Assessment of Nurse's Knowledge about Nosocomial Infection at Hospitals in Baghdad City

Objective: To assess nurse’s knowledge about nosocomial infection at hospital in Baghdad city. Methodology: A descriptive study was carried out at hospitals in the city of Baghdad and included (Baghdad teaching hospital, Gazi al-hariri hospital, Al-karama hospital, Al-yarmok hospital, and al-kadhmia hospital). Starting from 5 of August 2012 to 20 of February 2013. A non-probability (purposive) sample of 100 nurses who worked in hospitals in the city of Baghdad. The questionnaires was designed and constructed by the researcher according to review of literature and related study. The content validity of the instrument was established through penal of 14 experts. Reliability of the Instrument was determined by test-retest method which was estimated as average (r=0.802). Data was gathered by interview technique using the questionnaire format and data was analyzed by application of descriptive and inferential statistical methods. Results: The majority of nurses was male, with age group 30-39 years old, nursing institute graduated, the majority of nurses have less than 5 years of employment in the hospital and low number of training course about nosocomial infection. The result indicated that most of the nurses (69%) have poor knowledge toward NI. There is significance relationship at P <0.05 between nurse's educational level and their knowledge toward NI. There is no significance relationship at P >0.05 between nurse's (age, gender, years of employment in the hospital, and training course of nosocomial infection) and nurse's knowledge toward NI. Conclusion: The study concluded that the nurses not have appropriate knowledge toward nosocomail infection Recommendations: The training course is necessary to increase nurses’ knowledge toward nosocomial infection. This training course should be regularly done and updated in view of changing knowledge and practices

Therefore, knowledge about the frequency and distribution of NI is important to improve infection control measures as well as to develop effective preventive and curative strategies which, in turn, will help us in decreasing incidence, morbidity and mortality (2) .Nosocomial infection (NI) referrers to as a hospital acquired infections (HAI) or simply hospital infections are infections occurring during staying 48 hours or longer, which resulted in the use of the 48 hour criterion in several epidemiological surveillance system (3) .
NI an important health problem throughout the world and affects both developed and developing countries, it results in high morbidity and mortality, greater use of antibiotics, prolonged stays in the hospital and consequently increases hospital costs.An effective knowledge about infection prevention can reduce the rate of NI and its consequence (4) .
Nosocomial infection continues to be burden to the world health care system through increased risk to patient and employees.These infections have tremendous health and financial costs with an estimate incidence of 2,000,000 infection per year, 20.000 death per year and added costs of billion dollars per year.Effective infection control program are essential to controlling and preventing Nosocomial infection (5) .

Objective:
To assess nurse's knowledge about nosocomial infection at hospital in Baghdad city.

METHODOLOGY:
Quantitative design a descriptive study was conducted on female and male nurses who work in at hospitals in the city of Baghdad and included (Baghdad teaching hospital, Gazi alhariri hospital, Al-karama hospital, Al-yarmok hospital, and al-kadhmia hospital).Starting from 5 of August 2012 to 20 of February 2013.
A non-probability (purposive) sample of 100 nurses were selected from (28 nurses from Baghdad teaching hospital, 19 nurses from Gazi al-hariri hospital, 10 nurses from Al-karama hospital, 28 nurses from Al-yarmok hospital, and 15 nurses from al-kadhmia hospital) who were accepted to be involved in the study.
The content validity of the instrument was established through penal of ( 14) experts.Reliability of the problems scale was determined by test-retest method which was estimated as average (r=0.802).
Data was gathered by interview technique using the questionnaire format and data was analyzed by application of descriptive and inferential statistical methods.This table indicates that the observed frequencies, percents and cumulative percents of demographical characteristics variables in the sample which age group (30-39) (42%).More than half of the subjects are males (70%).(45%) of sample was nursing institute in educational level.About years of employment in the hospital (1-5) (43%) and about training course of nosocomial infection (1-5) was larger group (55%) in the sample.

DISCUSSION:
Throughout the course of data analysis table number (1) indicates that the majority of the samples were (30-39) years old who were a counted (42%).This finding comes along with result obtained from study done by (Motamed, et al., 2006) which indicated that majority of the nurse's age were (30-40) years old (6) .
In relation to gender, most of nurses in this study (70%) were male.This result is compatible with (Abdollahi, et al., 2003) which indicated that (67.7%) of nurses in their study was male (7) .
Relative to educational level (45%) of nurses was nursing institute.This finding agrees with results obtain from study done by (Abdollahi, et al., 2003) which indicated that the majority of the nurses in their study was nursing institute (7) .
Regarding years of employment of nurses in the hospital, about half of nurses (43%) have less than 5 years of employment in the hospital.This result is compatible with (Taheri  and Jokar, 2007) which indicated that most of sample has less than 5 years of employment in the hospital (8) .
In relation to training course about NI, more than half of nurses (55%) take (1 -5) training course.This result is incompatible with (Janjua, et al., 2007) which indicated that most of nurses take more than 5 training course about NI (9) .
Throughout the course of data analysis table number (2) indicates that the majority of the samples (69%) have poor knowledge toward nosocomial infection.This finding comes along with result obtained from study done by (Ghadamgahi, et al., 2011; and Taneja, et al.,  2009) which indicated that majority of the nurses (67.9% and 68.3% respectively) have poor knowledge toward nosocomial infection (10,11) .
In this study the results in table (3) reflect that there is no relation between nurse's age and their knowledge toward NI.This result may be related to inadequate training to the nurses about NI.This result is incompatible with (Motamed, et al., 2006) which indicated that there is relation between nurse's age and nurse's knowledge about NI (6) .

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Regarding gender, there is no relation at p>0.05 between nurse's gender and their knowledge toward NI.This result agrees with the results obtained from study done by (Harbarth, et al., 2009) which they found that there are no relationship between nurse's gender and their knowledge toward NI, and disagrees with the results obtained from study done by (Motamed, et al., 2006) which they found that females were more knowledgeable than males toward NI (12,6) .
Relative to educational level there is significant association at P <0.05 between nurse's educational level and their knowledge toward NI.When the nurses increased their level of education, their knowledge increased too.This finding agrees with results obtain from other studies done by (Cardo, et al., 2010) which indicated that there are good relation between nurse's educational level and their knowledge toward NI (13) .
Concerning years of employment of nurse in the hospital there is no relation at P >0.05 between nurse's years of employment and their knowledge toward NI.This result may be related to educational level of nurses or inadequate training during these years to the nurses about NI.This result is incompatible with (Taheri and Jokar, 2007) which indicated that there was positive relation between the knowledge and the years of employment as a nurse in to increasing their knowledge (8) .
In relation to training course, the findings showed that there is no significant association at P>0.05 between the nurse's training courses about NI and their knowledge toward NI.This result may be due to the facts that the nurses who have not the educational courses about NI, or they have training course 5 years ago, or the curriculum in that course has not been implemented effectively.This finding agrees with results obtain from other studies done by (Adra`a, 2008) which indicated that there are no significant relation between the nurse's training courses about NI and their knowledge about NI.This finding disagrees with results obtain from other studies done by (Ghadamgahi, et al., 2011) which indicated that there was good relation between nurse's knowledge and training course about NI (14,10) .

CONCLUSION:
According to the present study findings, the researcher can conclude the following: 1.The majority of nurses have less than 5 years of employment in the hospital.2. Most of the nurses have less than 5 training course of nosocomial infection.3. Nurses do not have adequate and appropriate knowledge about nosocomial infection.4.There is significance relationship at P<0.05 between nurse's educational level and their knowledge toward NI. 5.There is no significance relationship at P>0.05 between nurse's (age, gender, years of employment in the hospital, and training course of nosocomial infection) and nurse's knowledge toward NI.

RECOMMENDATIONS:
According to the results of the study, the researcher recommends to: 1. Training course is necessary to increase nurses' knowledge toward nosocomial infection.

2.
Training course should be regularly done and updated in view of changing knowledge and practices.

Table 3 : Association between the Nurse's Demographical Data and their Knowledge Nurse's Demographical Data Contingency Coefficient
This table shows that there are no significant correlation at P >0.05 between (age groups, gender, Years of employment in the hospital, and Training course about hospital acquired infection), and nurse's knowledge about nosocomial infection, which there are significant correlation at P <0.05 between nurse's educational level and their knowledge toward nosocomial infection.