DEPARTMENT OF COMMUNITY MEDICINE

Al-Aleem Medical College Lahore

Research Proposal

Safety Protocols and Practices Adopted by Nursing Staff during

Inpatient Care at Gulab Devi Hospital, Lahore Pakistan

4th year MBBS

Session 2023-2024
Muhammad Shahbaz Roll No.57
Mehwish Sadique Roll No.68
Minal Fatima Roll No.75
Bisma Javed Roll No.76
Ahmad Raza Roll No.77

Tutor’s Name:Dr. Asifa Asghar

Supervisor’s Name:Dr.M. Ashraf Majrooh

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Contents
Introduction 1
Objectives: 4
OPERATIONALLY DEFINED PROTCOL Of KNOWLEDGE 4
Safety Protocol and Procedure: 4
Nursing Care: 4
METHODOLGY: 4
Study Design: 4
Study Setting: 5
Duration: 5
Sample size : 5
Sampling Technique: 5
Inclusion Criteria: 6
Exclusion criteria 6
Data dissemination: 7
Ethical Consideration: 7
Work Plan 8
References 8
Annexures: 10
Research Questionnaire 10
Questionnaire for Assessing the knowledge (Interview Based) 10
Questionnaire for observation regarding the implementation of safety measures (15): 11

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Introduction

Guidelines have been in existence since the lateS 1970s and early 1980s to improve the
safety of healthcare workers (HCWs) which help to reduce the rate at which HCWs
were exposed to blood, fluids, needles and other sharp objects (1).

The infection such as hepatitis B virus (HBV) and human immunodeficiency virus
(HIV) to many healthcare workers (HCWs) via increased risk of exposure to blood
borne pathogens in 1970s resulting in taking initiative for guidelines. Changes have
been made in the guidelines content over period of time.

Gulab Devi Hospital Lahore is one of a large-scale hospital with respect to patients’
density in Lahore. A populous city of developing country like Pakistan brings many
kinds of diseases to the hospitals. It’s understandable healthcare workers (HCWs)
especially nurses are in a vulnerable environment and exposed to some deadly blood-
borne infections such as human immunodeficiency virus (HIV) and hepatitis B and C
virus (2) Nurses are exposed to infectious diseases while they are at work, especially
when caring for patients who have these illnesses. Exposure to viruses, bacteria,
parasites, and fungi can lead to illnesses such as influenza, hepatitis B or hepatitis C,
and tuberculosis. While some of these illnesses are mild, others can cause serious, often
harmful, symptoms. Nurses also have to take time off from work while recovering from
these diseases. Wearing personal protective equipment (PPE) and receiving
vaccinations for some infectious diseases can help keep nurses safe from these illnesses.
(3)

Various studies have shown that needle recapping, improper needle disposal, IV
cannulations and setting of drips are some common activities leading to needle stick
injuries. Nurses in healthcare institutions are highly susceptible to occupational hazards
and injuries. The nature of their work and obligations put them at risk of
musculoskeletal and physical postural risk factors, needle stick injuries, exposure to
sterilant, medications, and latex. These hazards can lead to disabilities, decreased
productivity, and even death, resulting in a loss of skilled personnel. Preventative

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measures, appropriate training, and promoting a culture of safety are crucial to ensure
healthcare workers' wellbeing (4).

Manual handling tasks, such as lifting heavy loads, contribute to the high incidence of
musculoskeletal injuries among healthcare workers, particularly nurses who work long
hours. Inadequate sleep and prolonged periods of standing and stooping also contribute
to postural issues and back injuries. Researches have shown that nurses with working
shifts longer than 12 hours per day or more than 40 hours a week have a greater
tendency to commit mistakes and the risk of errors were significantly high (5).
Exposure to sterilant during equipment cleaning can lead to long-term damage to the
central nervous system and increase the risk of cancer. The use of certain medications
and pesticides can also pose a threat to healthcare workers' health and well-being,
especially for women and children (6). Studies have shown that nurses are predisposed
to many infections and blood borne diseases and their incidence is about 45% which is
alarming (7).

Study identified multiple influencing factors on patient safety in hospitals, including

human factors, physical factors, patient factors, environmental factors, and safety
culture (8).Various studies have shown that nurse to patient ratio, workload and the duty
hours have an impact on patients, outcome and health. Malfunction and negligence can
result in allergic reactions, infections, physical and psychological injuries to the
patients. It may also lead to permanent damage to the patients ‘organs and wrongful
deaths (9). According to WHO about 10% of the patients are harmed as a result of
negligence and errors of healthcare workers. (10)

Ensuring patient safety and promoting a culture of safety in healthcare settings requires
implementing preventive measures, providing training, and supplying protective
equipment to healthcare workers. The "Patient Safety Friendly Hospital Initiative
(PSFHI)," a WHO-led program focused on patient safety standards implementation, is
being implemented in over 80 hospitals in Pakistan. By prioritizing these measures,
healthcare workers can deliver high-quality care to patients while maintaining their
safety and well-being (11).

Developing nations face unique patient safety concerns, and healthcare workers in these
countries often encounter unaddressed challenges. In response, countries like Pakistan
have developed their own accreditation systems through local acts to enhance

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healthcare quality. These systems ensure that healthcare services align with professional
knowledge and contribute to improved health outcomes (12).

GULAB DEVI HOSPITAL follows a comprehensive process for healthcare workers

that includes examining all work-related aspects such as the workplace, equipment,
materials, and procedures. This process involves identifying exposed workers, tasks,
safety measures, work accidents, occupational diseases, and relevant regulations.
Employers are legally required to ensure the health and safety of their employees by
controlling risks through the design of safety measures. Any risks that cannot be
eliminated must be reduced to an acceptable level.
The nursing students and healthcare workers are taught about the standard safety
measures throughout their curriculum. All clinical courses pay much heed to these
provisions. Students can fail a clinical course if they are neglecting the safety measures.
Education and training are the fundamentals for achieving goals regarding standard
safety customs. It is essential that the risk mitigation procedure is examined and
regularly revised, such as on an annual basis, to verify that the protective steps that
were put in place are suitable and efficient, and to contemplate additional measures
where required. However, the implementation of SPs has been a great challenge
especially in developing countries like Pakistan. These countries face shortage or lack
of PPEs, poor training and poor awareness which can greatly affect the health of HCW
as well as the patients (13).
Bullying and workplace incivility have unfavorable effects on nurse-assessed patient
quality through their effect on perceptions of patient safety risk there is no occupational
health and safety legislation for the healthcare sector (14). In others, the means to
monitor its implementation and the machinery to discipline the offending employers is
ineffective or non-existent. Additionally, most governments fail to regularly collect data
on the incidence of accidents, injuries and illness of nursing personnel and other
healthcare workers as the basis for sound policy formulation. Where data is collected
regularly, data collection can be hampered by underreporting of work-related injuries
and illnesses.
This research aims to evaluate the level of knowledge among nurses regarding safety
measures in nursing care and determine its prevalence. This will help identify whether
errors are due to inadequate nursing practices or suboptimal sterilization procedures and
equipment. By gaining a deeper understanding of the underlying causes of knowledge

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gaps, we can develop more targeted interventions to enhance the quality of care and
minimize patient harm.

Objectives:

The objective of this study is" To determine knowledge and practices of safety
procedures and protocols by nursing staff during inpatient care at GULAB DEVI
Hospital, Lahore, Pakistan ".

OPERATIONALLY DEFINED PROTCOL Of KNOWLEDGE

Safety Protocol and Procedure:

An action, procedure or contrivance designed to lower the occurrence or risk to the
health workers, patients, loss and danger to property or the environment.

Nursing Staff:
Nursing staff consists of licensed healthcare professionals trained to provide patient
care, administer treatments, and support individuals across healthcare settings.

Patient Safety:
Patient safety involves proactive measures to prevent harm, minimize risks, and ensure
the well-being of patients, aiming to create a safe healthcare environment and deliver
high-quality care free from preventable errors.

Nursing Care:
Nursing care is a specialist package of support delivered by specially trained carers and
overseen by a qualified clinical nurse. This type of care is typically more complex in its
nature, requiring specialist support for certain health care needs.

METHODOLGY:

Study Design:
This is a facility based cross-sectional study, intended to find out the safety measures
observed by the health care workers.

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Study Setting:
This research will be conducted at Medicine Unit-1 and Medicine Unit-2, Surgery Unit-
1 and Surgery Unit-2 and Gynecology and Obstretics, Orthopedics, Cardiology,
Pulmonology and emergency of the Gulab Devi Chest Hospital, Lahore.

Gulab Devi Hospital in Pakistan is a reputable healthcare institution affiliated with the
Gulab Devi Educational Complex and Research Center. It is well-known for its
excellence in Pulmonology and commitment to providing quality medical services.
Located centrally in Lahore, Punjab, the hospital offers convenient access to healthcare
for patients in the region.

Duration:
The estimated duration of study will be 6 months of time period.

Sample size :
Sample size is 381
Weblink: https://www.calculator.net/sample-
size-calculator.html?type=1&cl=95&ci=5&pp=20&ps=&x=106&y=17

This means 381 or more measurements/surveys are needed to have a confidence level
of 95% that the real value is within ±5% of the measured/surveyed value.

Sampling Technique:
It is purposive(non-random) sampling procedure.

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Inclusion Criteria:
Only the nurses of Medicine Unit-1 and Medicine Unit-2, Surgery Unit-1 and Surgery
Unit-2 and Gynecology and Obstetrics, Orthopedics, Pulmonology, Cardiology and
Emergency Unit of Gulab Devi Hospital, Lahore.

Exclusion criteria
1. Exclusion of all other healthcare workers: This includes physicians, dental
professionals and students, medical students, laboratory technicians, pharmacists,
hospital volunteers, and administrative staff. Only nurses will be included in the study.

2. Exclusion of nurses busy in emergency centers: Nurses working in emergency

centers will not be included in the study to ensure consistency and avoid potential
confounding factors.

3. Exclusion of nurses unwilling to cooperate: Nurses who express unwillingness

to participate or cooperate with the study procedures will be excluded from the
research.

Data collection procedure

For date collection we will visit Medicine Unit-1 and Medicine Unit-2, Surgery Unit-1
and Surgery Unit-2 and Gynecology and Obstetrics, Pulmonology, Orthopedics
Cardiology and Emergency Unit of Gulab devi hospital. Two questionnaires will be
used in this research. One will be interview based which will be filled by the nursing
staff. Questionnaire will contain questions regarding their knowledge about safety
measure.

interview will be conducted after observation checklist is completed.

Data analysis Plan:

The data collected through the Questionnaire will be analyzed by using SPSS.
The variables for the assessment will be
 Staff training
 Knowledge of sterilization,
 Risk during health care
 Sops

The frequency will be estimated for both knowledge and practices.

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Association will be estimated for years of training and knowledge and practices. The
data will be presented in tabular form , in Pie charts and histogram.

Data dissemination:
After completing our research, we will submit the report to our respective tutors in the
Community Medicine Department. Our priority will be to get our research published in
a Peer reviewed journal. Scientific reporting of the results, Major findings, and
translational implication will be communicated to healthcare professionals, patient
organizations, public health policy makers through our research publication. Our
research will also be disseminated through seminar, presentation and publication.

Ethical Consideration:

Ethics approval study will be received by institutional Review Board of Gulab Devi
Hospital. Rules and regulations of the hospital will be followed. Adequate level of
confidentiality will be ensured while collecting the data.

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 Work Plan

Work Plan for dissertation (Gantt Chart)

Task 1st Month 2nd Month 3RD Month 4TH Month 5th Month 6th Month
W W W W W W W W W W W W W W W W W W W W W W W W
1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4

synopsis
preparation
approval process
review and
feedback
preparation of
tools
pretesting tools
finalization of
tools
data collection
data entry
report writing
report review

References

1. Akagbo SE, Nortey P, Ackumey MM. Knowledge of standard precautions and barriers to
compliance among healthcare workers in the Lower Manya Krobo District, Ghana. BMC
research notes. 2017 Dec;10:1-9.

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2. Nadeem I, Alvi A, Raza S, Rasool MU, Munamm SA. Assessment of the Safety Measures
Adopted By Healthcare Workers in DHQ Hospital Faisalabad, Pakistan. Annals of Punjab
Medical College (APMC). 2013;7(1):67-72.

3. Blog PU. https://post.edu/. [Online].; 2022 [cited 2023 05 14. Available from:
https://post.edu/blog/understanding-preventing-workplace-hazards-nurses/.

4. Elewa AH, El Banan SH. Occupational hazards as perceived by nursing interns and
protective measures. IOSR Journal of Nursing and Health Science (IOSR-JNHS).
2016;5(6):107-18.

5. Rogers AE, Hwang WT, Scott LD, Aiken LH, Dinges DF. The working hours of hospital staff
nurses and patient safety. Health affairs. 2004 Jul;23(4):202-12.

6. Trinkoff AM, Geiger-Brown JM, Caruso CC, Lipscomb JA, Johantgen M, Nelson AL, Sattler
BA, Selby VL. Personal safety for nurses. Patient safety and quality: An evidence-based
handbook for nurses. 2008 Apr.

7. ZARNIGAR RE, ZIA T, SAGIR T, LATIF W, LAIQUE T. Practice of Nurses Regarding

Prevention from Needle Stick Injuries in Tertiary Care Hospital Lahore Pakistan.
Hospital.;31:33-.

8. Khan NU, Noor QU, Tasawar A, Hisamuddin E. DETERMINING THE FACTORS

INFLUENCING PATIENT SAFETY CULTURE IN HOSPITAL SETTINGS. Pakistan Armed
Forces Medical Journal. 2020 Jun 29;70(3):694-99.

9. The Pagan Law Firm PC. https://www.thepaganlawfirm.com/. [Online].; 2023 [cited 2023
May 14. Available from: https://www.thepaganlawfirm.com/the-consequences-of-
malpractice-nursing/#:~:text=Devastating%20consequences%20can%20occur%20if,lifelong
%20effects%20on%20the%20patient.

10 https://online.hpu.edu/. [Online]. [cited 2023 05 14. Available from:

. https://online.hpu.edu/blog/nurses-role-in-patient-safety/.

11 Kiaei MZ, Ziaee A, Mohebbifar R, Khoshtarkib H, Ghanati E, Ahmadzadeh A, Teymoori S,

. Khosravizadeh O, Zieaeeha M. Patient safety culture in teaching hospitals in Iran:
assessment by the hospital survey on patient safety culture (HSOPSC). Health
Management & Information Science. 2016 Apr 1;3(2):51-6.

12 Shah M, Perveen S. State of healthcare quality and patient safety in Pakistan. Pakistan
. Journal of Public Health. 2016 Dec 1;6(4):1-4.

13 Akagbo SE, Nortey P, Ackumey MM. Knowledge of standard precautions and barriers to
. compliance among healthcare workers in the Lower Manya Krobo District, Ghana. BMC
research notes. 2017 Dec;10:1-9.

14 Laschinger HK. Impact of workplace mistreatment on patient safety risk and nurse-assessed
. patient outcomes. The Journal of Nursing Administration. 2014 May 1;44(5):284-90.

15 Gershon RR, Vlahov D, Felknor SA, Vesley D, Johnson PC, Delcios GL, Murphy LR.
. Compliance with universal precautions among health care workers at three regional
hospitals. American journal of infection control. 1995 Aug 1;23(4):225-36.

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Annexures:

Research Questionnaire

Title: Safety Protocols and Practices Adopted by Nursing Staff during Inpatient
Care at Gulab Devi Hospital, Lahore Pakistan

Questionnaire for Assessing the knowledge (Interview Based)

Age:

Gender: ☐ Male ☐ Female

Title: ☐ Student/ Trainee Nurse ☐ Qualified Nurse ☐ Internee

or some other specify------

Basic Qualification☐ Technical secondary school ☐ Junior college

☐ Undergraduate ☐ Postgraduate ☐ Other specify-----------

In which of the following department you are working: ☐ Medicine

☐ Surgery

☐ pulmonology ☐ gynae and OBS ☐ orthopedics ☐ Emergency

☐ Cardiology
Trainee/student duration of enrollment in years--------------
If Qualified Nurse, working experience: __________ years

1) Have you received training on infection prevention and control measures before
starting work?
(a)Yes (b) No (C) Don’t know
2) were you given proper instructions and knowledge about the usage of personal
protective equipment (PPE)?
(a) Yes (b) No (C) Don’t know
3)were proper guidelines provided to you about the usage of soap and sanitizer?
(a)Yes (b) No (C) Don’t know
4) Were you guided about the usage of sanitizer, hands washing every time after
coming into contact with the patients?

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(a)Yes (b) No (C) Don’t know
5) Were you taught about the dangers of getting blood or body fluids on your clothes,
and how to prevent it?
(a)Yes (b) No (C) Don’t know
6) Were you guided about refraining from recapping of infected needles?
(a)Yes (b) No (C) Don’t know
7) Were you provided with proper knowledge about the disposal of syringes, needles
and other sharp objects?
(a)Yes (b) No (C) Don’t know
8) Have you received vaccination against hepatitis B?
(a)Yes (b) No (C) Don’t know
9) Were you trained on proper documentation procedures to ensure accurate and timely
record keeping of patients?
(a)Yes (b) No (C) Don’t know
10)Do you frequently update your knowledge regarding standard precautions?
(a)Yes (b) No (C) Don’t know
11)Have you been guided about disinfecting the areas where there are chances of
contamination?
(a)Yes (b) No (C) Don’t know
12)Are you aware of the consequences that can be faced by the patient in case of your
negligence?
(a)Yes (b) No (C) Don’t know

Questionnaire for observation regarding the implementation of safety measures

(15):
Procedure observed  IV/Intera Musular Injection  Blood Sampling
 Nasogastric Intubation  Catheterization
 Any other please specify--------------------------------------------------------------

Age:

Gender: ☐Male ☐ Female

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Title: ☐ Nurse ☐ Nurse practitioner ☐ nurse-in-charge ☐ deputy-
professor of

nursing or above
 Education: ☐ Technical secondary school ☐ Junior college

1)Did she get sterilized instruments?

(a) Yes (b)No
2) Wiped off the area where there is a chance of contamination with the disinfectant?
(a)Yes (b)No
3) Disinfected body part before applying injection?
(a)Yes (b) No
4) Covered-up whenever there’s danger of getting blood or body fluids on clothes
with a disposable outer garment?
(a)Yes (b) No
5) Covered up eyes when there is a chance of splash or splatter?
(a) yes (b) No
6) Disposed of used needles and other sharp objects into a container?
(a) Yes (b) No
7)Taken precautions while handling sharp objects?
(a)Yes (b)No
8) Refrained from recapping infected needles?
(a)yes (b)No
9) Practiced hand washing both before and after coming into contact with the patient?
(a) Yes (b) No
10) Washed hands after removing disposable gloves?
(a)Yes (b) No

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11)Used of disposable gloves when there is a chance of coming in contact with blood or
other body fluids?
(a)Yes (b)No

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