Evaluation of Nurses' Practices toward Some Sterilization Techniques at Emergency Department in Al-Diwaniya Teaching Hospital

: Background: Sterilization techniques are types of healthcare's many effective and relevant clinical competencies. It is a group of methods used to prevent contamination with microorganisms and, carefully applied under special conditions to reduce infection. The sterilization technique's terminology is frequently inconsistent, used inter changeably, misleading and without facts, all of which seems to have contributed to variability in application, insufficient risk management and unregulated realistic standards. It requires a series of steps to deter infection designed at shielding patients from diseases related to the spread of pathogenic microorganisms. One of the most important roles of nurses is infection control and prevention. Among the important measures that may reduce infection or complications of infection are patient education, use of personal protective equipment and hand hygiene and other invasive equipment. In hospitals, all nurses are responsible for the safety of patients and keeping hospitals clean and sterile from infection, although there are some nurses called infection control nurses.


INTRODUCTION
Sterilization techniques are a series of guidelines intended to avoid or reduce the exposure of hospital personnel, patients and their guests to infectious agents, is the most effective and easiest way to prevent infection in the hospital. Normal precautions assume that both patients' blood and body fluids are possible vectors of contamination, independent of diagnosis or alleged contagious status. HCW shows variable awareness, behavior and implementation of standard precautions based on their professional community and length of professional experience, along with much other sterilization, as that have indicated by many studies. Application of standard precautions by health care providers has increased with longer career practice, common precautionary awareness and preparation, and highly risky identification (1) .
In order to save HCWs, these steps are prepared and forbid the prevalence of infections among patients. The components of standard precautions includes "hands hygiene; use PPE (e.g., gloves, gowns, face masks); breathing hygiene and cough etiquette; safe injection practices; medical waste management; and cleanings, .disinfection, and sterilization of devices and tools". Infection prevention measures suggest the lower protective measures that, in every case of suspected or actual situations of disease, categories each client at any location that health care has been given (2) .
Nosocomial infection, also referred to as hospital-acquired infection, is caused by viruses, fungi, parasites, and bacteria present on medical equipment and instruments used in the care of patients, or in the air or surfaces, etc. This infection affects particular parts of the body, or is systemic, and its effects occur 48 hours after exposure, and are therefore especially severe for patients with autoimmune disease and for the aging. One of the most important problems caused by hospital infection is the length of staying in the hospital and financial problems, and it may lead to death, so it affects the health services provided to patients (3) .
Health care centers are among the most common places for infection among health care providers and patients, as microorganisms cause infection and invade the body, and then their signs and symptoms appear. The infection causes simple diseases that do not significantly affect the body and end within a short period, while others expose the body to a great risk that may reach death and often the infection is a disease that does not last long. Failure to properly eliminate pathogens by a health care professional and non-compliance lead to serious complications for the safety and health of patients (4) .
The Emergency Department (ED) is the place where patients are first exposed to the hospital's special infectious environment, and this is because of being primary entrance for patients admitted to the hospital. As the ED has specific obstacles to patient safety, involving crowding, the urgency of treatment, staff shortages, and lengthy delays in moving patients to the ICU and other facilities, the introduction of infection control measures in the ED is likely to face particular challenges. In addition, improving hand hygiene and complying with proper requirements for the application of a urinary catheter may not be initiated in a hectic situation relative to the essential health care needs of the patient requiring emergency care. However, in western European EDs no published studies on infection prevention are available to date (5) .
The emergency department nurses are working to limit the transmission of infection and prevent harmful risks by supplying patients with health and curative care. In addition to research undertaken to improve the practical procedures of nurses, adopting protective strategies and prevention steps such as hand washing and other precautionary steps properly contribute to infection management (6) .
Scientific literature shows that a clear correlation between failure compliance by healthcare workers with sterilization techniques and the spread of pathogens. Poor compliance with the recommended recommendations for healthcare staff is to monitor the transmission of diseases, especially that happens during the execution of surgical operations and leads patients to increase infected by pathogens, when the health-care staff refuse to follow aseptic protocols. Averages of 8.7 percent of patients have hospital infections, according to a study by the world health organization in 55 hospitals in 14 countries. Globally, the risks posed by hospital infections affect nearly 1.4 million (7) .

AIMS OF THE STUDY
To evaluating of nursesꞌ practices toward Some Sterilization Techniques at the Emergency Department.

METHODOLOGY
Quantitative design (a descriptive study) has been carried out as a choice to specific phenomena of interest related to evaluate nurses' practices regarding sterilization techniques at Emergency Department in Al-Diwaniya Teaching Hospital. The period of the study started from (17th September, 2020) to (16th March, 2021). A nonprobability (purposive) sample was selected to obtain representative and accurate data. The total number of nurses participating in the study were (30) nurses from the Emergency Department in Al-Diwaniya Teaching Hospital.
-Study instrument: The instrument for this study, including two parts, first consists of (6) paragraphs: age, gender, educational level, years of experience in nursing, years of experience in the Emergency Department, number of training courses on infection control and the date of the last course. The second part consists from 8 domains which include: hand washing, gloves, gown, mask, instruments and equipment, peripheral venous catheter (PVC), intravenous IV fluids and medication, and medical waste management. The content validity of the instrument has been established by evaluation of the observational checklist a panel of (11) experts, who had more than 10 years of professional experience in their fields, to visibility and competence the observational checklist about sterilization techniques.   Table (2) shows that the overall evaluation of the nurses' practices to main domains of sterilization techniques were fair practices in ratio (100%), except for domains (hand washing, gloves, and peripheral venous catheter) were the ratio (96.7%, 66.7%, 93.3%) respectively, and (3.3%, 33.3%, 6.7%) respectively, were poor practices.  Table (3) shows that the overall nurses' practices are related to main domains of sterilization techniques. The study result indicates that the overall evaluation of nurses' practices to main domains of sterilization techniques were fair practices at mean score (1.53).

DISCUSSION:
-Part I: Discussion of the Nursing Staffs' Demographic Characteristics of the Study Sample, as Shown in Table (1

):
The results of this study showed that the majority of nurses' age percentage in this study between 20 to 29 years is (56.6%). These results are consistent with (Desta et al., 2018), which show in their study that the participants age ratio between 24 to 30 is (52%) (8) .
According to the results of this study that indicates to more than half of the nursing staff are males in ratio 63.3% and 36.6% of females. These results agree with (Faris & Hassan, 2016), which found in their study that most of the sample's gender of males (9) .
Regarding the level of education, the results of this study found that 53.3% of the participants graduated from the college of nursing and 26.6% have diploma degree. These findings supported by (Ghorbani et al., 2016), which found that most participants were graduated from the college of nursing (60%) (10) .
According to the number years of experience in nursing field, the results of this study found that most nurses have 1 to 5 years of experience in ratio (53.3%). These finding agree with (Eskander et al., 2013) (11) , which indicates that percentage of the nursing staff (55.6 %) that had years of experience from (1 -5). While found the results of this study that 66.6% of nurses had from 1 to 5 years of experience in Emergency Department. This results agree with those by (Kilic et al., 2016), that found the majority of nurses had 1 to 5 years of experience in Emergency Department (12) .
The study findings according to the training sessions about practices of control infection shows that all samples in this study have no training courses about infection control measures. These results supported with those by (Attia et al., 2016), which indicates that all nurses did not participate in training courses in this field (13) .

-Part II: Discussion of the Overall Evaluation of Nurses' Practices Regarding
Sterilization Techniques, as Show in Tables (2and 3): The study findings shows that the overall evaluation of the nurses' practices to main domains of sterilization techniques were fair practices in ratio (100%), except for domains (hand washing, gloves, and peripheral venous catheter) were the ratio (96.7%, 66.7%, 93.3%) respectively, and (3.3%, 33.3%, 6.7%) respectively, were poor practices as show in table (2).
These results are agree with those by (Vinodhini, 2016), who evaluate infection control practices among health care workers in a specialty hospital, who found that more than half of the study sample were poor practices related to infection control measures (14) .
The study results indicate that overall nurses' practices related to main domains of sterilization techniques. The study result show that overall evaluation of nurses' practices to main domains of sterilization techniques were fair practices at mean score (1.53) as show in table (3).
These findings are along with studies performed by (Abdulhassan & Ali, 2020), who hand hygiene practices and infection control measures among emergency units health care providers, which found that the practices of healthcare workers recorded poor levels related to infection control measures (15) .
Nursing staffs at emergency department in AL-Diwaniyah Teaching Hospital had no available written protocols or resources of information to update their knowledge, and enhance their practices about appropriate application of sterilization techniques. And also, lack of personal protective equipment such as gloves, mask and others, in addition to the absence of continuous monitoring and evaluation necessary to maintain the correct practices: increasing the workload to receive patients infected with Coronavirus and other emergency cases, and on the other hand, the lack of nursing staff in the emergency department. However, that may explain the primary study results.

CONCLUSIONS
The researcher concluded that the nurses' practices were not at the level required (poor) to fit with the critical and special nature of Emergency Department. The nursing staff at the Emergency Department in Al -Diwaniyah Teaching Hospital had no available written protocols or resources of information update to improve their practices about sterilization techniques (Hand Washing, Personal protective equipment, Instrument and Equipment, Peripheral Venous Catheter, Intravenous Infusion and Medication, Medical Waste Management).