amount of HAI generation.⁵¹ “Universal precaution” plays a huge role in control of HAIs in Pakistan. However, precautions were not applied spiritually and after struggling years in 2006 a special attention was given to HIV, Various techniques or methods were basically used globally to reduce the HAI risk.⁵² HAI is caused by the unhygienic activities. The workers of health care such as Doctors, nurses etc. are at the great risk of bone-borne pathogen (BBP) such as HC, HIV, and other so proper if these bone-borne pathogens are controlled so the risk of HVI will eventually decrease it can be only possible when proper precautions are given.⁵³Beside all techniques cleaning of hospitals also play very vital role in HAI control. It has been noticed that cleaning hospitals had HAI to greater level.⁵⁴ Due to lack of awareness this precaution is mostly overlooked in many areas. Different polices including nation and international has overcome huge HAI infections. According to CDC published a document. In this document it is noticed that there is tremendous decrease in HAI globally.⁵⁵ According to this document there is 18% decrease in infections in New York after proper implementation of policy. Whereas some other countries Tennessee, South Caroline and other developed countries also overcome the spread of this infection by the help of policy implementation.⁵⁶ Not only hygiene this infection can also be caused by surgery or it is cause by surgical site. It is mostly due to complications in surgical procedures this HAI infection is also called surgical site infection around 14-17%⁵⁷of nosocomial infection includes surgical site infection. According to WHO survey this type of HAI 4 to 22% is due wounds infection.⁵⁸According to the survey which was held in 2002 reported that in United Kingdom is high and national health service of United Kingdom approximately use 1 billion pounds annually⁵⁹ for the reduction of this infection. The rate of this infection in other parts of the world are recorded as 19.4% in Tanzania, 2.6 percent in USA. It is noticed that this lethal wound infection occurs when patient is discharged from the hospital and it can be huge threat for community around 74% deaths of surgical patients are caused by this infection was carried by various hospitals in Peshawar in 2009.⁶⁰According to them this infection was mostly noticed in patients having bomb blast injuries, peptic ulcer, firearm injuries in abdomens. All these patients were examined by hospitals of Peshawar.

Diagnosis of this infection was totally made according to National Nosocomial infection. The wounds caused by surgery were tilting according to South Hampton wound tilting system⁶¹. A highly specific Performa was basically used for the complete study which usually includes the age, gender, address, name of surgeon who is going to perform the operation, grade of wound, operative findings.⁶² Ultrasonological report were probably use to see organ the main data was analyzed by using information of SPSS and the main results which were expressed as percentage. HAI are the single very complicated and most common class of infection that has reach excessive levels while catching great attention.⁶³ many health care organizations and the provider including (CDC) Centers for Disease Control and Prevention.

In 1992 a standardized definition published by surgical wound infection in USA. According to its presence of drainage frequent draining of fluid from wound regardless whether the bacteria which is been cultured is positive or negative. The main signs of infection for evidences of radiological of deep infection. These dangerous wounds are caused on direct exposure of surgical infection by surgeon⁶⁴. According to research Council USA a system for developed the very original and unique classification was generally based on four categories: contaminated, dirty, Clean-contaminated and dirty categories. Clean-contaminated cause wounds that are generally not traumatic and they don’t penetrate the digestive or urinary tract. These cases clearly involve sterile and skin body spaces without any break in this sterile technique e.g.⁶⁵ while dirty contaminated wounds are those in which there is a clear visible contamination which forms hollow and viscous infection these cases particularly involve very high exposure of bacteria which cause this infection e.g. drainage of abscess, perforated appendix etc. Although main process has been completely made for the prevention of HAI but still more work had to be done. On daily basis if 31 patients are there at least one is been infected by HAI. Some reports and data where published by CDC⁶⁶which helps to track those areas which needs proper assistance because of huge HAI records. The data of CDC come from two systems.⁶⁷ The National health care safety network (NHSN) and infections Community interface.

Worldwide hospital surveys in past few years recorded that in 2015 among 31 patients at least one was infected while in 2011 number of infected patients were 16% less¹⁷. In US hospitals 697,000 HAIs were recorded in 2015 and about 73,000 patients died due to infection.⁶⁸ HAI not only damages its victims physical it also damages it mentally, emotionally and financially because it cost billions of dollars. According to super germs theory it was recorded that the infection is due to pathogens(germs) that are spreading in hospitals due to unhygienic environment the drug which is typically used to fight this problem are antimicrobial drugs which are typically known as antibiotic⁶⁹ resistant germs. Antimicrobial drugs are those drugs which are generally use to reduce to infection caused by germs like viruses, fungi and bacteria. Improper use of these drugs can make germ completely resistant to the effect of drug will stop and the patient will remain infected.⁷⁰ So, the proper use of drug is very important. This hospital survey completely gathered the main data of all the types of HAI infection and patients suffering from different types of HAIs also included those HAI infections which were not tracked routinely.⁷¹ This survey was done in large number of hospitals in worldwide. One particular hospital was picked a day for survey on that day patients samples their data, medical records and other information were gathered and their data were used for their cure. This survey had four phases.⁷² Phase 1 was held in 2009 and it was conducted in 9 hospitals of Jacksonville. The main objective of this survey was to design and collect the main data. Whereas phase 2 was held in 2010 in 22 hospitals of EIP states this helped the phase 3 survey. Phase 3 was held in 183 hospitals of EIP states by the help of phase 2. While phase 4 was held 2015-2016.⁷³ The collected data of this survey describes the quality of antimicrobial drug. In this survey it was noticed that 13,299 patients in 200 hospitals were recorded in EIP states. This survey was held between May and September and the complete data took place during 2015-2017. The main objective of this survey was to estimate the frequency of infection and number of infections.⁷⁴ It was also used to identify HAI b observing pathogens and its infection sites. This survey also describes the antimicrobials use and its indications.⁷⁵ This survey also played an important role for identification of changes that occurs in HAI on response of antimicrobials some HAI becomes resistant to the drug and cannot be further killed by the same drug so this survey also clarified the use of drugs for different HAI and if the HAI is resistant to particular drug then how we can destroy it by using another non-resistant drug because of this survey the already gathered data was improved.⁷⁶ And they create different policies and different procedures to reduce HAI and to completely support the appropriate use of antimicrobial view of methods used in this survey.⁷⁷ The last survey was conducted in 2015. Those hospitals in which survey was held in 2011 they were added in 25 hospitals which were already surveyed in EIP site like these 25 more hospitals were added in this EIP site and they used the random stratified samples which were based on bed size of hospitals, the participation of hospitals were discretional and each hospital chose the single survey day which can be held between May and September of 2015.⁷⁸ The number of patients were randomly selected on the day of survey. EIP staff members reviewed the medical records and in clinical data and its demographic.⁷⁹ The brief data on the information of infection and use of antimicrobial drug. Beside hospitals nursing home surveys were also held to reduce this infection rate this survey record the risk factors for getting this infection. It also helped to identify the type of common and uncommon antimicrobial drugs and discover the situation in which antimicrobial drug is working properly.⁷⁹ The benefits of nursing home survey were to create new national policies for the reduction of HAI to improve further research on HAI and to totally improve the confusion of use of antimicrobial drug this survey had phases.⁸⁰ Its first phase was held in 2013-2014 and it was conducted in a nursing home and its main objective was to collect useful data on HAI.⁴⁴ Phase 2 was officially held in 2017 and was conducted on 171 nursing homes and this survey gathered additional data of HAI and its drugs. Methods which were followed by this survey team was that they randomly selected the particular nursing home.⁸¹The goal was to enlist 20 nursing homes globally. Demographic data were recorded on the basis of medical record.

2.3 Precautions necessary for HAI: –

With the help of collected data of survey many precautions and patient’s safety were determined.⁸² People go to the hospitals to get well but while they are treated in hospitals, they get infected due to HAI. It is noticed that the time spend in hospital can put you at great risk such as urinary tract infection, blood infection etc. Every day patients get infected while they are treated for something else. These infections not only damage its victim physically but it also damages them financially and emotionally even they can be dead due to these infections.⁸³ It is noticed that procedures of health care can lead of vulnerable conditions caused by the germs that cause infection these germs are basically spread by the patients to patient, unclean hands, dirty environment reused equipment or reused surgical equipment.⁸⁴So, patient’s safety is very important in every health care centers.42 Patients safety and health care services are deeply connected. Health care services are broad term which is used to encompass many major aspects of patient’s care. It is health care which is effective, timely, equitable and safe. Patient’s safety is most important aspect of health care services. To ensure the safety of patient health care system must prevent all errors and learn from those errors and create culture of safety which involve health care professional.⁸⁵ Our health care services initiate the basic aims which increase safety of patients throughout nation and plans used to focus on the prevention of dangerous medical and from HAI and the patients which suffers from HAI and other aspects use for patient’s care.

The main precaution which were noticed are as following:

Patient to patient interaction must be stopped.
Hospitals must be completely cleaned and unhygienic stuff must not be used.
Reused equipment must be stopped and without sterilization nothing should be used.⁸⁶
Antimicrobial drugs must be given to patients suffering from HAI special care must be given to patient’s suffering from HAI.

Nosocomial infection is one of the most common and complicated class of infection that can reach every high and excessive and is getting very little attention specially in developing countries⁸⁷. US centers for disease control and prevention and the surgical infection society started a survey by raising awareness. A standardized definition was published by surgical wound infection task force USA basically in 1992. According to this definition the spontaneous drainage of fluid from the wound regardless the type of bacteria is positive or negative.⁶⁶ This wound can cause HAI or having HAI infection.

Burden on WHO (World Health Organization): –

HAI is the biggest burden on worlds health care organization because treatments, surveys, preventions, research all wants lot of time and energy due to this lethal infection. Nosocomial infection or HAI occurs when patient in hospital and is going through process of health care and when patient is not provided by perfect incubation, they get infected this can happen in every possible time or it can also appear after patient gets discharge.⁸⁶Furthermore, not only the patients the staff can also be infected and can also transmit this infection to uninfected patient. While it can be a big threat for the visitors coming to visit here patient.⁸⁷ The most adverse event which can happen during care delivery and even now no country or institute had claim to solve this problem completely yet.⁸⁸ According to the data it was noticed that each year there are millions of patients all around the world are affected by HAI. The burden of HAI is higher on developing countries then developed ones.⁸⁹As this infection is shaking not only the health of people but also the economy of countries so there is a worldwide scheme to take urgent actions on this and to control and prevent its action WHO is taking lot more actions on it. Every day results of HAI are getting prolonged in hospitals because long herm durability gradually increased and the germs or microorganisms are becoming resistant to drugs which is getting high cost for patients and to unnecessary deaths.⁷¹ It is the biggest level countries lose who lacks surveillance system for this infection those countries are falling apart because they are lacking the chances to get the relevant data and they totally lack the opportunity to diagnose it. The burden of HAI is one of the biggest and most important issue for WHO⁹⁰ IPC globally unit and worked in both developed and in undeveloped and highlight the issues faced and cured from HAI. WHO gathered data from many surveys from relevant articles this data consists both information for the developing and developed.⁹¹WHO searched different data from relevant published articles in 1992-2007 consisting all data about infection incident and to access all the epidemiology of HAI infection is various countries also providing the studies or partial data of all countries and there major infection sites and the type of microbe was selected and all the data was precisely pooled for all type of analysis around 271 selected articles 228 were included in last analysis process dur to this high quality contents and prevention plus treatments were gathered WHO findings were to completely improve the surveillance and practices the control of infection.⁹². A comprehensive report was issued on 5 May 2011 which included the burden of WHO and highlighted the HAI factors in different settings and its risk also describe the advantages and the biggest challenges for surveillance of HAIs. The reports which are available for HAIs recorded huge burden on countries and their good impact on worldwide finally point out many useful things for HAI patients.⁹³ As HAI is one of the most adverse events for all health care associations. It was recorded that at any particular time 7% of patients in developed countries and 10% in developing countries. Survey held in 5 health care secondary hospitals of Peshawar KPK. In this research every aspect of HAI is discussed⁹⁴. The survey was held in 5 healthcare secondary hospitals of Peshawar.

This survey completely covered each and every point regarding HAV control program and its practices this survey was held in 5 secondary hospitals of Peshawar. In detail around 25 questionnaires are made and with the help of these questionnaires different data was made in form of groups, figures and table all are mentioned in results of this research⁹⁵. While references conclusions and other chapter completely explain the control program of HAI and its practices. Around 704 participants were recorded in secondary health care hospitals of Peshawar (KPK) listed in this research. Among 704 participants 250 were doctors, 220 were nurses and 234 were other staff members around 30 questionnaires were filled by the participants which consist of large amount of data needed for HAI precautions and cure. Some of the hospital authorities fully followed and helped us in questionnaire filling and sample size formation. ⁹⁶This criterion is known as inclusion criteria. While some of them didn’t participated and their no participation lead them to exclusion criteria. All the Sample Size or the data collected by the whole survey are highlighted in this survey.

Chapter 3

Literature Review

This chapter will discuss highly detail review of literature which is done to identify a systematic search

Introduction of literature review: –

Large number of studies can be directly searched online regarding HAI infection its cure and the precaution which can be taken. However, there is no such from fringe of District Khyber Pakhtunkhwa can be conveniently applied in literature. The available literature is very useful in verbalizing the methodology of this study and to properly know all the gaps in data which is already exist.

Objective of literature review: –

The objective of this literature review completely gives the gaps in existing literature for HAI and status of HAI in hospitals of province Khyber Pakhtunkhwa. This study is going to address all the important gaps with research objectives. This chapter is divided into two main parts:

Literature search
Literature review

Methodical literature search is use to find the relevant articles for various sites with the objectives of study and with the research questions. The search is majorly divided in two parts:

Hospital infection control program adaptations among secondary care hospitals of Peshawar, Khyber Pakhtunkhwa
Practices of HAI control polices adaptions among secondary care hospital of Peshawar, Khyber Pakhtunkhwa.

This research is going to cover these two aspects and aspects which are related to them in detail and the factors which effects these aspects positive and negative both are discussed in this research. How the negative aspects will not dominate on positive ones is discussed?

Research objective: –

Objectives on which this research is completely based are

To access hospital infection control program adapted in different secondary care hospitals of Peshawar, Khyber Pakhtunkhwa
To access the practices of hospital infection control polices among health care professionals of secondary care hospitals of Peshawar, Khyber Pakhtunkhwa.
- Inclusion criteria: –

This literature search includes all the related articles, reports, summaries, analysis based on the topic of research and its objective. High quality articles are used in it and are totally summarized in it.

exclusion criteria: –

the literature search excludes all those which were having old statistics, those which full text was not available and those articles which duplicate in search were totally excluded from this literature search.

Searching protocol: –

Search was based on four techniques:

Hand search by the help of journals, published articles and books.
Sample provided
Search engines like google scholars
Online database provided by different sites
- Search terms: –

The following search terms were eventually used to search related articles:

Google scholar
Peshawar Infection Control Program for practices of HAI control polices in secondary care hospitals of Peshawar

The detail of search is:

HAI Control Program in secondary care hospitals of Peshawar: –

Khyber Pakhtunkhwa is located in north-western region and forth province of Pakistan. Although Khyber Pakhtunkhwa is smallest geographically but its total population has gradually increased from 18.8 million to 30.5 million in 2018. According to the recent survey the population rate is been increased 2.9%.⁹⁰

Pakistan has very poor healthcare status as compared to other countries in east Asia and South Asia. Many weakness and harsh challenges regarding health care is identified in Khyber Pakhtunkhwa. According to health sector strategy (HSS)⁹¹ Khyber Pakhtunkhwa (Peshawar) assist weak health care services to secondary health care hospitals because of their low financial protection, low funding, insufficient resources, unhygienic environment, low effective care and much more.⁹² The health outcome of Peshawar needs to be actively working. HAI Control Program in Peshawar was started from many years ago by the help of WHO. Hospital is that place where there is a high risk of transferring wide range of infections caused by microorganism so it is very necessary that the essential steps must be taken to minimize the spread of infections.⁹³ It clearly ensures that the care and protection from the infection can be provided by providing clean and safe environment not only for the doctors but for the Doctors, patients and Paramedical staff. After lots of surveys and research practice polices were given in secondary care hospitals of Peshawar to minimize the risk of infection to control the infection rate and its transmission.⁹⁴

Practices of HAI control polices in secondary care hospitals of Peshawar: –

The survey was aimed to enlighten the current awareness on the HAI in hospitals of Peshawar. This survey also spread the knowledge and awareness regarding trainings for the staff and also train them for self-protections.⁹⁵ The need of this survey conductance was to help hospitals of Pakistan. HAI control survey also played an essential role in training to the patients and hospital staff to protect themselves from infection transmission by providing fund to the hospitals including immunizer, sterilizer, disinfectants, gloves, masks, hand sanitizers etc. Some researches had dismal picture of HAI in public hospitals. It states the most of the professionals are not following the correct path given by Control polices.⁹⁶ It was cleared in research that at some hospitals the facilities are given by the government but because of their lack of interest or lack of awareness they are not following it.⁹⁷ The lack of training is noticed in the front-line staff. Improper transmission of cast from the laboratories are also responsible for infection transmission to get rid of this problem following polices must be applied.

Hospital environment must be clean
Surgical instrument before sterilization must not be used
Every patient must be considered as infectious and proper principle of infection control must be used.
Avoid unnecessary interactions among patient-patient, patient-staff.
Gloves, sanitizers, mask must be use.
After surgery the surgical wounds must be disinfected before patient discharge.
Disinfected drugs must be used by people in the hospital.
Clean and healthy environment must be created.

Among the other practices for the control of HAI. One of the most important practice for HAI control is injections. Injection in a manner can safe patient’s life from HAI.⁹⁸ It can be applied to all patients and health care workers. Injections containing antibodies for specific HAI can cure is wisely but the improper use of needles or syringes and improper antibiotic can out bust the infection rate.⁹⁹ Wrong injection or administering injections resulted more than 50 deaths and 15000 patients were infected due to injections in US hospital. When basic infection control procedure is not followed it leads to high infection rate.¹⁰⁰ Basic infection control procedures are as following must avoid multi dose medicines, do not use unclean syringes and using blood sugar device without cleaning on patients etc. due to this administering injection the premier safety institutes around 11% are administering injections which can be one of the biggest causes of HAI. It was noticed that between 2 and 6% of health care were involve in unsafe injection practices. HAI control is in the hands of hospital authorities if they completely apply a proper precaution and medication method then concentration of HAI will gradually decrease which can decrease plus death rate in Pakistan and in its other provinces including Peshawar.

Rationale: –

Health care workers are at high risk of this infection this infection is getting the prevalent infection for developing as well as developed countries the study will not only determine the proper vaccination of members in staff but will also check the immunity of vaccinated staff member.⁹⁷ The literature search calculated it above. The above written chapter provides the ground for this research while the next chapter.⁹⁸ The chapter describes the brief methodology the aim of this research is to completely describe HAI and all factors related to it for this study large amount of data was concluded from 5 secondary hospitals of Peshawar and this data is briefly explained in this research the most important reason of this HAI was to find the percentage of HAI in secondary health care hospitals of Peshawar so, survey was held the aim of this survey was not just for the identification of HAI in secondary health care hospitals of Peshawar but its main reason was to conduct infection control program and its practices in these hospitals of Peshawar.⁹⁹ Large amount of data was conducted in the form of questioners known as sample size. According to these sample size large number of information were coded in figures graphs and tables. The important information was discussed in them.¹⁰⁰ Variety of sample size were coded for HAI and these sample size consists of important information given by members of these hospitals including doctors, nurses and other paramedical staff. This bulk of information is also coded in different chapters which are mentioned in this research.¹⁰¹ HAI rate in Peshawar is getting high just like others hospitals of another countries this research briefly explains it.

Chapter: 4

Methodology

Research Methodology: –

This chapter includes methodology of this theses in detail and on the basis of study was conducted to extract the results. This chapter will summarize from hypothesis formation to all materials and methods.

4.1 OBJECTIVES: –

To assess hospital infection control program adopted in different secondary care hospitals of Peshawar, Khyber Pakhtunkhwa.
To assess the practices of hospital infection control policies among Health Care Professionals of secondary care hospitals of Peshawar, Khyber Pakhtunkhwa.

4.2 OPERATIONAL DEFINATION: –

The cross-sectional study was held in 5 secondary health care hospitals of program and its practices among these secondary hospitals¹² this survey lead to large amount information regarding HAI. Different sample sizes were collected form nurses doctors and other medical staff around 704 samples were collected in which 250 were doctors, 234 were medical staff and 220 were nurses and other important information regarding HAI virus were recorded which are briefly given in this research.

RESEARCH METHODOLOGY: –

Study Design: –

Cross Sectional study.

Study Setting: –

Five secondary care hospitals of Peshawar, Khyber Pakhtunkhwa.
Molvi Ameer Shah Memorial Hospital, Peshawar.
Sifat Ghayoor Hospital, Peshawar.
Services Hospital, Peshawar.
Naseerullah Khan Babar Memorial Hospital Peshawar.
Government Mumtaz Maternity Hospital, Hashtnagri Peshawar.

Study Duration: –

6 Months after the approval of synopsis.

Sample Size: –

Post clusters, sample from different strata having definite (finite) population will be calculated via:

. (CI=95%, e=5%, p=50%^constant and N=varies)

Molvi Ameer Shah Memorial Hospital, Peshawar.
- For 52 Doctors the sample size will be 46.
- For 57 Nurses the sample size will be 50.
- For 54 Medical Allied staff members sample size will be 45.
Sifat Ghayoor Hospital, Peshawar.
- For 38 Doctors the sample size will be 34.
- For 28 Nurses the sample size will be 26.
- For 43 Medical Allied staff members sample size will be 38.
Services Hospital, Peshawar.
- For 76 Doctors the sample size will be 63.
- For 31 Nurses the sample size will be 44.
- For 45 Medical Allied staff members sample size will be 45.
Naseer Ullah Khan Babar Memorial Hospital Peshawar.
- For 93 Doctors the sample size will be 75.
- For 96 Nurses the sample size will be 77.
- For 80 Medical Allied staff members sample size will be 66.
Government Mumtaz Maternity Hospital, Hashtnagri Peshawar.
- For 35 Doctors the sample size will be 32.
- For 25 Nurses the sample size will be 23.
- For 45 Medical Allied staff members sample size will be 40.

Sampling Technique: –

Post clusters in each setting three groups will be made
- Doctors
- Nurses
- Medical Allied Staff Members
- SAMPLE SELECTION: –

Inclusion Criteria: –

All Doctors, Nurses and Medical Allied Staff Members from these five secondary care hospitals of Peshawar, Khyber Pakhtunkhwa. All of them participated in this survey by filling questionnaires and increased our sample size.

Exclusion Criteria: –

Others who refused to give consent for the study are excluded from this study or those who didn’t participated in this survey
- DATA COLLECTION: –
After taking Ethical and Board of Advance Studies and Research approval and consent from participant, a pre-selected and validated Performa by Center of Disease Control (CDC)¹³ will be distributed among all participants present in the hospital for data collection.
Already made questionnaire are distributed to all participants that is Administration, Doctors, Nurses and Medical Allied professions will be given different Performa.
Self-administration of Performa was given to administration and doctor staff.
Nurses and Medical Allied Professionals were interviewed to get vital data.

Summary: –

This comparative cross-sectional study was precisely conducted in district of KPK know as Peshawar. As Peshawar is among biggest cities of Pakistan so the population rate is also high as the population rate is high so the risk of HAI also increases generally this cross-sectional study was held in 5 secondary hospitals of Peshawar and the samples collected were around 704. Written consent was takin from subjects and the inclusion exclusion criteria and the important data was collected by of quinones which were filled by people present in those 5 secondary hospitals. This data was collected by hospitals different authorities like doctors, nurses, staff members. The sample size collected by doctors was around 250 from nurses was 220 and by other medical staff was 234.

DATA ANALYSIS PROCEDURE: –

Frequency and percentage is calculated for categorical variables.
Mean and standard deviation is calculated for numerical variables
Cross- tabulation is used to measure Chi-Square for association where needed.
SPSS v.22.0 software is used for the statistical analysis

Chapter 5

Results

5.1 Post cluster of doctors, nurses and staff:

This cluster consist of different sample sizes of doctors, nurses and medical staff of five

secondary hospitals of Peshawar. This sample size also tells about the population of nurse’s doctors and staff and their participation. Those who participated are added into inclusion criteria those who were not participating or were showing less interest were added in exclusion criteria. The total number of samples or sample size of 5 secondary hospitals of Peshawar are listed below.

Table 1

Sample Size of Doctors	Sample Size of Nurses	Sample Size of Medical Allied Staff Members
46	50	45
34	26	38
63	44	45
75	77	66
32	23	40

Table 2

Population Size of Doctors	Population Size of Nurses	Population Size of Medical Allied Staff Members
52	57	54
38	28	43
76	31	45
93	96	80
35	25	45

5.2 Frequency of Doctors:

There are 704 Sample size of doctors, nurses and medical allied staff members and in 704 the sample size of doctors is 250 which becomes around 36% of the Sample size. In case of Population size, 798 is total Population size. In which the population size of doctors is 294 which makes around 37% of the total Population size. In the figure 1 below all the values of sample size of doctors i.e. 46, 34, 63, 75, 32 has 1 frequency as the values occurred only one times in other words they have not frequently occurred. Same is the case with the Population Size of the doctors in the figure 2 below that all the values of Population size of doctors i.e. 52, 38, 76, 93, 35 occurred only one times therefore, each of the value has 1 frequency.

Graph: –

This graph is showing the relation between the Frequencies of Population Size and Sample Size of Doctors. The Curve of the graph is in an increasing trend and it incline cure with a little deviation in between the Frequencies of Population Size and Sample Size i.e. 40-50. As the values are derived from the Sample Size and the Population Size of Doctors in five Secondary Hospitals with respect to the total 704 Sample size of Staff members of these five Secondary Hospitals and 798 Population Size of Staff Members of the five secondary Hospitals.

Graph 1: Frequency of Population Size and Sample Size of Doctors

5.3 Frequency of Nurses:

There is total 220 Sample Size of Nurses which makes around 31% of total number of Sample Sizes of all the staffs which is 704. Whereas Population Size of Nurses is 237 which becomes around 33% of the total Population Size of all the staffs which is 798. According to the figure 3 the frequency of all the values of Sample Size of Nurses i.e. 50, 26, 44, 77, 23 has only 1 frequency because each value occurred only one times. In case of frequency of Population size of Nurses figure 4 show that all the values of the Population size of Nurses i.e. 57, 28, 31, 96, 25 has only 1 frequency due to the fact that these values occurred only one time.

Figure 3: Frequency of Sample Size of Nurses

Figure 4: Frequency of Population Size of Nurses

Graph: –

This graph is showing the relation between the Frequencies of Population Size and Sample Size of Doctors. The Curve of the graph is in an increasing trend and it incline cure with a huge deviation takes place in between the Frequencies of Population Size and Sample Size i.e. 40-50. As the values are derived from the Sample Size and the Population Size of Doctors in five Secondary Hospitals with respect to the total 704 Sample size of Staff members of these five Secondary Hospitals and 798 Population Size of Staff Members of the five secondary Hospitals.

Graph 2: Frequency of Sample Size and Population size of Nurses

5.4 Frequency of Medical Staff:

The Sample Size of Medical Staff in total is 234 which makes around 33% of the total Sample Size of all the Staff members which is 704. Whereas the Population Size of Medical staff in total is 267 which makes around 38% of the total Population Size of all the Staff members. According to the figure 5 below, the figure shows that the values i.e. 38, 40, 66 of Sample Size of Medical staff has the frequency of 1 because they occurred only one time and the value 45 has the frequency of 2 due to the fact that it occurred 2 times. According to the figure 6 as given below, the figure show that the values of Population Size i.e. 43, 54, 80 have the frequency of 1 this is because they occurred only one time and the value 45 has the frequency of 2 this due to the fact that it has occurred 2 times and has frequently occurred with the frequency of 2. Frequency is basically how frequently the event has occurred and can be presented in a table, line graph, histogram, dot plot, bar chart and pie chart (as used in figure 1-6) etc. and according to all the guidelines the frequency can be displayed in according to the requirement. Frequency is an important Statistical tool which can help to analyze all kinds of quantitative data and so on especially traders use frequency in finance to analyze price action and identify trends. The representation of the Frequency can be graphical as well as tabular to make it easier to understand. It is also applicable for determining the Probability of an event which take place.

Graph: –

Graph 3: Frequency of Population Size and Sample Size of Medical Staff

The Graph 3 above and the two bar charts below i.e. Figure 5 and Figure 6 displays the Frequency of Sample Size and the Population Size of the five secondary Hospitals which is showing how frequently the values occurred and their trend. The two bar charts are as following:

Figure 5: Frequency of Sample Size of Medical Staff

Figure 6: Frequency of Population Size of Medical Staff

5.5 Percentage of the Sample Sizes:

In figure 7 below the pie chart is used to represent the percentages of all the Sample Size of Doctors, Nurses, and Medical Staff. The pie Chart is a type of graph which display and present data in a circular graph. Which are divided in proportions or parts to show either percentage or frequency and the data can easily be interpreted from pie chart. In figure 7 it clearly shows that Sample size of Doctors is 35% of the total Sample size of all the Staff members, Sample size of Nurses is 31% of the total Sample size and Sample Size of the Medical Staff is 34% of the total Sample Size. Therefore, Sample Size of Doctors has the most numbers as their percentage is the highest.

Figure 7: Pie chart of Sample Sizes

5.6 Percentage of Population Sizes:

In figure 8 the pie chart is used to represent the data in Percentage. In this figure it clear that it is displaying Population Size of all the staff members including Doctors, Nurses and Medical Staff. It shows that the Population Size of Doctors is 37% whereas the Population Size of Nurses is 30% and the Population Size of Medical Staff is 33% of the total Population Size of all the staff members. This figure shows that the Population Size of Doctors has the largest number which is 37% as it’s percentage the highest.

Figure 8: Pie chart of Population Sizes

5.7 Mean and Standard deviation of Sample Size and Population Size of Doctors:

The mean of sample size of doctors in all 5 secondary care hospitals of Peshawar are round 50 and the standard deviation calculated according to the study and sample size is around 18.64135 which is calculated in IBM SPSS.

Table 3: Sample Size of Doctors

Mean	50
Standard Deviation	18.64135

After mean and standard deviation of sample size. The calculation of mean and standard deviation of population size of doctor’s is also an important parameter. The mean calculated for doctors’ populations size is 52 while the standard deviation is around 25.05394.

Table 4: Population Size of Doctors

Mean	52
Standard Deviation	25.05394

5.8 Mean and Standard Deviation of Sample Size and Population Size of Nurses:

The mean of sample size of Nurses in all 5 secondary care hospitals of Peshawar are round 44 and the standard deviation calculated according to the study and sample size is around 21.73707

Table 5: Sample Size of Nurses

Mean	44
Standard Deviation	21.73707

After mean and standard deviation of sample size. The calculation of mean and standard deviation of population size of Nurses is also an important parameter. The mean calculated for Nurses’ populations size is 47.400 while the standard deviation is around 30.00500.

Table 6: Population Size of Nurses

Mean	47.400
Standard Deviation	30.00500

5.9 Mean and Standard Deviation of Sample Size and Population Size of Medical Staff:

The mean of sample size of Medical Staff in all 5 secondary care hospitals of Peshawar are round 46.800 and the standard deviation calculated according to the study and sample size is around 11.16692.

Table 7: Sample Size of Medical Staff

Mean	46.800
Standard Deviation	11.16692

After mean and standard deviation of sample size. The calculation of mean and standard deviation of population size of Medical Staff is also an important parameter. The mean calculated for Medical Staffs’ populations size is 53.400 while the standard deviation is around 15.46932.

Table 8: Population Size of Medical Staff

Mean	53.400
Standard Deviation	15.46932

5.10 Population Size of Doctors and Sample Size of Doctors:

The data given in table 9 showing the cross-tabulation of Population size of Doctors and Sample Size of Doctors. Which show all the values of Population Size of Doctors and Sample Size of Doctors and their relation.

Table 9: Cross-table of Population Size of Doctors and Sample Size of Doctors

Population size of doctors	Sample Size of Doctors					Total Frequency
Population size of doctors	32.00	34.00	46.00	63.00	75.00
35.00	1	0	0	0	0	1
38.00	0	1	0	0	0	1
52.00	0	0	1	0	0	1
76.00	0	0	0	1	0	1
93.00	0	0	0	0	1	1
Total	1	1	1	1	1	5

Chi-Square Test:

Chi-Square test calculated the Linear by Linear Association which was required in the methodology 3.995.

Chi-Square Test

	Value	Df	Asymp. Sig. (2-sided)
Pearson Chi-Square	20.000^a	16	.220
Likelihood Ratio	16.094	16	.446
Linear-by linear Association	3.995	1	.046
N of Valid Cases	5

25 cells (100.0%) have expected count less than 5. The minimum expected count is .20.

5.11 Population Size of Doctors * Sample Size of Nurses:

The data given in table 10 showing the cross-tabulation of Population size of Doctors and Sample Size of Nurses. Which show all the values of Population Size of Doctors and Sample Size of Nurses and their relation.

Table 10: Cross-table of Population Size of Doctors and Sample Size of Nurses

Population size of doctors	Sample Size of Nurses					Total Frequency
Population size of doctors	23.00	26.00	44.00	50.00	77.00
35.00	1	0	0	0	0		1
38.00	0	1	0	0	0		1
52.00	0	0	0	1	0		1
76.00	0	0	1	0	0		1
93.00	0	0	0	0	1		1
Total	1	1	1	1	1		5

Chi-Square Test:

Chi-Square test calculated the Linear by Linear Association which was required in the methodology is 3.245.

Chi-Square Test

	Value	Df	Asymp. Sig. (2-sided)
Pearson Chi-Square	20.000^a	16	.220
Likelihood Ratio	16.094	16	.446
Linear-by linear Association	3.245	1	.072
N of Valid Cases	5

25 cells (100.0%) have expected count less than 5. The minimum expected count is .20.

5.12 Population Size of Doctors and Sample Size of Medical Staff:

The data given in table 11 showing the cross-tabulation of Population size of Doctors and Sample Size of Medical Staff. Which show all the values of Population Size of Doctors and Sample Size of Medical Staff and their relation.

Table 11: Cross-table of Population Size of Doctors and Sample Size of Medical Staff

Population size of doctors	Sample Size of Medical Staff				Total Frequency
Population size of doctors	38.00	40.00	45.00	66.00	Total Frequency
35.00	1	0	0	0	1
38.00	0	1	0	0	1
52.00	0	0	1	1	1
76.00	0	0	1	0	1
93.00	0	0	0	0	1
Total	1	1	2	1	5

Chi-Square Test:

Chi-Square test calculated the Linear by Linear Association which was required in the methodology is 3.085.

Chi-Square Test

	Value	Df	Asymp. Sig. (2-sided)
Pearson Chi-Square	15.000^a	12	.241
Likelihood Ratio	13.322	12	.346
Linear-by linear Association	3.085	1	.079
N of Valid Cases	5

25 cells (100.0%) have expected count less than 5. The minimum expected count is .20.

5.13 Population Size of Nurses and Sample Size of Doctors:

The data given in table 12 showing the cross-tabulation of Population size of Nurses and Sample Size of Doctor of five secondary hospitals of Khyber Pakhtunkhwa. Which show all the values of Population Size of Nurses and Sample Size of doctors and their relation.

Table 12: Cross-table of Population size of Nurses and Sample Size Doctors

Population size of Nurses	Sample Size of Doctors					Total Frequency
Population size of Nurses	32.00	34.00	46.00	63.00	75.00
25.00	1	0	0	0	0		1
28.00	0	1	0	0	0		1
31.00	0	0	0	1	0		1
57.00	0	0	1	0	0		1
96.00	0	0	0	0	1		1
Total	1	1	1	1	1		5

Chi-Square Test:

Chi-Square test calculated the Linear by Linear Association which was required in the methodology is 2.247.

Chi-Square Test

	Value	Df	Asymp. Sig. (2-sided)
Pearson Chi-Square	15.000^a	16	.220
Likelihood Ratio	13.322	16	.446
Linear-by linear Association	2.247	1	.134
N of Valid Cases	5

25 cells (100.0%) have expected count less than 5. The minimum expected count is .20.

5.14 Population Size of Nurses and Sample Size of Nurses:

The data given in table 13 showing the cross-tabulation of Population size of Nurses and Sample Size of Nurses. Which show all the values of Population Size of Nurses and Sample Size of Nurses and their relation.

Table 13: Cross-table of Population size of Nurses and Sample Size Nurses

Population size of Nurses	Sample Size of Nurses					Total Frequency
Population size of Nurses	23.00	26.00	44.00	50.00	77.00
25.00	1	0	0	0	0	1
28.00	0	1	0	0	0	1
31.00	0	0	1	0	0	1
57.00	0	0	0	1	0	1
96.00	0	0	0	0	1	1
Total	1	1	1	1	1	5

Chi-Square Test:

Chi-Square test calculated the Linear by Linear Association which was required in the methodology is 3.617.

Chi-Square Test

	Value	Df	Asymp. Sig. (2-sided)
Pearson Chi-Square	15.000^a	16	.220
Likelihood Ratio	16.094	16	.446
Linear-by linear Association	3.617	1	.057
N of Valid Cases	5

25 cells (100.0%) have expected count less than 5. The minimum expected count is .20.

5.15 Population Size of Nurses and Sample Size of Medical Staff

The data given in table 14 showing the cross-tabulation of Population size of Nurses and Sample Size of Medical Staff. Which show all the values of Population Size of Nurses and Sample Size of doctors and their relation.

Table 14: Cross-table of Population Size of Nurses and Sample Size of Medical Staff

Population size of Nurses	Sample Size of Medical Staff				Total Frequency
Population size of Nurses	38.00	40.00	45.00	66.00	Total Frequency
25.00	0	0	0	0	1
28.00	1	1	0	0	1
31.00	0	0	1	0	1
57.00	0	0	1	0	1
96.00	0	0	0	1	1
Total	1	1	2	1	5

Chi-Square Test:

Chi-Square test calculated the Linear by Linear Association which was required in the methodology is 3.583.

Chi-Square

	Value	Df	Asymp. Sig. (2-sided)
Pearson Chi-Square	15.000^a	12	.241
Likelihood Ratio	13.322	12	.446
Linear-by linear Association	3.583	1	.058
N of Valid Cases	5

25 cells (100.0%) have expected count less than 5. The minimum expected count is .20.

5.16 Population Size of Medical Staff and Sample Size of Doctors:

The data given in table 15 showing the cross-tabulation of Population size of Medical Staff and Sample Size of Doctor. Which show all the values of Population Size of Medical Staff and Sample Size of doctors and their relation.

Table 15: Cross-table of Population Size of Medical Staff and Sample Size of Doctors

Population size of Medical Staff	Sample Size of Doctors					Total Frequency
Population size of Medical Staff	32.00	34.00	46.00	63.00	75.00
43.00	0	1	0	0	0	1
45.00	1	0	0	1	0	1
54.00	0	0	1	0	0	1
80.00	0	0	0	0	1	1
Total	1	1	1	1	1	5

Chi-Square Test:

Chi-Square test calculated the Linear by Linear Association which was required in the methodology is 2.281.

Chi-Square Test

	Value	Df	Asymp. Sig. (2-sided)
Pearson Chi-Square	15.000^a	12	.241
Likelihood Ratio	13.322	12	.346
Linear-by linear Association	2.281	1	.131
N of Valid Cases	5

25 cells (100.0%) have expected count less than 5. The minimum expected count is .20

5.17 Population Size of Medical Staff * Sample Size of Nurses:

The data given in table 16 showing the cross-tabulation of Population size of Medical Staff and Sample Size of Nurses. Which show all the values of Population Size of Nurses and Sample Size of Nurses and their relation.

Population size of Medical Staff	Sample Size of Nurses					Total Frequency
Population size of Medical Staff	23.00	26.00	44.00	50.00	77.00
43.00	0	1	0	0	0	1
45.00	1	0	1	0	0	2
54.00	0	0	0	1	0	1
80.00	0	0	0	0	1	1
Total Frequency	1	1	1	1	1	5

Chi-Square test calculated the Linear by Linear Association which was required in the methodology is 3.427.

Chi-Square Test

	Value	Df	Asymp. Sig. (2-sided)
Pearson Chi-Square	15.000^a	12	.241
Likelihood Ratio	13.322	12	.346
Linear-by linear Association	2.281	1	.064
N of Valid Cases	5

25 cells (100.0%) have expected count less than 5. The minimum expected count is .20

5.18 Population Size of Medical Staff and Sample Size of Medical Staff:

The data given in table 17 showing the cross-tabulation of Population size of Medical Staff and Sample Size of Medical Staff. Which show all the values of Population Size of Medical Staff and Sample Size of Medical Staff and their relation.

Table 17: Cross-table of Population Size of Medical Staff and Sample Size of Medical Staff

Population size of Medical Staff	Sample Size of Medical Staff				Total Frequency
Population size of Medical Staff	38.00	40.00	45.00	66.00
43.00	1	0	0	0	1
45.00	0	1	1	0	2
54.00	0	0	1	0	1
80.00	0	0	0	1	1
Total Frequency	1	1	1	1	5

Chi-Square Test:

Chi-Square test calculated the Linear by Linear Association which was required in the methodology is 0.051.

Chi-Square Test

	Value	Df	Asymp. Sig. (2-sided)
Pearson Chi-Square	11.250^a	9	.259
Likelihood Ratio	10.549	9	.308
Linear-by linear Association	3.799	1	.051
N of Valid Cases	5

25 cells (100.0%) have expected count less than 5. The minimum expected count is .2

5.19 Distribution of responses among Administration: –

In this table 18 below data of the administration of five secondary hospitals of Peshawar which is basically derived from the survey conducted. In this table 18 total 72 Questions were asked which the Administration participant answered with Yes or No. In this table as the participant was only one in each of the five-secondary hospital of Peshawar therefore, there will be the total Percentages of Yes and No which will be in the final row of the table.

Note: The method which is used for the representation of Yes and No in this table is by tick mark which shows that the participant has answered the Question with either Yes or No.

The table below illustrates the responses of Administration Staff in different hospitals for different questions:

Table 18: Distribution of responses among Administration

Questions

Molvi Ameer Shah Memorial Hospital, Peshawar.

Sifat Ghayoor Hospital, Peshawar.

Services Hospital, Peshawar

Naseerullah Khan Babar Memorial Hospital Peshawar

Government Mumtaz Maternity Hospital, Hashtnagri Peshawar.

Written infection prevention policies and procedures are available, current, and based on evidence-based guidelines (e.g., CDC/HICPAC), regulations, or standards.

Yes

✓

Infection prevention policies and procedures are re-assessed at least annually or according to state or federal requirements, and updated if appropriate.

Yes

✓

At least one individual trained in infection prevention is employed by or regularly available (e.g., by contract) to manage the facility’s infection control program.

Yes

✓

Facility has system for early detection and management of potentially infectious persons at initial points of patient encounter.

Yes

✓

Facility has a competency-based training program that provides job-specific training on infection prevention policies and procedures to healthcare personnel.

Yes

✓

Facility has an exposure control plan that is tailored to the specific requirements of the facility (e.g., addresses potential hazards posed by specific services provided by the facility).

Yes

✓

HCP for whom contact with blood or other potentially infectious material is anticipated are trained on the OSHA bloodborne pathogens standard upon hire and at least annually.

Yes

✓

Following an exposure event, post-exposure evaluation and follow-up, including prophylaxis as appropriate, are available at no cost to employee and are supervised by a licensed healthcare professional.

Yes

✓

Facility tracks HCP exposure events and evaluates event data and develops/implements corrective action plans to reduce incidence of such events.

Yes

✓

Facility follows recommendations of the Advisory Committee on Immunization Practices (ACIP) for immunization of HCP, including offering Hepatitis B and influenza vaccination.

Yes

✓

All HCP receive baseline tuberculosis (TB) screening prior to placement; HCP receive repeat testing, if appropriate, based on the facility-level risk assessment.

Yes

✓

Facility has well-defined policies concerning contact of personnel with patients when personnel have potentially transmissible conditions.

These policies include:

i. Work-exclusion policies that encourage reporting of

illnesses and do not penalize with loss of wages, benefits, or job status.

ii. Education of personnel on prompt reporting of illness to supervisor.

Yes

✓

An updated list of diseases reportable to the public health authority is readily available to all personnel.

Yes

✓

Facility can demonstrate knowledge of and compliance with mandatory reporting requirements for notifiable diseases, healthcare associated infections (as appropriate), and for potential outbreaks.

Yes

✓

Patients who have undergone procedures at the facility are educated regarding signs and symptoms of infection that may be associated with the procedure and instructed to notify the

facility if such signs or symptoms occur.

Yes

✓

All HCP are educated regarding appropriate indications for hand hygiene:

i. Upon hire, prior to provision of care

ii. Annually

Yes

✓

HCP are required to demonstrate competency with hand hygiene following each training.

Yes

✓

Facility routinely audits (monitors and documents) adherence to hand hygiene.

Yes

✓

Facility provides feedback from audits to personnel regarding their hand hygiene performance.

Yes

✓

Hand hygiene policies promote preferential use of alcohol-based hand rub (ABHR) over soap and water in most clinical situations.

Yes

✓

HCP who use PPE receive training on proper selection and use of

i. Upon hire, prior to provision of care

ii. Annually

iii. When new equipment or protocols are introduced

Yes

✓

HCP are required to demonstrate competency with selection and use of PPE following each training.

Yes

Facility routinely audits (monitors and documents) adherence to proper PPE selection and use.

Yes

✓

Facility provides feedback from audits to personnel regarding their performance with selection and use of PPE.

Yes

✓

HCP who prepare and/or administer parenteral medications receive training on safe injection practices:

i. Upon hire, prior to being allowed to prepare and/or administer parenteral medications

ii. Annually

iii. When new equipment or protocols are introduced

Yes

✓

HCP are required to demonstrate competency with safe injection practices following each training.

Yes

✓

Facility routinely audits (monitors and documents) adherence to safe injection practices.

Yes

✓

Facility provides feedback from audits to personnel regarding their adherence to safe injection practices.

Yes

✓

Facility has policies and procedures to track HCP access to controlled substances to prevent narcotics theft/diversion.

Yes

✓

Facility has policies and procedures to contain respiratory secretions in persons who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and continuing through the duration of the visit.

Yes

✓

Policies include:

i. Offering facemasks to coughing patients and other symptomatic persons upon entry to the facility, at a minimum, during periods of increased respiratory infection activity in the community.

Yes

✓

Providing space in waiting rooms and encouraging persons with symptoms of respiratory infections to sit as far away from others as possible.

Yes

✓

Facility educates HCP on the importance of infection prevention measures to contain respiratory secretions to prevent the spread of respiratory pathogens.

Yes

✓

HCP who perform point-of-care testing receive training on recommended practices:

i. Upon hire, prior to being allowed to perform point-of- care testing

Yes

✓

ii. Annually

iii. When new equipment or protocols are introduced

Yes

✓

HCP are required to demonstrate competency with recommended practices for point-of-care testing following each training.

Yes

✓

Facility routinely audits (monitors and documents) adherence to recommended practices during point-of-care testing.

Yes

✓

Facility provides feedback from audits to personnel regarding their adherence to recommended practices.

Yes

✓

Facility has written policies and procedures for routine cleaning and disinfection of environmental surfaces, including identification of responsible personnel.

Yes

✓

Personnel who clean and disinfect patient care areas (e.g., environmental services, technicians, nurses) receive training on cleaning procedures

i. Upon hire, prior to being allowed to perform environmental cleaning

Yes

✓

ii. Annually

Yes

✓

iii. When new equipment or protocols are introduced

Yes

✓

HCP are required to demonstrate competency with safe injection practices following each training.

Yes

✓

Facility routinely audits (monitors and documents) adherence to safe injection practices.

Yes

✓

Facility provides feedback from audits to personnel regarding their adherence to safe injection practices.

Yes

✓

Facility has policies and procedures to track HCP access to controlled substances to prevent narcotics theft/diversion.

Yes

✓

Yes

✓

Policies include:

i. Offering facemasks to coughing patients and other symptomatic persons upon entry to the facility, at a minimum, during periods of increased respiratory infection activity in the community.

Yes

✓

ii. Providing space in waiting rooms and encouraging persons with symptoms of respiratory infections to sit as far away from others as possible.

Yes

✓

Facility educates HCP on the importance of infection prevention measures to contain respiratory secretions to prevent the spread of respiratory pathogens.

Yes

✓

HCP who perform point-of-care testing receive training on recommended practices.

Yes

✓

Upon hire, prior to being allowed to perform point-of- care testing

Yes

✓

Annually When new equipment or protocols are introduced

Yes

✓

HCP are required to demonstrate competency with recommended practices for point-of-care testing following each training.

Yes

✓

Facility routinely audits (monitors and documents) adherence to recommended practices during point-of-care testing.

Yes

✓

Facility provides feedback from audits to personnel regarding their adherence to recommended practices.

Yes

✓

Facility has written policies and procedures for routine cleaning and disinfection of environmental surfaces, including identification of responsible personnel.

Yes

✓

Personnel who clean and disinfect patient care areas (e.g., environmental services, technicians, nurses) receive training on cleaning procedures

Yes

✓

Upon hire, prior to being allowed to perform environmental cleaning

Annually

Yes

✓

When new equipment or protocols are introduced

Yes

✓

HCP are required to demonstrate competency with recommended practices for point-of-care testing following each training.

Yes

✓

Facility routinely audits (monitors and documents) adherence to recommended practices during point-of-care testing.

Yes

✓

Facility provides feedback from audits to personnel regarding their adherence to recommended practices.

Yes

✓

Facility has written policies and procedures for routine cleaning and disinfection of environmental surfaces, including identification of responsible personnel.

Yes

✓

Personnel who clean and disinfect patient care areas (e.g., environmental services, technicians, nurses) receive training on cleaning procedures

Yes

✓

i. Upon hire, prior to being allowed to perform environmental cleaning

ii. Annually

iii. When new equipment or protocols are introduced

Yes

✓

HCP are required to demonstrate competency with environmental cleaning procedures following each training.

Yes

✓

Facility routinely audits (monitors and documents) adherence to cleaning and disinfection procedures, including using products in accordance with manufacturer’s instructions (e.g., dilution, storage, shelf-life, contact time).

Yes

✓

Facility provides feedback from audits to personnel regarding their adherence to cleaning and disinfection procedures.

Yes

✓

Operating rooms are terminally cleaned after last procedure of the day.

Yes

✓

Facility routinely audits (monitors and documents) adherence to recommended infection control practices for surgical infection prevention including: Adherence to preoperative surgical scrub and hand hygiene

Yes

✓

Appropriate use of surgical attire and drapes

Adherence to aseptic technique and sterile field

Proper ventilation requirements in surgical suites

Minimization of traffic in the operating room

Adherence to cleaning and disinfection of environmental surfaces

Yes

✓

Facility provides feedback from audits to personnel regarding their adherence to surgical infection prevention practices.

Yes

✓

Total Percentage

Yes

(46%)

(50%)

(65.3%)

(44.5%)

(43.05%)

(54%)

(50%)

(34.7%)

(55.5%)

(56.95%)

5.20 Distribution of responses among Doctors: –

In this table 19 below data of Doctors of five secondary hospitals of Peshawar which is basically derived from the survey conducted. In this table 19 Total 24 Question were asked from the respected doctors answered with Yes or No. There are total 250 doctors of five secondary hospital of Peshawar in which Molvi Ameer Shah Memorial Hospital Peshawar has 46 doctors, Shifat Ghayoor Hospital Peshawar has 34 doctors, Services Hospital has 63 doctors, Naseer Ullah Khan Babar Memorial Hospital has 75 doctors and Government Mumtaz Maternity Hospital Hashtnagri Peshawar has 32 doctors who participated in the survey. In table 19 Below data of Doctors who participated in the survey by answering the Questions with Yes and No are listed.

The table below illustrates the responses of Doctors in different hospitals for different questions:

Table 19: Distribution of responses among Doctors

Questions

Molvi Ameer Shah Memorial Hospital, Peshawar.

Sifat Ghayoor Hospital, Peshawar.

Services Hospital, Peshawar

Naseerullah Khan Babar Memorial Hospital Peshawar

Government Mumtaz Maternity Hospital, Hashtnagri Peshawar.

Supplies necessary for adherence to hand hygiene (e.g., soap, water, paper towels, alcohol-based hand rub) are readily accessible to HCP in patient care areas.

Yes

(37%)

(28.6%)

(38.1%)

(32.4%)

(36.1%)

(63%)

(71.4%)

(61.9%)

(67.6%)

(63.9%)

Hand hygiene is performed correctly

Before contact with the patient

Yes

(8.7%)

(2.9%)

(7.9%)

(4.1%)

(5.6%)

(91.3%)

(97.1%)

(92.1%)

(95.9%)

(94.4%)

Before performing an aseptic task (e.g., insertion of IV or preparing an injection, administering eye drops)

Yes

(6.5%)

(8.6%)

(4.8%)

(4.1%)

(8.3%)

(93.5%)

(91.4%)

(95.2%)

(95.9%)

(91.7%)

After contact with the patient

Yes

(23.9%)

(22.9%)

(23.8%)

(24.3%)

(27.8%)

(76.9%)

(37.1%)

76.2%

(75.7%)

(72.2%)

When moving from a contaminated-body site to a clean-body site during patient care

Yes

(58.7%)

(60%)

(58.7%)

(56.8%)

(52.8%)

(41.3%)

(40%)

(41.3%)

(43.2%)

(47.2%)

Sufficient and appropriate PPE is available and readily accessible to HCP.

PPE is used correctly

Yes

(30.4%)

(31.4%)

(31.7%)

(32.4%)

(36.1%)

(69.6%)

(68.6%)

(68.3%)

(67.6%)

(63.9%)

PPE, other than respirator, is removed and discarded prior to leaving the patient’s room or care area. If a respirator is used, it is removed and discarded (or reprocessed if reusable) after leaving the patient room or care area and closing the door.

Yes

(45.7%)

(42.9%)

(49.2%)

(41.5%)

(50%)

(54.3%)

(57.1%)

(50.8%)

(58.1%)

(50%)

Hand hygiene is performed immediately after removal of PPE.

Yes

(45.7%)

(57.1%)

(49.2%)

(54.1%)

(50%)

(54.3%)

(42.9%)

(50.8%)

(45.1%)

(50%)

HCP wear gloves for potential contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated equipment.

Yes

(87%)

(85.7%)

(81.1%)

(83.3%)

(13%)

(14.3%)

(18.9%)

(16.7%)

ii. HCP do not wear the same pair of gloves for the care of more than one patient.

Yes

(100%)

(0%)

Gowns

i. HCP wear gowns to protect skin and clothing during

procedures or activities where contact with blood or

body fluids are anticipated.

Yes

(93.5%)

(97.1%)

(93.7%)

(95.9%)

(94.4%)

(6.5%)

(2.9%)

(6.3%)

(4.1%)

(5.6%)

F. Facial protection

i. HCP wear mouth, nose, and eye protection during procedures that are likely to generate splashes or sprays of blood or other body fluids.

Yes

(93.5%)

(97.1%)

(93.7%)

(95.9%)

(94.4%)

(6.5%)

(2.9%)

(6.3%)

(4.1%)

(5.6%)

Injections are prepared using aseptic technique in a clean area free from contamination or contact with blood, body fluids or contaminated equipment.

Yes

(80.4%)

(88.6%)

(79.4%)

(83.8%)

(80.6%)

(19.6%)

(11.4%)

(20.6%)

(16.2%)

(19.4%)

Needles and syringes are used for only one patient (this includes manufactured prefilled syringes and cartridge devices such as insulin pens).

Yes

(100%)

(0%)

The rubber septum on a medication vial is disinfected with

alcohol prior to piercing.

Yes

(47.8%)

(42.9%)

(52.4%)

(45.9%)

(36.1%)

(52.2%)

(57.1%)

(47.6%)

(54.1%)

(63.9%)

Medication containers are entered with a new needle and a new syringe, even when obtaining additional doses for the same patient.

Yes

(82.6%)

(82.9%)

(84.1%)

(83.8%)

(80.6%)

(17.4%)

(17.1%)

(15.9%)

(16.2%)

(19.4%)

Single dose (single-use) medication vials, ampules, and bags or

bottles of intravenous solution are used for only one patient.

Yes

(100%)

(0%)

Medication administration tubing and connectors are used for only one patient.

Yes

(100%)

(91.4%)

(100%)

(91.9%)

(97.2%)

(0%)

(8.6%)

(0%)

(8.1%)

(2.8%)

Multi-dose vials are dated by HCP when they are first opened and discarded within 28 days unless the manufacturer specifies a different (shorter or longer) date for that opened vial.

Yes

(52.2%)

(34.3%)

(50.8%)

(44.6%)

(36.1%)

(47.8%)

(65.7%)

(49.2%)

(55.4%)

(63.9%)

After contact with objects in the immediate vicinity of the patient

Yes

(28.3%)

(28.6%)

(32.4%)

(38.9%)

(71.7%)

(71.4%)

(67.6%)

(61.1%)

After contact with blood, body fluids or contaminated surfaces

Yes

(97.8%)

(100%)

(98.4%)

(100%)

(2.2%)

(0%)

(1.6%)

(0%)

HCP do not wash gloves for the purpose of reuse.

Yes

(100%)

(0%)

HCP do not wear the same gown for the care of more than one patient.

Yes

(100%)

(0%)

After removing gloves

Yes

(13%)

(25.7%)

(11.1%)

(16.2%)

(22.2%)

(87%)

(74.3%)

(88.9%)

(83.8%)

(77.8%)

5.21 Distribution of responses among Nurses: –

In this table 20 below data of the nurses of five secondary hospitals of Peshawar which is basically derived from the survey conducted. In this table 20 total 5 Questions were asked which the nurses answered with Yes or No. There are total 245 nurses in which Molvi Ameer Shah Memorial Hospital Peshawar has 45 nurses, Shifat Ghayoor Hospital Peshawar has 26 nurses, Services Hospital Peshawar has 43 nurses, Naseer Ullah Khan Babar Memorial Hospital has 75 nurses and Government Mumtaz Maternity Hospital Hashtnagri Peshawar has 22 nurses who participated in the survey. Percentages of Yes and No in each Question asked from the nurses of five secondary hospitals of Peshawar are given below in table

Table 19: Distribution of responses among Nurses

Questions

Molvi Ameer Shah Memorial Hospital, Peshawar.

Sifat Ghayoor Hospital, Peshawar.

Services Hospital, Peshawar

Nseerullah Khan Babar Memorial Hospital Peshawar

Government Mumtaz Maternity Hospital, Hashtnagri Peshawar.

Multi-dose vials to be used for more than one patient are kept in a centralized medication area and do not enter the immediate patient treatment area (e.g., operating room, patient room/cubicle).

Yes

(52.6%)

(46.2%)

(47.7%)

(51.9%)

(47.8%)

(47.4%)

(53.6%)

(52.3%)

(48.1%)

(52.2%)

All sharps are disposed of in a puncture-resistant sharps container.

Yes

(53.9%)

(53.8%)

(59.1%)

(62.3%)

(60.9%)

(46.1%)

(46.2%)

(40.9%)

(37.7%)

(39.1%)

Filled sharps containers are disposed of in accordance with state regulated medical waste rules.

Yes

(36.8%)

(26.9%)

(47.7%)

(48.1%)

(60.9%)

(63.2%)

(73.1%)

(52.3%)

(51.9%)

(39.1%)

All controlled substances (e.g., Schedule II, III, IV, V drugs) are kept locked within a secure area.

Yes

(69.7%)

(61.5%)

(65.9%)

(71.4%)

(65.2%)

(30.3%)

(38.5%)

(34.1%)

(28.6%)

(34.8%)

HCP wear a facemask (e.g., surgical mask) when placing a catheter or injecting material into the epidural or subdural space (e.g., during myelogram, epidural or spinal anesthesia).

Yes

(30.3%)

(30.8%)

14 (31.8%)

(33.8%)

(39.1%)

(69.7%)

18 (69.2%)

30 (68.2%)

(66.2%)

(60.9%)

5.22 Distribution of responses among Medical Allied Staff: –

In this table 21 Below data of Medical Staff of five secondary hospitals of Peshawar which is basically derived from the survey conducted. In this table 21 total 45 Questions were asked from the Medical Allied Staff of five secondary hospitals of Peshawar in which Molvi Ameer Shah Memorial Hospital Peshawar has 45 medical staff, Shifat Ghayoor Hospital Peshawar has 38 medical staff, Services Hospital has 45, Naseer Ullah Khan Babar Memorial Hospital has 66 medical staff and Government Mumtaz Maternity Hospital Hashtnagri Peshawar has 40 medical staff who participated in the survey. In table 21 Below data of Medical Allied Staff who participated in the survey by answering the Questions with Yes and No are listed.

Table 19: Distribution of responses among Medical Allied Staff

Questions

Molvi Ameer Shah Memorial Hospital, Peshawar.

Sifat Ghayoor Hospital, Peshawar.

Services Hospital, Peshawar

Nseerullah Khan Babar Memorial Hospital Peshawar

Government Mumtaz Maternity Hospital, Hashtnagri Peshawar.

New single-use, auto-disabling lancing device is used for each patient.

Yes

(28.9%)

(31.6%)

(51.1%)

(28.8%)

(45%)

(71.1%)

(68.4%)

(48.9%)

(71.2%)

(55%)

If used for more than one patient, the point-of-care blood testing

meter is cleaned and disinfected after every use according to manufacturer’s instructions.

Yes

(71.1%)

(75.6%)

(69.7%)

(65%)

(28.9%)

(24.4%)

(30.3%)

(35%)

Supplies necessary for appropriate cleaning and disinfection procedures (e.g., EPA-registered disinfectants) are available.

Yes

(46.7%)

(34.2%)

(46.7%)

(47%)

(60%)

(53.3%)

(65.8%)

(53.3%)

(53%)

(40%)

High-touch surfaces in rooms where surgical or other invasive procedures (e.g., endoscopy, spinal injections) are performed are cleaned and then disinfected with an EPA-registered disinfectant after each procedure.

Yes

(100%)

(86.8%)

(84.4%)

(98.5%)

(100%)

(0%)

(13.2%)

(15.6%)

(1.5%)

(0%)

Cleaners and disinfectants are used in accordance with manufacturer’s instructions (e.g., dilution, storage, shelf-life, contact time).

Yes

(55.6%)

(73.7%)

(62.2%)

(56.1%)

(50%)

(44.4%)

(26.3%)

(37.8%)

(43.9%)

(50%)

HCP engaged in environmental cleaning wear appropriate PPE to prevent exposure to infectious agents or chemicals (PPE can include gloves, gowns, masks, and eye protection).

Yes

(84.4%)

(78.9%)

(73.3%)

(77.3%)

(72.5%)

(15.6%)

(21.1%)

(26.7%)

(22.7%)

(27.5%)

Policies, procedures, and manufacturer reprocessing instructions for reusable medical devices used in the facility are available in the reprocessing area(s).

Yes

(55.6%)

(63.2%)

(51.1%)

(57.6%)

(55%)

(44.4%)

(36.8%)

(48.9%)

(42.4%)

(45%)

Reusable medical devices are cleaned, reprocessed (disinfection or sterilization) and maintained according to the manufacturer instructions.

Yes

(100%)

(0%)

Single-use devices are discarded after use and not used for more than one patient unless they have been appropriately reprocessed as described in the note below.

Yes

(84.4%)

(81.6%)

(77.8%)

(83.3%)

(82.5%)

(15.6%)

(18.4%)

(22.2%)

(16.7%)

(17.5%)

Adequate space is allotted for reprocessing activities.

A workflow pattern is followed such that devices clearly flow from high contamination areas to clean/sterile areas (i.e., there is clear separation between soiled and clean workspaces).

Yes

(88.9%)

(86.8%)

(88.9%)

86.4%

(85%)

(11.1%)

(13.2%)

(11.1%)

(13.6%)

(15%)

Adequate time for reprocessing is allowed to ensure adherence to all steps recommended by the device manufacturer, including drying and proper storage.

Yes

(57.8%)

(57.9%)

(55.6%)

(56.1%)

(45%)

(42.2%)

(42.1%)

(44.4%)

(43.9%)

(55%)

HCP engaged in device reprocessing wear appropriate PPE to prevent exposure to infectious agents or chemicals (PPE can include gloves, gowns, masks, and eye protection).

Yes

(68.9%)

(76.3%)

(75.6%)

(69.7%)

(72.5%)

(31.1%)

(23.7%)

(24.4%)

(30.3%)

(27.7%)

Medical devices are stored in a manner to protect from damage and contamination.

Yes

(44.4%)

(55.3%)

(53.3%)

(45.5%)

(40%)

(55.6%)

(44.7%)

(46.7%)

(54.5%)

(60%)

Devices are thoroughly cleaned according to manufacturer instructions and visually inspected for residual soil prior to sterilization

Yes

(57.8%)

(65.8%)

(62.2%)

(54.5%)

(52.5%)

(42.2%)

(34.2%)

(37.8%)

(45.5%)

(47.5%)

Cleaning is performed as soon as practical after use (e.g., at the point of use) to prevent soiled materials from becoming dried onto devices.

Yes

(68.9%)

(52.6%)

(55.6%)

(71.2%)

(62.5%)

(31.1%)

(47.4%)

(44.4%)

(28.8%)

(37.5%)

Enzymatic cleaner or detergent is used for cleaning and discarded according to manufacturer’s instructions (typically after each use)

Yes

(62.2%)

(63.2%)

(62.2%)

(62.1%)

(55%)

(37.8%)

(36.8%)

(37.8%)

(37.9%)

(45%)

Cleaning brushes are disposable or, if reusable, cleaned and high-level disinfected or sterilized (per manufacturer’s instructions) after use.

Yes

(51.1%)

(65.8%)

(60%)

(57.6%)

(50%)

(48.9%)

(24.2%)

(40%)

(42.4%)

(50%)

After cleaning, instruments are appropriately wrapped/packaged for sterilization (e.g., package system selected is compatible with the sterilization process being performed, items are placed correctly into the basket, shelf or cart of the sterilizer so as not to impede the penetration of the sterilant, hinged instruments are open, instruments are disassembled if indicated by the manufacturer).

Yes

(62.2%)

(68.4%)

(51.1%)

(62.1%)

(55%)

(37.8%)

(13.6%)

(48.9%)

(37.9%)

(45%)

A chemical indicator (process indicator) is placed correctly in the instrument packs in every load.

Yes

(84.4%)

(84.2%)

31
(68.9%)

(80.3%)

(70%)

(15.6%)

(15.8%)

(31.1%)

(19.7%)

(30%)

A biological indicator, intended specifically for the type and cycle parameters of the sterilizer, is used at least weekly for each sterilizer and with every load containing implantable items.

Yes

(60%)

(73.7%)

(66.7%)

(60.6%

21
(52.5%)

(40%)

(26.3%)

(33.3%)

(39.4%)

(47.5%)

For dynamic air removal-type sterilizers (e.g., pre-vacuum steam

sterilizer), an air removal test (Bowie-Dick test) is performed in an empty dynamic-air removal sterilizer each day the sterilizer is used to verify efficacy of air removal.

Yes

(51.1%)

(55.3%)

(48.9%)

(56.1%)

(55%)

(48.9%)

(44.7%)

(51.1%)

(43.9%)

(45%)

Sterile packs are labeled with a load number that indicates the sterilizer used, the cycle or load number, the date of sterilization, and, if applicable, the expiration date.

Yes

(62.2%)

(55.3%)

(57.8%)

(62.1%)

(72.5%)

(37.8%)

(44.7%)

(42.2%)

(37.9%)

(27.5%)

Sterilization logs are current and include results from each load.

Yes

(82.2%)

(81.6%)

(80%)

(80.3%)

(80%)

(17.8%)

(18.4%)

(20%)

(19.7%)

(20%)

Immediate-use steam sterilization, if performed, is only done in circumstances in which routine sterilization procedures cannot be performed.

Yes

(82.2%)

(78.9)

(84.4%)

(80.3%)

(82.5%)

(17.8%)

(21.1)

(15.6%)

(19.7%)

(17.5%)

Instruments that undergo immediate-use steam sterilization are used immediately and not stored.

Yes

(86.7%)

(86.8%)

(86.7%)

(83.3%)

(82.5%)

(13.3%)

(13.2%)

(13.3%)

(16.7%)

(17.5%)

After sterilization, medical devices are stored so that sterility is not compromised.

Yes

(60%)

(86.8%)

(60%)

(63.6%)

(60%)

(40%)

(13.3%)

(40%)

(36.4%)

(40%)

Sterile packages are inspected for integrity and compromised packages are reprocessed prior to use.

Yes

(73.3%)

(63.2%)

(51.1%)

(77.3%)

(50%)

(26.7%)

(36.8%)

(48.9%)

(22.7%)

(50%)

The facility has a process to perform initial cleaning of devices (to prevent soiled materials from becoming dried onto devices) prior to transport to the off-site reprocessing facility.

Yes

(66.7%)

(50%)

(60%)

(74.2%)

(70%)

(33.3%)

(50%)

(40%)

(25.8%)

(30%)

Flexible endoscopes are inspected for damage and leak tested as part of each reprocessing cycle. Any device that fails the leak test is removed from clinical use and repaired.

Yes

(51.1%)

(47.4%)

(42.2%)

(50%)

(48.9%)

(52.6%)

(57.8%)

(50%)

Devices are thoroughly cleaned according to manufacturer instructions and visually inspected for residual soil prior to high- level disinfection.

Yes

(55.6%)

(52.6%)

(28.9%)

(51.5%)

(45%)

(44.4%)

(47.4%)

(71.1%)

(48.5%)

(55%)

Cleaning is performed as soon as practical after use (e.g., at the point of use) to prevent soiled materials from becoming dried onto instruments.

Yes

(46.7%)

(55.3%)

(62.2%)

(51.5%)

(57.5%)

(53.3%)

(44.7%)

(37.8%)

(48.5%)

(42.5%)

Enzymatic cleaner or detergent is used and discarded according to manufacturer instructions (typically after each use).

Yes

(51.1%)

(55.3%)

(40%)

(60.6%)

(42.5%)

(48.9%)

(44.7%)

(60%)

(39.4%)

(57.5%)

Cleaning brushes are disposable or, if reusable, cleaned and high-level disinfected or sterilized (per manufacturer instructions) after use.

Yes

(64.4%)

(73.7%)

(57.8%)

(72.7%)

(60%)

(35.6%)

(26.3%)

(42.2%)

(27.3%)

(40%)

For chemicals used in high-level disinfection, manufacturer instructions are followed for:

i. Preparation

ii. Testing for appropriate concentration

iii. Replacement (i.e., upon expiration or loss of efficacy

Yes

(73.3%)

(65.8%)

(73.3%)

(66.7%)

(67.5%)

(26.7%)

(34.2%)

(26.7%)

(33.3%)

(32.5%)

If automated reprocessing equipment (e.g., automated endoscope reprocessor) is used, proper connectors are used to assure that channels and lumens are appropriately disinfected.

Yes

(66.7%)

(73.7%)

(60%)

(69.7%)

(60%)

(33.3%)

(26.3%)

(40%)

(30.3%)

(40%)

Devices are disinfected for the appropriate length of time as specified by manufacturer instructions.

Yes

(77.8%)

(60.5%)

(75.6%)

(60.6%)

(77.5%)

(22.2%)

(39.5%)

(24.4%)

(39.4%)

(22.5%)

Devices are disinfected at the appropriate temperature as specified by manufacturer instructions.

Yes

(60%)

(50%)

(66.7%)

(43.9%)

(67.5%)

(40%)

(50%)

(33.3%)

(56.1%)

(32.5%)

After high-level disinfection, devices are appropriately rinsed as specified by the manufacturer.

Yes

(37.8%)

(44.7%)

(44.4%)

(48.5%)

(50%)

(62.2%)

(55.3%)

(55.6%)

(51.5%)

(50%)

Devices are dried thoroughly prior to reuse. After high-level disinfection, devices are stored in a manner to protect from damage or contamination.

Yes

(44.4%)

(50%)

(53.3%)

(57.6)

(52.5%)

(55.6%)

(50%)

(46.7%)

(42.4%)

(47.5%)

After high-level disinfection, devices are stored in a manner to protect from damage or contamination.

Yes

(57.8%)

(60.5%)

(51.1%)

(59.1%)

(60%)

(42.2%)

(39.5%)

(48.9%)

(40.9%)

(40%)

Facility maintains a log for each endoscopy procedure which includes: patient’s name and medical record number (if available), procedure, date, endoscopist, system used to reprocess the endoscope (if more than one system could be used in the reprocessing area), and serial number or other identifier of the endoscope used.

Yes

(62.2%)

(65.8%)

(66.7%)

(63.6%)

(57.5%)

(37.8%)

(34.2%)

(33.3%)

(36.4%)

(42.5%)

The facility has a process to perform initial cleaning of devices (to prevent soiled materials from becoming dried onto devices) prior to transport to the off-site reprocessing facility.

Yes

(64.4%)

(60.5%)

(66.7%)

(59.1%)

(60%)

(35.6%)

(39.5%)

(33.3%)

(40.9%)

(40)

Chapter 6

Discussion:

In this research all major aspects of infection control program and its practices in secondary health care hospitals is totally explained. Bulk of samples were collected by the survey which was held in 5 secondary care hospitals of Peshawar KPK. These collected samples were in form of questioners. Varity of questions were present in these questioners. And these questioners were filled by hospital authorities all the major points are concluded in the results on this study. This Research describes the overview of lethal infection known as Hospital associated Infection (HAI) which is getting very common nowadays.¹⁰⁵ This research is about the collection of data related HAI from secondary care hospitals of Peshawar by different questioners and interviewing the hospital members including Doctors, staff members and nurses. Around 25 questioners were made and filled by the members of the hospital authorities and different data regarding HAI were collected. The data collected by the hospital were HAI.¹⁰⁶ The questions which were generally asked through the questioners about healthcare personal safety. Personal protective equipment, infection control programs, personal health care safety, disease reporting, environmental cleaning and many more¹⁰⁷. Different sample sizes were collected by secondary hospitals of Peshawar.¹⁰⁸The information collected by those samples are briefly explained in this thesis.¹⁰⁹Different tables, figures pie charts are made according to the samples collected. Hospitals which are discussed briefly in this research are Molvi Ameer Shah memorial hospital Peshawar, Naseerullah Khan Babar memorial Hospital Peshawar, Services hospital, Sifat Ghayoor hospital, Peshawar and Government Mumtaz maternity hospital, Hashtnagri Peshawar. These were the 5 secondary hospitals of Peshawar KPK selected for research.¹²⁰ The research methodology briefly explains each and every step to this research and the results mentioned in this research explains each and every point of the survey held in these three secondary hospitals.¹²¹Various table, charts and figures are made with their description.¹²². The key results for the current study was to not only identify HAI.¹²³ Its types and other background of it but the reasons of this study were to known the practices and infection control programs taking place in these secondary hospitals of Peshawar.¹²⁴ Pakistan is among developing countries so rate of HAI is high even in developed countries, the rate of HAI is high the proper precautions and its practices are not followed by every hospitals and health care centers all around the world while some countries are unaware of HAI problem, they just neglect this lethal fact.¹²⁵Because of these chances of HAI increases large number of deaths are caused. It not only damages the life rate but it also damages the economy rate of the country facing HAI because cure of HAI needs large amount of funds and many more effects are needed.¹²⁹ HAI is very lethal and dangerous not because it can cause death or many worse symptoms but it is more lethal because its ease of spread or transmission there are two ways of transmission.¹³⁰ One direct transmission while other is indirect transmission, these transmissions have many other ways and rate of these transmission is very high and rapid even within seconds the infection can be transmitted from one person to another due to this rapid rate this infection is becoming very common. HAI have different types and its different types have different symptoms and every symptom of this infection is very dangerous to life.¹³¹ These symptoms can cause death. In this research around 704 sample sizes are discussed with its frequencies and components¹³². This infection is caused by Bacteria, fungi and viruses etc. and there are different types of bacteria which are responsible for HAI production and HAI caused by them are different from one another due to variety of these bacteria HAI is having different varieties with different symptoms.¹³⁴ HAI can be caused by unhygienic places and by defected person but one of the most important causes of HAI is overuse of unnecessary antibiotic. Unnecessary use of antibiotic can lead its victim to various infection.¹³⁵ These infections can be of different types but mostly unnecessary use of antibiotics give rise to many infections other than HAI enters into body from hospital and hospital linked people but this infection can live in the body of its victim for long time.¹³⁷ Mostly it lives for 3 days or more than that but when the patient is discharged from the hospital after the operation the HAI can live in its body for more than 30 days within its life cycle it can transmit from its victim to others.¹³⁸

6.1 Distribution of responses among Administration: –

According to this search 5 secondary health care hospitals of Peshawar were selected, about 72 questions were given to each administration staff member from every hospital, One administration number was selected for this survey, so around 5 participants were there, 72 question were filled by them in form of Yes/No and the Tick marks indicates the answers whether the answer is Yes or No depending on the question asked and these are recorded in table 18. As the data given in the table 18 for five secondary hospitals one administration participant each was asked questions for survey and the administration participants were all males. In Molvi Ameer Shah Memorial Hospital the participant answered 33 Questions as Yes which makes around 46% of the total Questions asked while the participant answered 39 Questions as No which makes around 54% of the total Questions which clearly shows that the percentage of No is more than Yes. In Shifat Ghayoor Hospital Peshawar, the participant answered 36 Questions as Yes which makes around 50% of the total Questions asked while the participant answered 36 questions as No which makes around 50% it shows that the percentage of No and Yes are equal. In Naseerullah Khan Babar Memorial Hospital Peshawar, participant answered 32 Questions as Yes which makes around 44.5% of the total Questions asked while the participant answered 40 as No which makes around 55.5% of the total Questions asked. Which clearly shows that the percentage of No is greater than Yes. In Service Hospital Peshawar, the participant answered 47 Questions as Yes which makes around 65.3% of the total Questions asked while the participant answered 25 Questions as No which makes around 34.7% of the total Questions asked. Which clearly shows that the percentage of Yes is more than No. In Government Mumtaz Maternity Hospital Hashnagri Peshawar, the participants answered 31 Questions as Yes which makes around 43.05% of the total Questions asked while the participant answered 41 as No which makes around 56.95% of the total Questions asked. It clearly shows that the percentage of No is more than Yes.

6.2 Distribution of responses among Doctors: –

Total number of doctors who were asked Questions were 250 from five secondary hospitals of Peshawar and they were asked 24 total Questions related to the survey. Molvi Ameer Shah Memorial Hospital Peshawar has 46 doctors, Shifat Ghayoor Hospital Peshawar has 34 doctors, Services Hospital has 63 doctors, Naseer Ullah Khan Babar Memorial Hospital has 75 doctors and Government Mumtaz Maternity Hospital Hashtnagri Peshawar has 32 doctors who participated in the survey. In Question 1 which is “Supplies necessary for adherence to hand hygiene (e.g., soap, water, paper towels, alcohol-based hand rub) are readily accessible to HCP in patient care areas.” The frequency and percentage of Yes and No answered by the doctors of Molvi Ameer Shah Memorial Hospital, Peshawar are ‘Yes’ is 17 frequency and 37% percentage and ‘No’ is 29 frequency and 63% percentage, doctors of Sifat Ghayoor Hospital, Peshawar are ‘Yes’ is 10 frequency and 28.6% and ‘No’ is 25 frequency and 71.4% doctors of Services Hospital, Peshawar are ‘Yes’ is 24 frequency and 38.1% percentage and ‘No’ is 39 frequency and 61.9%, doctors of Naseerullah Khan Babar Memorial Hospital Peshawar are ‘Yes’ is 24 frequency and 32.4% and ‘No’ is 50 frequency and 67.6%. doctors of Services Hospital, Peshawar are ‘Yes’ is 24 frequency and 38.1% and ‘No’ is 39 frequency and 61.9%, doctors of Government Mumtaz Maternity Hospital, Hashtnagri Peshawar are ‘Yes’ is 13 frequency and 36.1% and ‘No’ is 23 frequency and 63.9%. Question 2 which is “Hand hygiene is performed correctly. Before contact with the patient” The frequency and percentage of Yes and No of this Question answered by the doctors of Molvi Ameer Shah Memorial Hospital, Peshawar are ‘Yes’ is 4 frequency and 8.7% and ‘No’ is 42 frequency and 91.3%, the doctors of Sifat Ghayoor Hospital, Peshawar are ‘Yes’ is 1 frequency and 2.9% and ‘No’ is 34 frequency and 97.1%, the doctors of Services Hospital, Peshawar are ‘Yes’ is 5 frequency and 7.9% and ‘No’ is 58 frequency and 92.1%. the doctors of Naseerullah Khan Babar Memorial Hospital Peshawar are ‘Yes’ is 3 frequency and 4.1% and ‘No’ is 71 frequency and 95.9% and the doctors of Government Mumtaz Maternity Hospital, Hashtnagri Peshawar are ‘Yes’ is 2 frequency and 5.6% and ‘No’ is 34 frequency and 94.4%. In Question 3 which is “Before performing an aseptic task (e.g., insertion of IV or preparing an injection, administering eye drops)” The frequency and percentage of Yes and No of this Question answered by the doctors of Molvi Ameer Shah Memorial Hospital, Peshawar are ‘Yes’ is 3 frequency and 6.5% and ‘No’ is 43 frequency and 93.5%, by the doctors of Sifat Ghayoor Hospital, Peshawar are ‘Yes’ is 3 frequency and 8.6% and ‘No’ is 32 frequency and 91.4%, %, by the doctors of Services Hospital, Peshawar are ‘Yes’ is 3 frequency and 4.8% and ‘No’ is 60 frequency and 95.2%, by the doctors of Services Hospital, Peshawar are ‘Yes’ is 3 frequency and 4.8% and ‘No’ is 60 frequency and 95.2% ,by the doctors of Naseerullah Khan Babar Memorial Hospital Peshawar are ‘Yes’ is 3 frequency and 4.1% and ‘No’ is 71 frequency and 95.9% and by the doctors of Government Mumtaz Maternity Hospital, Hashtnagri Peshawar are ‘Yes’ is 3 frequency and 8.3% and ‘No’ is 33 frequency and 91.7% and so on up to the final Question “After removing gloves” The frequency and percentage of Yes and No of this Question answered by the doctors of Molvi Ameer Shah Memorial Hospital, Peshawar are ‘Yes’ is 6 frequency and 13% and ‘No’ is 40 frequency and 87%, by the doctors of Sifat Ghayoor Hospital, Peshawar are ‘Yes’ is 9 frequency and 25.7% and ‘No’ is 26 frequency and 74.3%, by the doctors of Services Hospital, Peshawar are ‘Yes’ is 7 frequency and 11.1% and ‘No’ is 56 frequency and 88.9%, by the doctors of Services Hospital, Peshawar are ‘Yes’ is 12 frequency and 16.2% and ‘No’ is 62 frequency and 83.8% ,by the doctors of Naseerullah Khan Babar Memorial Hospital Peshawar are ‘Yes’ is 12 frequency and 16.2% and ‘No’ is 62 frequency and 83.8% and by the doctors of Government Mumtaz Maternity Hospital, Hashtnagri Peshawar are ‘Yes’ is 8 frequency and 22.2% and ‘No’ is 28 frequency and 77.8%.

6.3 Distribution of responses among Nurses:-

Total number of Nurses were 219 in the five secondary hospitals of Peshawar. In which Nurses of Molvi Ameer Shah Memorial Hospital were 75, Services Hospital were 43, Nurses of Naseerullah Khan Babar Memorial Hospital were 76 and Sifat Ghayoor Hospital’s Nurses were 22. The nurses were asked 5 questions each. The Question 1 which is Multi-dose vials to be used for more than one patient are kept in a centralized medication area and do not enter the immediate patient treatment area (e.g., operating room, patient room/cubicle) which was answered by the nurses of 5 secondary hospitals. By the nurses of Molvi Ameer Shah Memorial Hospital, the frequency and percentage of ‘Yes’ is 40 and 52.6% And in ‘No’ is 36 and 47.4% By the nurses of Sifat Ghayoor Hospital, the frequency and percentage of ‘Yes’ is 12 and, 46.2% and in ‘No’ is 14 and 53.6% By the nurses of Services Hospital, the frequency and percentage of ‘Yes’ is 21 and 47.7%, and in ‘No’ is 23 and 52.3% By the nurses of Naseerullah Khan Babar Memorial Hospital, the frequency and percentage of ‘Yes’ is 40 and 51.9% and in ‘No’ is 37 and 48.1% By the nurses of Government Mumtaz Maternity Hospital, the frequency and percentage of ‘Yes’ is 11 and 47.8% and in ‘No’ is 12 and 52.2% The next question that was asked by the nurses was All sharps are disposed of in a puncture-resistant sharps container. By the nurses of the Molvi Ameer Shah Memorial Hospital, the frequency and percentage of ‘Yes’ is 41 and 53.9%, and in ‘No’ is 35 and 63.2% By the nurses of Sifat Ghayoor Hospital, the frequency and percentage of ‘Yes’ is 14 and 53.8%, and in ‘No’ is 12 and 46.2% By the nurses of Services Hospital, the frequency and percentage of ‘Yes’ is 26 and 59.1%, and in ‘No’ is 18 and 40.9% By the nurses of Naseerullah Khan Babar Hospital, the frequency and percentage of ‘Yes’ is 48 and 62.3%, and in ‘No’ is 29 and 37.7. By the nurses of Government Mumtaz Maternity Hospital, the frequency and percentage of ‘Yes’ is 14 and 60.9%, and in ‘No’ is 9 and 39.1% The next Question asked from the nurses was: Filled sharps containers are disposed of in accordance with state regulated medical waste rules. By the nurses of the Molvi Ameer Shah Memorial Hospital, the frequency and percentage of ‘Yes’ is 28 and 36.8%, and in ‘No’ is 48 and 63.2%. All controlled substances (e.g., Schedule II, III, IV, V drugs) are kept locked within a secure area. By the nurses of the Molvi Ameer Shah Memorial Hospital, the frequency and percentage of ‘Yes’ is 53 and 69.7%, and in ‘No’ is 23 and 30.3%. By the nurses of Sifat Ghayoor Hospital, the frequency and percentage of ‘Yes’ is 16 and 61.5%, and in ‘No’ is 10 and 38.5%. By the nurses of Services Hospital, the frequency and percentage of ‘Yes’ is 29 and 65.9%, and in ‘No’ is 15 and 34.1%. By the nurses of Naseerullah Khan Babar Hospital, the frequency and percentage of ‘Yes’ is 55 and 71.4%, and in ‘No’ is 22 and 28.6%. By the nurses of Government Mumtaz Maternity Hospital, the frequency and percentage of ‘Yes’ is 15 and 65.2%, and in ‘No’ is 8 and 34.8%. HCP wear a facemask (e.g., surgical mask) when placing a catheter or injecting material into the epidural or subdural space (e.g., during myelogram, epidural or spinal anesthesia). By the nurses of the Molvi Ameer Shah Memorial Hospital, the frequency and percentage of ‘Yes’ is 23 and 30.3%, and in ‘No’ is 53 and 69.7%. By the nurses of Sifat Ghayoor Hospital, the frequency and percentage of ‘Yes’ is 8 and 30.8%, and in ‘No’ is 18 and 69.2%. By the nurses of Services Hospital, the frequency and percentage of ‘Yes’ is 14 and 31.8%, and in ‘No’ is 30 and 68.2%. By the nurses of Naseerullah Khan Babar Hospital, the frequency and percentage of ‘Yes’ is 26 and 33.8%, and in ‘No’ is 51 and 66.2%. By the nurses of Government Mumtaz Maternity Hospital, the frequency and percentage of ‘Yes’ is 9 and 39.1%, and in ‘No’ is 14 and 60.9%.

6.4 Distribution of responses among Medical Staff: –

Total number of Medical Allied Staff is 234. Total 45 Questions were asked from the Medical Allied Staff of five secondary hospitals of Peshawar in which Molvi Ameer Shah Memorial Hospital Peshawar has 45 medical staff, Shifat Ghayoor Hospital Peshawar has 38 medical staff, Services Hospital has 45, Naseer Ullah Khan Babar Memorial Hospital has 66 medical staff and Government Mumtaz Maternity Hospital Hashtnagri Peshawar has 40 medical staff who participated in the survey. In Question 1 which is “New single-use, auto-disabling lancing device is used for each patient.” The frequency and percentage of Yes and No answered by the doctors of Molvi Ameer Shah Memorial Hospital, Peshawar are ‘Yes’ is 13 frequency and 28.9% and ‘No’ is 32 frequency and 71.1%, doctors of Sifat Ghayoor Hospital, Peshawar are ‘Yes’ is 12 frequency and 31.6% and ‘No’ is 26 frequency and 68.4% doctors of Services Hospital, Peshawar are ‘Yes’ is 23 frequency and 51.1% and ‘No’ is 22 frequency and 48.9%, doctors of Naseerullah Khan Babar Memorial Hospital Peshawar are ‘Yes’ is 19 frequency and 28.8% and ‘No’ is 47 frequency and 71.2%, doctors of Government Mumtaz Maternity Hospital, Hashtnagri Peshawar are ‘Yes’ is 18 frequency and 45% and ‘No’ is 22 frequency and 55%. In Questions 2 which is “If used for more than one patient, the point-of-care blood testing meter is cleaned and disinfected after every use according to manufacturer’s instructions” The frequency and percentage of Yes and No answered by the doctors of Molvi Ameer Shah Memorial Hospital, Peshawar are ‘Yes’ is 32 frequency and 71.1% and ‘No’ is 13 frequency and 28.9%, doctors of Sifat Ghayoor Hospital, Peshawar are ‘Yes’ is 27 frequency and 71.1% and ‘No’ is 11 frequency and 28.9% doctors of Services Hospital, Peshawar are ‘Yes’ is 34 frequency and 75.6% and ‘No’ is 11 frequency and 24.4%, doctors of Naseerullah Khan Babar Memorial Hospital Peshawar are ‘Yes’ is 46 frequency and 69.7% and ‘No’ is 20 frequency and 30.3%, doctors of Government Mumtaz Maternity Hospital, Hashtnagri Peshawar are ‘Yes’ is 26 frequency and 65% and ‘No’ is 14 frequency and 35%. In Question 3 which is “Supplies necessary for appropriate cleaning and disinfection procedures (e.g., EPA-registered disinfectants) are available” The frequency and percentage of Yes and No answered by the doctors of Molvi Ameer Shah Memorial Hospital, Peshawar are ‘Yes’ is 21 frequency and 46.7% and ‘No’ is 24 frequency and 53.3%, doctors of Sifat Ghayoor Hospital, Peshawar are ‘Yes’ is 13 frequency and 34.2% and ‘No’ is 25 frequency and 65.8% doctors of Services Hospital, Peshawar are ‘Yes’ is 21 frequency and 46.7% and ‘No’ is 24 frequency and 53.3%, doctors of Naseerullah Khan Babar Memorial Hospital Peshawar are ‘Yes’ is 31 frequency and 47% and ‘No’ is 35 frequency and 53%, doctors of Government Mumtaz Maternity Hospital, Hashtnagri Peshawar are ‘Yes’ is 24 frequency and 60% and ‘No’ is 16 frequency and 40% and so on up to final Question which is “The facility has a process to perform initial cleaning of devices (to prevent soiled materials from becoming dried onto devices) prior to transport to the off-site reprocessing facility” The frequency and percentage of Yes and No answered by the doctors of Molvi Ameer Shah Memorial Hospital, Peshawar are ‘Yes’ is 29 frequency and 64.4% and ‘No’ is 16 frequency and 35.6%, doctors of Sifat Ghayoor Hospital, Peshawar are ‘Yes’ is 23 frequency and 60.5% and ‘No’ is 15 frequency and 39.5% doctors of Services Hospital, Peshawar are ‘Yes’ is 30 frequency and 66.7% and ‘No’ is 15 frequency and 33.3%, doctors of Naseerullah Khan Babar Memorial Hospital Peshawar are ‘Yes’ is 39 frequency and 59.1% and ‘No’ is 27 frequency and 40.9%, doctors of Government Mumtaz Maternity Hospital, Hashtnagri Peshawar are ‘Yes’ is 24 frequency and 60% and ‘No’ is 16 frequency and 40%.

Chapter 7

Conclusion:

The finding of this study highlights each and every factor regarding hospital associated infection. The important data collected from five secondary hospitals of Peshawar KPK. According to this Research it is concluded that HAI is among the most dangerous infection. Its transmission rate is very high, 704 samples collected from five secondary hospitals of Peshawar KPK describes nature, frequency and other factors of this Infection. The precautions and cure of HAI is listed in this research. And other parameters are also unlighted and conclude. HAI rate is different in different countries but highest rate of HAI is recorded in developing countries. The countries which are developed are having less recorded rate. WHO played an important role for the detection and preventions of HAI with WHO many different polices worked and very useful results were found HAI is very lethal infection because it can easily penetrate into the body of its victim and starts its life cycle this infection can be easily transmitted from its victim’s body to the others. WHO (World Health Organization) and many other polices highlighted the HAI its precautions and cure all are listed in this research. This infection problem is almost faced by every country due to this WHO and many other polices stared their surveys in different year. Majority the last survey held was 2015. It was the most recent survey. These surveys concluded very useful information about HAV and its precaution some countries are following it while some of them are neglected it. Due to the survey held in 5 secondary health care hospitals highlighted the main points regarding HAV. How the rate of HAI is highlighted the main points regarding HAV. How the rate of HAI is high in Peshawar like other cities of Pakistan and how it can be controlled.

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