key: cord-0880107-l6emdimm authors: Ankita, Banerjee; Ipsa, Mohapatra title: First year medical students' and standard precautions: The need for change date: 2020-09-18 journal: Clin Epidemiol Glob Health DOI: 10.1016/j.cegh.2020.09.002 sha: bebc6629a7974b1a644881813b6a6880b0126337 doc_id: 880107 cord_uid: l6emdimm BACKGROUND: Standard Precaution (SPs) practices protect health-care workers prevent hospital-acquired infections. With Competency Based Medical Education (CBME) and early clinical exposure (ECE) implemented in the new curriculum, the first year medical students need to be aware of SPs, so as to protect themselves and the patients from these hazards. AIMS & OBJECTIVE: To assess the knowledge of standard precautions among the medical students and find out association of knowledge with selected demographic variables. METHODS AND MATERIAL: This cross-sectional study was done among first year medical undergraduate students of a medical college.Data was collected through google form with researcher-made questionnaire including questions on knowledge about SPs and socio-demographic variables of the study participant and their parents. RESULTS: Response rate was 97.9%. Mean age of the participants was 19.13 ± 0.858 years; 57.7% were girls.Although 80.3% had heard of SPs but as high as 83.1% were of the opinion that “SPs were only for protection of the health-care team”, 23.2% felt that it should “only be used in patients diagnosed with infection”. 96.5% knew that “hand hygiene should be performed while providing care to patients”, 97.2% had knowledge about respiratory and cough hygiene practices, 14.1% of them felt that “PPE can be shared”. 57% of the respondents answered that “needle should be recapped after giving injections”. CONCLUSIONS: Students in early clinical years were found to have a varied level of knowledge of SPs and a lot of gaps in correct understanding of required facts. Continued medical education and skill-assessment to test their knowledge, must be incorporated into their teaching curriculum before ECE, so as to minimize the risk of preventable infections. As defined by CDC,Standard Precautions(SPs) are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. SPs practices include -hand hygiene,use of personal protective equipment(PPE), respiratory hygiene,sharps safety,safe injection practices,sterile instruments and devices,clean and disinfected environmental surfaces. (1) Hand hygiene is a major component of SPs and is one of the most effective methods to prevent transmission of Hospital Acquired Infections(HAIs). In addition to practices carried out by health-care workers(HCWs) , all individuals (including patients and visitors) should comply with infection control practices to control spread of pathogens from the source. (2) Among source control measures, cough etiquette/respiratory hygiene,is now gaining importance amidst the current evolving pandemic of COVID-19. (12) Some of the main sources of exposure to HCWs are needle-stick injury,touching own eyes, nose, mouth, or open skin after touching or handling contaminated materials,droplet infection. (3) Compliance and adherence to SPs practices protect HCWs including medical students from percutaneous injuries and prevent HAIs. Limited exposure of the medical undergraduates in performing invasive procedures in early clinical years, particularly puts in higher risk of acquiring noscomial infections. (4) Competency based Medical Education(CBME)is an approach to ensure that the graduates develop the competencies required to fulfill the patients' needs in the society and emphasize more on skill based learning. It de-emphasizes time-based training and promises greater accountability, flexibility, and learner-centeredness. (5) Text J o u r n a l P r e -p r o o f With CBME and early clinical exposure (ECE) in the new curriculum, the first-year medical students need to be aware of SPs, so as to protect themselves and the patients from these hazard before they are exposed to the clinical wards. Assessing knowledge of the medical undergraduates towards SPs will help in bringing in reforms and measures necessary to develop better knowledge,compliance,skill and clinical acumen in students later on during real clinical practice (4) help prevent HAIs by them. SPs has been researched in varied Health Care Provider(HCP) groups, but is not much researched yet in medical students. Keeping this in view and the need due to ECE with CBME in the new curriculum, this study was taken up with the following objectives: o u r n a l P r e -p r o o f study will take around 20-30 minutes. All the answers and your identity will be confidential and used for research purpose only.Your participation in the study is voluntary.With the filling of the study questionnaire,we understand that you are providing consent to participate" was added in the google form prior to answering the questionnaire) Exclusion criteria: Students absent on the date of data collection. All 150 students were invited to participate in the study, but on the day of data collection ,5 students were absent and 3 students out of the 145 students who were present ,submitted incomplete-questionnaire(google form), hence were excluded from the study, making a final sample size of 142. Google form with semi structured, pre-designed, pretested researcher-made self-administered questionnaire developed after a through review of literature on SPs (1) (2) (3) 6) including 18 questions on knowledge about SPs containing closed ended questions(with options yes/no);the questions had the following sections: 1. Socio-demographic details of the participants and their parents education and occupation was considered. For education and occupation we used modified kuppuswamy scale.For data analysis, parental occupation was categorised as medical professional and non medical professional,where we found that those categorised as medical professional were all doctors. With regard to the knowledge about SPs among students, association was established with parental education and occupation (table 3). Children of medical professionals and those whose parents who had higher education (post-graduation and above),were found to have better knowledge regarding SPs as compared to their counterparts; this difference was not found to be statistically significant. This study was done among 142 first year medical undergraduate students of a private medical college to assess their knowledge on standard precautions. The mean age of the students was 19.13+0.858 years, majority were Hindus and all belonged to upper class (according to modified Kuppuswami classification 2019). 16.2% of the fathers and 7.1% of the mothers were medical professionals. In this study,80.3% had answered that they had heard about SPs as compared to 53.5% medical students had heard about it in a study done by N.Motamed et al. (7) and 33.6% medical students in clinical years had heard as shown in a study by Karim et al in Kuwait university. (8) Whereas study done by Solanki, et.al among nursing staff ,showed 100% of participants had heard before. (9) This difference can be due to the earlier exposure of the nursing students as compared to medical students to real clinical practice. In the present study,16.9% knew SPs not only protects the health care team but also protects the patients as well.76.8% students answered that SPs measures should be adopted regardless of the infection status of patients as compared to 90.9% medical students agreed to the same fact in the study done by N.Motamed et al. (7) .The overall knowledge for SPs in the study participants were good in the domains of hand hygiene, respiratory hygiene, sharp management, personal protective equipment as compared to the results shown in the study done in Saudi University (4) in the year 2013.Knowledge on hand hygiene practices amongst the medical students was good as 96.5% knew hand hygiene to be performed while providing care to patients and 95.1% agreed they should wash hands immediately after contact with potentially contaminated fluid or material whereas while conducting a comparative evaluation of the level of knowledge and practice among nursing and medical students by Garcia Zapata et al in Brazil their study ascertained that 100% of the nursing student and 91% of the medical students knew that their hands had to be washed before and after patient care. However,compliance in practice was noted in 26.9% of the nursing students and 2.6% of the medical students. (10) .With CBME and ECE, medical students also need to have practice and training sessions to develop appropriate skills along with knowledge. Correct knowledge regarding handling and disposal of needle sticks and other sharp objects among medical J o u r n a l P r e -p r o o f students was found to be 57% compared to 42.3% in the study by Garcia Zapata et al (10) . Only 69.8% of the study participants responded that goggles/face shield are to be used as PPE while handling contaminated materials/patients along with gloves,apron and caps,which showed inadequate knowledge among students. No statistical significant difference was found amongst association of parental education and occupation with knowledge of SPs among students ,but findings showed children of parents with higher educational background and children of medical professionals had better residual knowledge,which might be due to better knowledge regarding basic hygiene practices and also complying to those practices in the home environment as well. As noted barriers to comply with standard infection control protocol in a study among hospital support staff by Jha A T et al showed ,40% of the respondents were educated only up to primary level or were illiterates (11) ,so level of education can be an important factor, regarding compliance. The strengths of the study are it was first of its kind being done among first year students after introduction of CBME and ECE in the new curriculum. This study aimed to assess the knowledge of SPs in detail among the first year medical undergraduate students.Students in these early clinical years were found to have a varied level of knowledge about the Standard Precaution measures;lot of gaps were found in correct understanding of required facts.Although parents education and occupation was not found to be statistically significant but it were found that children of parents in medical profession had better residual knowledge compared to those whose parents were in some other profession. Recommendation:Continued medical education and skill-assessment to test their knowledge, must be incorporated into their teaching curriculum before ECE, so as to minimize the risk of preventable infections amongst these group of students. Future research J o u r n a l P r e -p r o o f can be planned with objective to assess and compare the knowledge of students prior and later to application of CBME curriculum. The limitation of the study being, the study was done only for first year students, hence variations in the overall knowledge of medical students in higher semesters may be there. Being a cross-sectional study, it limits its ability to draw a causal relationship. Lastly, being a self-reported study, there may be instances of reporting bias. Relevance of the study:This study was an attempt to assess the level of knowledge of SPs of students in their early clinical years. It also assessed the socio-demographic variables of parents influencing their knowledge. Findings based on this study will provide evidence that continued medical education and skill assessment to test their level of knowledge, incorporated into their teaching curriculum before clinical exposure, will help them develop better clinical acumen. Acknowledgement:We would like to acknowledge all the participants of the study,and the class representatives for facilitating one of the Self directed learning(SDL) classes for data collection and video demonstration. J o u r n a l P r e -p r o o f J o u r n a l P r e -p r o o f J o u r n a l P r e -p r o o f WHO:standard-precautions-in-health-care Caring for Yourself While Caring for Others Standard precautions and infection control, medical students' knowledge and behavior at a Saudi university: the need for change Competency-based medical education: An overview and application in pharmacology QUESTIONNAIRE ON STANDARD PRECAUTION KNOWLEDGE: VALIDATION STUDY FOR BRAZILIAN NURSES USE. Texto contextoenferm Knowledge and practices of health care workers and medical students towards universal precautions in hospitals in Mazandaran Province Knowledge and self-reported practice of universal precautions among Kuwait University medical students in their clinical years Knowledge and practice of universal precautions among nursing staff at a tertiary care hospital in South Gujarat, India Standard precautions: knowledge and practice among nursing and medical students in a teaching hospital in Brazil | International Journal of Infection Control Awareness and practices regarding standard precautions for infection control among the hospital support staff in a tertiary care hospital in South India: a cross sectional study Coronavirus disease (COVID-19) advice for the public How to handwash? With soap and water Demonstration of Donning (Putting On) Personal Protective Equipment (PPE) Demonstration of Doffing (Putting Off) Personal Protective Equipment (PPE)