Precautions used by occupational health nursing students during clinical placements

Kev words Universal precautions, high risk pa­ tients, micro-organisms, human immu­ nodeficiency virus, occupational health nursing students. Abstract: Curationis 32(1): 14-19 Protection of health care workers including students from being infected when caring for high risk patients is a major cause for concern to all promoting occupational health. Safety of every employee is mandatory. Furthermore, universal guidelines for precautions must be used by all interacting with high risk patients and clients to protect themselves and prevent the spread of infection.

The aim of this paper was to ascertain the availability o f universal guidelines for precautions against the spread o f infection in clinical settings and determine the precautions used by OHN students during their clinical placements.To realise these objectives, a quantitative and descriptive design was followed.A purposive sam pling method was used to select 45 Occupational health nursing students who par ticipated in the study.
Data was collected with the use of a structured questionnaire and the results re vealed that: most units where OHN students were placed for clinical experience had guidelines for universal precautions although these were not always accessible to them; regarding compliance to universal precautions, OHN students were reportedly aware o f the hazards o f failure to comply although in some emergencies and where personal protective material was not available, they had to provide care without using protective equipments.Recommendations made include that employers and staff at all occupational settings must ensure that updated guidelines for universal precautions are available and accessible to every body interacting with high risk patients; health care providers and students must be fully informed about and should always adhere to universal precautions.

Introduction
Health care providers exposed to high risk patients, blood and bloody fluids are particularly vulnerable to the threat of being infected with blood borne vi ruses and human immunodeficiency virus (HIV), hepatitis B and hepatitis C if universal precautions are not adhered to consistently whilst caring for these patients.These emerging infectious diseases have generated anxieties, fears and challenges to health care pro viders including students who may be exposed to high risk patients during clinical training.As part of their daily interventions, health care providers handle needles, syringes, sharps and have to administer injections to pa tients suffering from different types of ailments.Safe practices in handling in jections are crucial to prevent acciden tal needle pricks which may result in infecting self or other patients.Esti mates are that annually, unsafe injec tions account for a proportion of (39%) new hepatitis B and (40%) hepatitis C infections and (5%) new HIV infections (WHO, 2003).
Employers and staff responsible for clinical settings must be fully informed about universal precautions to be taken by all interacting with patients and cli ents/employees to ensure safe and con ducive environments for working and learning.In terms of the Occupational Health and Safety Act 85 of 1993, "every employer shall provide and maintain a working environment that is safe and without risks to the health of employ ees" (South Africa, 1993:12).Most em ployers regard hazards and risks to health as relating to safety, noise, chemicals, heat and dust and do not often identify risks caused by infec tions.
In the 1980s, the Centres for Disease Control and Prevention (CDC), USA, published guidelines urging the use of "universal p recau tio n s" based on amongst others, that health care work ers could not promptly identify most patients infected with contagious dis eases at initial presentation and there fore do not take precautions when pro viding care to patients (CDC, 2001:6).In South Africa, it has been estimated that 5.54 million people have been in fected with HIV, while almost 50% of all deaths are attributed to HIV/AIDS (Sta tistics South Africa, 2007: 12).Preven tion of HIV and AIDS is therefore the first priority area as reflected in the HI V/ AIDS and STD Strategic Plan for South Africa 2002-2005(National Department of Health, 2000:15).Health care provid ers are also urged to comply with the safety rules embedded in universal pre cautions at all times when caring for high risk patients.
Students enrolled for Occupational health nursing are expected to have practical exposure in occupational set tings suitable for creating learning op portunities, in addition to the theory offered in the classroom.The purpose of creating learning opportunities is to prepare the student to function effec tively in this speciality and to be skilled in ethical decision making and moral reasoning by the end of the programme (South African Nursing Council, 1993: 23).It has been argued that nursing is a practice discipline and the importance of clinical learning cannot be over em phasized.Research indicates that clini cal learning provides opportunities to apply theory to practice and foster problem-solving and decision-making skills, collaboration with others and development o f legal and ethical mor als (Chabeli, 1999: 22;Maja, Van Niekerk & Van Dyk, 1997:2;Masarweh, 1999:44).

Problem Statement
Emerging infectious diseases such as blood borne viruses and human immu nodeficiency virus (HIV) in recent years have created new challenges for all health care providers, including stu dents who may be interacting with in fected patients and clients during their clinical exposure.Microbes transmitted by airborne, droplet or contact routes often generate anxieties and fears of being infected among OHN students, particularly when placed in units hav ing high risk patients/clients.All pa tients need quality care and equal treat ment from health care providers, includ ing students.In line with their require ments for training, OHN students must be exposed to relevant occupational settings for practical experience so as to be competent by the time they com plete their studies.The concern, how ever, is that during their placement in occupational settings, OHN students are also exposed to the risk o f being infccted if universal precautions are not complied with when interacting with high risk patients.No studies were found that explored precautions used by students exposed to high risk pa tients during clinical placements.

Operational definitions
The following terms are used to con vey the meanings of the main concepts in this paper: • Infection Infection refers to the transfer of dis ease causing organisms from one per son to another or inanimate objects, or orthopod vector to a human being (Zulu & Chalandra, 2001:46).

*
High risk patients In this study, high risk patients or cli ents refer to those infected with HIV, hepatitis B, and hepatitis C and other related infectious diseases.

■
Occupational health nursing student An Occupational health nursing stu dent is a registered nurse who is en rolled to advance studies in Occupa tional Health Nursing at a tertiary edu cation institution.

*
Occupational settings For the purpose of this study, occupa tional settings refer to industries, hos pital wards or units, clinics/health care centres and any other work setting.Occupational settings may be used for clinical teaching and learning.

•
Clinical practica Clinical practica involves clinical learn ing opportunities in health care settings under the supervision o f the registered nurse or registered midwife, and where appropriate, other knowledgeable and skilled persons (South African Nurs ing Council, 1994:5) Purpose and Objectives

of the study
The purpose o f this study was to de termine the availability of guidelines for universal precautions used in occupa tional heath settings and describe pre cautionary measures used by OHN stu dents in protecting them selves and other patients against being infected.
The following objectives were set to achieve the purpose of the study:

Methods
The

Data Collection
The study employed a structured ques tionnaire with closed and open ended questions for data collection.The in strument included a section on demo graphic data and questions which fo cused on availability o f guidelines for universal precautions, preventative measures used by OHN students dur ing their placement in selected clinical settings and compliance with univer sal precautions.The researchers dis tributed the questionnaires to eligible participants and these were collected after completion.

Validity and reliability
An expert in the field o f occupational health nursing assessed the question naire for content validity and recom mended that additional qualifications should be added in the biographic data of participants.These were included in the questionnaire and content validity was further enhanced by including a variety of questions based on informa tion gathered during literature review.
A pilot study was conducted with five OHN students who met the set criteria to pre-test the reliability of the research instrument.No flaws were detected as all participants interpreted questions as anticipated and the results tallied with the final findings of the study.

Data Analysis
Quantitative data was analysed using SPSS version 11.5 and Microsoft Ex cel.Descriptive and inferential statis tics were employed to describe the find ings.
The responses to open-ended questions were analysed by the re searcher through content analysis.

Biographic data
Forty five OHN students participated in the study.Their ages ranged from 30 to 45 years with a mean age of 38 years.
All were registered nurses mostly hav ing additional qualifications such as Diploma Operating Theatre, Paediatric Nursing, Advanced Community and Psychiatric Nursing.Participants were allocated to wards/units for clinical ex perience during their training as re flected in Table 1.

Availability of universal guidelines for precautions
As reflected in Table 2, most partici pants 35 (77,7%) acknowledged that the units where they were placed for occupational clinical experience had guidelines for universal precautions against occupational infections, 7 (22,2%) participants reported that the units where they were allocated did not have the guidelines and 3(6,6%) were unsure.O f those who reported that the units had guidelines, 28 (62,2%) added that these were mainly kept in the sister-in-charge's room and were not al ways accessible when needed.Al though staff in units where guidelines were accessible should be commended, it is important that these guidelines must always be made available to all health care providers interacting with patients.Having these universal pre cautions guidelines available and ac cessible to all, will allow health care providers, including students to refer and clarify issues without depending

Limitations of the study
The study sample.comprisedOHN stu dents from only one tertiary institution in Gauteng province.Although occu pational clinical settings selected were also used by students from other insti tutions, these findings may not be gen eralized to other tertiary education in stitutions due to the small sample size n=45 used for this study.

Conclusion and recommendations
The results revealed that OHN stu dents had information about preven tion o f health risks and had evidently applied this theory in clinical settings during their placements.Guidelines for universal precautions were reportedly available in most units, although OHN students reported inaccessibility o f these in some units.In units where PPEs were not available when needed, OHN students had to risk interacting with patients and clients without pro tection.