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Awareness & knowledge of medical students and interns about infection control measures.

Introduction

Hospital-associated infections (HAI) are those infections acquired during the patient's stay in hospital. They form a major worldwide public health problem despite advances in our understanding and control of these infections. [1,2] The best clinical care in the world can be worthless if patients pick up other infections while they are in the hospital. HAI also include occupational infections which occur in HCW due to occupational hazards. [3]

Regardless of where the infection originates, it is surely the first duty of every member of the staff in a hospital to do everything he can make sure that patients are cared for, and returned to health, as quickly as possible and as free from HAI as possible. [4,5]

New students or interns annually start their practical training of different specialties in the different hospitals from different colleges and schools. Previous studies have demonstrated that the levels of awareness and knowledge of IC protocols or policies vary between specific groups of medical staff, and that compliance is greatly influenced by the examples set by senior staff members. [3,6]

For implementation of all the preventive measures to decrease the risk of infection hazards and maintain safety of our future physicians and other HCW as well as patient safety, adequate awareness and knowledge of MS and interns about IC measures and policies are essential. To our knowledge, on the nation level, no similar study has been conducted to address the knowledge and awareness about IC policies among medical and paramedical students and interns.

Objectives

1. To assess the awareness of MS and interns about IC measures.

2. To assess the knowledge of MS and interns regarding IC measures.

3. To define the impact of unawareness & noncompliance with IC measures.

Materials and Methods

Study Design

A cross-sectional, interview-based survey was conducted using a validated questionnaire to MS and interns of CM and CAMS, Taif University who were receiving training in the Ministry of Health (MOH) hospitals, Armed Forces Hospitals (AFH) and University Hospitals. Interns and MS in the above-mentioned hospitals, who gave written consent, were interviewed.

Questionnaire Design

A valid and modified questionnaire which was designed based on the study objectives, taking help from the previous literature and studies available on the topic. It demonstrated the following aspects: (i) participants demographic data; (ii) awareness assessment and (iii) knowledge assessment

Pilot Study

A pilot study was conducted by distribution of 20 questionnaires to 20 interns to assess the validity of the questionnaire.

Study Population

Overall 144 trainees in hospitals [102 from the CM (58 interns and 44 students) and 42 from the CAMS (24 interns and 18 students)] were enrolled in this study.

Study Area

(i) MOH hospitals; (ii) Taif AFH and (iii) University's hospitals

Statistical Analysis

Data entry was done through EpiData twice. Two members of the team entered the same data and the data files were compared to rule out errors in entering the data. Data were collected and analyzed using SPSS version 16. Percentages and proportions were calculated for all the variables. Relevant tables and graphs were computed. The following statistics were applied:

1. Descriptive statistics: The number and percent of the studied personnel for different variables.

2. Analytical statistics: Chi-square test was used to compare 2 or more qualitative variables Significance was determined at p value < 0.05.

Ethical Consideration

Ethical approval was obtained from Taif University ethical review committee before starting data collection.

Results

The Studied Trainees

There were 144 interview-based questionnaires filled. One hundred and two were from CM (58 interns and 44 students) and forty two were from CAMS (24 interns and 18 students). There were in total 90 males and 54 females. They were involved in training in MOH (92), University Hospitals (39) and AFH (13). The duration of training of the enrolled trainees was variable as shown in table 1.

Awareness Assessment

The overall awareness percentage amongst the entire studied group was 64.6% as demonstrated in table 2. Comparison between students of CM and CAMS is shown in table 3. Students of CM had significantly (P<0.001) more awareness about using face masks, dealing with isolated patients and IC guide manual. On the other hand, students of CAMS had significantly (P<0.001) more awareness about the proper way of wearing sterile gloves. There was no significant difference regarding attendance orientation course in the college or hospital, hand washing technique, NS injury, rules of safety during injection and the proper methods of waste disposal. Awareness assessment among interns is shown in table 3. All of the interns of CM had attended an orientation course in the college. They were aware about NS injury, rules of safety during injection, IC guide manual (P<0.001) and dealing with isolated patients (P<0.05). However, interns of CAMS were more aware about using face masks (P<0.01) and the proper methods of waste disposal (P<0.05).

Knowledge Assessment

Table 2 showed that 73.5% of MS and interns gave correct answers about different types of questions in IC. There was no significant difference in the overall knowledge percentage between MS and interns or between CM and CAMS as shown (Figure 1). However, there were significant differences between these groups when the single parameters were compared. Students of CAMS had more knowledge about nosocomial infection (NI), hand hygiene (P<0.01) and using gloves (P<0.05). Interns of CM had more knowledge about alcohol-based hand rub (P<0.01). There was no significant difference between the 2 colleges (for both MS and interns) concerning precaution standards or their behavior after splashes (table 4).

Training of IC Policies

About 67% of the studied trainees had received training in one or more of IC policies (table 2). Higher percentage of MS of CAMS had attended training about wearing gloves and safe waste disposal (P<0.05 and P<0.01 respectively). On the other hand, higher percentage of interns of CM had attended training about dealing with infectious patients P<0.01) and safe IV cannulation (P<0.05). There was no significant difference regarding hand washing, and wearing of face masks or gloves (table 5).

Compliance with IC Policies During Training

Table 2 showed that 25.4% of the studied trainees had been exposed to a problem during training (NS, SBF, CNS, SO or AI). Students of CM were more significantly exposed to CNS, SO and AI (P< 0.01, P<0.05 and P<0.05 respectively) (Figure 2A). On the other hand, interns of CAMS were more significantly exposed to SO (P< 0.001) as shown in Figure 2B.

Requirement for further Training

Table 2 shows that 78.5% of the studied trainees desired further training about IC. However, there was no significant difference between the 2 colleges or between students and interns regarding the need of further training (Figure 3).

HBV Vaccination

About 65% of the trainees had received HBV vaccination; however, 54.9% of those who received the vaccine did not complete the regimen (table 2). There was no significant difference between 2 colleges or between students & interns regarding receiving HBV vaccine (Figure 4).

Discussion

Exposure to infectious diseases is one of the most frequently identified occupational hazards facing HCW. Awareness and adequate knowledge are important requirements for all HCW. In this study, the overall awareness of the studied trainees about IC measures was about 65%. Our results showed that students of CM had more awareness about using face masks, dealing with isolated patients and IC guide manual while those of CAMS had more awareness about wearing sterile gloves. Medical and paramedical students and trainees, being a part of the healthcare delivery system, are exposed to the same, if not greater magnitude of risk as other HCW when they come into contact with patients and contaminated instruments. [5,7] In many teaching centers, medical and paramedical students and trainees are the first level of contact with patients. [8,9] They are expected to undertake activities related to patient care with the starting of their clinical years. [10] All of the interns of CM had attended an orientation course in their college. They were aware about NS injury, rules of safety during injection, IC guide manual and dealing with isolated patients. Interns of CAMS were more aware about using face masks and safe use and disposal of sharps. However, not all of them were aware about all aspects of IC although they have to face the risks associated with occupational hazards facing HCW. [11,12]

The overall percentage of knowledge assessment of the trainees was about 73.5%. There was no difference between students and interns or between MS and CAMS in the overall assessment. However, students of CAMS had more knowledge about NI, hand hygiene and using gloves while interns of CM had more knowledge about alcohol-based hand rub. There were some wrong answers for some of the questions, indicating presence of some defects in their knowledge. To protect MS and interns from injuries and to prevent NI, they should have adequate knowledge before their initial training period. [13,14] Lack of adequate knowledge of standard precautions [9,15] and isolation precautions has been reported to be insufficient [7]. Significant improvement in short-term knowledge of IC practices by MS was previously reported. [16] As IC is a part of the curriculum for MS in both CM and CAMS, continuous improvement of this course is mandatory. [17]

Our results showed that about 67% of the studied trainees had received training in one or more of IC policies. Higher percentage of students of CAMS had attended training about wearing gloves and safe waste disposal. On the other hand, higher percentage of interns of CM had attended training about dealing with infectious patients and safe IV cannulation. However, some of the studied trainees had r no previous training. Therefore, the provision of training programs that provide information about IC is a priority for both medical and paramedical students. Moreover, efforts are required for bringing a reduction in the risk perception of interns through awareness campaigns and reorientation trainings. [18]

Our findings revealed that about 25% of the studied trainees had been exposed during training to one or more of these conditions (NS, SBF, CNS, SO or AI). This result indicates a possible lack of compliance with IC measures. Despite the continuing impact of HAI on the National Health Care System, reports suggest that medical staff have poor compliance with even the most basic IC procedures. [19] Our findings showed that students of CM were more significantly exposed to CNS, SO and AI while interns of CAMS were more significantly exposed to SO. NS injuries have been reported to be among the potential occupational hazards for HCW and to be associated with a number of different health hazards as acquisition of potentially fatal diseases such as Hepatitis B and C and human immunodeficiency virus [6]. Therefore, a high level of noncompliance with basic IC measures by medical staff may exist and may be attributed to lack of familiarity with IC guidelines. [19]

A large percentage (78.5%) of our studied trainees had a desire for further IC training. Those personnel included participants from the 2 colleges as well as from both students and interns. These findings may indicate the importance of implementation of continuous training about the different IC policies for all the medical and paramedical students and interns. The provision of training programs will protect both the HCW and patients from exposure to HAI [19], however, educational aims and strategies must depend on the target group. Poor IC practices will be regarded in a negative light by patients and their families, regardless of any other manifest skills of the practitioner. [19]

Occupational exposure to blood or other body fluids in health care settings constitutes a small but significant risk of transmission of blood-borne viruses. [20] Only 65% of the trainees enrolled in our study had received HBV vaccine and 54.9 % of those who received the vaccine did not complete the regimen. This was noticed in students and interns of both CM and CAMS, indicating that lack of protective antibody level may occur in a large proportion of them. Dental students were reported to have occupational exposure to blood or other potentially infectious materials. [21] Therefore, the medical universities should take necessary action to inform, educate and vaccinate the trainees who may be at risk. The MOH should make HBV vaccination mandatory for all health professionals. However, there may be a false impression about prophylaxis, vaccination and treatment of HBV. [22] Therefore, knowledge alone is not sufficient to bring about behavioural changes, but is imperative for health education personnel to remove misconceptions. This can be done by well-structured health education programs, seminars, workshop and conferences.

Conclusion

This study points to inadequate knowledge and awareness about IC amongst the medical and paramedical students and interns. Only through proper education of the future HCW, the burden of HAI can be reduced.

Recommendations: (1) Improvement of IC education programs must be performed to increase safety of our graduates and patients. (2) A medical education program should be started at the hospital level along with seminars which highlight the importance of IC policies. (3) More emphasis should be placed on IC curriculum taught in undergraduate education. (4) Administration of HBV vaccine to all non-immune medical and paramedical students and interns.

ABBREVIATIONS

AFH: Armed Forces Hospitals; AI: acquired infection; CAMS: College of Applied Medical Sciences; CM: College of Medicine; CNS: contact with non-intact skin; HAI: Hospital-associated infections; HBV: hepatitis B virus; HCW: health care workers; IC: infection control; MS: medical students; MOH: Ministry of Health; NI: nosocomial infection; NS: needle stick; SBF: splash of blood or body fluid; SO: sharp objects.

References

[1.] McDermott C, Gibb AP, Paterson-Brown S, Brady RR. Fact or infection: do surgical trainees know enough about infection control? Ann R Coll Surg Engl 2008; 90 (8): 647-50.

[2.] Tavolacci M-P, Ladne J, Bailly L, Merle V, Pitrou I, Czernichow P. Prevention of nosocomial infection and standard precautions: knowledge and source of information among healthcare students. Infect Control Hosp Epidemiol 2008; 29: 642-7.

[3.] Hayashida K, Imanaka Y, Fukuda H. Measuring hospital-wide activity volume for patient safety and infection control: a multi-centre study in Japan. BMC Health Serv Res 2007; 7: 140.

[4.] Mousa AA, Mahmoud NM, Tag El-Din AM. Knowledge and attitudes of dental patients towards cross-infection control measures in dental practice, East Med Health J1997; 3 (2): 263-73.

[5.] Shariati B, Shahidzadeh-Mahani A, Oveysi T, Akhlaghi H. Accidental exposure to blood in medical interns of Tehran University of Medical Sciences, J Occupational health 2007;49 (4): 317-321.

[6.] Saleem T, Khalid U, Ishaque S, Zafar A. Knowledge, attitudes and practices of medical students regarding needle stick injuries. J Pak Med Assoc. 2010; 60 (2):150-6.

[7.] Friedewald M, Elwin C. New graduate nurses and infection control: knowledge versus practice. Austra Infect Control 2003; 8 (1): 21-27.

[8.] Askarian M, Honarvar B, Tabatabaee HR, Assadian O. Knowledge, practice and attitude towards standard isolation precautions in Iranian medical students.. J Hosp Infect 2004; 58 (4): 292-6.

[9.] Bellamy E. An evaluation of patient satisfaction regarding the care and information provided by infection control nurses relating to MRSA. Br J Infect Control 2008; 9 (3): 6-10.

[10.] Danchaivijitr S, Tantiwatanapaiboon Y, Chokloikaew S, Tangtrakool T, Suttisanon L, Chitreechuer L. Universal precautions: knowledge, compliance and attitudes of doctors and nurses in Thailand. J Med Assoc Thai. 1995; 78: (Suppl 2): S112-7.

[11.] Calabro K, Bright K, Kouzekanani K. Long-term effectiveness of infection control training among fourth-year medical students. Med Educ Online [serial online] 2000; 5:1. Available from URL http://www.med-ed-online.org.

[12.] Mathur M, Shripad T, Tainwala S, Misra V. A study to evaluate the impact of hospital infection control training programme on health care workers, Bombay hospital J 2007; 49 (4): 65-71. 2007.

[13.] Stein AD, Makarawo TP, Ahmad MFR. A survey of doctors' and nurses' knowledge, attitudes and compliance with infection control guidelines in Birmingham Teaching Hospitals. J Hosp Infect 2003; 54 (1): 68-73.

[14.] Madani TA, Albarrak AM, Alhazmi MA. Steady improvement of infection control services in six community hospitals in Makkah. BMC Infect Dis. 2006;6: 135-9.

[15.] Houang ETS, Hurley R. Anonymous questionnaire survey on the knowledge and practices of hospital staff in infection control. J Hosp Infect. 1997;35 (4): 301-306.

[16.] Calabro K, Weltge A, Parnell S, Kouzekanani K, Ramirez E. Intervention for medical students: effective infection control. AJIC 1998;26:431-436.

[17.] Koller W, Flamm H, Rotter M, Wewalka G, Mittermayer H. Educational programmes for infection control in Austria. J Hosp Infect. 1991 Jun; 18 Suppl A:495-501.

[18.] Lal P, Singh MM, Malhotra R, Ingle GK. Perception of risk and potential occupational exposure to HIV/AIDS among medical interns in Delhi. J Commun Dis. 2007 Jun;39(2):95-9.

[19.] Ferguson JK. Preventing healthcare-associated infection: risks, healthcare systems and behaviour. Intern Med J. 2009 Sep;39(9):574-81.

[20.] Sagoe-Moses C, Pearson RD, Perry J, Jagger J. Risks to health care workers in developing countries. N Engl J Med 2001, 345(7):538-541.

[21.] Kotelchuck D, Murphy D, Younai F. Impact of underreporting on the management of occupational bloodborne exposures in a dental teaching environment. J Dent Educ 2004;68:614-22.

[22.] Tirounilacandinn P, Krishnarajj S, Chakravarthy K. Hepatitis-B infection: awareness among medical, dental interns in India. Ann Trop Med Public Health, 2009; 2 (2): 33-36.

Source of Support: Nil

Conflict of interest: None declared

Saad Al-Zahrani (1), Fahad Al-Amry (2), Mabrouk Ghonaim (3), Osama Abo-Salem (3)

(1) Department of Family Medicine, College of Applied Medical Sciences, Taif University, KSA

(2) Al-Hada Military Hospital, Taif, KSA

(3) Department of Medical Laboratories, College of Applied Medical Sciences, Taif University, KSA

Correspondence to: Saad Al-Zahrani (ssmz2002@hotmail.com)

DOI: 10.5455/ijmsph.2013.2.331-337

Received Date: 15.12.2012

Accepted Date: 16.12.2012
Table-1: Characteristics of the Studied Group

Characteristics                         CM          CAMS

                                   No.     %     No.     %

Level                 Interns      58    56.86   24    57.14
                     Students      44    43.14   18    42.86

Sex                    Males       66    64.71   24    57.14
                      Females      36    35.29   18    42.86

Training Place          AFH         6    5.88     7    16.67
  (hospital)       MOH Hospitals   64    62.75   28    66.66
                    University     32    31.37    7    16.67
                     Hospitals

Duration (month)        0-3        32    31.37   10    23.81
                        3-6        20    19.61   14    33.33
                        6-9        20    19.61    9    21.43
                       9-12        30    29.41    9    21.43

Table-2: Overall Assessment of IC Parameters among
the Studied Population

Parameters                                  Average
                                         Awareness (%)

Awareness assessment                         64.6
Knowledge assessment                         73.5
Receiving training                           66.9
Exposure to a problem during training        25.4
Requirement of further training              78.5
Receiving HBV vaccination                    64.6
Completing HBV vaccine regimen               54.9

Table-3: Awareness Assessment about IC among MS

Awareness Parameter                            CM

                                       Total   Yes     %
                                        No.

The Studied College (MS)

Orientation attendance in college       44     24    54.55
Orientation attendance in hospital      44     18    40.91
Hand washing technique                  43     30    69.77
Using face mask                         44     44    100.00
NS injury                               43     26    60.47
Rules of safety during injection        44     20    45.45
Dealing with isolated patients          44     38    86.36
Proper way of wearing sterile gloves    44     16    36.36
IC guide manual                         44     34    77.27
Proper methods of waste disposal        44     22    50.00

The Studied College (Interns)

Orientation attendance in college       58     58    100.0
Orientation attendance in hospital      58     34    58.62
Hand washing technique                  58     56    96.55
Using face mask                         58     44    75.86
NS injury                               58     56    96.55
Rules of safety during injection        58     34    58.62
Dealing with isolated patients          57     36    63.16

Proper way of wearing sterile gloves    58     56    96.55
IC guide manual                         58     34    58.62
Proper methods of waste disposal        58     52    89.66

Awareness Parameter                           CAMS

                                       Total   Yes     %
                                        No.

The Studied College (MS)

Orientation attendance in college       18     14    77.78
Orientation attendance in hospital      18      4    22.22
Hand washing technique                  18      8    44.44
Using face mask                         18     12    66.67
NS injury                               18     12    66.67
Rules of safety during injection        18      6    33.33
Dealing with isolated patients          17     10    58.82
Proper way of wearing sterile gloves    18     18    100.0
IC guide manual                         18      4    22.22
Proper methods of waste disposal        18      8    44.44

The Studied College (Interns)

Orientation attendance in college       24     22    91.67
Orientation attendance in hospital      23     12    52.17
Hand washing technique                  24     22    91.67
Using face mask                         24     24    100.0
NS injury                               24     16    66.67
Rules of safety during injection        24      4    16.67
Dealing with isolated patients          24      8    33.33

Proper way of wearing sterile gloves    24     22    91.67
IC guide manual                         24      6    25.0
Proper methods of waste disposal        24     16    100.0

Awareness Parameter                    [chi square]

The Studied College (MS)

Orientation attendance in college          3.33
Orientation attendance in hospital         1.95
Hand washing technique                     3.46
Using face mask                           16.26 *
NS injury                                  0.21
Rules of safety during injection           0.77
Dealing with isolated patients            22.4 *
Proper way of wearing sterile gloves      20.9 *
IC guide manual                           16.3 *
Proper methods of waste disposal           0.17

The Studied College (Interns)

Orientation attendance in college         20.91 *
Orientation attendance in hospital         0.27
Hand washing technique                     0.87
Using face mask                        6.98 ([euro])
NS injury                                 13.68 *
Rules of safety during injection          12.02 *
Dealing with isolated patients         6.07 ([pounds
                                        sterling])
Proper way of wearing sterile gloves       0.87
IC guide manual                        7.68 ([euro])
Proper methods of waste disposal       6.33 ([pounds
                                        sterling])

([pounds sterling]) P<0.05; ([euro]) P<0.01; * P<0.001

Table-4: Knowledge Assessment about IC

Knowledge Parameter                   CM

                          Total No.    RA      %

The Studied College (MS)

NI                           44        25    56.82
Precaution standards         44       27.5   62.50
Hand hygiene                 43       23.5   54.65
Using gloves                 44       29.5   67.05

Behavior after splashes      44       37.5   85.23
Alcohol-based hand rub       42        15    35.71

The Studied College (Interns)

NI                           58        45    77.59
Precaution standards         56        50    89.29
Hand hygiene                 58       55.5   95.69
Using gloves                 58       50.5   87.07
Behavior after splashes      58       56.5   97.41
Alcohol-based hand rub       58        46    79.31

Knowledge Parameter                   CAMS

                          Total No.    RA      %

The Studied College (MS)

NI                           18        16    88.89
Precaution standards         18        12    66.67
Hand hygiene                 18       16.5   91.67
Using gloves                 18       16.5   91.67

Behavior after splashes      17        15    88.24
Alcohol-based hand rub       18       8.5    47.22

The Studied College (Interns)

NI                           24       16.5   68.75
Precaution standards         24       22.5   93.75
Hand hygiene                 24       23.5   97.92
Using gloves                 24        18    75.00
Behavior after splashes      24       23.5   97.92
Alcohol-based hand rub       24       11.5   47.92

Knowledge Parameter       [chi square]

The Studied College (MS)

NI                        8.21 [euro]
Precaution standards          0.05
Hand hygiene              8.58 [euro]
Using gloves              4.79 [pounds
                            sterling]
Behavior after splashes       0.03
Alcohol-based hand rub        1.07

The Studied College (Interns)

NI                            1.23
Precaution standards          0.91
Hand hygiene                  0.85
Using gloves                  2.04
Behavior after splashes       1.00
Alcohol-based hand rub    7.05 [euro]

RA; Right answer; P < 0.05 [pounds sterling]; P < 0.01 [euro]

Table-5: Training about IC Polices among Students and Interns

                                                CM

                                    Total No.   Yes     %

The Studied College (MS)

Hand washing                           44       24    54.55
Wearing gloves                         44       22    50.00

Wearing face mask                      44       16    36.36
Dealing with infectious patients       44       18    40.91
Safe IV cannulation                    44       16    36.36
Safe use and disposal of sharps        44       18    40.91

The Studied College (Interns)

Hand washing                           58       56    96.55
Wearing gloves                         58       52    89.66
Wearing face mask                      58       50    86.21
Dealing with infectious patients       58       44    75.86
Safe IV cannulation                    58       34    58.62

Safe use and disposal of sharps        58       56    96.55

                                                CAMS

                                    Total No.   Yes      %

The Studied College (MS)

Hand washing                           18        12    66.67
Wearing gloves                         18        14    77.78

Wearing face mask                      18        8     44.44
Dealing with infectious patients       18        8     44.44
Safe IV cannulation                    18        10    55.56
Safe use and disposal of sharps        18        14    77.78

The Studied College (Interns)

Hand washing                           24        24    100.00
Wearing gloves                         24        22    91.67
Wearing face mask                      24        22    91.67
Dealing with infectious patients       24        10    41.67
Safe IV cannulation                    24        8     33.33

Safe use and disposal of sharps        24        24    100.00

                                    [chi square]

The Studied College (MS)

Hand washing                            3.16
Wearing gloves                      4.05 [pounds
                                      sterling]
Wearing face mask                       0.35
Dealing with infectious patients        0.07
Safe IV cannulation                     1.93
Safe use and disposal of sharps     6.96 [euro]

The Studied College (Interns)

Hand washing                            0.86
Wearing gloves                          0.07
Wearing face mask                       0.48
Dealing with infectious patients    8.81 [euro]
Safe IV cannulation                 4.34 [pounds
                                       sterling
Safe use and disposal of sharps         0.86

P < 0.05 [pounds sterling]; P < 0.01 [euro]

Figure-1: Comparison of Knowledge Assessment
between CM and CAMS among Interns and Students
(There was no significant difference between the 2
colleges or between interns and students)

% of Right Answer

           Interns   Students

Medicine   79.000    77.00
CAMS       64.50     65.80

% of Right Answer

           Medicine   CAMS

Interns    79.00      64.50
Students   77.00      65.80

Note: Table made from bar graph.

Figure-2: Comparison of Compliance with IC Policies
during Training between CM and CAMS among
Students and Interns (A) Students of CM were more
significantly exposed to CNS, SO and AI (P< 0.01, P<0.05
and P<0.05 respectively); (B) Interns of CAMS were more
significantly exposed to SO (P< 0.001). [NS; needle sticks:
SBF; splash of blood or body fluids: CNS; contact with non-intact
skin: SO; sharp objects: AI; acquired infection]

Yes % of students

      CM      CAMS

NS    36.00   11.00
SBF   18.00   23.00
CNS   23.00   11.00
SO    36.00   0.00
AI    27.00   0.00

Yes % of interns

      CM       CAMS

NS    28       33.00
SBF   41.000   17.00
CNS   55.000   25.00
SO    21.000   42.00
AI    14.000   8.00

Note: Table made from bar graph.

Figure-3: Comparison between Interns and Students
and between CM and CAMS Concerning Requirment of
Further Training (There was no significant difference
between the 2 colleges or between interns and students.)

% of training requirment

           CM      CAMS

Intern     67.00   83.00
Students   86.00   100.00

       Interns   Students

CM     67.00     86.00
CAMS   83.00     100.00

Note: Table made from bar graph.

Figure-4: Comparison between Interns and Students
and between CM and CAMS Concerning Receiving HBV
Vaccine (There was no significant difference between the
2 colleges or between interns and students.)

           CM      CAMS

Intern     62.00   100.00
Students   55.00   56.00

       Interns   Students

CM     62.00     55.00
CAMS   100.00    56.00

Note: Table made from bar graph.
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Title Annotation:RESEARCH ARTICLE
Author:Zahrani, Saad Al-; Amry, Fahad Al-; Ghonaim, Mabrouk; Abo-Salem, Osama
Publication:International Journal of Medical Science and Public Health
Geographic Code:1USA
Date:Apr 1, 2013
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