This research proposal aims to assess the knowledge, attitudes, and practices of healthcare providers regarding safe injection practices in Surat City, India. The study will use a cross-sectional descriptive design and survey 400 healthcare providers using a questionnaire to assess knowledge and a scale to measure attitudes. Observations of injection practices will also be made. The results could help identify gaps and variations in safe injection protocols across different zones in Surat City.

1. RESEARCH PROPOSAL
PREPARED BY: Sanjaykumar Dabhi
Ph.D Scholar
Community Health Nursing
Sumandeep Vidyapeeth
Vadodara

2. PROBLEM STATEMENT
• A STUDY TO ASSESS THE KNOWLEDGE, ATTITUDE AND
PRACTICES AMONG HEALTH CARE PROVIDERS OF SELECTED
HEALTH CARE FACIALTIES OF SURAT CITY WITH FOCUS ON
DEVELOPING A LOCAL GUIDELINE TO MEET THE DEMAND OF
SAFE INJECTION NURSING PRACTICES.

3. INTRODUCTION
• Injection is one of the most common health care procedures.
Each year at least 16 billion injections are administered in
developing and transitional countries. The vast majority around
95%, are given in curative care. Immunization accounts for around
3% of all injections.
• In certain regions of the world, use of injections has completely
overtaken the real need.
• Patients tend to prefer injections because they believe them to be
stronger and faster medications
• In turn, doctors over-prescribe injections because they believe
that this best satisfies patients, even though patients are often
open to alternatives.
• In addition, prescription of an injection sometimes allows the
charging of a higher fee for service. Better communication
between patients and providers can clarify these types of
misunderstandings and help to reduce injection overuse.

4. Need of the Study
• There are 40% of injections administered with unsterilized faulty
techniques, reused syringes and needles. This proportion goes up to
70% in some developing country exposing millions of people to risk
of infection and needle stick injuries. Poor collection and disposal of
dirty injection equipment's plays vital role to exposes health care
provider and community people to the risk of needle stick injuries.
There are some black markets who recycled unsafe disposals and
resale it in some counties which is highly risky to health care
providers and community people. To prevent the risk to the health
care providers and community people, some country have their
policies or legislation to use safety syringe or another method for
administering medicines whenever required.
• Prescribers and health care providers have a key role to play in
making the right choices that support safe injections and reduce
unnecessary injections

5. GAP IN THE EXISTING RESEARCH
• “Over 16 billion injections are administered annually
of which India accounts for a third, making it one of
the most common means of administering
medication. However, only 37% of these procedures
are deemed safe. Unsafe injection practices leave no
one behind (The Quint, 2018).”

6. OBJECTIVES OF THE STUDY
1. To assess the knowledge, attitude and practice of health care providers
towards safe injection practices.
2. To find out the association between knowledge, attitude and practices with
demographical variables.
3. To determine the knowledge of health care providers about:
 The injection safety polices in the hospital.
 Clean work practices
 The reporting to the hospital administration after the needle stick injury.
 The diseases transmitted through the needle stick injury.
 Risk of unsafe injection practices.

7. CONTI…..
4. To identify the practice of health care providers regarding the following procedures
related to safety injection:
 Proper hand hygiene.
 Cleaning the skin of the patient with an antiseptic solution.
 Recap the used needles and syringes.
 Reuse of syringes.
 The action of HCPs toward the prick site of post injury.
 Injection Preparation of using aseptic technique in clean area.
 Immediately disposed needles in appropriate sharp containers after use.
 Overuse of injections for illnesses for which effective oral medications exist
5. To determine the vaccination status of HCPs.

8. RESEARCH METHODOLOGY
• Study Design
• The present Descriptive Cross-sectional KAP study
will be conducted in the selected health care
facilities of Surat city. This study will consist of
observation of health care facilities, injection events
and interview with all the participated health care
providers to assess the knowledge, attitude and
practices regarding safe injection among the health
care facilities.

9. • Study population
• The population of the study comprises of
Health care providers including staff nurses
(ANM, GNM, BSC, MSC, Non-Allopathic
doctors, bare foot doctors) who will associate
with injection practices of health care facilities
and available during the data collection
period.

10. • Sampling and sampling method
• There are seven zones in Surat city. First of all, health care
facilities of the present study will be selected with the simple
random method from the seven zones of Surat city. The staff
nurses who will work at those facilities will be observed for
injection events with the modified checklist from WHO
Revised tool-C, interview will be taken with the structured
questionnaire for knowledge and Likerts’ rating scale will be
used to assess attitude regarding safe injection practices.
Likewise, non allopath and bare foot doctors will be assess
same at their own health care facilities. I will select 35 staff
nurses, 15 Non Allopathic doctors and 5 bare foot doctors
randomly from each zone. Therefore, Total health care
providers from each zone will be 55. So, there will total 385
health care providers selected from all zones. Therefore, I will
select total 245 staff nurses, 105 Non Allopathic doctors and
35 bare foot doctors to assess injection practices in the Surat
city.

11. • Size of the sampling
• Size of the sample will be decide by the OPEN EPI
software which is online available or KAP Model.
Approximate total population of Surat is 6873756.
• N= Z square * p * (1-p)
• C square
• As per the reference previous study no, 14, 15 and 23,
who had sample size 1100, 5000, 130. I will take it as a
reference population and will calculate sample size
with the use of OPEN EPI software and KAP Model at
confidence level of 95% and margin of error is 5%, the
approximate sample size for present study will 384. So
we can consider round figure therefore ideal sample
size for the present study will be 400 health care
providers.

12. • INCLUSION CRITERIA
• Health care providers, male or female, age between
the 18 to 58, who is associated with injection
practices in the Surat city.
• They must read and write Gujarati, Hindi and English.
• They must be voluntarily to participate.
• Trained (Anm, Gnm, Bsc, Msc) and untrained nurses
, Non-Allopathic and bare foot doctors included in
the list of health care providers.
• Participants available during the study.

13. • EXCLUSION CRITERIA
• Health care providers who is not willing to
participant.
• Health care providers who is Unable to read and
write Gujarati, Hindi and English.
• Health care providers who is not associated with
injection practices.
• Health care providers who will not available at the
time of data collection.

14. • STUDY AREA AND STUDY SETTING
• The Investigator will conduct the study among the
HCPs of selected health care facilities of Surat city.
The study will conduct in all zones of Surat city
located in South Gujarat state. The study will conduct
in selected OPD of Government, semi government,
municipal hospitals, private hospitals, clinics.

15. • RESEARCH TOOL AND TECHNIQUES
• First of all, Surat city is divider in seven zones. Out of
seven zones, one zone will be select by simple random
lottery method for pilot study. Remain will be for main
study. The investigator will follow the Simple Random
Sampling to select health care providers from selected
health care facilities of the different zones of Surat.
• To collect the data for present study tool will be selected
and modified from the WHO Revised tool guideline and
will be constructed with help of it. Tool will be in the
form of structured knowledge questionnaire ,
observational check list and Likert’s attitude scale for
assessing knowledge, practices and attitudes.

16. • The tool consists of:
• Part 1: Base line characteristics.
• Part 2: Structured knowledge questionnaire on
injection practices
• Part 3: observational check list to assess practices
level.
• Part 4: Likert attitude scale to assess attitude about
injection practices.

17. • Validity
• The content validity of the tool will be tested by the
opinion of experts in nursing and medical profession,
who had done MD, M.sc. and PhD in their respected
field and having minimum 3 years experience in
teaching or clinical side.

18. • Reliability
• The structured knowledge questionnaire will be
administered randomly to the sample population;
reliability will be tested by split half method and item
analysis or through computer software.

19. • Pilot study
• After reliability and validity the investigator will do
pilot study on 40 HCPs in one of the selected zone
of Surat city by Lottery method. The sample
characteristics will be similar to the final study
samples. The pilot study will be conducted to find
out clarity, reliability & feasibility of the tools. There
will be no ambiguity within, language will be clear.

20. DATA COLLECTION AND DATA ANALYSIS
• Plan for data collection
• Data will be collected after obtaining prior permission from the
concerned authorities of the Surat city and from clearance of
ethical committee, sumandeep vidyapeeth. The list of selected
zones will be made, from that one zone will be selected by lottery
method without replacement for the pilot study. Remain zones will
select for main study. Each participant will be visited twice during
study period. If he/she will be not available, they will be replaced.
Each participant will get 30 minutes.
• Data presentation
• Data will present in simple frequency statistical tables, charts and
figures.

21. • STATISTICAL TOOL AND TECHNIQUES
• Data will review, edit and enter into computer and
will analyze by software program statistical package
for social sciences (SPSS) V20. Some variables under
study will be tested using chi squire test with p value
less than 0.05 considering significant relation.

22. • Data Analysis and Interpretation
• Collected data will be organizing systematically and will be
interpreted in the form of tables and charts for analysis. For
interpretation investigator will use descriptive statistical
methods.
• Descriptive method:
• Descriptive statistical techniques will reduce data manageable
proportions by summarizing them and they will also describe
various characteristics of data under study. It will includes
measures of central tendency such as mean, median, mode
and measures of variability such as model percentage range
and standard deviation and some correlation technique.
• Inferential statistics:
• it includes parametric and non parametric test to find out the
association and correlation between variable under the study.

23. • EXPECTED RESULTS
• The study will be conducted in all zones of Surat city.
There may be differences between the knowledge,
attitude and practices among the health care providers.
Some zone like athwa zone, central zone may have a
good practice regarding safe injection practices vice versa
some zone like udhna; limbayat may have poor practices.
Other zone may have average practices. There may also
have differences among knowledge and attitude
regarding safe injection practices. All the differences may
be due to their educational level, experience, working
hours, patient ratio etc.

24. • Work plan
• The study will commence following the approval of RAC,
Sumandeep Vidyapeeth, Vododaraand Ethical Committee,
government College of Nursing, New Civil Hospital, Surat. A
total of FOUR years of study which includes:
• First SIX months- literature collection, review and selection of
study title
• Next TWO years – RAC approval, Ethical Committee approval,
data collection and compilation of data.
• Next SIX months- Preparation of synopsis and correction.
• Next SIX months- Final report preparation and correction.
• Last SIX months- Thesis submission and final Viva-voce.

25. • ETHICAL CONSIDERATION
• The written ethical approval will be taken from the authority
before the study conduct and also from the sumandeep
ethical committee . Health care providers will voluntary
participate. Verbal and written consent will be taken from
participants. Privacy, anonymity and confidentiality of the
data obtain will be assured.