Demographic data:
All participant were Male of different age range 23 years-27years were 6 participants,28years -32 years were 7 participants and 33 years and above were 12 participants. Mean qualification was matric and 4 out of 25 participants were intermediate. Job experience range 1-3 years were 04 participants,4 years-7 years were 10 participants,8 years-11 years were 06, 12 years and above were 05 years. Out of 25 participants, 12 interviews were taken from the public sector and 13 interviews were taken from participants who belonged to the private sector (Table 1).
Lack of infection control process in Hospital:
In the public hospital of Islamabad, the infection control process was not standardized because of the poor infrastructure of local bodies and lack of interest of government officials. The participants were not aware of the infection control process. Hospital did not organize any session for ward-boys about infection control process. There was a big gap of knowledge among ward-boys about infection control. They had a lot of experience working in a high-risk environment, but they still did not have knowledge about infection control process.
The spread of infection:
The ward boys were working in tertiary care hospitals of Islamabad did not have in-depth knowledge about the spread of infection. The ward boys were working in these hospitals having Matriculation Certificate. While collecting data from ward boys, they were telling, they did not have knowledge about this disease and its spread in hospital and community, Even during the hiring process they did not get any departmental training nor from human resource department one ward boy verbalize during his concern during an interview about spreading the infection control . Ward boys from both hospitals told about their perceptions regarding the spread of infection. When they told their perceptions it was concluded that they do not have enough awareness about the spread of infection. Ward boys informed that they had never taught about the spread of infection ever. They knew a little bit about spreads of infection but still, there was a need to know more about spreads of infection.
Awareness about the spread of disease:
Both Public and private hospital ward-boys have different knowledge and perceptions regarding disease spread. There was a vast gap in knowledge among them. They did not have sufficient knowledge about the diseases process and its spread. They were not aware of the disease as it is a communicable disease. They answered like; they are unaware of this disease. They heard about it from unit and patients. It is a liver disease in which our liver does not work properly. Patients suffered from anorexia and paleness of the body. They knew a little bit about the spread of disease but that was not enough. Ward-boys working in hospitals were on high risk of being infected. They were telling about this, I concluded they did not have enough knowledge about it.
Lack of in-service Refresher training in hospital:
Both hospitals public as well as private were not giving the opportunity to their ward-boys to learn and advance their knowledge. There was no facilitation for ward-boys to enhance their knowledge and skills according to modern technology medical field are so vast and both hospitals have a great opportunity to advance their workers with skill and knowledge. Knowledge and skill deficiency have been found among ward-boys as they answered questions.Ward-boys from both hospital said that there were no educational activities and in-service refresher trainings occur up till now. They did not know about disease process and its spreading process. Furthermore, hospital administration was not taking imitative to take any action to teach the ward-boys. Ward boys from hospital verbalize that, they did not take any lecture or trainings session related to any disease pattern in hospital. They were not trained at any point at all.
Public Hospital v/s Private Hospital perceptions:
Ward-boys from both hospitals said that they were on high risk to get this disease. Ward-boys told that they knew they are working in a hospital where patients came with different diseases so we can get this disease from them. Ward-boys from both hospitals identified they are on high to get this disease. Risk perception of ward-boys from the private hospital was almost the same as a public hospital. As both hospitals ward-boys told same thing, they are on high risk of getting this disease, and can be a career of spreading disease among patients.
Hospital perceptions
As far as hospital perceptions is concern, the management was least bother to educate their most important line of staffs . The management of both hospitals were had the same thinking process towards the education of staff members.
Analysis of the interview yielded interconnected themes. These were that hepatitis disease is not very known to everyone. They do not have knowledge about disease its spread. They have knowledge about its precaution due to the enforcement of hospital policy.
A ward boy from the public hospital told, “ I am working here since 10 years. We don’t know about infection control process. We were told us about to wash hand and wear gloves from infection control team. Infection control department did not take any class regarding infection control process. I perform precautions according to my knowledge.
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Lack of infection control process in the hospital:
Health system is worthy if it has control over the infection. It will never improve if there is no control over the spread of infection in the hospital setting as well as the community. In Pakistan public and private sector, the hospital's infection rate is high. The infection control process is very important in every hospital because if it is in control then it has a great effect all over the disease burden and if it is not in control then it increases morbidity and mortality rate of a hospital as well as the country.
In the public hospital of Islamabad, the infection control process was not standardized. The participants were not aware of the infection control process. Hospital did not organize any session for ward-boys about infection control process. There was a big gap of knowledge among ward-boys about infection control. They had a lot of experience working in a high-risk environment but they still did not have knowledge about infection control process.
A ward boy from public hospital identified, “There is a team for the infection control process that is working to control the infection. They never told me how we control the spread of infection. I am working here for more than 7 years. I did not learn about it. I use gloves while handling the patients and changing their bed sheet. I wear gloves mostly but not all the time while caring for the patients”.
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Ward boys from public hospital realized that there is a lack of infection control process in their hospital. They were not trained in the hospital regarding infection control. They have been working here from many years but the organization of the hospital did not take any interest to teach them. They did not know about the infection control process. They come to perform their duties and then going back without even knowing. They did learn from other staff that spread of infection occurs from patients. Mostly they use gloves but sometimes they do not use gloves while handling the patients. They were doing malpractice in the hospital.
A ward-boy from private hospital informed. “We do not know about infection control process nor our department told us about it. Only nursing supervisor came and tell us about to wear gloves. in unit we have gloves sometimes we wear gloves. Infection control department never took any class session regarding infection control.
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The participant from the private hospital informed about the infection control process. They told that there is an infection control department in our hospital that is working to control the spread the infection in the hospital. Routinely rounds, check and balance are maintained in every department. There is a proper team for the infection control program. It has a separate department name as infection control department which is working in the hospital. When asked they knew about infection control process. They said they did not know about it. They also identified that there is no session from this team for us about infection control process.
A ward-boy from the private hospital said “ I do not exactly know about infection control process and I did not take any class about it I think there is lacking in infection control process in my hospital because they came in our department and go back without giving any information. They never focus on us. I am working here for more than 3 years I did not know anything about it”.
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In private hospitals, ward-boys realized they don’t have sufficient knowledge regarding infection control process. They were told that there is a lack of infection control process in our hospital. They did not know anything regarding infection control. They identified infection control come and did nothing.
In both hospitals, ward-boys identified that they did not know about the infection control process although both hospitals have infection control department separately. Infection control process in both hospitals was not good according to the ward boy’s point of view. Ward-boys told that they wear gloves while care of the patients, not all the time but sometimes they wear gloves. Hospitals infection control management never takes any action to organize infection control session for them. That’s why they did not know about the infection control process. They did not have any idea about infection control except wearing gloves. They have a knowledge deficit about the infection control process.
The infection control process is very important to know among ward-boys working in tertiary care hospitals because in tertiary care hospitals multiple patients having different diseases came, ward-boys have direct contact with patients if they do not know about infection control process they are on high risk to get the infection in the hospital. As the ward-boys explained that they do not know about it. In both hospitals, there was no learning environment for ward-boys. All the ward-boys did not about the infection control process they have deficit knowledge which leads to malpractice.
According to ward-boys, both hospitals have infection control department but they were focusing to control the spread the infection and unable to teach the ward boys till now how it spread what precautionary measure are necessary for communicable diseases. Both hospitals have the same issues about the gap in knowledge and practices. As ward-boys told there was infection control team in both hospitals which are working to control the spread of infection but many lacking are still present in both hospitals. Ward-boys working in both hospitals do not know in-depth knowledge about infection control. All participants from the public sector and private sector said they are using gloves while handling the patients. They did not use always gloves but mostly use gloves. And there were no specific precautions for hepatitis patients in their point of view.
Awareness about the spread of infection:
Effective use of infection preventions and control strategies is very important for the provision of quality health care to the clients as well as for maintenance of a safe working environment. Ward-boys educational background was not sufficient to work with patients. Infections are an important cause to increase or decrease the morbidity rate and mortality rate of any country. If we control the spread of infections of communicable diseases, then we will be able to control the spread of the diseases.
A ward-boy from public hospital informed “It spreads through needles prick injuries, used razor blade, direct contact with patients while they are coughing”.
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The ward-boys were working in tertiary care hospitals of Islamabad did not have in-depth knowledge about the spread of infection. The ward-boys were working in these hospitals having 10 grade qualification. While collecting data from ward-boys they said, they did not have knowledge about this disease and its spread in hospital and community. When they told their perceptions it was concluded that they do not have enough awareness about the spread of infection.
Ward-boys from the public hospital told that they do not know about how exactly spreads of infection occur. They gave their different perceptions, when asked if they were ever taught about the spread of infection. All the ward-boys of the study informed that they had never taught about the spread of infection ever. They knew a little bit about spreads of infection but still, there was a need to know more about spreads of infection.
A ward-boy working in private hospital Islamabad told, “infection spread through needle stick injuries and through blood and waste products”.
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Ward-boys working in private hospital gave a little information about spreads of infection. Their knowledge was limited related to awareness of the spread of infection. They were told that they did not have any idea about how it spreads.
A ward boy working in private hospital Islamabad expressed himself “It spreads through sharing razors blade, used syringes, dirty bed sheets. It also spread through sharing patient’s meal with others and if we do not wear gloves while working in hospital infection will spread”.
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From private hospitals, participants were not fully aware of the spread of infection. They informed according to their understanding. Participants were focusing on that infection will spread many ways like sharing meals. Most of the participants realized they do not have enough knowledge about the spread of infection. It seemed ward-boys had little idea about the mechanism of spread of infection in the hospital.
In both hospitals, the public and private hospital interviews were taken from ward-boys. Ward-boys said they do not know how the infection spread in the hospital. They realized that they do not have enough knowledge to describe exactly how it spread. As yet, in Pakistan, there is no institute which has started any certificate or diploma course in infection control. Awareness about the spread of infection is very important especially in developing countries because the infection rate is high in developing countries like Pakistan. They were telling according to their thoughts. They were telling about their qualification which does not contain such information. While working in hospitals they never conduct any class related to infection control. Participants said they are telling according to their point of view. Some of the ward boys kept a little information on how the infection spreads. They identified one or two things in which infection will spread; as ward-boys mentioned it spreads through needle stick injuries and razor blades.
Awareness about the spread of disease:
Awareness about disease pattern is very important because if one knows about the disease process one will deal with the patients well and take precautions to prevent infections. The deficiency in knowledge seems like a high-risk attitude. It is most prominent in ward-boys of these hospitals. Education of ward-boys about risks and modes of transmission of hepatitis disease is important.
A ward-boy from public hospital. “Hepatitis B and C spread when we have deficiency of blood in our body especially in digestive system. It also happen when we don’t eat and drink properly. This leads to liver problem and we acquired Hepatitis disease. It also spread through dirty clothes and shaking hands and sharing meals with hepatitis patients.
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The ward-boys working in a public hospital did not know about the disease process and its spread in hospitals. They told about the spread of disease was totally irrelevant, unrealistic and also very limited. Mostly signs and symptoms were not present. It was concluded there was a big gap of knowledge among ward-boys. Ward-boys from the public hospital did not study the disease process and its spread in their academic studies as they mentioned. Ward-boys had little knowledge about the disease process. Ward-boys informed they did not take any class related to the disease process as they were working for many years in the hospital. They learned things from their own.
A ward-boys from public hospital was telling about the spread of disease “I do not know anything about Hepatitis disease except it has two types these are Yellow(Hepatitis A) and Black Hepatitis(Hepatitis B, C) It spreads if we don’t take care of its precautions like sharing meal with hepatitis patients. It also spreads utensils sharing and food sharing with patients. Its signs and symptoms are abdominal distension, bleeding from mouth and jaundice”.
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Mostly ward-boys from the public hospital gave the same answers about the spread of disease.
They responded like common men who do not know about hepatitis disease exactly. They were focusing on the disease will spread if we will share meals with hepatitis patients. In fact, there was a big gap between knowledge and practice. They identified there was not a single session organized from management for them, Where they learned about the disease process. They were working in the hospital for many years; ward-boys identified there was no learning facility for them.
A ward-boy from private hospital Islamabad said “ Hepatitis spread through sharing meals with patients and talking with them. It also spreads by eating frozen bakery items from market ”.
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Ward-boys from private hospitals described disease process according to their knowledge. Their educational background was not covering clinical education. They did not study any disease in their studies. Although they were working in the hospital still they did not exactly know how the disease process and its spread was. They do not know anything about the disease process most of them said they do not have any idea about the disease process and its spread. They were trying to answer the questions according to their knowledge as they listen from others. They were telling, they were never asked about the spread of disease that’s why they do not know about it.
A ward-boy working in private hospital Islamabad, “Hepatitis is a disease of the liver in which level of blood volume in the human body will decrease and water in blood also decreases. In this disease the blood volume will decrease in our body due to malfunctioning of liver and blood colour will become black. It has two types Hepatitis A and Hepatitis B, C. if a person having this disease he became weak. Hepatitis B is very dangerous no treatment for it”.
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Ward-boys told about hepatitis disease is basically liver disease. They heard about it from unit and patients. It is a liver disease in which our liver does not work properly. Patients suffering from anorexia and paleness of the body. They knew a little bit about the spread of disease but that was not enough. Ward-boys working in hospitals were on high risk of being infected. They had to know about it spreads. They were telling about this, I concluded they did not have enough knowledge about it.
Both Public and private hospital ward-boys have different knowledge and perceptions regarding disease spread. There was a vast gap in knowledge among them. They did not have sufficient knowledge about the diseases process and its spread. They were not aware of the disease as it is a communicable disease. They answered like; they are unaware of this disease.
Lack of in-service Refresher training in hospital:
In every organization, refresher training is important especially in the hospital setting as they play an important role. Health care workers need to know what is happening around the world. In service, training basically enhances the knowledge and competency of a person. In-service refresher training is very important for tertiary care hospital because this type of hospital has an advanced level of care and dealing with multiple specialities at a time. The workers deal with different types of patients having different diseases-service refresher training play an important role to overcome causes of mortality and effectiveness in patient’s care.
Ward-boys from public hospitals informed that was no in services refresher training in their hospital for them. Ward-boys were not aware of in-service refresher training. Ward-boys informed they are working for many in hospitals but did not attend any training related to their fields. As concluded they were not aware of it.
A ward-boy from the public hospital said.” There is no in-service refresher training in hospital for ward-boys since I am working 10 years. We did not take any training in hospital related to patient care and about a disease or clinical related”.
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Ward-boys were working in the hospital they had many years’ experience as a ward-boys still hospital was not focusing on their clinical knowledge and training. There were no educational and in-service refresher training to be arranged for this group.
As the ward-boys from private hospital realized that there is a good infection control department in our hospital but they are not facilitating us. There was not a single training session arranged from higher management or infection control department for them. They did not attend any service related training during their service in their hospital.
A ward-boy from private hospital explained. “There is no training session or short courses for ward-boys in this hospital. We did not know about disease process because our hospital organized many sessions for other workers but there is not a single training or session for us related to clinical and about patient handling for us. They came and told us to wear gloves while handling the patient only”.
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Ward-boys private hospital said that there were no educational activities and in-service refresher trainings occur up till now. They did not know about disease process and its spread. Hospital was not taking any action to teach the ward-boys. Ward-boys from hospital told, they did not take any lecture or trainings session related to any disease pattern in hospital. They were not trained at any point at all.
Both hospitals public as well as private were not giving the opportunity to their ward-boys to learn and advance their knowledge. There was no facilitation for ward-boys to enhance their knowledge and skills according to modern technology medical field are so vast and both hospitals have a great opportunity to advance their workers with skill and knowledge. Knowledge and skill deficiency have been found among ward-boys as they answered questions.
Public hospital vs. Private hospital perceptions:
The ward-boys in these hospitals have different knowledge and having different risk perceptions about disease. While collecting the data according to their knowledge and they have different perceptions about the disease and its risk.
A ward-boy from public hospital expressed his views “Hepatitis disease is a very dangerous disease which affect all the person especially when we think bad about peoples this disease will target us, as I am working in hospital I am more prone to get this disease.
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Ward-boys from the public hospital had different perceptions about the risk of the disease. According to their knowledge, they have different perceptions. They were told that we were on high risk of getting this disease.
A ward-boy from private hospital answered. “Hepatitis spread through blood and needle prick injuries, as I am working on hospital I am on high risk to get this disease I directly deal these patients”.
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According to them, the disease spread with blood and needle prick injuries. They deal with multiple patients in a day. They thought this disease came from God. Everyone was on high risk to get this disease and they were on high risk to get this disease
Some ward-boys from private hospitals had different perceptions regarding the spread of this disease they thought this disease spread from the community. One ward-boys expressed his feeling he infected from hepatitis when he was not working in the hospital. Peoples mostly got this infection from the community, not in the hospital so according to his views, we cannot get hepatitis disease from the hospital.
Ward-boys from both hospitals said that they were on high risk to get this disease. Ward-boys told that they knew they are working in a hospital where patients came with different diseases so we can get this disease from them. Ward-boys from both hospitals identified they are on high to get this disease. Risk perception of ward-boys from the private hospital was almost the same as a public hospital. as both hospitals told same that, they are on high risk of getting this disease.