The practice of Standard Precautions During COVID-19 Pandemic among Professional Healthcare Workers

The Practice of Standard Precautions During COVID-19 Pandemic among Professional Healthcare Workers

Christabel Jumbo¹, Eunice. O Osuala¹, Basil. N Ogbu²*, John. E Anieche³

¹Department of Nursing Sciences, Faculty of Allied Health Sciences, PAMO University of Medical Sciences, Port Harcourt, River State, Nigeria.

²Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.

³Department of Nursing Science, Faculty of Health Science & Technology, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria.

*Corresponding Author

DOI: https://doi.org/10.51244/IJRSI.2025.12020079

Received: 10 September 2024; Accepted: 23 September 2024; Published: 19 March 2025

ABSTRACT

This study aimed to evaluate the adherence to standard precautions among healthcare professionals during the COVID-19 pandemic at Rivers State University Teaching Hospital, Port Harcourt, Nigeria. A descriptive cross-sectional survey was utilised with a sample size of 196. Data was collected through self-structured questionnaires and analysed using SPSS version 26 and Excel. The study found that most healthcare professionals implemented standard precaution measures during the pandemic. Doctors consistently practised hand hygiene (53, 100%) but only occasionally wore hand gloves. Most nurses adhered to hand hygiene and personal protective equipment (45, 70.3%), while the Medical laboratory scientists predominantly wore hand gloves (43, 100%). Healthcare professionals in COVID-19 centres consistently utilised personal protective equipment and hand gloves and adhered to safe injection practices.    Most study participants think that the most effective means of promoting compliance with standard precaution measures include ensuring the availability of personal protective equipment, organising conferences and seminars on standard precaution measures and making the guidelines accessible to all health professionals. They believe these measures would be more effective than penalising those who do not comply with standard precautions or making standard precautions obligatory.

Key recommendations include maintaining a consistent supply of personal protective equipment (PPE) and implementing a monitoring system to enhance healthcare professionals’ adherence to standard precautions. Regular training sessions, including workshops and continuing professional development, should reinforce infection prevention practices. Institutional policies should reward compliance rather than impose penalties. Guidelines should be easily accessible in multiple formats. A compliance monitoring framework with audits and feedback is essential, alongside encouraging professionals to report barriers to adherence. These steps will foster a safer environment for practitioners and patients alike.

Keywords: COVID-19, Pandemic, Practice of standard precaution, Professional healthcare workers.

INTRODUCTION

The Novel Coronavirus Infection emerged in December 2019 in Wuhan, China, igniting a global health crisis with rapid transmissibility and severe mortality rates (Tooba Masood, 2020). On January 30, 2020, the WHO classified COVID-19 as a public health emergency. By June 12, 2020, Nigeria reported 15,181 cases and 399 deaths, including frontline healthcare workers. The WHO (2020) identifies transmission modalities as direct, through respiratory droplets, and indirect via contact. Therefore, strict adherence to standard precautions is crucial for healthcare workers to reduce virus spread among staff and patients (Al-Faouri et al., 2021).

Standard precaution protocols are recommended in all clinical environments, regardless of patients’ presumed infection status. This principle protects against airborne, droplet, and contact-transmitted pathogens (WHO, 2020). Key components include thorough hand hygiene, the use of personal protective equipment (PPE), such as gloves, gowns, masks, and measures to prevent needlestick injuries. For COVID-19 management, these precautions aim to lessen infection transmission between healthcare workers and patients.

Research regarding the knowledge and adherence to SPs among healthcare workers (HCWs) in Rivers State, Nigeria, reveals concerning trends. A study at the University of Port Harcourt Teaching Hospital showed universal awareness of SPs; however, many participants held misconceptions, particularly about the safety of recapping needles (Mbenyi et al., 2023). At Madonna University Teaching Hospital, while nurses understood SPs, ongoing training initiatives are needed to boost compliance (Frank et al., 2024).

A national analysis found that over one-third of nurses lacked adequate knowledge of COVID-19, and about 25% exhibited poor adherence to SPs (Oyewumi et al., 2023). Alarmingly, under 50% of HCWs reported receiving specific training on COVID-19 and PPE usage, with only 20% having sufficient PPE access throughout the pandemic (Abubakar et al., 2022). These findings underscore the urgent need for targeted interventions, such as comprehensive training and resource provision, to improve HCWs’ implementation of standard precautions.

This study focuses on Rivers State University Teaching Hospital (RSUTH), targeting professional healthcare workers at heightened risk due to direct patient contact. Adherence to standard precautions is vital in mitigating virus transmission, as many healthcare workers have succumbed to COVID-19 while caring for patients. This necessitates evaluating and improving SP practices to protect caregivers and patients alike.

This research underscores the urgent need for compliance with standard precautions (SPs) to mitigate healthcare-associated infections, particularly in the COVID-19 pandemic. The findings indicate substantial deficiencies in adherence among healthcare professionals, thereby elevating the risks of disease transmission. The emergence of infectious diseases and the anticipation of future pandemics mandate unwavering compliance with SPs to safeguard both healthcare workers and patients. Moreover, challenges such as insufficient access to personal protective equipment (PPE) and inconsistent training underscore the pressing need for immediate policy reforms and judicious resource allocation. Addressing these challenges will enhance preparedness for future health crises and combat public health threats, including antimicrobial resistance.

METHODS

Research Design

The research design adopted in this study was the observational cross-sectional design, which allows for the analysis of present-day information on practices within the target population.

Area of Study

The study was conducted at the Rivers State University Teaching Hospital (RSUTH), Port-Harcourt, Nigeria, formally known as Braithwaite Memorial Specialist Hospital (BMSH).

Target Population

This research’s target population consists of 387 professional healthcare workers who worked at the Rivers State University Teaching Hospital between April 2023 and June 2023.

S/N	Professions	Number
1	Doctors	160
2	Medical Lab. Scientists	30
3	Nurses	182
4	Healthcare workers in COVID-19 Unit.	15

Table 1.0 Number of professional healthcare workers

Source: RSUTH Records and Statistics

Sample size

The sample size was determined using the Taro Yamane formula;

n = N/1+N*(e)2

Where;

n is the sample size =?

N is the population size =387

e is the level of significance = (0.05). is always constant

n=196

Sampling Technique

The research used a stratified random sampling technique, classifying respondents based on their profession into categories such as doctors, Medical Laboratory Scientists, Nurses, and those assigned to the COVID-19 unit. After the classification, participants were selected using simple random sampling.

Instrument for data collection

The research employed a self-structured questionnaire designed by the researchers. The questions were formulated based on the study’s objectives and administered to gather information on the practice of standard precautions among professional healthcare workers at Rivers State University Teaching Hospital during the COVID-19 pandemic.

Validity and Reliability of the Instrument

The instrument underwent validation by experts at the Department of Nursing, PAMO University of Medical Sciences in Port Harcourt, Rivers State, Nigeria. The reliability was determined using the test-retest method, resulting in a reliability value of 0.821.

Method of data collection and analysis

The researchers provided copies of the questionnaire to the respondents after obtaining their informed consent and explaining the purpose of the study. A total of 196 questionnaires were administered. The collected data were analysed using Statistical Package for Social Sciences (SPSS) version 26 and presented using descriptive statistics.

 Ethical consideration

Ethical clearance was obtained from the Ministry of Health in Rivers State, and informed consent was secured from all participants before data collection. The ethical approval form bears the approval number RSHMB/RSHREC/2023/0011.

RESULTS AND DISCUSSIONS

Out of 196 questionnaires disseminated, 194 were retrieved, yielding a response rate of 98.9%. Four incomplete questionnaires were excluded after a review, resulting in a data completeness rate of 96.9%. Therefore, 190 complete questionnaires (96.9%) were employed for the data analysis. The notable response rate of 98.9% and the data completeness rate of 96.9% signify robust participant engagement and the reliability of the data collected. After the exclusion of the four incomplete questionnaires, 190 complete responses were analysed, thereby ensuring the integrity and accuracy of the findings. This comprehensive dataset significantly enhances the validity of the study’s conclusions concerning the practice of standard precautions among healthcare professionals.

The socio-demographic profile of respondents is presented in the table below:

Table 2: Socio-Demographic Data of Respondents

Variable	frequency	percentages %
Gender
Male	53	27.9
Female	137	72.1
Total Age	190	100
20-30	11	5.8
31-40	144	75.8
41-50	35	18.4
Total	190	100
Marital status
Single	32	16.8
Married	158	83.2
Total	190	100
Educational level
BSC/HND	169	88.9
MSC/PGDE	21	11.1
Total	190	100
Profession
Doctor	53	27.9
Medical lab. Science	43	22.6
Nurse	64	33.7
Covid-19 workers	30	15.8
Total	190	100
Religion
Christian	179	94.2
Muslim	11	5.8
Total	190	100
Years of working experience
0-10	96	50.5
20-Nov	70	36.8
21-30	24	12.6
Total	190	100

Table 3: Practice of standard precaution measures among the Doctors.

S/N	TYPES         OF       STANDARD PRECAUTIONS	PRACTICE OF STANDARD PRECAUTION
		Always		sometimes		Most times		Neve r		Mean
		Number	%	Number	%	Number	%	Number	%
1	Hand gloves	42	79.2	11	20.8	–	–	–	–	1.21
2	Hand hygiene	53	100	–	–	–	–	–	–	1
3	Sharp safety	–	–	53	100	–	–	–	–	2
4	Safe injection practice	–	–	53	100	–	–	–	–	2
5	Sterilising       instruments     and	–	–	–	–	53	100	–	–	3
	devices
6	Personal protective equipment	11	20.8	–	–	42	79.2	–	–	2.58

The data from the table demonstrates that doctors consistently prioritised hand hygiene as the most common standard precaution, with 100% reporting that they always practiced it. However, the consistent use of personal protective equipment was notably low, with only 20.8% of doctors reporting consistent use. The results were incongruent with the study conducted among healthcare workers in India by Yashaswini et al. in 2023. The research indicated that doctors consistently employed Personal Protective Equipment (PPE) as the standard precautionary measure, with all study respondents demonstrating 100% adherence to this practice.

The discrepancy suggests potential contextual factors such as institutional policies, resource availability, or differing perceptions of risk that may influence compliance. These findings underscore the need for targeted interventions to improve PPE adherence, ensuring comprehensive standard precaution practices to enhance patient and healthcare worker safety.

Table 4: Practice of standard precaution measures among the Medical Laboratory Scientists.

S/N	TYPES         OF       STANDARD PRECAUTIONS	PRACTICE OF STANDARD PRECAUTION
		Always		sometimes		Most times		Neve r		Mean
		Number	%	Number	%	Number	%	Number	%
1	Hand gloves	43	100	–	–	–	–	–	–	1
2	Hand hygiene	22	51.2	21	48.8	–	–	–	–	1.49
3	Sharp safety	–	–	22	51.2	21	48.8	–	–	2.49
4	Safe injection practice	–	–	22	51.2	21	48.8	–	–	2.49
5	Sterilising       instruments     and	–	–	–	–	43	100	–	–	3
	devices
6	Personal protective equipment	21	48.8	–	–	22	51.2	–	–	2.02

The data in the table indicates that all medical laboratory scientists consistently wore hand gloves, with a compliance rate of 100%. In contrast, only 51.2% consistently adhered to hand hygiene practices during the COVID-19 pandemic. The observed disparity in hand hygiene adherence suggests potential gaps in training, institutional enforcement, or perceived risk associated with different precautionary measures. These results emphasise the need for targeted interventions to enhance compliance with hand hygiene practices, strengthening overall infection prevention strategies in laboratory settings.

Table 5: Practice of standard precaution measures among the Nurses.

S/N	TYPES         OF       STANDARD PRECAUTIONS	PRACTICE OF STANDARD PRECAUTION
		Always		sometimes		Most times		Neve r		Mean
		Number	%	Number	%	Number	%	Number	%
1	Hand gloves	40	62.5	24	37.5	–	–	–	–	1.38
2	Hand hygiene	45	70.3	19	29.7	–	–	–	–	1.3
3	Sharp safety	24	37.5	40	62.5	–	–	–	–	1.63
4	Safe injection practice	–	–	45	70.3	19	29.7	–	–	2.3
5	Sterilising       instruments     and	43	67.2	21	32.8	–	–	–	–	1.33
	devices
6	Personal protective equipment	19	29.7	–	–	45	70.3	–	–	2.41

The data in the table above indicate that hand hygiene was the participating nurses’ most frequently practised standard precaution measure. The compliance rate for always practising hand hygiene was 70.3%. While 70.3% of the respondents used personal protective equipment most of the time, only 29.7% reported always using it. The results suggest that although hand hygiene is widely practiced, targeted interventions are needed to improve the consistent use of PPE. Strengthening institutional policies, increasing training programs, and addressing potential barriers to PPE adherence may enhance compliance with standard precautions, ultimately improving infection control practices among nurses.

Table 6: Practice of standard precaution measures among the professional healthcare workers in the COVID-19 unit.

S/N	TYPES         OF       STANDARD PRECAUTIONS	PRACTICE OF STANDARD PRECAUTION
		Always		sometimes		Most times		Neve r		Mean
		Number	%	Number	%	Number	%	Number	%
1	Hand gloves	30	100	–	–	–	–	–	–	1
2	Hand hygiene	–	–	30	100	–	–	–	–	2
3	Sharp safety	19	63.3	11	36.7	–	–	–	–	1.37
4	Safe injection practice	30	100	–	–	–	–	–	–	1
5	Sterilising       instruments     and	–	–	19	63.3	11	36.7	–	–	2.37
	devices
6	Personal protective equipment	30	100	–	–	–	–	–	–	1

The data presented in the table indicates that all members of the COVID-19 unit consistently utilised personal protective equipment and hand gloves and adhered to safe injection practices. The high compliance rate among professional healthcare workers in the COVID-19 unit may be attributed to the heightened risk of contracting COVID-19 in this unit compared to other hospital areas.

These findings suggest that risk awareness significantly influences healthcare workers’ adherence to infection control measures. Future research should explore whether similar levels of compliance are maintained in other hospital departments with lower perceived risks and identify strategies to enhance adherence across all healthcare settings.

Table 7: Ways to improve the Practice of standard precaution measures among the professional healthcare workers in RSUTH.

S/N	ITEMS	A		SA		DA		SD
		NO	%	NO	%	NO	%	NO	%	MEAN	S.D
1	Guidelines on standard precaution practice should be accessible in the hospital	54	28.4	136	71.6	–	–	–	–	1.72	0.452
2	Provision of a committee to monitor                               standard precautions practices in the hospital	11	5.8	64	33.7	115	60.5	–	–	2.55	0.605
3	Organise a seminar on the need for the practice of standard precautions	169	88.9	21	11.1	–	–	–	–	1.11	0.314
4	Organise conferences on the need for the practice of standard precaution	145	76.3	45	23.7	–	–	–	–	1.24	0.426
5	Standard precautions should be mandatory	40	21.1	107	56.3	43	22.6	–	–	2.02	0.662
6	Adequate provision of PPE, sharp box, running water and sink	72	37.9	118	62.1	–	–	–	–	1.62	0.486
7	Penalize defaulters of the standard precaution practice	24	12.6	21	11.1	145	76.3	–	–	2.64	0.697
	SUBSCALE MEAN									1.84	0.52

The data presented in the table indicates that most study participants think that the most effective means of promoting compliance with standard precaution measures include ensuring the availability of personal protective equipment, sharp boxes, and running water. They also suggested organising conferences and seminars on standard precaution measures and making the guidelines accessible to all health professionals. They believe these measures would be more effective than penalising those who do not comply with standard precautions, establishing a committee to monitor compliance, or making standard precautions obligatory.

These results suggest that a supportive and resource-driven approach may be more conducive to enhancing compliance with infection prevention protocols than regulatory enforcement alone. Future research and policy considerations should address resource gaps and strengthen educational programs to foster a culture of adherence to standard precautionary measures in healthcare settings.

CONCLUSION AND RECOMMENDATIONS

This research investigated the adherence to standard precautionary practices among healthcare professionals at Rivers State University Teaching Hospital in Port Harcourt, Nigeria. The findings revealed that none of the healthcare professional groups consistently followed all standard precaution measures. As a result, it is recommended that comprehensive written guidelines on standard precaution measures be distributed across all hospital units, regular seminars and conferences on standard precaution measures be conducted for all healthcare professionals, and that the hospital ensures an adequate supply of personal protective equipment and running water.

Conflict of Interest

The authors of this study affirm that they have no financial, personal, or other relationships that could unduly influence the research. The research was conducted independently, and all findings and conclusions are solely based on the collected and analysed data. Any opinions, recommendations, or conclusions expressed in the publication belong to the authors and may not necessarily reflect the views of the institutions involved.

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