SCHOOL OF PUBLIC HEALTH 

COLLEGE OF HEALTH SCIENCES 

UNIVERSITY OF GHANA 

 
 
 
 
 
 

RISK PERCEPTION OF HIV AND PERCEIVED BARRIERS TO 
 

COMPLIANCE WITH STANDARD PRECAUTIONS AMONG 
 

HEALTHCARE WORKERS IN LOWER MANYA DISTRICT 
 
 

 

 

BY 
 
 

 

SANDRA ENYONAM AKAGBO 
 

(10211632) 
 

 

 

 

THIS DISSERTATION IS SUBITTED TO THE UNIVERSTY OF GHANA, 

LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE 

AWARD OF MASTER OF SCIENCE APPLEID HEALTH SOCIAL 

SCIENCE DEGREE 

 

 

 

 

JULY 2013

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DECLARATION 

I Sandra Enyonam Akagbo hereby declare that except for other people‟s 

investigations which have been duly acknowledged, this work is the result of my own 

original research, and that this dissertation, either in whole or in part has not been 

presented elsewhere for another degree. 

 

I hereby certify that this dissertation was supervised in accordance with procedures 

laid down by the University 

 
 
 
 

 

….………………………………… Date……………..………….. 

 

Sandra Enyonam Akagbo  

(10211632) 

 
 
 
 

 

………………………………. 

 Date………………………………. 

Dr. Mercy Ackumey 

   

(Academic  Supervisor) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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DEDICATION 

This work is dedicated to the Almighty God who has continually sustained me and 

brought me this far, my family especially my mum, Madam Georgina Hayman, who 

first instilled unconditional love in me, the joy of hard work and the satisfaction of a 

job well done; I wish you long life filled with happiness. Also to my good friend and 

Brother Mr. Emmanuel Sarku (Clinical Psychologist). 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
     

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ACKNOWLEDGEMENT 

 

To God be the glory, great things He hath done 

 

This work has come to being as a result of intensive labour and sacrifices. I will like 

to take this opportunity to sincerely and humbly thank EL-Shaddai who watches over 

me through life‟s journey. 
 
First and foremost I would like to use this opportunity to acknowledge the IIDP 

(Institute of Infectious Disease of Poverty) consortium for sponsoring and supporting 

the cost of the program and this entire project. 

 

My profound gratitude goes to my academic supervisor Dr. MERCY ACKUMEY for 

her wonderful academic support, professional guidance, assistance, patience, precise 

perception for honest delivery, and instilling in me the spirit of self-help that allows to 

learn from my mistakes. 

 
My sincerest appreciation goes to Mr. Emmanuel Sarku for his patience, guidance, 

invaluable suggestions, enthusiasm and the ability to find the heart of every 

circumstance allowed me to find what was important in this research. 

 

My sincerest gratitude goes to all the lecturers in the department for their tremendous 

proficiency, direction, and the gentle nudges which endowed me with knowledge and 

skills. 

 

I am also indebted to Mr. Yaw Osei-Aboagye (Executive Head of Corporate Banking, 

N.I.B) for his immeasurable support, encouragement, contributions and advice 

throughout the program. 

 
Also, I want to thank my mum Georgina Hayman for her relentless support, prayers 

and pieces of constructive advice. 

 

Also, I want to thank all the participants and the medical director and administrator of   

Akuse Government hospital and St. Martins Hospital. 

 

Last but not least my gratitude goes to my friend, roommate and sister from another 

mother Adelaide Ntiriwah Gyebi, God bless you all. 

  
                                                                  

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ABSTRACT 

Human Immunodeficiency Virus (HIV) is a devastating health condition that affects 

every sphere of society including workplaces. A number of occupational exposures to 

patients‟ blood and body fluids occur each year in health-care settings putting 

healthcare workers (HCWs) at a high risk of several blood-borne infections including 

human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C (HBC). 

This study investigated the health care provider‟s risk perception of HIV, knowledge 

on standard precautions (SPs), barriers and rate of compliance with standard 

precautions and also work related injuries faced by the HCWs.A Self-administered 

semi-structured questionnaire was use to elicit responses from one hundred healthcare 

workers comprising of laboratory technicians, midwives, nurses and ward aides. 

Majority of the participants regarded HIV as a public health issue and most of them 

perceived that they were at risk of contracting HIV on the job. Data revealed good 

compliance with standard precautions (SPs) among quite a number of HCWs. 

However, most of the HCWs were of the view that complying with standard 

precautions (SP) during emergency situations sometimes put the patients at risk and 

therefore they were likely not to adhere. Knowledge of the basic concept of the 

standard precautions was inadequate among the health care workers and most of the 

HCWs sometimes experience chemical splashes in the cause of their duty. Despite the 

risk of non-compliance and benefits of compliance with universal precautions, HCWs 

still often fail to strictly adhere to universal precautions. Therefore, interventions need 

to address individual provider‟s attitudes and emphasize that universal precautions are 

standard practice and not just for a special group of patients but for all patients. Key 

words: Health care workers, Risk perception, HIV, Barriers to Compliance, standard 

precautions.  

    

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TABLE OF CONTENTS 

Content                   Page 

DECLARATION ....................................................................................................... ii 

DEDICATION ......................................................................................................... iii 

ACKNOWLEDGEMENT ........................................................................................ iv 

ABSTRACT .............................................................................................................. v 

LIST OF TABLES ................................................................................................. xiii 

LIST OF FIGURES ................................................................................................ xiv 

LIST OF ACRONYMS/ ABBREVIATION ............................................................ xv 

 

CHAPTER ONE........................................................................................................ 1 

INTRODUCTION ..................................................................................................... 1 

1.0 Background ......................................................................................................... 1 

1.1.Statement of the Problem ..................................................................................... 2 

1.2. Objectives for Study ........................................................................................... 5 

1.2.1 General objectives............................................................................................. 5 

1.3.  Specific objectives ............................................................................................. 5 

1.4. Justification ........................................................................................................ 6 

1.5. Research Questions: ............................................................................................ 6 

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CHAPTER TWO ....................................................................................................... 8 

LITERATURE REVIEW .......................................................................................... 8 

2.0. Introduction ........................................................................................................ 8 

2. 1 Theoretical Framework ................................................................................... 8 

2.1.1 Health Belief Model .......................................................................................... 8 

2.2 History of Standard Precautions ......................................................................... 10 

2.3. Prevalence of HIV ............................................................................................ 11 

2.4. HIV and work place policy ............................................................................... 12 

2.5. Post-exposure Management .......................................................................... 15 

2.6. Post-exposure Prophylaxis (PEP) for HIV ..................................................... 16 

2.7. Risk-perception regarding HIV ..................................................................... 17 

2.8. Compliance to Standard Precautions ............................................................. 19 

2.9. Barriers/Factors leading to non-compliance ................................................... 21 

2.10.  Work–Related Injuries/ Accidents .................................................................. 22 

2.11.   Knowledge of Standard Precautions .............................................................. 24 

 

CHAPTER THREE ................................................................................................. 27 

METHODS ............................................................................................................. 27 

3.0 Introduction ....................................................................................................... 27 

3.1 Study Design ..................................................................................................... 27 

3.2. Study Location .................................................................................................. 27 

3.3.1 St. Martin de Porres Catholic Hospital, Agormanya ........................................ 28 

3. 3.2 Akuse Government Hospital, Akuse............................................................... 28 

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3.4 Study population ................................................................................................ 29 

3.5. Sampling .......................................................................................................... 29 

3.6. Sample size determination ................................................................................ 30 

3.7. Sampling technique........................................................................................... 32 

3.8 Variables ........................................................................................................... 32 

3.9. Data Collection Technique and Tools................................................................ 33 

3.10. Tools .............................................................................................................. 33 

3.10.1 HIV Risk Perception Questionnaire (Akinboro et al., 2010) .......................... 33 

3.10.2 Compliance with Standard Precautions Questionnaire (Akinboro et al., 2010)34 

3.10.3 Barriers to Compliance (Ferguson et al., 2004) .............................................. 34 

3.10.4 Knowledge of standard precautions Questionnaire (Okechukwu, 2009)......... 35 

3.10.5 Work Related Accidents or Injuries questionnaire (Ofili et al., 2004) ............ 35 

3.11. Pilot study ....................................................................................................... 35 

3.12. Data Collection Procedure .............................................................................. 36 

3.13. Data analysis ................................................................................................... 37 

3.14. Ethical considerations ..................................................................................... 37 

 

CHAPTER FOUR ................................................................................................... 38 

RESULTS ............................................................................................................... 38 

4.1. Introduction ...................................................................................................... 38 

4.2. Findings on Risk Perception of HIV.................................................................. 39 

4.3. Findings on Compliance with standard precautions ........................................... 43 

4.4. Findings Barriers to Compliance ....................................................................... 46 

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4.5. Findings Knowledge on SP among HCWs ........................................................ 48 

4.6. Findings on Work-related Injuries ..................................................................... 51 

1.7 Summary of Key Findings ................................................................................. 55 

CHAPTER FIVE ..................................................................................................... 56 

DISCUSSIONS ....................................................................................................... 56 

5.0. Introduction ...................................................................................................... 56 

5.01. Risk Perception among health care workers .................................................... 56 

5.02. Compliance with standard precautions ............................................................ 57 

5.03. Barriers to compliance among health care workers .......................................... 59 

5.04 Knowledge on Standard Precautions ................................................................ 60 

5.05. Level of Exposure to injuries among health care workers ................................ 61 

5.06. Implications of findings with Health Belief Model: ......................................... 63 

5.07. Limitations of the Study .................................................................................. 64 

 

CHAPTER SIX ....................................................................................................... 65 

CONCLUSIONS AND RECOMMENDATION ...................................................... 65 

6.0 Introduction ....................................................................................................... 65 

6.01 Conclusions ..................................................................................................... 65 

6.02 Recommendation for future research ................................................................ 66 

6.03 Recommendations for practice ......................................................................... 66 

REFERENCES ........................................................................................................ 68 

APPENDIX………………………………………………………………….……….76 

 

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LIST OF TABLES 

 

Table 3.1. Summary of distribution of Participants……………………………… 32 

 

Table 3.2. Summary of Cronbach Alpha Reliability of Tests…………………….. 36 

 

Table 4.1: Background Characteristics of Respondents………………………….. 39 

 

Table 4. 2: Respondents‟ risk-perception regarding HIV………………………… 40 

 

Table 4.3: Summary of X
2
 result of significant values of variables on                                

risk perception…………………………………………………………………….... 41 

 

Table 4.4: respondents level of compliance………………………………………. 44 

 

Table 4.5: Summary of X
2
 results of significant values of variables on 

compliance…………………………………………………………………………. 45 

 

Table 4.6: responses on Barriers to compliance…………………..……………….. 47 

 

Table 4.7: Summary of X
2
 result of significant values of barriers to compliance…...... 48 

 

Table 4.8: Level of knowledge of respondents of standard precautions……………50 

 

Table 4.9: Work related injuries…………………………………………….…...… 53 

 

Table 4.10: Summary of X
2
 result of significant values of variables on work related 

injuries.....…………………………………………………………………...………54 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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LIST OF FIGURES 

 

         Figure 1: Conceptual Framework……………………………………..………4 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

            

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LIST OF ACRONYMS/ ABBREVIATION 

 

 

H.B.C  Home-Based Care 

HBM  Health Belief Model 

HBV  Hepatitis B virus 

HCV  Hepatitis C virus 

HCWs  Health care workers 

HIV  Human immunodeficiency virus 

ILO  International Labour Organisation 

PPE  Personal protective equipment 

PLWHA  People Living with HIV/AIDS 

PMTCT  prevention of mother to child transfer 

SPs  Standard Precaution 

USAIDS  United States Agency for International Development 

UPs  Universal Precautions 

VCT  voluntary counselling and testing 

WHO  World Health Organization 

 

 

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CHAPTER ONE 

INTRODUCTION 

1.0 Background  

Human Immunodeficiency Virus (HIV) is a devastating health condition that affects 

every sphere of society including workplaces. A number of occupational exposures to 

patients‟ blood and body fluids occur each year in health-care settings putting 

healthcare workers (HCWs) at a high risk of several blood-borne infections including 

human immunodeficiency virus (HIV), hepatitis B (HBV), and hepatitis C(HBC) 

[Dement et al., 2004; Timilshina et al., 2011]. 

Health workers are "all people engaged in actions whose primary intent is to enhance 

health" (World Health Report 2006). They include physicians, nurses, emergency 

medical personnel, dental professionals and students, medical and nursing students, 

laboratory technicians, pharmacists, hospital volunteers, and administrative staff (CDC, 

2013). 

Guidelines to enhance the safety of HCWs have been in existence since the late 1980‟s 

and early 1990‟s to help reduce the rate at which HCWs were exposed to blood, fluids, 

needles and other sharp objects. This initiative was as a result of the HCWs increased 

risk of exposure to blood-borne pathogens in the 1970s which led to the infection of 

many HCWs to hepatitis B virus (HBV) and HIV (Kermode et al., 2005). The content 

and labelling of the guidelines have changed over time. It was referred to as universal 

precautions or body substance isolation but now it is termed standard precautions 

(Kermode et al., 2005). 

Researches have indicated that needle-stick injuries (NSIs) and prick from other sharp 

devices are the most common occupational accidents in addition to exposures to direct 

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contact with body fluids/ blood and tissues that may be contaminated. Contact with 

blood and bodily fluids is a serious occupational concern for health-care workers and it 

represents a common mode of the transmission of HIV (Pruss-Ustun et al., 2005; 

WHO/ILO, 2005; Kabbash et al., 2007; Reda et al., 2008; Sreedharan et al., 2010). 

 

Studies have also revealed that the use of personal protective equipment (PPE) such as 

sterile surgical gloves and gowns, and sterile equipment, hygiene practices such as 

antiseptic hand washing, and safe instrument and waste disposal procedures outlined in 

universal precaution guidelines, can keep the HCWs safe from blood-borne infections 

(Akinboro et al., 2012; Timilshina et al., 2010). The first reported case of a healthcare 

worker developing HIV infection after a needle stick injury was in 1984 (Varghese et 

al., 2003). HCWs are often seen as “immune” to injury or illness, this is because in 

their job to care for the sick and incapacitated; their patients come first. They are often 

likely to sacrifice their own safety for the sake of their patients (WHO, 2013). 

 

In sum, HCWs form an enormous and mounting workforce facing an exceptional 

occupational hazard, such as exposure to human blood and body fluids, which puts 

them at risk of contracting numerous blood borne infections (BBIs) including the 

Hepatitis B Virus (HBV), the Hepatitis C Virus (HCV), and HIV. 

 

1.1. Statement of the Problem 

Studies  reveal a high risk perception of HIV and other blood-borne infections among 

HCWs (Kermode et al., 2005; Hanafi et al., 2007; Kocić et al., 2008; Akinboro et al., 

2012; Basavaprabhu et al., 2012). The perception of risk can lead to exaggerated fears 

of HIV and AIDS related risks and these over-blown perceptions influence the quality 

of care given to patients, it can also lead to stigmatisation and discrimination against 

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people living with HIV or AIDS (Akinboro et al., 2012). In other words, the manner 

HCWs perceive their own risks in relation to caring for HIV positive patients 

potentially influences their willingness to provide care. 

 

Also, infection control practices are poor and prevalent with a higher incidence of HIV 

in Africa. All over the developing world, healthcare providers, patients, and the 

community as a whole are placed at risk of contracting HIV because of a shortage or 

lack of supplies, poor training, poor awareness about the danger of unsafe infection 

control practices and limited organizational support for safe practice. Implementing 

universal precautions has been a major challenge for health care providers and, the 

occupational safety of HCWs is often neglected (Akinboro et al., 2012; Sagoe-Moses et 

al., 2001). 

Furthermore, there are limited studies in Ghana about compliance among HCWs to 

standard precautions. However, there has been previous research that focused on 

attitudes to and management of HIV/AIDS among health workers in Ghana (Awusabo-

Asare & Marfo, 1997).  

Finally some studies conducted outside Ghana, have also reported that HCWs fail to 

comply with standard precautions but the studies failed to investigate barriers to 

compliance of standard precaution among HCWs aimed at reducing risk associated 

with HIV exposure (Kabbash et al., 2007; Akinboro et al., 2012; Reda et al., 2010). 

With this in mind, the need for studies targeting health facilities cannot be over-

emphasised. 

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1.03. Conceptual Framework 

The conceptual framework for the study was adapted from the health belief model to 

explain the association between variables of the study (Figure 1.0). 

Figure 1.0 Conceptual Framework 

 

 

 

 

 

 

Adapted from HBM (Rosenstock, 1974) 

 

  

Modifying variables; 

 Demographics, area of practice, 

years of practice, health facility, 

knowledge on SP, etc. 

Barriers to compliance 

The unavailability of PPE, inadequate 

training on the use of PPE, skin 

irritation, etc. 

 

Perceived Susceptibility 
II am at risk of HIV as a result of 
my job, I see HIV as a public 
health issue 
 

Perceived threat of HIV Compliance with SP 

Injuries 

Blood splashes, needle pricks, glove 

perforation during surgery, scalpel 

blade injury, etc. 

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From figure 1: It is expected that 

 Modifying factors such as HCWs level of knowledge on standard precautions; 

profession/area of practice, years of practice and location of hospital will inform 

their perception of HIV as a threat 

 Modifying factors such as HCWs profession/area of practice, and location of 

hospital will inform their perception of barriers to compliance 

 The perception of HIV will compel HCWs to see HIV as a threat. 

 HCWs perception of HIV as a threat will compel them to comply with standard 

precautions 

 Barriers  will influence level of compliance with standard precautions 

 Work related injuries will be associated with poor compliance and vice versa.

 1.2. Objectives for Study  

1.2.1 General objectives 

This study seeks to examine health care provider‟s risk perception of HIV, knowledge 

of SPs, barriers and rate of compliance with standard precautions and also the work 

related injuries faced by the HCWs. 

1.3.  Specific objectives 

o To examine risk perception of HIV and compliance with standard 

precautions 

o To assess health care worker‟s compliance with standard precautions 

o To identify barriers to compliance with standard precautions 

o To identify the Work-related accident/injury 

o To determine the knowledge of HCWs on standard precautions  

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1.4. Justification  

Universal Precautions (UPs) and more recently standard precautions have been widely 

promoted in high-income countries to protect health care workers (HCWs) from 

occupational exposure to blood and the consequent risk of infection with blood-borne 

pathogens.  

 

In low-income countries, the situation is very different: UPs are often practiced 

partially, if at all, thereby exposing the HCWs to unnecessary risk of infection 

(Kermode et al., 2005). It will therefore be of great importance to study the factors that 

influence low compliance with standard precautions in Ghana. 

 Findings of this study would highlight factors related to compliance with standard 

precaution among HCWs. It will also help in planning and targeting appropriate 

measures/interventions to improve compliance to standard precautions among health 

care workers. 

Findings and recommendations of the study will be useful for ensuring that barriers to 

compliance are minimised at hospital settings. Recommendations emerging from this 

study will be useful for improving occupational health and safety in hospitals. The 

health care workers will be the ultimate beneficiary of interventions that will be based 

on findings from the study. 

1.5. Research Questions: 

 The following research questions were asked in order to meet the goals. 

a. Do healthcare workers perceive themselves to be at risk of HIV? 

b. How often do the HCWs comply with standard precautions? 

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c. What are the barriers to compliance with standard precautions? 

d. What injuries are the HCWs frequently exposed to? 

e. How knowledgeable are HCWs on standard precautions? 

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CHAPTER TWO 

LITERATURE REVIEW 

2.0. Introduction 

The literature review was guided by the problem statement, justification and the 

objectives for the study. The literature looked at theoretical framework, and various 

reports and studies conducted in different countries. The focus of the review was on 

risk perception of HIV, health care worker‟s practice of standard precautions, barriers 

to compliance with standard precautions, work-related accident/injury and knowledge 

of standard precautions. 

 

2. 1 Theoretical Framework 

2.1.1 Health Belief Model 

The health belief model (HBM) has been widely used and is considered as one of the 

most useful models in health care prevention and promotion (Roden, 2004). It assists in 

the understanding of the different behaviours or attitudes people may develop under the 

same condition by following or not following certain guidelines or requirements 

(Kartal & Ozsoy, 2004). 

Hochbaum, Kegels, Rosenstock and Leventhal in the 1950s developed this theory as a 

way to examine the barriers that prevented people from using free programs, which 

would detect or prevent diseases 

The theory is based on two components: a) the perceived threat for acquiring a disease, 

which comprises of the perceived susceptibility and perceived severity, constructs. 

Based on this, an individual faces pressure to take action, nevertheless this action may 

not necessarily take place (Nejad, 2005). b) The enabling factors that generate or  

trigger the behaviour, which include the perceived benefits and perceived barriers 

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(Efstathiou et al., 2011). Additional constructs were added later in order to overcome 

some limitations the model showed. Hence, the self-efficacy and cues to action were 

added (Rosenstock, 1974). 

 

HBM has been used in many studies related to health care behaviours and attitudes 

such as weight management (Daddario, 2007), sexual behaviours (Lin, Simoni & 

Zemon, 2005), vaccination behaviours (Rhodes, 2003; Raftopoulos 2007). It has also 

been previously applied as a theoretical model to measure attitudes of nurses and health 

care workers towards implementing certain aspects of universal precautions from 

occupational exposure to pathogens (Grady et al.,, 1993; Williams, Campbel, Henry & 

Collier, 1994; Osborn, 2003; Efstathiou et al., 2011). 

 

The six constructs of the health believe model is summarized below: 

•Perceived susceptibility: personal perception on the risk of acquiring a certain 

disease or condition 

• Perceived severity: personal perception of the seriousness of a certain disease, 

behaviour or condition 

• Perceived Benefits: personal perceptions on the effectiveness and positive 

consequences when adopting a Behaviour 

• Barriers: personal perception of the obstacles that may prevent him/her to adopt a new 

behaviour 

Added constructs: 

• Cues to action: factors that trigger a behaviour  

• Self-efficacy: personal perception on his/her ability to adopt a behaviour  

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2.2 History of Standard Precautions 

The center for disease control (CDC) initially issued a document in 1983 entitled 

„Guidelines for Isolation Precautions in Hospital‟, which contained information on 

precautions for blood and body fluids (Okechukwu, 2009). It recommended preventive 

measures that need to be taken when a patient is known or suspected to be infected with 

blood-borne pathogens (Garner, Simmons, & Williams, 1983). In 1987, 

CDC again published „Recommendations for Prevention of HIV Transmission in 

Healthcare Settings‟. The guidelines suggested that precautions should be consistently 

practiced for all patients regardless of their blood-borne infection status. This 

contradicted the earlier (1983) recommendation which states that preventive measures 

should be taken when a patient is known or suspected to be infected with blood-borne 

pathogens (Garner et al., 1983). 

Due to this extension, Standard precautions became known as Universal Precautions 

and it was defined by CDC (1996) as a set of precautions designed to prevent the 

transmission of HIV, HBV and other blood-borne pathogens when providing first aid or 

health care (Okechukwu, 2009). “Thus, universal precautions replaced and eliminated 

the need for the isolation category blood and body fluid precautions in the 1983 CDC 

Guidelines for Isolation Precautions in Hospitals” (Okechukwu, 2009). 

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2.3. Prevalence of HIV 

According to the UNAIDS report (2012), on the Global AIDS Epidemic, approximately 

34 million people are currently living with HIV and nearly 30 million people have died 

of AIDS-related causes since the beginning of the epidemic. 

The UNAIDS report on the global AIDS epidemic (2012) and Population Reference 

Bureau. (2011) suggests that Sub-Saharan Africa is the hardest hit region in terms of 

HIV and currently it has more than two-thirds (69%) of people living with HIV. 

The UNAIDS report on the global AIDS epidemic (2012) reveals South Africa as the 

country in sub-Saharan region with the highest number of people living with HIV in the 

world (5.6 million) and Swaziland with the highest prevalence rate in the world 

(26.0%) 

According to the 2011 HIV sentinel report in Ghana, five regions namely Central, 

Eastern, Greater Accra, Ashanti and Volta recorded an increase in HIV prevalence. The 

Regional prevalence ranged from 0.3% in the Northern Region to 4.7% in the Central 

Region. The 2011 prevalence for Eastern Region where this study was carried out is 

3.6%, second after Cape coast. 

Out of the 35 million health care workers worldwide, nearly 3 million experience 

percutaneous exposures to blood borne viruses each year (Wilburn & Eijkemans, 2004). 

According to a World Health Organization (WHO) estimate, in year 2002, these sharp 

injuries resulted in 16 000 hepatitis C virus, 66 000 hepatitis B virus and 1000 HIV 

infections in health care workers worldwide (Pruss-Ustun, 2005). WHO (2003) has 

estimated that in developing countries, 40%–65% of HBV and HCV infections in 

HCWs are attributable to percutaneous occupational exposure. As of the year 2000, 

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there were no reported studies investigating the prevalence of HIV among health 

workers (Shisana et al., 2004). 

However, based on a sample of 721 health workers a study conducted by Shisana et al. 

(2004) in South Africa found that 15.7% of health workers employed in the public and 

private health facilities located in four South African provinces were living with 

HIV/AIDS in 2002. 

Furthermore, to determine the prevalence of HIV infection and the extent of disease 

progression based on CD4 count in a public health system workforce in southern 

Africa, a study was conducted in two public hospitals in Gauteng, South Africa by 

Connelly et al., (2007). The study reported that the overall prevalence of HIV was 

11.5%. “By occupation, prevalence was highest among student nurses (13.8%) and 

nurses (13.7%). The highest prevalence by age was in the 25 - 34-year groups 

(15.9%)[Connelly et al., 2007]. 

 

2.4. HIV and work place policy 

An HIV work place policy is a written document that acknowledges the effects of HIV 

and other related illnesses on the smooth operation of a company. Since HIV/AIDS has 

been recognized as a workplace health concern, more and more organizations including 

healthcare facilities are formulating HIV/AIDS Workplace Policies that address the 

many issues surrounding HIV/AIDS. Although each and every workplace around the 

country has its own way of responding to the AIDS pandemic, a well-written 

HIV/AIDS Workplace Policy contains key factors that are internationally accepted 

(WHO/ILO, 2005). 

 

The policy must define how the health facility will use a combination of engineering 

and work practice controls, enforce the use of personal protective clothing and 

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equipment , provide training , medical surveillance, pre and post exposure prophylaxis, 

and signs and labels, among other provisions. HIV/AIDS is a concern or problem for 

the workplace because it affects the workforce, and also the workplace can play a 

vibrant role in limiting the transmission and effects of the epidemic (WHO/ILO, 2005). 

According to the April 2005 International Labour Organisation (ILO) / World Health 

Organisation (WHO/ILO, 2005) joint guidelines on prevention and control of 

occupational risks related to infectious diseases, to successfully manage risk or 

exposure, one must first of all go through the process of hazard identification, then risk 

assessment and risk control. 

The management of risk starts with the “identification of situations, activities and tasks 

in the workplace which may put health-care workers at risk of exposure to HIV and 

other blood-borne infections or associated opportunistic infections” (WHO/ILO, 2005). 

To effectively identify hazards, there should be established and implemented 

procedures that ensure that health-care workers can report perceived hazards without 

sanction (WHO/ILO, 2005). “This requires an active programme to educate health-care 

workers about the importance of reporting and how and when to report” hazards 

(WHO/ILO, 2005). Identification of hazards also involves “analyses of reports of 

incidents of exposure to blood or body fluids” and “Surveillance of the workplace 

layout, work practices and other sources of worker exposure” (ILO/WHO, 2005). 

As soon as a hazard is identified, the next step is to do a risk assessment. Risk 

assessment is carried out in order to assess the level and nature of the risk to health-

care workers of exposure to hazards such as blood or body fluids and to determine the 

measures needed to eliminate the hazard or minimize the risk factors (ILO/WHO, 

2005). 

Risk assessment includes taking into account modes of transmission of HIV and other 

blood-borne pathogens in the workplace; type and frequency of exposure to blood or 

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body fluids, availability, adequacy and use of protective clothing and equipment; the 

knowledge and training of employers, supervisors and health-care workers regarding 

HIV and other blood-borne pathogens and safe work practices and many more 

(ILO/WHO, 2005). 

The final step in risk management is risk control. The objective of risk control is “to 

follow the hierarchy of controls, selecting the most effective control measures in order 

of priority for their effectiveness in minimizing health-care workers‟ exposure to blood 

or body fluids, or preventing injury or illness resulting from exposure” (ILO/WHO, 

2005). 

Risk control involves Substitution, Engineering controls, Administrative controls 

(workplace policies aimed at limiting exposure to the hazard,).Work practice controls 

(“Controls reduce exposure to occupational hazards through the method by which the 

work is conducted, protecting the health and improving the confidence of health 

service workers and their patients. Examples include no needle recapping, placing 

sharps containers at eye-level and within arm‟s reach, emptying sharps containers 

before they are full, and establishing the means for safe handling and disposing of 

sharps devices before beginning a procedure”). Personal protective equipment (PPE) 

(making available equipment to protect workers from exposure to blood or body 

fluids, there are adequate supplies of items for personal protection, proper 

maintenance of equipment, adequate training on use of PPE, etc.) and Elimination of 

hazard (ILO/WHO, 2005). 

Elimination is the most effective and preferred measure is the complete removal of a 

hazard from the work area (ILO/WHO, 2005). Where elimination is not possible, the 

organization has to replace the work practices with others that present a lesser risk, for 

example „substituting a less toxic chemical for a disinfectant, such as paracetic acid for 

glutaraldehyde‟ (ILO/WHO, 2005). 

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Engineering controls encompasses the isolation or removal of hazard from a workplace. 

They may include the use of suitable mechanisms, methods and equipment to avert 

worker exposure. Some of these measures developed to curtail exposure to blood or 

body fluids should take into account: sharps containers, also known as safety boxes; 

newer device technology such as safer devices with engineered injury prevention 

features and many more (ILO/WHO, 2005). 

Furthermore, the management of risk exposure according to the 2005 ILO/WHO 

guidelines should consider safe work practices/ standard precautions such as, personal 

hygiene; good hand-washing practices and an infection control programmes which aim 

to minimize the risk of transmission of HIV and other blood borne infections in the 

workplace. 

 

It also takes into account safe handling of disposable sharp sand injection equipment. It 

requires placement of clearly marked puncture-resistant containers for the disposal of 

sharps (sharp boxes), regular replacement of sharps containers before they reach the 

manufacturer‟s fill line or when they are half full, containers should be sealed before 

they are removed, the disposal of non-reusable sharps in safely positioned containers 

that comply with relevant national regulations and technical guidelines, avoiding 

recapping and other hand manipulations of needles, and, if recapping is necessary, 

using a single-handed scoop technique, responsibility for proper disposal by the person 

using the sharp, responsibility for the proper disposal and for reporting the incident by 

any person finding a sharp (ILO/WHO, 2005). 

2.5. Post-exposure Management 

Adhering to standard precautions remains the principal approach for the prevention of 

infections due to work-related exposure (Okechukwu, 2009). Nonetheless, occupational 

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exposure every now and then occurs; hence, appropriate post-exposure management is 

vital for workplace safety (Okechukwu, 2009). Health care facilities should make 

accessible a system that comprises written protocols for prompt reporting, evaluation, 

counseling, and treatment as well as follow-up of occupational exposures that might 

place HCWs at risk for acquiring infections (Okechukwu, 2009). Furthermore, HCWs 

ought to be trained on the risk for and prevention of infections, including the need to be 

vaccinated against hepatitis B and C (CDC, 1989: CDC, 1991; Garner, 1996).  

If an occupational exposure occurs, the conditions and post exposure management 

should be recorded in the HCWs confidential medical record (usually on a form the 

facility designates for this purpose) [CDC, 1998]. 

 

Significant information to be documented includes date and time of exposure, details of 

the procedure being performed, including where and how the exposure occurred, and if 

the exposure was related to a sharp device, the type of device and how and when in the 

course of handling the device the exposure occurred, details about the exposure source 

(i.e., whether the source material contained HIV or other blood-borne pathogens), and if 

the source is an HIV-infected person, the stage of disease, history of antiretroviral 

therapy, and viral load, if known; and details about counseling, post exposure 

management, and follow-up (CDC, 1998). 

 

2.6. Post-exposure Prophylaxis (PEP) for HIV 

Post-exposure prophylaxis (PEP) plays a vital role i n post-exposure management 

(CDC, 1998). PEP for HIV involves the commencement of antiretroviral treatment as 

soon as possible preferably within hours rather than days of exposure. The 

recommended PEP includes a basic 4-week regimen of two drugs (zidovudine and 

lamivudine) depending on the level of risk for HIV transmission represented by the 

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exposure (CDC, 1998; Okechukwu, 2009). 

The decision to recommend HIV post exposure prophylaxis must consider the nature of 

the exposure (e.g exposure from NSI or potentially infectious fluid) and the quantity of 

blood or body fluid involved in the exposure (CDC, 1998). An evaluation of the risk for 

infection resulting from the exposure and of the infectivity of the exposure source is 

key determinants of offering PEP. 

2.7. Risk-perception regarding HIV 

Risk perception can be said to be the “belief (whether rational or irrational) held by an 

individual, group, or society about the chance of occurrence of a risk or about the 

extent, magnitude, and timing of its effect(s)”; it is posited that risk susceptibility 

dominates both the actual and perceived characteristics of the situation as a determinant 

of risk behavior (Sitkin & Pablo, 1992). 

 

Individual and social features form an individual‟s risk perception and influence the 

way they react towards risks; understanding perceived risk can draw upon factors 

associated with the person (e.g. demographics, personality, social/professional status, 

political orientation), or to the risk source (e.g. health impacts, economic effects). 

Individuals respond to risk or hazard in ways consistent to their perception of that risk. 

In other words it is their perception that influences behaviour or action (Mileti, 1993; 

Brenot et al., 1996; Schmidt, 2004). 

 

Several studies conducted on risk perception regarding HIV among HCWs have 

indicated that majority of them have a very high risk perception regarding occupational 

exposure to HIV and other blood-borne pathogens. Most HCWs regarded HIV as a 

public health concern and often see themselves at risk of contracting the infection 

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whilst working (Kermode et al., 2005; Hanafi et al., 2007; Kocić et al., 2008; Akinboro 

et al., 2012; Basavaprabhu et al., 2012). 

 

The level of risk depends on the number of patients with that infection in the healthcare 

facility and the precautions the HCWs observe whilst dealing with these patients 

(Akinboro et al., 2012).The perception of high risk can be attributed to the high rate of 

infection of HIV in the larger population (Kermode et al., 2005). 

 

Akinboro et al. (2012) in a study on Community health care workers‟ risk perception of 

occupational exposure to HIV in Ibadan, south-west Nigeria and reported a very high 

risk-perception amongst HCWs regarding occupational exposure to HIV and AIDS but 

a poor compliance with universal precautions in their professional duties. HCWs 

perception of risk and workplace safety climate did not influence their compliance with 

universal precautions. 

 

HCWs regard HIV and AIDS as a public health issue and believe that they are at risk 

of contracting HIV whilst working (Akinboro et al., 2012). HCWs agree they stand a 

higher risk of contracting HIV than non-health professionals and also non- availability 

of personal protective equipment (PPE) sometimes when caring for patients put them 

at risk (Akinboro et al., 2012). 

 

Further studies investigating the perception of professionals risk, knowledge, attitudes 

and practice of HCWs to HIV and AIDS, have found a high perception of professional 

risk among HCWs frequently exposed to patients‟ blood and body fluid (Jovic-Vranes 

et al., 2006; Kocić et al., 2008). 

There have been similar situation of non-compliance reported in other studies that have 

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been carried out Egypt, Italy, Serbia, Ethiopia, Nigeria and other countries across the 

world (Kotwal & Taneja 2010; Parmeggiani et al., 2010; Hanafi, et al., 2011; Akinboro 

et al., 2012). 

 

2.8. Compliance to Standard Precautions 

The term compliance according to, Haynes et al., (1979) is the extent to which certain 

behaviour (for example, following physician‟s orders or implementing healthier 

lifestyles) is in accordance with the physicians‟ instructions or health care advice. 

Compliance is the degree to which a person adheres to advice and it may also be 

defined as “the act of complying, yielding, or acting in accord (Haynes, et al., 1979).” 

Rules and procedures that govern all behaviour exists in a variety of settings (including 

health care settings), but people do not always comply with them (Efstathiou et al., 

2011). 

 

According to Kelman (1958) compliance or obedience occurs when another person or 

group influences an individual. The ability of a person to comply may be influenced or 

controlled by a variety of factors like culture, socio-economic factors, self-efficacy, and 

lack of knowledge or means (Efstathiou et al., 2011). 

 

The importance of compliance to standard precautions cannot be underestimated 

(Garner, 1996). Standard precautions are regarded as the most effective means of 

protecting HCWs, patients, and the public, thereby reducing hospital acquired 

infections (Wang et al., 2003). 

 

Siegel, et al., (2007) report that, the use of precautionary measures during patient care is 

determined by the nature of the health care worker-patient interaction and the extent of 

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anticipated blood, body fluid, or pathogen exposure. In some cases for example the 

health personnel performing venipuncture, might need only gloves, but for other 

situations such as intubations, use of gloves, gown, and face shield or mask and goggles 

is necessary. 

 

Standard precautions comprise of the use of gown/plastic apron, proper hand washing, 

use of gloves, putting used needles and other sharp objects into the designated „sharps‟ 

containers, not recapping needles that have been contaminated with blood or body 

fluids, covering of broken skin before coming to work, reporting and recording needle 

stick injury when it occurs, promptly wiping up all blood spills and other body fluids 

with disinfectants and many more.  

Compliance with these standard precautions has been shown to reduce the risk of 

exposure to blood and body fluids (Ferguson, et al., 2004). 

 

Studies have also identified that even though the HCWs believe that they are at risk to 

infection, their risk perceptions do not act in accordance with compliance to standard 

precautions (Akinboro et al, 2012; Basavaprabhu et al., 2012; Hanafi et al., 2011; 

Kermode et al., 2005; Kocić et al 2008). Despite the existence of universal precautions 

guidelines since 1987, suboptimal observance to these has been documented 

extensively. 

 

Despite the evidence that failure to use universal precautions increases the risk of 

mucocutaneous blood and body fluid exposure and adherence decreases risk, several 

HCWs act in violation to the standard precautions. For instance in a study carried out 

by Timilshina, et al., (2011) in Nepal, it was reported that a total of 62% regularly used 

protective gloves while handling patients and 72% reported that they never used high-

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level disinfection to eliminate all microorganisms (bacteria, viruses, fungi, and 

parasites, including bacterial endospores) from instruments and other items that would 

come into contact with broken skin or intact mucous membranes. 

 

Also a study conducted by Kermode et al. (2005) in 7 rural north Indian health care 

setting to identify level of knowledge and Compliance of universal Precautions (Ups) 

among 266 HCW, revealed that standard compliance was low only 32% wore eye 

protection when indicated, and 40% recapped needles at least sometimes. 

 

2.9. Barriers/Factors leading to non-compliance 

Several studies have identified some factors that contribute to non-compliance with 

Standard Precautions. Some factors that accounted for these were lack of knowledge, 

lack of time, forgetfulness, lack of means, negative influence of the equipment on 

nursing skills, uncomfortable equipment, skin irritation, lack of training, conflict 

between the need to provide care and self-protection, and distance to necessary 

equipment or facility (Tait et al., 2000; Osbome, 2003; Stein et al., 2003; Sax et al., 

2005; Oliveira et al., 2010). 

 

Neves et al., (2011) in a qualitative study conducted in a teaching hospital with 15 

nursing professionals attempted to analyse the reasons, attitudes and beliefs of nursing 

staff regarding adherence to personal protective equipment., result revealed several 

barriers interfere in matters of safety and personal protective equipment, such as 

communication, work overload, physical structure, accessibility of protective 

equipment. 

 

Kotwal and Taneja (2010) in his study to assess the knowledge, attitude, practices and 

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barriers to compliance of universal Precautions (Ups) among HCWs in LokNayak 

Hospital in India also disclosed that the perceived barriers to compliance with UPs, 

were that HCWs felt too busy to use personal protective equipment (PPE), they also did 

not use PPE because colleagues did not use it, the HCWs felt that using PPE may 

offend patients, and lead to discomfort. 

 

Non-compliance with standard precautions among health care workers has been 

associated with their belief that their workload is increased by adhering to universal 

precautions and therefore, these procedures are difficult to accommodate due to day to 

day current clinical pressures (Cutter & Jordan, 2004). Additionally, non-compliance 

among health care workers may be due to a lack of understanding among health care 

workers of how to properly use protective barriers (Vaz et al., 2010). 

 

2.10. Work–Related Injuries/ Accidents 

Occupational risks exist wherever health care is practiced. However, there is dearth of 

information on the status of occupational safety among hospital workers in Ghana. 

Occupational / work-related injuries are hazards to which health workers are exposed to 

(Ofili et al., 2004) 

 

Injuries among HCWs may negatively affect job satisfaction, contribute to job 

shortages, and affect overall quality of care provided by nursing facility residents 

(Khatutsky et al., 2012). Injuries are also expensive, as they lead to missed days of 

work and require shifting CNA staff to lighter duties. 

 

The risks HCWs are exposed to may be physical, chemical, mechanical or 

psychosocial. Some of the hazards that hospital workers experience are “physical 

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hazards such as radiation, leading to sickness, burns and cancers; hazards from 

chemicals, leading to contact dermatitis and allergic asthma” (Ofili et al., 2004). The 

most common injuries in the health industry according to studies are needle-stick, 

splashes from bodily fluids, Cuts from other sharp objects, etc. and nurses have the 

highest risk of suffering NSI compared with the other occupational categories such as 

doctors and ward aides (Hanafi, et al., 2011; Vaz et al., 2010; Kermode et al., 2005; 

Manyele et al., 2008). 

 

According to Reda et al., (2010), needle stick injuries are significantly associated with 

females. This suggests that females are more prone to needle pricks. Furthermore their 

study on occupational exposures and behaviour of health care workers (HCWs) in 

eastern Ethiopia; revealed a Life time risks of needle stick injury. 

 

To examine differences in exposure rates across categories, Ferguson et al. (2004) 

studied exposure rat0es for all respondents who reported an incident of a break in 

standard precautions. In terms of sharps injuries, only 23% of those who said they had 

forgotten to use precautions had experienced a sharps injury in the past 3 months, 

which was lower than the overall rate. In terms of mucocutaneous exposures, those 

who had not anticipated exposure had a higher exposure rate (59%). 

 

Kabbash et al., (2007) carried out a cross sectional studies in 32 Haemodialysis units in 

the Nile Delta, Egypt. The purpose of the study was to evaluate and Knowledge and 

practices towards Risk of HIV infection by 317 HCWs. At the end the research they 

accounted that exposure to needle stick injury reported in the previous year was 48.6%. 

 

 

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At the end of a study conducted by Ofili et al., (2004), they instituted that the major 

accidents/injuries recorded at work among the laboratory workers, nurses and doctors 

were contact with patient‟s blood with ungloved hands, blood splashes on face and 

parts of the body, needle pricks and chemical splashes. 

 

2.11.  Knowledge of Standard Precautions  

Knowledge  is often attributed  to  a  recall  of  information  and  it  is  essential  to 

suitable behavioral change (Okechukwu, 2009). It is the most significant tool for 

achieving behavioural change (Gbefwi, 2004). 

 

HCWs are expected to have training and some knowledge of the basic concept of 

standard precautions, potential sources of occupational exposure and clinical 

conditions and body fluids that require observance of the standard Precautions. 

 

Li et al 2011 in a study have associated UP training with better knowledge of and 

adherence to UP. In other words, adequate training in standard precautions can lead to 

increase in the knowledge of SPs and in turn lead to adherence. Training and education 

have been found to be of utmost importance to developing awareness among health 

care workers (Vaz et al., 2010) 

 

The knowledge of UP among HCWs also has a „weak association with perceived 

adherence and suffering of occupational sharp injuries‟ (Sri et al., 2011). This suggests 

that knowledge is not the sole determinant of compliance to UP and prevention of work 

related injury 

 

According to a study by Vaz et al. (2010), the knowledge of universal precautions was 

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highest among women compared with men, and among the nurses more than medical 

doctors. Furthermore Vaz et al. (2010) identified that the level of awareness of 

universal precautions increased with longer year of service in health care sector. 

 

Timilshina et al., (2011), in a research to identify the infection control knowledge and 

practice compliance of basic health workers of 28 primary health care centers in two 

districts of the Western Development Region, Nepal, between 2003 and 2004 revealed 

that of the 100 basic health workers studied, only 22% had correct knowledge of 

universal precautions. Furthermore, some of the HCWs (46%) had ever received 

training and on standard. This study therefore shows that most of the HCWs in an urban 

tertiary health care facility (HCF) in India possessed incomplete knowledge. This lack 

of appropriate knowledge may be a factor leading to a high level of anxiety among 

them regarding exposure to blood and body fluids and needle stick injuries. 

 

However Parmeggiani et al., (2010) in an attempt to assess knowledge, attitudes, and 

compliance regarding standard precautions about health care-associated infections 

(HAIs) and the associated determinants among healthcare workers (HCWs) in 

emergency departments in Italy, employed an anonymous questionnaire, self-

administered by all HCWs in eight randomly selected non-academic acute general 

public hospitals, revealed that HCWs who know the risk of acquiring Hepatitis C 

(HCV) and Human Immunodeficiency Virus (HIV) from a patient were in practice 

from less years, worked fewer hours per week, knew that a HCW can transmit HCV 

and HIV to a patient, knew that HCV and HIV infections can be serious, and have 

received information from educational courses and scientific journals. 

 

 

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HCWs who know that the use of gloves, mask, protective eyewear, and hands hygiene 

after removing gloves are control measures were nurses, provided care to fewer patients 

Parmeggiani, et al., (2010). This indicates that HCWs have high knowledge, positive 

attitudes, but low compliance concerning standard precautions. The reasons for low 

compliance have not been adequately answered by the study. It is therefore important 

to find out the situation in Ghana. 

 

Vaz et al. (2010) investigated the knowledge, awareness and practices of health care 

workers towards universal precautions at the University Hospital of the West Indies. 

The findings showed that majority of the health care workers were aware of policies 

and procedures for reporting accidents. Splashes from body fluids, needle stick injuries 

and cuts from other objects were quite prevalent among health care workers. In spite of 

workers knowledge of precautionary measures, majority still experience accidents due 

to low compliance with standard procedures. 

 

HCWs in a study conducted by Abdulraheem et al. (2012) in the local government 

areas of Borno State knew that the aim of standard precautions was to protect both 

health care workers and patients from transmission of infection. Majority thought that 

standard precautions were meant to protect health workers alone from getting infections 

from patient. Some also agreed that standard precautions are aimed at protecting health 

workers while handling infectious waste. 

 

The HCWs who had been in long service have greater knowledge of standard 

precautions and this may be due to their participation in a greater number of seminars, 

conferences and training some of which may include universal precautions which not 

only encouraged safer work practices but also improved concordance with policy and 

procedures (Abdulraheem et al., 2012). 

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CHAPTER THREE 

METHODS 

3.0 Introduction  

This chapter presents the design and methods used for the research project. A research 

design refers to the overall approach or strategy taken in conducting a research. 

Baumgartner, Strong and Hensley (2002), refer to research methods as an account of 

research participants, research instruments and procedures for administration, data 

collection and data analysis. 

3.1 Study Design  

A quantitative cross-sectional survey design was employed for the study. This design 

allow the study to be carried out at one point in time from different developmental 

groups at a single point in time for the purpose of inferring trends over time. 

 

This study design is appropriate because the purpose of the study is to understand the 

knowledge and practice of standard precautions among health care workers in order to 

generate information on how to improve compliance. This cross-sectional study 

describes and examines factors associated with the practice of standard precautions. 

 

3.2. Study Location 

The study was carried out in Lower Manya Krobo district in Akuse Government 

Hospital and St. Martin de Porres Catholic Hospital. 

 

Lower Manya Krobo is one of the 21 districts in the Eastern Region and it lies in the 

South-eastern part of the Eastern Region. 

 

 

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According to the HIV sentinel surveillance report (2011), the Eastern region of Ghana, 

ranks second in terms of HIV prevalence. This implies that the populations of HCWs 

who continually handle these patients are at risk of exposure to HIV. 

 

Akuse Government Hospital and St. Martin Hospital were selected for the study 

because they are the two major referral points for HIV related cases in the Lower 

Manya Krobo District. 

3.3.1 St. Martin de Porres Catholic Hospital, Agormanya 

The St. Martin de Porres Catholic Hospital is located at Agormanya in the Lower     

Manya Krobo District of the Eastern Region of Ghana. The health facility was 

established by Rt. Reverend Joseph Oliver Bowers (later Bishop) [1910 – 2012] in 

1946 as a Maternity Home. 

 

The facility offers a full range of HIV/AIDS services, including voluntary counselling 

and testing services (VCT) and prevention of mother to child transfer (PMTCT). It also 

undertakes specialized services in home-based care (H.B.C.) for people living with 

HIV/AIDS (PLWHA‟s). 

3. 3.2 Akuse Government Hospital, Akuse 

Akuse Government hospital is one of the oldest hospitals in Ghana built by the 

Germans in 1911. It is located in Akuse in the Eastern region of Ghana. It is located 

between Somanya and Asutsuare in the Lower Manya Krobo district. The hospital 

provides health services for a number of communities in the Lower Manya Krobo 

District and the surrounding districts such as Yilo Krobo, Asuogyaman, North Tongu, 

and Dangbe West districts. 

 

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The health facility is made up of the male and female ward, a maternity ward, a 

laboratory unit and a voluntary, counseling and testing unit (VCT).  

3.4 Study population  

A HCW is a person (e.g. nurse, physician, pharmacist, technician, mortician, dentist, 

student, contractor, attending clinician, public safety worker, emergency response 

personnel, health-care waste worker, first-aid provider or volunteer) whose activities 

involve contact with patients or with blood or other body fluids from patients (World 

Health Report, 2006 & CDC, 2013 ). 

 

However for the purpose of this study, the population for this research comprised of 

nurses, ward aides/ward orderlies, laboratory technicians and midwives since they often 

come into contact with blood and bodily fluids during treatment especially in 

emergencies. The target population was identified at Akuse and St. Martins Hospital. 

These hospitals are two of the largest facilities that serve the lower Manya Krobo 

district. The estimated population for our study of the two facilities is 172. 

 

3.5. Sampling 

A sample of 100 HWCs namely 18 midwifes, 55 nurses, 5 lab technicians and 22 ward 

aides participated in the study. The participants were sampled from the population of 

HCWs in both Akuse and St. Martin Hospital respectively. A total of 7 midwives, 30 

nurses, 5 lab technician, and 10 ward aides were sampled from Akuse. A sample of 11 

midwives, 25 nurses, and 22 ward aides were sampled from St. Martin. Lab technicians 

from St. Martin could not avail themselves for the 4 week period of data collection as a 

result of other commitments. In all 52 participants were selected from Akuse 

Government Hospital while 48 were Sample from St. Martin Hospital. 

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The above HCWs were sampled for the study because of their frequent interaction with 

patients and hospital treatment equipment which often expose them to potentially 

infectious blood and other bodily fluids 

3.6. Sample size determination 

The sample size was based on the 10% estimate of the population with a confidence 

interval of 95% using the formula; 

 

n = Z² * P * (1 - P) 

d² 

 n = Sample Size 




 Z = Z-value (e.g., 1.96 for a 95 percent confidence level) 


 P = Percentage of population picking a choice, expressed as decimal (Godden, 2004) 


 

d = Confidence interval, expressed as decimal 

Therefore: n = (1.96)
2
 * 0.1(1-0.1) = 138 

 

(0.5)
2
 

 
For a population < 10.000 
 
nf = n Araoye (2004) 

  1 + (n)  

  N  
 
Where: 
 

nf = the desired sample size when the population is less than 10,000 

 

n = 138, i.e. the desired sample size when the population is more than 10,000 

 

N = 172, i.e. the estimate of the population size 

 

nf =   138 Araoye (2004) 
 

1 + (138) 

 

172 

 

nf =  49 

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Hence the sample size for the study was estimated at 49. However, one hundred (100) 

were selected for the study in order to make room for inadequate response rate. This is 

because the sampling population is always busy. Per HCWs distribution ratio of the two 

hospitals, quota sampling technique of 50:48 was used to select 52 HCWs and 48 

HCWs from Akuse and St. Martin respectively. Similar quota technique of 5:18:55:22 

was used to sample a total of 5 laboratory technicians, 18 midwives, 55 nurses and 22 

ward aides for the study. Similar technique was used to select participants per hospital 

distribution in the ratio 7:30:5:10 for midwives, nurses, lab technicians and ward aides 

respectively for Akuse government hospital.  

 

A ratio of 11:25:12:0 was used in St. Martin for midwives, nurses, ward aides and lab 

technicians respectively. In terms of hospital distribution of staffs, a ratio of 7:11 for 

midwifes; Akuse: St. Martin, 30:25 for nurses; Akuse: St. Martin, 5:0 for lab 

technician; Akuse: St. Martin and ward aides, 10:12; Akuse: St. Martin. The 

distribution is summarized in Table 3.1 below 

 

 

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Table 3.1: Summary of distribution of participants from Akuse and St. Martin 
 

HWCs  Akuse St. Martin Total 
     

Midwives  7 11 18 
     

Nurses  30 25 55 
     

Lab technicians  5 0 5 
     

Ward aides  10 12 22 
     

  52 48 100 
Total     

     

 

3.7. Sampling technique    

Participants for the study were conveniently and purposively selected for the 

research from St. Martin and Akuse Government hospital. The sampling techniques 

were used because the research settings were at the convenience of the researcher 

and the researcher was interested in only the population of midwifes, nurses, lab 

technicians and ward aides. 

 

3.8 Variables  

 
 Knowledge on standard precaution 





 Risk perception of HIV 




 Perceived barriers to compliance with standard precautions 




 Work-related injuries/accidents 




 Compliance with standard precautions 


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3.9. Data Collection Technique and Tools 

 

Self-administered semi-structured questionnaire was used to obtain data from 

respondents. Questionnaires were adopted from other studies such as Akinboro et al., 

(2012), Ofili et al., (2004), Ferguson et al., (2004) and Okechuku, (2009). These 

questionnaires were used to measure risk perception, knowledge of standard 

precautions, compliance with standard precautions, barriers to compliance and work-

related accidents at the hospital settings. These studies have been adapted because it has 

been reliably tested and have been used in studies in Nigeria and some other countries. 

They are therefore reliable and valid. 

 

Data collection was done within a period of four weeks. The research team spent the 

first two weeks collecting data in Akuse and the last two weeks was spent in 

Agormanya. 

 

3.10. Tools 

 

The semi-structured questionnaire was divided in to six sections. First section captured 

the demographic characteristics of the participants. The second section measured risk 

perception, third section measured compliance to standard precautions (SPs), the fourth 

section measured barriers to compliance, fifth section was on knowledge on standard 

precautions and final section measured work- related injuries. 

 

3.10.1 HIV Risk Perception Questionnaire (Akinboro et al., 2010) 

This questionnaire measures perception of the risks posed by HIV to Health workers. 

 
A 5-point Likert scale (1= strongly disagree,   2= disagree, 3= undecided, 4= 

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agree, 5= strongly agree) was used to rate the perception ranging from 1 to 5 

 

(According to the Likert responses). Scores for each of seven items was added and 

those scoring more points were seen to have higher risk perception. 

 

3.10.2 Compliance with Standard Precautions Questionnaire (Akinboro et al., 

2010) 

 

This questionnaire measures the rate at which healthcare workers adhere to standard 

precautions when providing treatment and care. A 5-point Likert scale (1= never, 2= 

rarely, 3= sometimes 4= often, 5= always) was used to rate the level of compliance 

ranging from 1 to 5 (according to the likert responses). Scores for each of twelve items 

was added and those scoring more points were considered more compliant to universal 

precaution and vice versa. 

 

3.10.3 Barriers to Compliance (Ferguson et al., 2004) 

 

This questionnaire measures the factors that hinder health care workers effort to adhere 

to standard precautions when providing treatment and care. A 5-point Likert scale (1= 

Never, 2= Rarely, 3= Sometimes, 4= Often, 5= Always) was used to rate the level of 

compliance ranging from 1 to 5 (according to the Likert responses). Scores for each of 

eleven items was added and those scoring points were seen as experiencing more 

barriers and vice versa. 

 

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3.10.4 Knowledge of standard precautions Questionnaire (Okechukwu, 2009) 

This questionnaire deals with healthcare workers level of knowledge of standard 

precautions associated with healthcare delivery. Knowledge about standard precautions 

was measured through 7 questions having with multiple responses set. On this 

questionnaire, respondents circle the number that corresponds with a chosen answer/ 

option to the items. They were permitted to choose more than one response for some 

items. Items were scored per number of correct responses. 

 

Scores for all items are summed to create knowledge score. Those having more points 

will be having more knowledge regarding standard precautions. The scores are then 

divided  to  into  three  categories  of  level  of  knowledge.  These  include,  less 

 
knowledgeable  (0-5),  somewhat  knowledgeable  (6-15)  and  very  knowledgeable 

 
(15+). 
 

3.10.5 Work Related Accidents or Injuries questionnaire (Ofili et al., 2004) 

This questionnaire measures the Accidents/Injuries that are bound to occur at the 

workplace when providing treatment and care. A 5-point Likert scale (1= Never, 2= 

Rarely, 3= Sometimes, 4= Often, 5= Always) was used to rate the level of work related 

injuries from 1 to 5 (according to the Likert responses). Scores for each of eleven items 

was added and those scoring points were seen as experiencing more work related 

accidents and vice versa. 

 

3.11. Pilot study 

The questionnaire was pretested at the university of Ghana hospital Legon before the 

main data collection. Similar to the St. Martin and Akuse government hospitals, Legon 

hospital has trained physicians and dedicated nursing and pharmacy staff who have 

been fully engaged in developing ART programmes and models of care. 

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The facility has an out-patient and in-patient department, theatre, antenatal care, dental, 

eye, laboratory, family planning, prevention of mother to child transmission (PMTCT), 

voluntary counselling and testing (VCT), pharmacy, laundry, mortuary and X-ray units. 

The purpose of the pilot study was to establish the procedures and parameters to use for 

the research and to determine the reliability of the questionnaire. Based on the 

responses and comments from participants, minimal changes were made to some of the 

question to fit the research situation. 

 
The Cronbach's Alpha results for reliability are as follows (Table 3.2): 

 

Table 3.2 Summary of Cronbach’s Alpha Reliability of Tests 

 

Variables Alpha  Result 
  

Risk perception .64 

  

Compliance to SP .72 

  

Barriers to SP .80 

  

Knowledge of SP .75 

  

Work-related injury .86 

  
 
 

3.12. Data Collection Procedure 

Letter of introduction was obtained from the school of public health of the University 

of Ghana to obtain permission from the hospitals of interest. An office space was 

secured at the various hospitals for the purpose of data collection. Participants who 

agreed to participate were invited for the study. During the appointment, the 

investigator explained the purpose of the research and the procedures involved. If the 

participant wished to proceed, the consent form was reviewed and then signed by both 

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the participant and the investigator. A second copy of the consent form was also 

signed and given to the participant. 

 

An initial assessment was conducted by the researcher to obtain basic demographic 

information from participant. Afterwards, the participants completed a booklet of 

self-report questionnaires with the help of the researcher. For participants who had 

difficulty reading or focusing on text, the researcher assisted them by reading the 

questions aloud and marking the answers. Participants who were too fatigued to 

complete the entire procedure in one sitting were given the option to schedule an 

additional appointment to finish the questionnaires or to complete them 

independently. Data collection lasted for a month. 

 

3.13. Data analysis 

Data was analysed using SPSS v.19. The frequency distribution table was used to 

determine the response rate on variables. The Chi Square (x
2
) test and Fishers exact test 

as appropriate was used to determine the association between variables 

 

3.14. Ethical considerations 

Ethical Clearance for the study was obtained from Ghana Health Service ethical review 

committee. The Ghana Health Service Ethical Code of conduct of research was 

considered for this study. It requires that when obtaining data informed consent, 

confidentiality and right to withdraw from the study must be taken into consideration. 

Although a research study may be feasible on practical grounds it remains unacceptable 

due to its ethical implications. It is important that a researcher explores these 

implications prior to embarking on a research work 

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CHAPTER FOUR 

RESULTS 

4.1. Introduction 

This chapter presents the findings, based on responses in the completed copies of the 

questionnaire on risk perception, work-related injury as well as the barriers, 

knowledge and practice of standard precautions among health care workers. The 

Fisher Exact Chi-square test was used to determine association between variables. 

Due to the large response rate however, only significant values are reported for Chi-

square test tables. 

 

The majority of respondents were female (73%). With respect to categories of health 

care providers, 55% were nurses, 22% were ward aides, 5 % were laboratory 

technicians and 18% % were midwives. Fifty-two per cent (52%) of the participants 

were from Akuse government hospital with the other respondents from St. Martin 

catholic hospital in Agormanya (table 4.1). 

 
 
 
 

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Table 4.1: Background Characteristics of Respondents *: N=100 
 
 

 Variables Frequency Percentage 

  N=100 (%) 
    

 Sex   

 Men 27 27.0 

 Females 73 73.0 

 Area of practice   

 Midwife 18 18.0 

 Nurse 55 55.0 

 Lab technician 5 5.0 

 Ward aides 22 22.0 

 Level of Education   

 SHS/ Vocational 23 23.0 

 Tertiary 77 77.0 
    
 

4.2. Findings on Risk Perception of HIV 

 

Majority of the participants (94%) regarded HIV as a public health issue and most of 

them (57% strongly agree and 37% agree) perceived that they were at risk of 

contracting HIV on the job (Table 4.2). The study also revealed that 89% of the 

respondents agreed that their risk of contracting HIV is larger than other professional 

outside the health care industry because of the job they do (Table 4.2). Furthermore, 

94% of the respondents agreed that unavailability of personal protective equipment 

(PPE) puts them at risk of contracting HIV 

 

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More than half of the respondents did not like working with colleagues who would 

not adhere to standard precautions (72%) while 81% of the participants were of the 

view that not knowing the HIV status of patients placed them at risk of infection; 

However 61% of respondents mentioned that an HIV- infected worker may poses a 

health risk. The Chi-square test and Fisher exact test was used to test the association 

of variables. Only significant values are reported (Table 4. 3) 

 
 

 

TABLE 4. 2: Respondents’ risk-perception regarding 

HIV        

 Variables Degree of risk perception      

  Strongly Disagree Undecide Agree Strongly 
  disagree   d    Agree 

  F % F % F % F % F % 

 I  think  about  HIV  and/or  AIDS  as  a 1 1.0 2 2.0 2 2.0 39 39.4 55 55.6 

 public health problem all the time (R1).           

 I think I am at risk of contracting HIV as 2 2.0 4 4.0 0 0.0 37 37.0 57 57.0 

 a result of my job           

 My risk of contracting HIV is larger than 1 1.0 8 8.0 2 2.0 36 36.0 53 53.0 

 that   of   other   professionals   outside           

 healthcare industry.           

 Unavailability  of  personal  protective 3 3.0 3 3.0 0 0.0 28 28.0 66 66.0 

 equipment such as gloves, gowns, masks,           

 nylon  aprons,  et  cetera,  at  some  times           

 when caring for patients put me at a very           

 high risk.           

 Not knowing the HIV status of patients 5 5.0 8 8.0 6 6.0 36 36.0 45 45.0 

 before giving them care puts me at very           

 high risk of contracting HIV.           

 Working with a colleague who does not 6 6.0 13 13.0 9 9.0 42 42.0 30 30.0 

 adhere  to  universal  precautions  in  the           

 course of duty puts me at a very high risk           

 of HIV infection.           

 An   HIV-infected   healthcare   worker 13 13.1 19 19.2 6 6.1 25 25.3 36 36.3 

 constitutes  a  very  high  risk  to  their           

 colleagues and patients.           
 
Fisher Exact test analysis indicated that nurses (58.3%) (p = 0.05) and ward aides 

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        (21%;  p  =  0.04)  were  more  likely to  perceive  HIV  as  a  public  health 

problem  compared to other health professionals such as Midwife (17.4%) and lab 

technicians(5.2%). Additionally, more  

nurses significantly (p = 0.05) considered themselves to be at high risk of HIV 

(55.1%) as a result of the nature of their job compared with ward aides (21.4%) 

midwifes (16.5%), and lab technicians (5%) respectively (Table 4.3). 

 

Table 4.3: Summary of X
2
 result of significant values of variables on risk 

perception 

 Variable Frequency df X
2
 P 

  (%)    

     

1 I view HIV as a public health issue    

      

 Nurse 54(58.3) 4 7.13 0.05 

 Ward aides 22(21.0) 4 8.89 0.04 

    

2  I am at a high risk of HIV as a result of my job   

      

 Nurse 55(55.1) 3 6.52 0.05 

 

3 My risk of contracting HIV is larger than that of other professionals outside 

healthcare industry.   
Akuse hospital 52(49.8) 4 7.77 0.05 

St. Martin 48(50.2) 4 7.77 0.05 

 

4 Unavailability of personal protective equipment such as gloves, gowns, 

masks, waterproof aprons, et cetera, at some times when caring for patients put 

me at a very high risk.   
 Midwife 18(18.2) 3 6.70 0.05 
 Ward aides 22(21.1) 3 7.24 0.05 

 

5. Not knowing the HIV status of patients before giving them care puts me at very 

high risk of contracting HIV. 
 

Nurse 55(57.6) 4 8.94 0.05 

 

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Working with a colleague who does not adhere to universal precautions in the course 

of duty puts me at a very high risk of HIV infection  

 

Midwife 18(16.7) 4 10.94 0.02 

Nurse 55(59.4) 4 15.08 0.03 

     
 
 
 

6. An HIV-infected healthcare worker poses a very high risk to colleagues and 

patients.  

 
Lab technician 5(2.9) 4 7.09 0.05 

 
*p < 0.05 
 

 

Furthermore, almost majority of the HCWs purported that their risk of contracting 

HIV is larger than that of other professionals outside healthcare industry. Compared 

to Akuse Hospital (49.8%; p = 0.05), most HCWs from St. Martin hospital (50.2%) 

significantly believed that their risk of contracting HIV was larger than that of other 

professionals outside the healthcare industry (Table 4.3). 

 

Additionally, quite a minority of the HCWs (Midwife, 18.25% and Ward Aide, 

21.1%) believed that unavailability of personal protective equipment such as gloves, 

gowns, masks, waterproof aprons, et cetera, at some times when caring for patients 

puts them at a very high risk (p = 0.05). [Table 4.3] 

 

Most HCWs [(nurses) 57.6%] attributed the lack of knowledge on the HIV status of 

patients before giving them care as a potential source of high risk of exposure to 

HIV.  

Thus, majority of the HCWs were more likely not to work with colleagues who do not 

adhere to standard precautions since they can be at risk of contracting HIV. 

 

This was significant for nurses (p = 0.02) and midwifes (p =0.03). This implied that 

majority of the midwives and nurses would not like to work with colleagues who do 

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not comply with standards. Notwithstanding, some of the Lab technicians who were 

in the minority were of the view that an HIV-infected healthcare worker hardly posed 

a very high risk to colleagues and patients (p =0.05). 

 

 

4.3. Findings on Compliance with standard precautions 

Data gathered through the self-reporting questionnaire revealed good compliance with 

standard precautions (SP) amongst the HCWs surveyed; 99.0% of the participants 

claimed that they protected themselves against contact with blood and body fluids of 

all patients. This was significant for HCWs in Akuse government hospital (54.6%) 

who tend to protect themselves compared to St. Martin (45.4%; p =.05)[Table 4.5]. 

For example 50% reported that they always protect themselves against blood and 

body fluid whilst 24% often protect themselves and 25% sometimes protected 

themselves (Table 4.4). 

 

Almost all the respondents reported washing their hands after removing their gloves 

(99%). However, HCWs who have been practicing for 12-17 years hardly wash their 

hands immediately after removing gloves (p =0.02) [table 4.5]. Nonetheless, 97% of 

the respondents agreed that HCWs promptly wipe all blood spills but about 6% of 

HCWs do not cover their broken skin to avoid contamination. Additionally, HCWs 

who have been practicing for 0-5 years (67.9%) are more likely to cover broken skins 

compared to other HCWs who have been practicing for various years (p = 0.02). 15% 

of the participants agreed that HCWs do not report needlestick injuries (NSI).  

 

      Furthermore, majority of the HCWs (57%) claimed they recap needles while more 

than half    of the respondents (55%) always put used needles in to „sharps containers‟ 

especially nurses (57.2%; p = 0.006) and midwifes (16.2%; p = 0.02). 30% often 

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would put used needles into „sharps‟ containers. 17% of the HCWs always put on eye 

protection and this is significant for Midwifes (22.1%) compared to other HCWs (p = 

0.05). this means that Midwives claim they always put on eye protection. 12% often 

wear eye protection whilst 25% and 9% rarely or never wore eye protection 

respectively. Additionally, 3% of the respondents claim they have never had adequate 

training while majority (88%) agree that their supervisors always, often or sometimes 

encourage training and this is significant for those who have been practicing for 6-11 

years (p = 0.04; refer to Table 4.5). this means that HCWs who have been practicing 

for 6-11 years see regular training on compliance as very important 

 

Table 4.4: respondents level of compliance 
 

 Variables   Degree of compliance      

  Never Rarely  Sometimes Often Always 

  F % F % F % F % F % 

 Protection against blood and 0 0.0 1 1.0 25 25.0 24 24.0 50 50.0 

 body fluids of all patients           

 Puts used needles into 1 1.0 1 1.0 13 0.0 30 30.0 55 55.0 

 sharps container           

 Wears gloves 0 0.0 1 1.0 10 10.0 28 28.0 61 61.0 

 Wash hands after removing 0 0.0 1 1.0 21 21.0 29 29.0 49 49.0 

 Gloves           

 Wears waterproof apron 2 2.0 11 11.0 35 35.0 26 26.0 26 26.0 

 Wears eye protection 9 9.0 25 25.0 37 37.0 12 12.0 17 17.0 

 Do not recap needles 25 25.0 18 18.0 17 17.0 6 6.0 34 34.0 

 Promptly wipes all blood 1 1.0 2 2.0 8 8.0 28 28.0 61 61.0 

 Covers broken skin 2 2.0 4 4.0 14 14.0 34 34.0 46 46.0 

 Reports needlestick injury 8 8.0 7 7.0 27 27.0 25 25.0 33 33.0 

 Supervisors encourage 6 6.0 6 6 40 40.0 19 19.0 29 29.0 

 Training           

 Staffs have had adequate 3 3.0 0 0 23 23.0 42 42.0 46 46.0 

 Training           

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Table 4.5: Summary of X
2
 result of significant values of variables on compliance 

 

Variables Frequency (%) Df X
2
 P 

   

Protection against blood and body fluids of all patients   
     

Akuse hospital 52(54.6) 3 6.79 0.05 

St. Martin 48(45.4) 3 6.79 0.05 
    

Puts used needles into sharps container    
     

Midwife 18(16.2) 4 10.81 0.02 

Nurse 55(57.2) 4 11.82 0.006 
     

Wears gloves     
     

Midwife 18(16.9) 3 7.72 0.04 
    

Wash hands after removing gloves    
     

12-17 years 5(4.0) 2 6.23 0.02 
     

Wears waterproof apron     
     

Midwife 18(20.4) 4 15.82 0.01 

Nurse 55(56.6) 4 9.55 0.04 

Akuse hospital 52(52.3) 4 9.93 0.03 

St. Martin 48(47.7) 4 9.93 0.03 
     

Wears eye protection     

     

Midwife 18(22.1) 4 8.73 0.05 
     

Covers broken skin     
     

0-5 years 65(67.9) 4 10.80 0.02 

 

     Supervisors encourage training 
 

 

 6-11years 23(21.2) 4 9.03 0.04 
      

 *p < .05     

      
      

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Table 4.5 further indicates that wearing of gloves is highly significant for midwifes 

compared to other HCWs (p = 0.04). This means that midwives perceive hand gloves 

to be very important in health care delivery. Moreover, wearing of water proof apron 

is highly significant for nurses (56.6%) and midwifes (20.45%) compared to other 

HCWs (p <. 05). This indicates that midwifes and nurses are more likely to make use 

of water proof aprons compared to other HCWs. Moreover HCWs of Akuse (52.3%) 

were more likely to wear water proof apron compared to HCWs at St. Martin (47.7%; 

p = 0.05) 

 
4.4. Findings Barriers to Compliance 

Half of the participants (n=50) were of the view that complying with standard 

precautions (SP) during emergency situations sometimes put the patients at risk and 

therefore they are likely not to adhere (Table 4.6). Significantly, 58.6% of HCW who 

have been practicing for 0-5 years and 6-11 (23.1%) claim that complying with 

precautions interferes with the ability to provide care (p < 0.05) compare to other 

HCWs. Furthermore, majority (74%) of respondents believed that sometimes the 

unavailability of personal protective equipment (PPE) could be a barrier to 

compliance with SP. However lab technicians (4.7%) compared to other HCWs (p 

 
=0.005) belief that PPE should not be a barrier to compliance (Table 4.7) 
 
 

 
Other reasons given for not using precautions were: HCWs did not anticipate the 

exposure (63%); this perception was significantly high for HCWs who have been 

practicing for 0-5 years (68.3%) and 6-11 years (28.6%) compared to other HCWs (p 

< .05). other HCWs claim that high demands in care led to being in a hurry and 

therefore they forgot precautions (79%). Quite a number of the HCWs were of the 

opinion that the patients did not pose a risk (75%), the available equipment was not 

effective (78%). Additionally, many of respondents (73%) would not comply with 

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precautions because of the perception that it might cause fear to the patients. The 

study also revealed that because PPE is not conveniently located 72% of the 

respondents did not adhere to precautions. A few participants thought practicing SP 

always (5%) or often (9%) was time consuming, majority however agreed that 

sometimes it did (45%). Most respondents (79%) also experienced discomfort with 

protective gear and therefore they were not always using it to prevent infection. This 

was significant issue for those who have been practicing for 0-11 years (91.4%; Table 

4.7) 

 
 

Table 4.6: responses on Barriers to compliance 
 

Variables     Degree of barriers      

   Never Rarely  Sometimes Often  Always 

   F % F % F % F % F % 

Compliance  During 17 17.0 8 8.0 50 50 50 50 0 0 

emergency puts patient at risk           

Interferes With ability   to 26 26.3 10 10.1 38 38.3 19 19.2 6 6.1 

provide care            

Unanticipated exposure 17 17.2 19 19.2 39 39.4 15 15.2 9 9.1 

care demands led to being in 9 9.0 12 12.0 44 44.0 29 29.0 6 6.0 

Hurry             

Unavailability of equipment 10 10.0 3 3.0 74 74.0 7 7.0 6 6.0 

Belief  that  patients  do  not 23 23.5 12 12.0 38 38.8 17 17.3 8 8.2 

pose risk             

Discomfort With protective 25 25.0 12 12.0 42 42.0 16 16.0 5 5.0 

Gear             

Ineffective equipment 10 10.0 12 12.0 60 60.0 12 12.0 6 6.0 

   

Protective  equipment  might 19 19.0 11 11.0 63 63.0 4 4.0 3 3.0 

cause fear           

PPE   is   not   conveniently  17 17.2 10 10.1 53 53.5 14 14.1 5 5.1 

Located           

Practice is time consuming 30 30.0 11 11.0 45 45.0 9 9.0 5 5.0 
           

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  Table 4.7: Summary of X

2
 result of significant values of barriers to compliance 

 

 Variables Frequency (%) Df X2 P 

    

 Interferes with ability to provide care   

      

 0-5 years 64(58.6) 4 9.16 0.05 

 6-11 years 23(28.6) 4 9.35 0.04 

     

 Unanticipated exposure    

 0-5 years 64(68.3) 4 13.98 0.006 

 6-11 years 23(23.1) 4 10.64 0.03 

     

 Unavailability of equipment    

      

 Lab technicians 5(4.7) 4 12.77 0.005 

     

 Discomfort with protective gear    

      

 0-5 years 69(62.5) 4 10.40 0.03 

 6-11 years 23(25.4) 4 11.11 0.02 

      

 *p < .05     

      
 
 

 4.5. Findings Knowledge on SP among HCWs 

Knowledge of the basic concept of the standard precautions was inadequate among 

the health care workers; only 37% of them knew that SP includes; hand washing 

before and after any direct contact with patient and , consideration of the potential for 

transmission of infectious agents in patient placement decisions., Cough etiquette 

such as directing patients/relatives with symptoms of a respiratory infection to cover 

their mouths/noses when coughing or sneezing and Safe injection   practices  and 

aseptic technique. 

 

 

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More than half of the respondents (64%) had adequate knowledge on the potential 

ways of occupational exposure whilst 54% of the participants knew hand washing is 

performed; before any direct contact with patients, between patients‟ contact, 

immediately after removing gloves and after touching body fluids such as blood, 

excretions and sweat. 

 
Almost all the respondents (90%) were aware that SP should be performed uniformly 

to all hospitalized patients and also 91% of the respondents were aware that body 

fluids such as blood, vaginal fluid, blood tinged body fluids and saliva in dental 

procedures required SP. Findings from the study show that the 51.5% of the 

respondents know that PPE should be worn regardless of the patients‟ factor (HIV, 

HBV or any sign and symptom of infection). 

 

 

Furthermore, only 49% of the HCWs had knowledge that HIV counseling and testing was 

required after occupational exposure, and that PEP should be given if the HIV test result 

is negative. Almost all the participants (90%) were aware that ART is taken within 72 

hours and 63.6% had correct knowledge on the duration of ART. Almost two third of the 

respondents (82%) were more knowledgeable of standard precautions. 

 

The chai square (X
2
) and Fisher exact test was used to determine the association of 

hospital, area of practice and years of practice with level of knowledge (Table 4.8). 

 
 

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Table 4.8: Level of knowledge of respondents of standard precautions 
 
 

Variables Level of knowledge     

      

 Somewhat Very    

 Knowledgeable knowledgeable    

      

 Frequency (%) Frequency (%) Df X2 P 
      

Area of practice   3 2.12 .53 

Midwife 2(11.1) 16(88.9) 1 .77 .31 

Nurse 9(16.4) 46(88.9) 1 .22 .42 

Lab technician 1(20) 4(80) 1 .01 .64 

Ward aide 6(27.3) 16(72.7) 1 .20 .17 

Hospital   1 .04 .53 

Akuse 9(17.3) 43 (82.7) 1   

St. Martin 9(18.8) 39(81.3) 1   

Years of practice   4 5.04 .25 

0-5 12(18.5) 53(81.5) 1 .06 .50 

6-11 5(21.7) 18(78.3) 1 .13 .47 

12-17 0(0.00) 5(100) 1 1.25 .34 

24-29 1(100) 0(0.00) - - - 

30 or more 0(0.00) 6(100) 1 4.27 .20 

      

*p < .05      
 

 

Table 4.8 shows that midwife (88.9%), nurses (88.9%), and lab technicians (80%) 

were more knowledgeable of standard precautions compared to ward aides (72.7%) 

although the difference was not statistically significant (p > .05). 

 

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Moreover, HCWs of St. Martin (81.3%) displayed virtually equal knowledge of 

standard precaution as HCWs of Akuse (82.7%, p = .53). HCWs of various years of 

experience also display equivalent level of knowledge on standard precaution 

although Knowledge was high for lesser years of experience compared to higher years 

of experience. The difference is however, is statistically insignificant (p > 0.05). 

Knowledge level is worse for those who have been practicing for 24-29 years. 

 

4.6. Findings on Work-related Injuries 

The findings from the study show that although 9% of the respondents claim they 

always experience blood splashes on their face and other parts of their body, 23% and 

55% often and sometimes respectively experience it. The study also reported that 

more than half (53%) sometimes experience chemical splashes. This was significant 

for HCWs who have been practicing for 6-11 years (p = 0.04) as they believe that 

chemical splash is a serious issue that requires attention compared to other HCWs. 

27.2% of the respondents experience knife relates injuries whilst glove perforation 

during surgery was experienced by 39% of the respondents and then 37 of the 

participants reported that they sometimes experience scalpel injury (Table 4.9). 

 
11% of the respondents always experience open wound contamination when working 

as against 38% of them who sometimes experience it. However, HCWs who have 

practicing for 6-11 years (21.6%) hardly encounter wound contamination compared to 

other health workers (p = 0. 04) 

 

Majority (32%) rarely experienced accidental falls when rushing to attend to patients 

although quite a number of them (29%) sometimes experience falls. This is significant 

for lab technicians (p = 0.05) and Ward Aides (p = 0.001) compared to other health 

workers (table 4.10). 

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Moreover HCWs at Akuse (51.5%) were more likely to experience accidental falls 

compared to HCWs at St. Martin (p = .05). Over half (59%) said they had never 

experienced fire injury. 42% of the HCWs who participated said they sometimes 

experience NSI, 16% always got pricked by needle and then a quarter of them (25%) 

often got injured by needle. 

 

The level of needle prick injury is significant for Lab technicians (p = 0.02) and 

HCWs who have been practicing for 12-17 years (p = 0.02) as compared to other 

HCWs. This means that Lab technicians and HCWs who have been practicing for 12-

17 years hardly experience needle stick injury. When asked to report any other injury 

apart from the ones stated on the questionnaire, 4 respondents had experienced 

aggression or attack from patients or